A lesão medular pode prejudicar a marcha de um indivíduo. Para estes casos, uma técnica de reabilitação que tem se tornado mais popular é a Estimulação Elétrica Neuro Muscular (EENM). Na marcha assistida por EENM tradicional, o controle da estimulação é realizado utilizando-se acionamento manual, um fato que ajuda a torná-la distante da marcha saudável. Este trabalho propõe um sistema que monitora variáveis da marcha - ângulos da articulação do joelho, e forças de reação do solo (retropé e antepé) - e as utiliza como entradas para uma rede neural artificial (RNA), a fim de poder controlar automaticamente a EENM na marcha. Os transdutores utilizados para medir ângulos foram eletrogoniômetros, montados nos membros inferiores do indivíduo utilizando tiras de velcro. Para medição das forças, os transdutores utilizados foram células de carga construídas com strain gages, montadas em sandálias instrumentadas. Os métodos para construção do hardware de aquisição de dados (transdutores e interface) e do software estão descritos, bem como os métodos de calibração dos transdutores. Todos os transdutores apresentaram comportamento linear. Testes iniciais foram realizados, utilizando primeiramente um indivíduo saudável, e depois dois pacientes que normalmente realizam treinamento de marcha com suspensão de peso (assistida por EENM ou não). Os resultados mostraram que o módulo de monitoramento permite gravar os dados coletados, e realizar comparações entre padrões de marcha de diferentes indivíduos, bem como diferentes estágios de reabilitação para um mesmo indivíduo. O treinamento da RNA para o indivíduo saudável apresentou uma taxa de acerto próxima de 90%, e para os pacientes lesados medulares a taxa foi de cerca de 80%. O módulo de controle apresentou resultados promissores nos testes práticos realizados, com respostas rápidas e corretas para o indivíduo saudável. Sugestões para trabalhos futuros foram dadas, para que testes práticos de controle possam ser realizados utilizando pacientes lesados medulares. / Spinal cord injury (SCI) may impair an individual\'s gait. For these cases, a rehabilitation technique that has become more popular is functional electrical stimulation (FES). On traditional FES-assisted gait, the stimulation control is performed with manual triggering, a fact that helps make it distant from healthy gait. This work proposes a system that monitors gait variables - knee joint angles, and ground reaction forces (rearfoot and forefoot) - and uses them as inputs for an Artificial Neural Network (ANN), in order to be able to automatically control gait FES. The transducers used for angle measurement were electrogoniometers, mounted on the individuals lower limbs using Velcro straps. For force measurement, the transducers used were load cells built with strain gages, mounted on instrumented sandals. The methods for building the data acquisition hardware (transducers and interface) and software are described, along with the transducer calibration methods. All transducers presented linear behavior. Initial tests were performed, using first a healthy individual, and then a couple of patients that normally undergo suspended gait raining (FES-assisted or not). The results showed that the monitoring module allows recording the data collected, and making comparison between different individuals\' gait patterns, as well as different rehabilitation stages for the same individual. The ANN training for the healthy individual presented an accuracy rate close to 90%, and for the SCI patients the rate was about 80%. The control module showed promising results on practical tests performed, with quick and accurate responses for the healthy individual. Suggestions for future works were given, so that practical control tests can be performed using SCI patients.

