A periodontite é uma doença inflamatória crônica, multifatorial, altamente prevalente na população que compromete os tecidos de suporte dos dentes gerando sequelas de difícil resolução, mesmo com as mais modernas técnicas regenerativas. A terapia tecidual parece ser uma alternativa promissora e as células indiferenciadas do ligamento periodontal (PDL) tem demonstrado grande potencial terapêutico. No entanto, o PDL necessita de estímulos adequados de biomodificadores para que a diferenciação ocorra de forma coordenada. As proteínas da matriz do esmalte (EMD) é um tipo de biomodificador que promove formação de novo cemento. Apesar de ser utilizada clinicamente, a sua associação com células frescas do PDL ainda não foi explorada. Este é um estudo da expressão gênica e proteica do PDL com finalidade de reaproveitamento do tecido recém-extraído, estimulado por EMD, tendo em vista a regeneração periodontal. Os resultados da expressão gênica apresentam VEGF (p=0.5194) com diferença entre medianas de -0.201 e FGF-2 (p = 0,0059) com diferença entre medianas de -0.4167. No estudo de citocinas, VEGF-A (p<0,0001) com diferença entre medianas de 60,93, enquanto VEGF-D (p=0.0049) com entre medianas de 2,45. Através dos resultados da expressão gênica baseada em FGF-2 e proteica baseada em VEGF-A, foi possível observar que as EMD modularam a resposta tecidual ex-vivo no período de 10 minutos tendo em vista o padrão angiogênico. Essa combinação poderá servir como uma proposta terapêutica, visando a aplicação clínica futura de tecidos comumente descartados após exodontia, como o PDL. / Periodontitis is a chronic inflammatory disease, multifactorial and highly prevalent in the world population that affects the teeth of the supporting tissues, generating sequels difficult to solve even with the most modern regenerative techniques. Tissue therapy appears to be a promising alternative and undifferentiated cells of the periodontal ligament (PDL) have shown great therapeutic potential. However, the PDL needs to appropriate stimuli biomodificatores that differentiation occurs in a coordinated fashion. The enamel matrix proteins (EMP) are a type of biomodificator that promotes new cementum formation. Despite being used clinically, its association with PDL fresh cells has not yet been explored. This is a study of gene and protein expression of PDL with reuse purpose of the newly extracted tissue stimulated by EMD, with a view to periodontal regeneration. The results show VEGF gene expression (p = 0.5194) difference in median -001 and FGF-2 (p = 0.0059) difference in medians of -0.4167. In the study of cytokines, VEGF-A (p <0.0001) with the difference between medians of 60.93, whereas VEGF-D (p = 0.0049) with from 2.45 medians. Through the results of the FGF-2-based gene expression and protein-based VEGF-A, it was observed that the EMD modulated the tissue response ex vivo in the 10-minute period considertingthe standard angiogenic. This combination may serve as a therapeutic approach aimed at future clinical application of tissues commonly discarded after extraction, such as the PDL.

Introdução: A doença do refluxo gastroesofágico (DRGE) é definida pela intensidade e/ou qualidade de refluxo do conteúdo gástrico ou duodenal para o esôfago. O tratamento cirúrgico da DRGE tem mostrado resultados conflitantes e índices inaceitáveis de recidiva, principalmente devido a migração da válvula anti-refluxo para o tórax. Variações técnicas têm sido propostas com objetivo de diminuir a recidiva da DRGE, inclusive com uso rotineiro de prótese na hiatoplastia. A prevalência de DRGE em portadores de HH pode chegar a 94%. A membrana frenoesofágica (MFE) que atua na estabilização da junção esofagogástrica no abdômen pode ser um fator etiológico da hérnia hiatal (HH)? Conduzimos um estudo para avaliar o colágeno na constituição da MFE de pacientes com HH e cadáveres sem HH. Métodos: Foram coletadas amostras da MFE de 29 pacientes com HH e DRGE (casos) e amostras de 32 cadáveres sem HH (controles). O colágeno total foi quantificado pela técnica histoquímica de Picrossirius e o colágeno tipo I e tipo III por imuno-histoquímica (anticorpo monoclonal). As imagens das lâminas coradas foram fotografadas, armazenadas em arquivo.tiff e quantificadas por programa de computador (Image Pro Plus) para contagem de pixels por campo. Resultados: A média de idade dos casos foi de 49,5 (±11,5) anos e dos controles foi de 38,5 (±13) (p<0,01). Em relação ao gênero, 58,6% (17) dos casos e 18,75% (6) dos controles eram do sexo feminino (p<0,01). A quantidade, em pixels por campo, de colágeno total (p<0,01), tipo I (p<0,01) e tipo III (p<0,05) foi significativamente menor, em torno de 60%, nos pacientes com HH em relação aos