Novo método de avaliação dinâmica da articulação patelo-femoral em RM

A patologia patelo-femoral é uma das mais frequentes causas de consulta do joelho. A problemática desta articulação é reconhecidamente multifactorial. Apesar de estabelecidos vários factores de risco, tem sido globalmente assumida a necessidade de uma avaliação dinâmica e objectiva desta “articulação”, face a recorrentes erros diagnósticos. Revela-se essencial, quer no âmbito do diagnóstico, orientando a triagem patológica (e por conseguinte a escolha das terapias mais adequadas); quer ao nível do “follow-up” do paciente, nomeadamente para avaliação dos novos métodos cirúrgicos incluindo reconstruções do ligamento patelo-femoral medial (LPFM) para instabilidades objectivas. A hipótese deste estudo é que, da avaliação funcional dinâmica combinada com os factores morfológicos clássicos pode resultar a detecção de novos factores de risco e de avaliação funcional pós operatória da patelo-femoral

Caloric restriction rescues yeast cells from alpha-synuclein toxicity through autophagic control of proteostasis

α-Synuclein (SNCA) is a presynaptic protein that is associated with the pathophysiology of synucleinopathies, including Parkinson's disease. SNCA is a naturally aggregation-prone protein, which may be degraded by the ubiquitin-proteasome system (UPS) and by lysosomal degradation pathways. Besides being a target of the proteolytic systems, SNCA can also alter the function of these pathways further, contributing to the progression of neurodegeneration. Deterioration of UPS and autophagy activities with aging further aggravates this toxic cycle. Caloric restriction (CR) is still the most effective non-genetic intervention promoting lifespan extension. It is known that CR-mediated lifespan extension is linked to the regulation of proteolytic systems, but the mechanisms underlying CR rescue of SNCA toxicity remain poorly understood. This study shows that CR balances UPS and autophagy activities during aging. CR enhances UPS activity, reversing the decline of the UPS activity promoted by SNCA, and keeps autophagy at homeostatic levels. Maintenance of autophagy at homeostatic levels appears to be relevant for UPS activity and for the mechanism underlying rescue of cells from SNCA-mediated toxicity by CR.BSM and HP are supported by fellowships from the Fundação para a Ciência e Tecnologia (FCT, Portugal) (SFRH/BPD/90533/2012 and SFRH/BD/133087/2017, respectively).info:eu-repo/semantics/publishedVersio

Prevalence of articular cartilage lesions and surgical clinical outcomes in football (soccer) players' knees: a systematic review

"Article in Press" ; "Published Online: April 16, 2016"Purpose: To systematize the available scientific literature on the prevalence of articular cartilage and/or osteo- chondral lesions in football (soccer) playersâ knees, and overview the surgical procedures and functional outcomes and return to sports. Methods: A comprehensive search using Pubmed, Cochrane Library, SPORTDiscus, and CINAHL databases was carried out until September 30, 2015. All English language studies that assessed the outcomes of a surgical technique for the treatment of articular cartilage lesions in football playersâ knees, with a minimum follow-up of 12 months, were included. The reference list of the most relevant papers was screened. The main outcomes of interest were the clinical, arthroscopy or imaging primary outcomes and the return to sports rate. The methodological and reporting qualities were assessed according to Coleman methodology score. Results: The search provided 485 titles and abstracts. Five studies were eligible for inclusion (mean Coleman score of 37.2 points), comprising a total of 183 football players with a mean age of 25.7 years. A total of 217 articular cartilage and/or osteochondral lesions were reported, where the medial and lateral femoral condyles were the most common sites of lesion. The surgical procedures investigated were mosaicplasty, microfracture, autologous chondrocyte implantation, and chondral debridement. Conclusions: No definitive conclusion could be made in respect to the best current surgical technique for articular cartilage and osteochondral lesions. Microfracture and mosaicplasty can provide a faster return to competition and faster clinical and functional results, whereas autologous chondrocyte implantation and/or matrix-induced autologous chondrocytes implantation procedures can enhance longstanding clinical and functional results. Level of Evidence: Level IV, systematic review of Level III and IV studies

Arthroscopic repair of ankle instability with all-soft knotless anchors

In recent years, arthroscopic and arthroscopically assisted techniques have been increasingly used to reconstruct the lateral ligaments of the ankle. Besides permitting the treatment of several comorbidities, arthroscopic techniques are envisioned to lower the amount of surgical aggression and to improve the assessment of anatomic structures. We describe our surgical technique for arthroscopic, two-portal ankle ligament repair using an all-soft knotless anchor, which is made exclusively of suture material. This technique avoids the need for classic knot-tying methods. Thus it diminishes the chance of knot migration caused by pendulum movements. Moreover, it avoids some complications that have been related to the use of metallic anchors and some currently available biomaterials. It also prevents prominent knots, which have been described as a possible cause of secondary complaints.info:eu-repo/semantics/publishedVersio