Abstract Osteoarthritis (OA) is a common chronic condition that reduces the quality of life of millions of individuals worldwilde. In OA, the progressive degradation of articular cartilage (AC) and bone can cause joint pain and disability. Currently there is no effective treatment available for OA besides gross joint replacement surgery. This is largely due to the lack of accurate biomarkers to test potential drugs and treatments that could stop or reverse the disease progression. The primary tools in use for OA diagnostics are inadequate in the early stage of the disease and merely allow its late manifestations to be visualized. Quantitative MRI (qMRI) has demonstrated the ability to distinguish degenerated from intact AC prior to radiographic changes. Moreover, so-colled rotating frame relaxation time parameters are sensitive to the slow molecular motion domain, relevant for clinical applications. T1ρ and T2ρ relaxation time measurements using adiabatic spin-lock pulses (AdT1ρ and AdT2ρ) have shown superior sensitivity to cartilage degeneration in vitro over conventional qMRI parameters. This thesis aimed to compare the differences that exist between established qMRI methods for AC against arthroscopic evaluation as well as optimize and validate AdT1ρ and AdT2ρ mapping of cartilage in vivo. The findings showed that T1 and T2 relaxation time and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) were able to discriminate among different arthroscopic grades of cartilage lesions. However, arthroscopic findings and qMRI parameters were not correlated, supporting the viewpoint that qMRI may be able to elicit more comprehensive information on the quality of remaining cartilage tissue as compared to diagnostic arthroscopy, which detects cartilage loss. AdT1ρ and AdT2ρ mapping of cartilage in vivo were successfully implemented and validated on a clinical MRI system. AdT1ρ and AdT2ρ were able to overcome limitations of the existing methods (continuous wave spin-lock approach), which are challenging to implement on clinical settings for their susceptibility to field inhomogeneity and relatively high power deposition in tissue. The association of AdT1ρ and AdT2ρ with cartilage and bone marrow lesions and osteophytes was demonstrated. The findings indicate the utility of AdT1ρ and AdT2ρ mapping as potential biomarkers for evaluation of early cartilage degeneration in OA research and clinical applications. / Tiivistelmä Nivelrikko on tavallinen krooninen sairaus, joka huonontaa miljoonien ihmisten elämänlaatua ympäri maailman. Nivelrikossa nivelruston ja luun asteittain etenevä rappeuma voi aiheuttaa nivelkipua ja liikuntakyvyttömyyttä. Tällä hetkellä nivelrikkoon ei ole muuta tehokasta hoitokeinoa kuin tekonivelleikkaus. Tämä johtuu suuremmaksi osaksi tarkkojen biomarkkereiden puutteesta, joiden avulla voitaisiin kokeilla mahdollisia nivelrikon pysäyttäviä tai tautia parantavia lääkkeitä tai hoitokeinoja. Nykyisin nivelrikon diagnostiikassa käytetyimmät menetelmät ovat riittämättömiä sairauden alkuvaiheessa, ja ne tunnistavat vain sairauden loppuvaiheet. Kvantitatiivisilla magneettikuvausmenetelmillä pystytään erottamaan rappeutunut ja ehjä nivelrusto toisistaan ennen röntgenkuvissa havaittavia muutoksia. Nk. pyörivän koordinaatiston relaksaatioaikaparametrit ovat herkkiä havaitsemaan hidasta molekyyliliikettä, jolla on merkitystä kliinisissä sovelluksissa. Kokeellisissa olosuhteissa T1ρ- ja T2ρ-relaksaatioaikojen mittaaminen käyttäen adiabaattisia spin-lukkopulsseja (AdT1ρ ja AdT2ρ) on osoittautunut erityisen tarkaksi nivelruston rappeutumisen toteamiseksi verrattuna perinteisiin kvantitatiivisiin magneettikuvausmenetelmiin. Tämän väitöskirjan tavoitteena oli vertailla vakiintuneita nivelrikon kvantitatiivisia magneettikuvausmenetelmiä sekä optimoida ja validoida AdT1ρ- ja AdT2ρ-menetelmien käyttöä ihmisen ruston tutkimisessa. Tulokset osoittivat, että T1- ja T2-relaksaatioajat sekä varjoainetehosteinen nivelruston magneettikuvaus pystyivät erottelemaan niveltähystyksessä määritettyjä nivelrikon eri asteita. Kuitenkaan niveltähystyslöydökset ja kvantitatiiviset magneettikuvausparametrit eivät korreloineet viitaten kvantitatiivisen magneettikuvauksen kykyyn osoittaa tarkemmin jäljellä olevan ruston laatua verrattuna niveltähystykseen, jossa arvioidaan ruston puutosta. Nivelruston AdT1ρ- ja AdT2ρ-relaksaatioaikamittaukset onnistuttiin suorittamaan ja validoimaan vapaaehtoisilla koehenkilöillä kliinisellä magneettikuvauslaitteella. AdT1ρ ja AdT2ρ eivät kärsineet samoista puutteista kuin tavanomaiset jatkuva-aaltoiset spin-lukkomenetelmät, joka ovat herkkiä kenttäepähomogeenisuuksille ja aiheuttavat suuremman radiotaajuusaltistuksen. Tutkimuksessa osoitettiin AdT1ρ- ja AdT2ρ-mittausten ja luuödeemin sekä osteofyyttien välinen yhteys. Tulokset osoittivat, että AdT1ρ- ja AdT2ρ-mittaukset ovat potentiaalisia biomarkkereita varhaisen nivelruston rappeuman havaitsemiseksi tutkimus- ja kliinisessä käytössä.