controles. Conclusão: Nossos dados demonstram que a constituição da MFE dos pacientes com HH e DRGE tem menor quantidade de colágeno total, tipo I e tipo III que a MFE de cadáveres sem HH. A qualidade da MFE pode ser um fator etiológico para o desenvolvimento da HH. / Background: Gastroesophageal reflux disease (GERD) is defined by the intensity and/or quality of the reflux of gastric or duodenal contents into the esophagus. Surgical treatment of GERD has shown conflicting results and unacceptable recurrence rates, mainly due to herniation of the antireflux valve into the chest. A variety of techniques have been proposed to reduce GERD recurrence, including routine use of prosthesis in cruroplasty. The prevalence of GERD in patients with hiatal hernia (HH) can reach 94%. It is possible that the phrenoesophageal ligament (POL) engaged in the stabilization of the gastroesophageal junction in the abdomen may be an etiologic factor of HH. We conducted a study to evaluate collagen in the constitution of the POL in patients with HH and cadavers without HH. Methods: POL samples were collected from 29 patients with HH and GERD (cases) and 32 samples from cadavers without HH (controls). Total collagen was quantified through the Picro-Sirius histochemical technique, and type-I and type-III collagens were quantified immunohistochemically using a monoclonal antibody. The stained slides were photographed, and images were quantified by computer software (Image Pro Plus) to count the pixels per field. Results: The mean age was 49.5 (±11.5) years for the cases and 38.5 (±13) years for the controls (p < 0.01). Seventeen cases (58.6%) and 6 controls (18.75%) were female (p < 0.01). The quantity of total (p < 0.01), type-I (p < 0.01), and type-III (p < 0.05) collagen was significantly lower, about 60%, in patients with HH compared to controls. Conclusion: Our data indicate that the composition of POL for patients with GERD and HH has fewer total, type I and type III collagen than that of the POL of cadavers without HH. The quality of the POL may be an etiological factor in the development of HH.

Introdução: O ligamento cruzado anterior (LCA) é o principal restritor à translação tibial anterior. O tratamento indicado para indivíduos atleticamente ativos é cirúrgico. Apesar de serem encontradas descrições de bons-excelentes resultados em mais de 90% dos casos, ainda há complicações relevantes, sendo a evolução para a artrose uma ocorrência frequente. Sabese que pacientes com desvio do eixo em varo, lesões condrais mediais e/ou meniscectomia medial têm maior evolução para artrose do compartimento medial. A realização da reconstrução intra-articular clássica, com tensionamento do enxerto e fixação do mesmo no túnel tibial, o qual tem ponto de entrada na metáfise medial, pode ser causa de sobrecarga medial. Objetivo: O presente estudo visa comparar duas técnicas de reconstrução intra-articular do LCA distintas entre si apenas no que tange ao ponto de entrada tibial (metáfise medial ou lateral) e o resultante grau de sobrecarga medial. Método: Estudo transversal, não randomizado, experimental em cadáveres. Três cadáveres (06 joelhos) foram submetidos à reconstrução intra-articular do ligamento cruzado anterior. Foi mensurado o grau de abertura articular medial em milímetros (mm) a 0 e 20° de flexão durante o estresse controlado em valgo (40 N) em quatro situações: LCA íntegro (grupo I), LCA seccionado (Grupo S), LCA reconstruído com o ponto de entrada do túnel tibial na posição clássica anteromedial (Grupo RC) e LCA reconstruído com o ponto de entrada do túnel tibial na posição alternativa anterolateral (Grupo RA). Resultados: A média de abertura medial a 0 e a 20 graus de flexão foram respectivamente de 3,48 e 3,55 (grupo I), 5,82 e 5,97 (grupo S), 3,22 e 3,27 (grupo RC), 5,27 e 5,28 (Grupo RA). Houve diferença significativa entre todos os grupos, com exceção da comparação Grupo I x Grupo RC, tanto a 0 como a 20 graus de flexão. Conclusão: O túnel tibial com entrada na região anterolateral da metáfise tibial lateral causa menor restrição medial do que a técnica de posicionamento clássico do túnel. / Introduction: Anterior Cruciate Ligament (ACL) is the main stabilizer of the anterior tibial translation. Surgical treatment usually is indicated for Young and active individuals. Even though good to excellent results are expected in 90% of the cases, there are several complications, and arthrosis progression still is a concern. Varus, condral and menisci injuries are well known risk of factors to gonarthrosis. Classic intra-articular ACL reconstruction with medial sided tibial tunnel positioning and tensioning can be a cause of medial compartment overload. Purpose: The present study aims to