A medical device for patellofemoral disorders: design and development

Patellofemoral disorders have been recognized as one of the major causes of the human knee articulation problems. In general, the current available methods to assess patellofemoral joint disorders include the analysis of clinical history, clinical tests and imaging exams. These approaches are ambiguous in the diagnosis produced since they strongly depend on the expertise of the examinant. With the purpose to assist in the diagnosis process of the patellofemoral disorders, a new medical device is proposed throughout this work. In the sequel of this process, the identification and full characterization of the main issues associated with patellofemoral joint are presented. The main features and the engineered solution are accuracy and reproducibility, possibility of incorporation into imaging equipment, adaptability to a large range of knee sizes, easy and cheap to manufacture and anatomically and ergonomically fashion. The mechanical system designed and built allows for the measurement and quantification of the most significant patellofemoral joint motions, more precisely the medial-lateral translation, internal-external tilt and internal-external rotation. The validation of the medical device is investigated here by analyzing the data produced from actual clinical exams, being the early results quite satisfactory and very promising for extensive use in helping in the diagnosis of the patellofemoral disorders.Portuguese Foundation for Science and Technology trough the PhD grant (SFRH/BDE/51821/2012). The author' s would like to thank to the Portuguese Foundation for Science and Technology through the project UID/EEA/04436/2013info:eu-repo/semantics/publishedVersio

Tissue engineering in orthopaedic sports medicine: current concepts

Tissue engineering (TE) has been revolutionising the concepts and therapeutic approaches for the treatment of different sports injuries. To overcome the drawbacks of the current treatments, TE-based strategies provided new possibilities, either in the treatment of defects, which were previously considered unrecoverable, but also in what concerns to the decrease of recovery time. Supported in three mainstream concepts, TE uses the combination of scaffolds, cells and biological factors to pursue a better functional regenerative process. Aware of the limitations of today's treatments, the scientific and medical communities have made great effort to apply, in the safest and most efficient manner, the panoply of new TE tools. However, it is important to understand that there is still a long way to go until these new approaches turn out to be the 'gold standard' treatment in the clinics. This review aims to overview the current concepts of TE applications in orthopaedic sports medicine under preclinical and clinical research applied to growth factors, scaffolds and stem cells.info:eu-repo/semantics/publishedVersio

Building the basis for patient-specific meniscal scaffolds

The current strategies for the total or partial meniscus replacement with allograft transplantation or scaffold implantation need to be improved to overcome the limitations in the clinics. In addition to the required biological and biomechanical performance of the implants, the size and the shape of the implant are critical for the success of the treatment. The commercial implants are re-sized by cutting at the time of surgery according to the patientâ s need; however, not completely in a 3D manner. The meniscal implants should advance beyond the traditional biomaterial concept by being patient-specific not only in terms of size and shape but regarding the cells and biologics derived from the patient. Herein, we overview the recent reports related to manufacturing of patient-specific meniscal implants.I. F. Cengiz thanks the Portuguese Foundation for Science and Technology (FCT) for the Ph.D. scholarship (SFRH/BD/99555/2014). J. M. Oliveira also thanks the FCT for the funds provided under the program Investigador FCT 2012 (IF/00423/2012).info:eu-repo/semantics/publishedVersio

Tissue engineering in orthopaedic sports medicine: current concepts

Tissue engineering (TE) has been revolutionising the concepts and therapeutic approaches for the treatment of different sports injuries. To overcome the drawbacks of the current treatments, TE-based strategies provided new possibilities, either in the treatment of defects, which were previously considered unrecoverable, but also in what concerns to the decrease of recovery time. Supported in three mainstream concepts, TE uses the combination of scaffolds, cells and biological factors to pursue a better functional regenerative process. Aware of the limitations of today's treatments, the scientific and medical communities have made great effort to apply, in the safest and most efficient manner, the panoply of new TE tools. However, it is important to understand that there is still a long way to go until these new approaches turn out to be the 'gold standard' treatment in the clinics. This review aims to overview the current concepts of TE applications in orthopaedic sports medicine under preclinical and clinical research applied to growth factors, scaffolds and stem cells.info:eu-repo/semantics/publishedVersio

Complex Elbow Dislocations

Complex Elbow DislocationsSports practice has become common in all ages, and the number of persons practicing extreme sports has been rapidly increasing. High-risk activities have raised the number and severity of (elbow) lesions that can cause severe disability. Diagnosis of acute elbow dislocation is usually clinically evident, and reduction should be performed expeditiously. On-field reduction should be performed if an experienced health technician is present. Most of the times, the radiographic evaluation is performed first and usually allows identifying an associated fracture that defines a complex dislocation. Postreduction radiographic control is essential, and frequently CT scan or MRI can complete the information needed to fully understand the lesion and plan the treatment. Fractures associated with elbow dislocation are frequent, but fortunately most of them are impacted fractures that do not require surgical treatment. When the dislocation causes a fracture of the olecranon, the radial head, and/or the coronoid, this can justify surgical treatment to provide stability and allow for early rehabilitation in an attempt to avoid either the stiffness or the instability. The most frequent patterns of complex dislocation needing surgical treatment are transolecranon fracture-dislocations and elbow dislocations associated with fracture of the coronoid and/or the radial head. When both coronoid and radial head fractures are present, this pattern of injury is known as “elbow terrible triad” due to the bad outcomes associated with treatment. Surgical treatment can include open reduction and internal fixation of the fractures, exploration, and repair of the medial collateral ligament and/or the lateral ulnar collateral ligament. Dynamic external fixation is another useful option when the elbow remains unstable even after surgical treatment, allowing an early mobilization while maintaining a concentric and stable reduction. Its use needs a strict technique to avoid possible complications such as radial nerve palsy. In summary, ensuring a stable elbow that allows an early active range of motion is the critical point to improve elbow function after a complex elbow dislocation.(undefined)info:eu-repo/semantics/publishedVersio