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Iliotibial band friction syndrome is a common dysfunction seen in athletes. Athletes develop biomechanical changes yet still continue with their sport. However, this syndrome limits their ability to participate at peak performance. This study determined which participants benefitted in terms of biomechanical and clinical outcomes in one of four groups: ankle joint, superior tibio-fibular joint, sacroiliac joint or a combination manipulation group (which contained any two of the three joint restrictions). Methods: This Durban University of Technology Institutional Research and Ethics Committee approved prospective clinical trial, utilised stratified sampling, with 48 participants across four groups: ankle (14); superior tibio-fibular (11), sacroiliac (12) and combination (11). The participants underwent six treatments in three weeks. Data collection occurred before consultations one, three, five and seven. The data included primary measures of the knee score questionnaire (KSQ), the algometer, the visual analogue scale (VAS) and the secondary measures of the Feiss line, the heel leg alignment, bilateral leg length, Q angle and tibio-femoral angle. All data was computed utilising the ANOVA testing, with a p-value <0.05 being significant and a 95% confidence interval. Pearson’s correlations were completed for intragroup associations between primary and secondary outcome measures. Results: The intragroup analysis revealed that all groups had significant changes in the KSQ and VAS, with the exception of the sacroiliac joint manipulation group (KSQ outcome not significant). Intergroup analysis revealed no differences between the groups with the exception of the combination group, which showed a significant increase in the tibio-femoral angle. Most commonly, the Pearson’s correlation revealed that changes in leg length were related to differences in primary outcome measures, irrespective of the group being tested. Conclusion: The outcomes of this study indicated that manipulation of the distal kinematic chain improved alignment and clinical outcomes to a greater degree than manipulating proximal restrictions. It is suggested with caution (due to limited sample size) that patients should first have their distal kinematic chain manipulated before more proximal joints are manipulated to achieve better outcomes. / M

In Germany alone, 10,000 to 12,000 transfemoral amputations occur every year. Persistent rehabilitation efforts and advanced medical devices like prosthetic knee joints are crucial to reintegrating amputees into daily life successfully. Modern knee joints represent a highly integrated mechatronic system including special kinematics, a lightweight design, various sensors, microprocessors and complex algorithms to control a damping system in the context of the given situation. A knee joint is a passive system and normally has no actuator for an active movement. To enable a natural gait pattern, dampers decelerate the swinging speed of the prosthesis depending on the walking speed and situation. The invention of a novel knee joint called VarioKnie provides two kinematics - a monocentric and a polycentric one. Both kinematics have diametrical advantages and the user can choose the preferred setting through an electromechanical switching unit. With this knee joint in mind, a special hydraulic damper is developed to support both kinematics. Requirements and technical data are provided in the present paper. State of art are microprocessor-controlled knee joints with only one kinematic and either a hydraulic, a pneumatic, or a rheological damper.

Tato práce se zabývá pokročilou technologií výroby personalizovaných kloubních implantátů metodou EBM za použití titanové slitiny Ti6Al4V-ELI a navrhuje nový unikátní design kolenního implantátu společně s metodologií jeho inserce, přičemž tato řešení jsou součástí patentové přihlášky č. PV 2020-459. Toto neinvazivní řešení náhrady kolenního kloubu je šetrnější k pacientovi, maximálně chrání jeho zdravé tkáně a kosti, navíc se dá předpokládat vyšší životnost implantátu ve srovnání s tradičními dostupnými řešeními. Byla uskutečněna výroba vzorků z materiálu Ti6Al4V-ELI metodou EBM, proveden rozbor jejich materiálových, mechanických, technologických a únavových vlastností. Dále byly popsány pokročilé metody zobrazování, úpravy a tvorby kloubních ploch a použity k vyvinutí nového designu personalizovaného kloubního implantátu společně s inovační technologií jeho inserce a nástroji potřebnými k její úspěšné realizaci. Toto nové řešení bylo úspěšně ověřeno mnoha testy i výrobou Ti6Al4V-ELI a CoCrMo prototypů implantátů metodou EBM. Proveditelnost a použití v praxi bylo konzultováno a schváleno odborníky v této oblasti.