compare two similar intra-articular ACL reconstructions, differing one another only by the tibial tunnel entry, and its effect on medial compartment load. Methods: Transversal, non-randomized, experimental biomechanical study. ACL reconstruction was performed in three fresh cadavers (06 knees). Medial joint opening was measured in terms of millimeters (mm) during controlled valgus stress (40 N) both at 0 and 20 degrees of flexion. The specimens were tested in the intact state (group I) and after sectioning of ACL (group S). Also, they were tested after ACL reconstruction with medial (group MT) and lateral tunnel fixation (group LT). Results: Mean medial joint opening at 0 and 20 degrees of flexion were respectively 3,48 and 3,55 (group I), 5,82 and 5,97 (group S), 3,22 and 3,27 (group MT), 5,27 and 5,28 (group LT). Statistically significant difference occurred in comparisons between all groups, but in group I x MT, both at 0 and 20 degrees of flexion. Conclusion: The lateral based tibial tunnel for ACL reconstruction leads to lesser medial joint overload than the classic medial one.

The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee, with upwards of 100,000 ACL reconstructions performed annually. Current grafting techniques are limited by insufficient integration with subchondral bone and donor site morbidity issues related to graft harvest, potentially resulting in revision surgery and long-term joint pain. Therefore, significant demand exists for alternative grafting solutions that do not require additional surgery and can regenerate the native ACL-to-bone interface to promote biological fixation of the implanted ACL graft. To address this need, the ideal system must be able to withstand the functional demands of the native tissue by demonstrating physiologically equivalent mechanical properties, be comprised of compositionally varying phases in order to recapitulate the inherent heterogeneity of the native ligament to bone transition and be biodegradable such that it is gradually replaced by the regenerated tissue following implantation. It is hypothesized that a biomimetic, multi-phased scaffold comprised of optimized bone, interface and ligament regions coupled with controlled chemical and/or mechanical stimulation in vitro will guide phase-specific differentiation of mesenchymal stem cells (MSC) and result in a biologically integrated bone-ligament-bone complex in vivo. Mesenchymal stem cells are particularly attractive for this application as they can be routinely harvested from bone marrow, have been shown to respond to chemical, mechanical and structural cues, and are capable of differentiating towards the primary cell types (fibroblasts, osteoblasts and chondrocytes) found within ligament, bone and the ligament-to-bone interface. To this end, a nanofiber-based synthetic graft was designed with compositionally-varying phases to regenerate ligament, bone and interface tissues. The ligament phase was optimized in terms of nanofiber alignment, composition, mechanical stimulation and chemical stimulation. It was demonstrated that an aligned nanofiber substrate coupled with controlled mechanical stimulation was necessary to differentiate MSCs towards a fibroblastic phenotype. The bone phase was optimized in terms of ceramic content and it was shown that a threshold of mineral incorporation into nanofibers was necessary to differentiate MSCs towards an osteogenic phenotype. Lastly, a mechanoactive nanofiber collar was designed to induce interface formation. It was demonstrated that compressive stimulation applied via nanofiber collar contraction induced chondrogenic differentiation of MSCs. Subsequently, the three phases were incorporated to form a synthetic graft, for which graft architecture and cell seeding density were optimized. The resulting graft was cultured in vitro under the optimized parameters, demonstrating the formation of distinct and structurally continuous regions of bone, interface and ligament tissue. The graft was implanted in vivo where it was shown to be suitable for ACL reconstruction as it maintained knee stability and promoted ligament regeneration. In summary, this thesis focuses on the design of a biomimetic, nanofiber-based, integrated bone-ligament-bone construct, and elucidates chemical, mechanical and scaffold design-related parameters that can guide MSC differentiation towards desired tissue types. The impact of these studies extends beyond ligament reconstruction as they yield valuable scaffold design criteria, establish scaffold and culturing-related parameters to induce stem cell differentiation and can readily be applied to the formation of interfaces between soft-to-hard tissues as well as other complex tissues.

Introdução: Os ligamentos denteados são extensões da pia-máter em cada lado da medula espinhal, totalizando cerca de 20 a 21 pares de estruturas fibrosas que se conectam com a dura-máter, ancorando a medula espinhal. Esses ligamentos são importantes referências anatômicas para cirurgias envolvendo estruturas no interior do canal vertebral e, portanto, muito bem conhecidos por cirurgiões que abordam o canal vertebral. No entanto, não encontramos a descrição deste ligamento em estudos de ressonância magnética (RM). Objetivo: Nosso objetivo foi avaliar a detecção dos ligamentos denteados na coluna cervical por meio de imagens de RM em sequências de aquisição volumétrica e com alta resolução espacial, e comparar a frequência de detecção desses ligamentos nos equipamentos de 1,5 Tesla e 3,0 Tesla. Resultados: Foram avaliados 116 exames de ressonância magnética da coluna cervical, sendo observada alta frequência de detecção dos ligamentos denteados na coluna cervical utilizando sequência volumétrica 3D COSMIC, tanto no equipamento de 1,5 Tesla quanto no equipamento de 3,0 Tesla. Não houve diferença estatisticamente significativa quando comparamos a frequência de detecção dos ligamentos entre os equipamentos de RM de 1,5T e 3,0 T. / Introduction: Denticulate ligaments are extensions of the pia mater on each side of the spinal cord, totaling about 20 to 21 pairs of fibrous structures that connect with the dura mater, anchoring the spinal cord. These ligaments are important anatomical references for surgeries involving structures inside the spinal canal and therefore well known to surgeons who approach the spinal canal. To our knowledge, there is no previous study on the feasibility to detect the denticulate ligaments using MRI. Objective: Our aim was to evaluate the detection of denticulate ligaments in the cervical spine using high resolution magnetic resonance imaging (MRI), and to compare the frequency of detection of these ligaments in 1.5 Tesla and 3.0 Tesla equipment. Results: We evaluated 116 MRI scans of the cervical spine and observed high frequency of detection of the denticulate ligaments in the cervical spine using the volumetric sequence 3D COSMIC on both the 1,5 Tesla and 3,0 Tesla MR equipments. There was no statistically significant difference in the frequency of detection of the ligaments between the MRI equipments.

No description available.

Bakgrund: Skada på det mediala kollateralligamentet (MCL) är en av de vanligast förekommande knäskadorna och drabbar främst yngre idrottande personer. En av fysioterapeutens roller i rehabiliteringen är att se till människans helhet där biomedicinska, psykiska och sociala aspekter ingår, detta för att patienten ska få ett bra omhändertagande. Syfte: Att undersöka hur fysioterapeuter beskriver sitt arbete med rehabilitering av patienter med MCL-skador. Metod: En kvalitativ intervjustudie med deskriptiv design utfördes. Data insamlad från sex intervjuer av fysioterapeuter bearbetades med hjälp av en induktiv ansats i en kvalitativ innehållsanalys. Ett ändamålsenligt bekvämlighetsurval användes vid valet av intervjupersoner. Resultat/slutsats: Studiens resultat mynnade ut i fyra kategorier med två underkategorier inom varje. Kategoriernas namn var ”Identifierar behov av och arbetar med att ge patienterna stöd”, ”Anpassar rehabilitering efter patientens träningsmöjligheter och olika aktiviteter”, ”Arbetar med att minska rädsla, oro och öka tillit till knät hos patienterna” och ”Arbetar med patienternas motivation”. Det visade sig i studiens resultat att hänsyn togs av intervjupersonerna till såväl biomedicinska som psykosociala faktorer i sitt arbete med denna patientgrupp. / Background: Injury to the Medial Collateral Ligament (MCL) are one of the most common knee injuries and mainly affect younger athletes. One of the physiotherapists' roles in rehabilitation is to look at the whole of the human being, which includes biomedical, psychological and social aspects, in order to ensure a good medical care. Purpose: To investigate how physiotherapists describe their work with rehabilitation of patients with MCL injuries. Method: The design of the study was a qualitative interview study, with an inductive approach. Data collected from six interviews of physiotherapists was analysed using a qualitative content analysis. An appropriate convenience sample was used in the selection of interviewees. Result / conclusion: The study's results consisted of four categories with two subcategories within each. The names of the categories were "Identifying need of and work with supporting biopsychosocial factors", "Adapting rehabilitation to the patient's possibilities regarding training and various activities", "Working with reducing fear, worry and increasing the patient’s confidence regarding their knees" and "Working with the patients' motivation". It was shown in the results that consideration was taken by the interviewees regarding the patient’s biomedical and psychosocial factors.