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No / We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

Knorpeldefekte des Kniegelenks zeichnen sich durch eine sehr begrenzte spontane Heilungstendenz aus und führen im Verlauf häufig zur Arthrose. Trotz intensiver Forschungsbemühungen konnte bisher keine neue Therapieoption eine zufrieden-stellende Alternative zu den bisherigen Therapien hervorbringen. Eine ACI in Kombination mit einem künstlich hergestellten Knorpel-Knochen-Ersatzmaterial scheint jedoch großes Potential für die Therapie von Knorpel-Knochen-Schäden zu besitzen. Im vorliegenden Langzeittierversuch mit Kaninchen wurde eine einzeitige ACI mit einem biphasischen Ersatzmaterial (TruFit®) und platelet-rich-plasma (PRP) kombiniert. Zu diesem Zweck wurde in der medialen Femurkondyle ein critical-size-Defekt mit einem Durchmesser von 4,5 mm gesetzt. In der ersten Versuchsgruppe blieb der Defekt unbehandelt (Leer). Bei der zweiten Gruppe wurde die Defekthöhle mit einem TruFit®-Zylinder aufgefüllt (TFP). Gruppe drei erhielt zusätzlich PRP (TFP+PRP) und Gruppe vier wurde darüber hinaus mit einer einzeitigen ACI kombiniert (TFP+PRP+C), bei der Chondrozyten mit Hilfe eines speziellen Kollagenase-Schnellverdaus isoliert werden konnten. Die Auswertung der Knorpel-Knochen-Regeneration erfolgte nach 12 Monaten durch eine Mikroradiographie, eine intravitale Fluoreszenzmarkierung des Knochens und durch Toluidinblau-O- und Safranin-O-Färbungen. Verwendet wurden die Scores nach Wakitani und O’Driscoll. Dabei konnte gezeigt werden, dass eine TruFit®-Therapie die Knochenregeneration positiv beeinflussen kann. Die Zugabe von PRP bewirkte die Bildung von zahlreichen dünnen Trabekeln mit einer erhöhten Anzahl trabekulärer Verbindungen, allerdings auch eine schlechtere Rekonvaleszenz der subchondralen Knochenschicht. Bezüglich der Knorpelheilung schnitt die Gruppe TFP+PRP+C am besten ab, wobei die Unterschiede nicht signifikant waren. Insgesamt zeigten alle Versuchsgruppen eine unzureichende osteochondrale Regeneration, so dass für die Therapie am Menschen zunächst weitere Studien nötig sind, die sowohl ossär als auch chondral eine verbesserte Heilungspotenz demonstrieren können. Bisher fehlen groß angelegte Studien um Therapieempfehlungen bezüglich des Ersatzmaterials, der genauen Durchführung der einzeitigen ACI und Zusätzen wie Wachstumsfaktoren zu machen.