by Wang Wen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 113-124). / Abstracts in English and Chinese. / ABSTRACT --- p.i / FLOWCHART --- p.vi / ACKNOWLEDGEMENT --- p.x / ABBREVIATIONS --- p.xi / INDEX FOR FIGURES --- p.xii / INDEX FOR TABLES --- p.xv / TABLE OF CONTENTS --- p.xvi / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 1.1 --- PATELLAR TENDINOSIS --- p.1 / Chapter 1.1.1 --- Introduction --- p.1 / Chapter 1.1.2 --- Epidemiology of Patellar Tendinosis --- p.3 / Chapter 1.1.3 --- Etiology of Patellar Tendinosis --- p.3 / Chapter 1.1.4 --- Manifestations of Patellar Tendinosis --- p.4 / Chapter 1.1.5 --- Imaging Examination on Patellar Tendinosis --- p.4 / Chapter 1.1.6 --- Clinical Diagnosis of Patellar Tendinosis --- p.6 / Chapter 1.1.7 --- Management of Patellar Tendinosis … --- p.6 / Chapter 1.2 --- ANATOMY AND HISTOLOGY OF PATELLAR TCNDON --- p.7 / Chapter 1.3 --- STRUCTURE AND METABOLISM OF TENDON --- p.9 / Chapter 1.3.1 --- Tenocytes --- p.9 / Chapter 1.3.2 --- Extra-cellular Matrix --- p.11 / Chapter 1.3.2.1 --- Collagen --- p.11 / Chapter 1.3.2.2 --- Proteoglycans --- p.12 / Chapter 1.4 --- ROLES OF GROWTH FACTORS TENDON HEALING AND REPAIR --- p.14 / Chapter 1.4.1 --- Platelet-Derived Growth Factor --- p.14 / Chapter 1.4.2 --- Transforming Growth Factor-beta --- p.15 / Chapter 1.5 --- HISTOPATHOLOGY OF PATELLAR TENDINOSIS --- p.16 / Chapter 1.6 --- STUDY PLAN --- p.17 / Chapter 1.6.1 --- Characterization on Hypercellularity --- p.18 / Chapter 1.6.2 --- Characterization on Disorganization and Loosening of Collagen --- p.18 / Chapter 1.6.3 --- Characterization on Inflammatory Trace --- p.20 / Chapter 1.6.4 --- Characterization on Growth Factors in Tendinosis --- p.21 / Chapter 1.7 --- OBJECTIVES --- p.22 / Chapter 2. --- MATERIALS AND METHODS --- p.27 / Chapter 2.1 --- HUMAN TISSUES --- p.27 / Chapter 2.1.1 --- Patellar Tendinosis Tissues --- p.27 / Chapter 2.1.1.1 --- Diagnosis of patellar tendinosis --- p.27 / Chapter 2.1.1.2 --- Recruitment of patients --- p.27 / Chapter 2.1.4 --- Healthy Patellar Tendon tissues --- p.28 / Chapter 2.2 --- TISSUES COLLECTION AND PREPARATION --- p.28 / Chapter 2.3 --- HISTOLOGICAL STUDY ON HUMAN SPECIMENS --- p.28 / Chapter 2.3.1 --- Haematoxyline and Eosin Staining --- p.29 / Chapter 2.3.2 --- Safranin O Staining --- p.29 / Chapter 2.3.2.1 --- Reagents preparation --- p.29 / Chapter 2.3.2.2 --- Experimental procedure --- p.30 / Chapter 2.3.5 --- Polarization Microscopy --- p.30 / Chapter 2.4 --- IMMUNOHISTOCHEMICAL STAINING --- p.30 / Chapter 2.4.1 --- Reagents Preparation --- p.31 / Chapter 2.4.2 --- Experimental Procedure --- p.33 / Chapter 2.5 --- IMAGE ANALYSIS --- p.35 / Chapter 2.5.1 --- Equipment --- p.35 / Chapter 2.5.2 --- Procedures --- p.35 / Chapter 2.6 --- IN SITU ZYMOGRAPHY --- p.37 / Chapter 2.6.1 --- Reagents Preparation --- p.37 / Chapter 2.6.2 --- Experimental Procedure --- p.38 / Chapter 2.7 --- STATISTIC ANALYSIS.… --- p.39 / Chapter 3. --- RESULTS --- p.42 / Chapter 3.1 --- HUMAN SAMPLES --- p.42 / Chapter 3.1.1 --- Patellar tendinosis patients --- p.42 / Chapter 3.1.2 --- Healthy control group --- p.43 / Chapter 3.2 --- HISTOLOGICAL STUDY ON HUMAN SPECIMENS --- p.43 / Chapter 3.2.1 --- Gross Morphology --- p.43 / Chapter 3.2.2 --- Haematoxyline and Eosin Staining --- p.44 / Chapter 3.2.3 --- Safranin O Staining --- p.44 / Chapter 3.2.4 --- Polarization Microscopy --- p.44 / Chapter 3.3 --- IMAGE ANALYSIS --- p.45 / Chapter 3.3.1 --- Immunohistochemistry of PCNA --- p.45 / Chapter 3.3.2 --- Immunohistochemistry of hsp47 --- p.46 / Chapter 3.3.3 --- Immunohistochemistry of Procollogen Type I --- p.47 / Chapter 3.3.4 --- Immunohistochemistry of MMP1 --- p.47 / Chapter 3.3.5 --- Immunohistochemistry of TIMP1 --- p.48 / Chapter 3.3.6 --- Immunohistochemistry of COX-2 --- p.49 / Chapter 3.3.7 --- Immunohistochemistry of TGFP --- p.49 / Chapter 3.3.8 --- Immunohistochemistry of PDGFbb --- p.50 / Chapter 3.3.9 --- Immunohistochemistry of PDGFRβ --- p.51 / Chapter 3.3.10 --- Summary of Image Analysis of Immunohistochemical staining --- p.51 / Chapter 3.4 --- IN SITU ZYMOGRAPHY --- p.52 / Chapter 4. --- DISCUSSION --- p.93 / Chapter 4.1 --- DIAGNOSIS OF PATELLAR TENDINOSIS --- p.93 / Chapter 4.2 --- HYPERCELLULARITY IN PATELLAR TENDINOSIS --- p.95 / Chapter 4.3 --- COLLAGEN DISTURBANCE IN PATELLAR --- p.97 / Chapter 4.4 --- INFLAMMATORY RESPONSE IN PATELLAR TENDINOSIS --- p.100 / Chapter 4.5 --- THE EXPRESSION OF GROWTH FACTORS IN PATELLAR TENDINOSIS --- p.102 / Chapter 4.6 --- PROPOSED PATHOGENESIS FOR PATELLAR TENDINOSIS --- p.105 / Chapter 4.7 --- LIMITATION OF THIS STUDY --- p.108 / Chapter 4.8 --- FUTURE STUDY --- p.109 / Chapter 5. --- CONCLUSION --- p.111 / BIBLIOGRAPHY --- p.113

Made available in DSpace on 2014-06-11T19:30:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-16Bitstream added on 2014-06-13T20:40:41Z : No. of bitstreams: 1 bonfim_tr_dr_rcla.pdf: 758193 bytes, checksum: 4e539179f9c143bb71a697cea610fe9a (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Após a lesão do Ligamento Cruzado Anterior (LCA), a percepção de movimento e o controle postural estão comprometidos, possivelmente pela redução de informação sensorial da perna lesada. Assim, o objetivo desta tese foi investigar o efeito do uso de informação sensorial adicional na propriocepção e no controle postural de indivíduos com lesão do LCA e de indivíduos com joelhos sadios. Foi realizada uma breve revisão teórica e dois conjuntos de análises em um mesmo estudo experimental. O primeiro conjunto de análises investigou o efeito da adição de informação sensorial no limiar para detecção de movimento passivo da articulação do joelho e no controle postural de 28 indivíduos com lesão unilateral do LCA e de 28 indivíduos com joelhos sadios. O limiar para detecção de movimento passivo (LDMP) foi avaliado nas posições de 15 e 45 graus, para as direções de flexão e extensão. O controle postural foi investigado por meio da área de deslocamento, amplitude e velocidade média de oscilação e freqüência mediana de oscilação do centro de pressão (CP). As condições de informação sensorial foram: informação normal, bandagem infra-patelar, faixa infra-patelar e toque suave em uma barra estacionária (força inferior a 1 Newton). Os resultados demonstraram que o LDMP é maior em indivíduos com lesão do LCA, no entanto, há redução do mesmo com a utilização de informação sensorial adicional. A área, a amplitude e a velocidade média de oscilação do CP são maiores após a lesão do LCA e há uma redução com o uso de informação sensorial adicional. Indivíduos com joelhos sadios apresentam uma redução da oscilação corporal apenas na condição de toque suave. / After Anterior Cruciate Ligament (ACL) lesion, perception of movement and postural control are compromised, possibly by reduction of the sensorial information from the injured leg. Therefore, the purpose of this thesis was to examine the effect of the use of additional sensorial information in the proprioception and in the postural control of individuals with ACL lesion and individuals with healthy knees. A short theoretical revision and two groups of specific in a same experimental study were realized. The first group of analyses investigated the effect of the addition of sensorial information in the threshold to detection of passive knee motion and in the control postural of 28 individuals with ACL unilateral lesion and 28 individuals with healthy knees. The threshold to detection of passive motion (TDPM) was evaluated in the positions of 15 and 45 degrees, for flexion and extension directions. Postural control was investigated through the displacement area, mean sway amplitude, mean sway velocity and medium frequency of the center of pressure (CP). The conditions of sensorial information were: normal information, infra-patellar adhesive tape, infra-patelar band and light touch in a stationary bar (applied force below 1 Newton). The results demonstrated that TDPM is larger in individuals with ACL lesion; however, TDPM is reduced with the use of additional sensorial information. The area, mean sway amplitude and mean sway velocity of the CP are larger after ACL lesion and there is a reduction with the use of additional sensorial information. Individuals with healthy knees presented a reduction of the body oscillation only in the condition of light touch.