INTRODUÇÃO: A incidência de rotura do LCA aumentou, principalmente, entre atletas jovens. Além disso, esta população possui compromissos esportivos e necessidade de retornar às atividades em curto prazo. O posicionamento dos túneis é uma das variáveis mais importantes no sucesso da reconstrução do LCA em que o cirurgião pode intervir. Apesar de existirem trabalhos sobre reconstrução do LCA e avaliações funcionais, poucos estudos prospectivos avaliam a relação entre o posicionamento radiográfico dos túneis e os resultados clínicos. Portanto, o objetivo do presente estudo é avaliar a relação entre o posicionamento radiográfico dos túneis na reconstrução do LCA e as avaliações funcionais de atletas no período de retorno ao esporte. MÉTODOS: O estudo foi conduzido prospectivamente em 86 atletas (23 ± 5,9 anos, 63 homens) com lesão do LCA submetidos à reconstrução artroscópica pela técnica transtibial no Grupo de Medicina do Esporte do IOT HC-FMUSP, de 2008 a 2010. Realizadas radiografias digitais (aparelho Duo Diagnost InRad) nos planos coronal, sagital e incidência de túnel e mensurações no sistema iSite PACS HC-FMUSP (Philips). Coletados protocolos de Tegner, Lysholm, IKDC objetivo, IKDC subjetivo e retorno ao esporte aos seis e 12 meses (m). Avaliada força de associação pelo teste de correlação de Pearson, regressão logística e ANOVA, p<0,05 (STATA 10). RESULTADOS: Radiografias projeção plano coronal (fêmur 38 ± 4%; tíbia 43 ± 3%), projeção plano sagital (fêmur Amis 62 ± 7%; fêmur Harner 74 ± 8%; tíbia 39 ± 6%), inclinação do enxerto (plano coronal 190 ± 40; incidência túnel 190 ± 50). Avaliações funcionais: Lysholm (6m = 87 ± 10,7; 12m = 91 ± 12,2), Tegner (6m = 5 ± 1,4; 12m = 7 ± 1,8), IKDC subjetivo (6m = 75 ± 13,8; 12m = 85 ± 14,5), retorno ao esporte em 12m (66,7%). Projeções sagitais de túneis femorais por sobre a linha de Blumensaat ( de Pearson = -0,33, p = 0,02), assim como túneis tibiais no plano coronal ( de Pearson = 0,35, p = 0,01) e sagital (F = 3,36, p = 0,04) possuem associações significativas com as escalas funcionais. Estas relações não puderam ser explicadas por fatores basais ou demográficos. CONCLUSÃO: Nos atletas, as projeções dos túneis femorais mais posteriores, assim como projeções dos túneis tibiais mais mediais e posteriores, estão relacionadas a menores valores de avaliações funcionais. / There has been an increase of ACL injuries occurring in young athletes. Aside from this increase, athletes have intensive scheduling and must resume physical activity shortly after injury. Tunnel positioning is one of the most important variables in ACL reconstruction success in which surgeons can interfere. Although there are many studies on ACL reconstruction and functional assessments, few studies have prospectively investigated the relationship between radiographic tunnel positioning and clinical outcomes. PURPOSE: The aim of this study is to evaluate the relationship between tunnel positioning and functional assessments in athletes during return to sports. METHODS: A prospective study was conducted with 86 athletes (23 ± 5.9 years, 63 males) who underwent transtibial ACL reconstruction in the Sports Medicine Group (IOT-HC FMUSP) from 2008 to 2010. Digital radiographs were acquired (Duo diagnostic InRad) in coronal, sagittal and tunnel incidence and analyzed at iSite PACS HC-FMUSP (Philips). Tegner, Lysholm, IKDC form and return to sports were collected at six and 12 months (m). Task force was assessed by Pearson correlation test, logistic regression and ANOVA, p<0.05 (STATA 10). RESULTS: Radiographic coronal view (femur 38 ± 4%, tibia 43 ± 3%), sagittal view (femur Amis 62 ± 7%; femur Harner 74 ± 8%, tibia 39 ± 6%), graft inclination (coronal 190 ± 40; tunnel 190 ± 50). Functional outcomes: Lysholm (6 m = 87 ± 10.7, 12 m = 91 ± 12.2), Tegner (6 m = 5 ± 1.4, 12 m = 7 ± 1.8), IKDC subjective (6m = 75 ± 13.8; 12m = 85 ± 14.5), return to sports (66.7%). Femoral tunnel projections along Blumensaat line on sagittal view (PCC = -0.33, p = 0.02) and tibial tunnels on coronal view (PCC = 0.35, p = 0.01) and sagittal view (F = 3.36, p = 0.04) are statistically correlated to functional outcomes. These correlations between tunnel positioning on functional outcomes could not be explained by demographic or baseline characteristics. CONCLUSION: Athlete population has lower values of functional outcomes related to more posterior femoral tunnel projections and more medial and posterior tibial tunnel projections.