Exercícios em cadeia cinética aberta e fechada tem sido propostos para a reabilitação no pós operatório de reconstrução do ligamento cruzado anterior. Não há consenso na literatura sobre qual o tipo de exercício é mais apropriado e ao mesmo tempo seguro, não pondo em risco o procedimento cirúrgico. O propósito deste estudo foi verificar os efeitos da utilização de protocolos de reabilitação em cadeia cinética aberta e fechada de indivíduos em pós operatório de reconstrução do ligamento cruzado anterior, através de respostas comportamentais verificadas por indicadores biomecânicos. A amostra experimental foi constituída de trinta indivíduos, divididos em três grupos amostrais independentes: (CON) dez indivíduos normais que não sofreram nenhum tipo de intervenção; (CCF) dez pacientes submetidos ao programa de reabilitação em cadeia cinética fechada e (CCA) dez pacientes submetidos ao programa de reabilitação em cadeia cinética aberta. Os testes para avaliar os parâmetros biomecânicos selecionados foram realizados em duas etapas: avaliação clínica (deslocamento tibial anterior e escore de Lysholm) e avaliação da marcha (análise dinâmica, cinemática e eletromiográfica). O tratamento foi realizados três vezes por semana, durante doze semanas. Os pacientes foram submetidos a três testes; o primeiro no pré-operatório; o segundo após quatro semanas da cirurgia e o terceiro após quatro meses de cirurgia. O grupo controle realizou apenas um teste e não foi submetido a nenhum tipo de tratamento. Para a xx análise do deslocamento tibial anterior foi utilizado o aparelho KT1000. A análise da marcha foi realizada através da esteira rolante Gaitway Kistler, a análise da atividade eletromiográfica através do sistema Bagnoli 8, composta de eletrodos de superfície e a análise da variação angular do joelho através do eletrogoniômetro Elgon-Burns. Os dados foram registrados, armazenados, processados e analisados estatisticamente, levando-se em consideração o nível de significância de 0,05. As variáveis relativas à força de reação do solo foram analisadas através da determinação de componentes principais. O deslocamento tibial anterior diminuiu ao final do tratamento e o escore de Lysholm aumentou em ambos os grupos, sem diferença significativa entre eles. Das variáveis analisadas relativas à marcha o tempo de apoio simples, as taxas de crescimento para os picos da força vertical, a deflexão da força mínima, a força mínima e o segundo pico parecem-nos serem as variáveis mais sensíveis para identificar diferenças na forma de andar em função do protocolo de reabilitação. Ao analisar a amplitude de movimento percebe-se que esta variável é sensível a mudanças expressivas na variação angular do joelho, como ocorreram no teste após quatro semanas de pós-operatório. Pela análise descritiva, diferenças angulares menores devem ser analisadas através dos ângulos em momentos específicos da marcha. Em relação à atividade elétrica muscular o M.bíceps femoral foi o que apresentou maior variação na sua atividade. E os valores de simetria demonstram que o grupo cadeia cinética aberta foi o que apresentou maiores diferenças entre as pernas no teste após quatro semanas de cirurgia, o que demonstra maior instabilidade no andar. O presente estudo permite concluir que as alterações da marcha são mais expressivas um mês após a cirurgia do que no período pré-operatório. O escore de Lysholm, os componentes principais das variáveis relativas a força de reação do solo e a variação angular do joelho indicam que os exercícios em cadeia cinética fechada são mais eficientes para a recuperação da marcha do que os de cadeia cinética aberta. No entanto, os dois tipos de exercícios propiciam melhora dos parâmetros da marcha e parecem ser eficientes na recuperação da marcha dos pacientes submetidos à reconstrução do ligamento cruzado anterior. O período de quatro meses de reabilitação assegura uma marcha sem riscos para o paciente, mas ainda distinta da característica da marcha de indivíduos não acometidos pela lesão / Open kinetic chain and closed kinetic chain exercises have been proposed for rehabilitation protocol in the reconstruction of the anterior cruciate ligament. There is no consensus in the literature regarding which exercise is more appropriate and at the same time safe without putting in risk the surgical procedure. The purpose of this study was to evaluate the results of the open kinetic chain and closed kinetic chain protocols in the rehabilitation of those individuals that were subject to the reconstruction of the anterior cruciate ligament based on biomechanical indicatives. The sample was made of thirty individuals, divided in three independent groups: (CON) ten normal individuals that were not submitted to the surgical intervention; (CCF) ten patients submitted to the closed kinetic chain rehabilitation program, and (CCA) ten patients submitted to the open kinetic chain rehabilitation program. Tests to evaluate the desired biomechanical parameters had been carried out through two stages: clinical evaluation (anterior tibial displacement and Lysholm`s score) as well as gait evaluation (dynamic, kinematic and electromyografic analysis). The treatment was carried out three times per week, during twelve weeks. Each patient had been evaluated in three occasions: before the surgery; four weeks after the surgery; and four months after the surgery. The group control was submitted to only one evaluation test and no treatment at all. KT1000 equipament was used for evaluating the tibial displacement. The gait analysis was carried out through the Gaitway Kistler treadmill; the electromyography analysis was evaluated through xxii the System Bagnoli 8 composed of surface electrodes and the analysis of the angular variation of the knee through Elgon-Burns electrogoniometer. Data had been collected and analyzed considering the 0,05 significance level. The ground reaction force variable had been analyzed through of the determination of main components. The anterior tibial displacement diminished at the end of the treatment and the Lysholm`s score increased in both groups without significant difference between them. From the analyzed variables regarding gait, the time of simple support, the taxes of growth for peaks of the vertical force, the deflection of the minimum force, the minimum force and as the peak, seem to be the most sensible variables to identify gait differences due to the rehabilitation protocol. Upon analyzing the amplitude of movement it was noticed that this variable was sensible to huge changes in the angular variation, as those observed after four weeks from the surgery. By the descriptive analysis, lesser angular differences must be analyzed through the angles at specific moments of the gait. Regarding the muscular activity the femoral biceps femoris (long head) presented greater variation in its activity. And, the symmetry values demonstrate that the open kinetic chain group presented greater differences between both legs in the test four weeks after the surgery, demonstrating greater instability in walking. The current study permit to conclude that the variations in the gait are higher in one month after the surgery than in the pre-surgery period. The Lysholm`s score, the ground reaction force, variable the main components and the angular variation of the knee indicates that the exercises in closed kinetic chain are more efficient than opened kinetic chain for recovering the gait. However, the two exercises improved the parameters of gait and seem to be efficient in recovering the gait pattern of patients submitted to the anterior cruciate ligament reconstruction. Although the four months period of rehabilitation is enough to reinstate a harmless gait pattern to patients, it is still not sufficient to return the patients` gait standards to those of individuals without injury