Chronic patellar tendinopathy is a degenerative tendon disorder characterized by chronic activity-related, anterior knee pain associated with localized tenderness, swelling and impaired performance, which is a common clinical problem in athletes. The pathogenesis of patellar tendinopathy is still largely unknown, although tendon overuse is the most commonly suggested etiological factor, and treatment is usually symptomatic. / Histopathologically, the predominant feature of patellar tendinopathy is tendinosis, which is characterized by progressive tissue degeneration with a failed healing response and the absence of inflammatory cells. Hypercellularity with non-tenocyte phenotype cells and tissue metaplasia, including hyaline metaplasia, fibrocartilaginous metaplasia and bony metaplasia were observed in clinical patellar tendinopathy samples. The degeneration of patellar tendon in patellar tendinopathy is an active cell-mediated process rather than a passive degenerative process. Using a patellar tendinopathy animal model, we observed the presence of chondrocytic and osteoblastic phenotype / markers in patellar tendinopathy samples with or without ossification, which was consistent with the findings in clinical samples. Interestingly, chondrocyte makers were expressed by healing tendon cells at week 2 which became round prior to their expression in the chondrocyte-like cells at week 4. This leads us to speculate that erroneous differentiation of tendon-derived stem cells (TDSCs) identified recently in tendon tissues by our group, to chondrocyte / osteoblasts, due to alteration of mechanical and biological microenvironment during overuse, may lead to the ectopic chondro-ossification and failed healing in patellar tendinopathy. Osteo-chondrogenic BMPs, such as BMP-2, BMP-4 and BMP-7 might be possible factors regulating the osteo-chondrogenic differentiation of TDSCs in the pathogenesis of patellar tendinopathy. / In conclusion, our results have provided new insights about the pathological mechanisms of patellar tendinopathy involving the resident stem cells, osteo-chondrogenic BMPs and mechanical overloading. Erroneous differentiation of TDSCs to chondrocytes / osteoblasts due to ectopic osteo-chondrogenic BMP-2 expression, which were induced by repetitive tensile loading stimulation, might account for the chondro-ossification and failed healing in patellar tendinopathy. Re-directing of stem cells for tenogenic differentiation by blocking the ectopic expression of osteo-chondrogenic BMPs may help to promote tendon healing in patellar tendinoapthy. / In this study, we hypothesized that (1) TDSCs isolated from pathological patellar tendon of the CI model will exhibit higher osteogenic and chondrogenic differentiation potential but lower proliferative capacity compared to TDSCs isolated from healthy patellar tendon. Rat pathological tendon in our collagenase-induced failed healing animal model will harbor more TDSCs compared to healthy patellar tendon. (2) Osteo-chondrogenic BMPs, such as BMP-2, BMP-4, and BMP-7, will be expressed ectopically in both preclinical and clinical samples of patellar tendinopathy. (3) BMP-2 will promote osteo-chondrogenic differentiation and inhibit tenogenic differentiation of TDSCs in vitro. (4) Repetitive tensile loading will increase the expression of BMP-2 in TDSCs in vitro. / Our results showed that TDSCs isolated from the collagenase-induced tendinopathic patellar tendon of the animal model exhibited higher osteogenic/chondrogenic differentiation potential as well as lower proliferative capacity, supporting that there might be some defects in the TDSCs from the animal model, which might undergo osteo-chondrogenic differentiation and hence reduced the pool of TDSCs for tendon repair in the development of patellar tendinopathy. The higher clonogenicity and increased yield of TDSCs in tendinopathic patellar tendon might be caused by a compensation for the impaired differentiation potential and proliferative capacity of TDSCs. The histopathological features of our clinical patellar tendinopathy were characterized by tissue degeneration. Non-tenocyte phenotype cells and tissue metaplasia, such as chondrocyte-like cells and endochondral ossification were also observed. We observed the ectopic expression of osteo-chondrogenic BMP-2, BMP-4 and BMP-7 in both our animal model and clinical samples of patellar tendinopathy, which might trigger the erroneous differentiation of TDSCs to non-tenocytes. Indeed, we further showed that BMP-2 could promote the osteo-chondrogenic and inhibit tenogenic differentiation of TDSCs in vitro, which might provide a possible explanation for ectopic chondro-ossification and failed healing in patellar tendinopathy. In addition, our results also showed that in vitro repetitive cyclic tensile loading could increase the expression of BMP-2 in TDSCs, which might provide a possible explanation for the ectopic expression of BMP-2 in patellar tendinopathy. / This study aimed to compare the osteogenic / chondrogenic differentiation potential, proliferative capacity and yield of TDSCs isolated from rat healthy patellar tendon and pathological tendon in our collagenase-induced failed tendon healing animal model of patellar tendinopathy in vitro. The histopathological characteristics of our clinical patellar tendinopathy with or without ossification were examined. The ectopic expression of BMP-2, BMP-4, and BMP-7 in both human and rat samples of patellar tendinopathy was also examined. The effects of BMP-2 on the osteogenic, chondrogenic and tenogenic differentiation of TDSCs was further investigated in vitro. The effect of repetitive tensile loading on the expression of BMP-2 in TDSCs was studied in vitro. / Rui, Yunfeng. / Advisers: Kai Ming Chan; Po Yee Lui. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 172-193). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Orientador: Bruno Watanabe Minto / Resumo: O presente estudo objetiva estabelecer padrões elastográficos normais das principais estruturas da articulação femorotibiopatelar (joelho) de cães saudáveis, em diferentes faixas etárias. Foram examinados 30 cães (60 articulações) da raça Beagle sem alterações musculoesqueléticas, os quais foram distribuídos em três grupos: jovens, adultos e idosos. Realizou-se elastografia ARFI do ligamento patelar, menisco medial, ligamento cruzado caudal e ligamento cruzado cranial de cada articulação. Análises qualitativas e quantitativas detectaram correlação positiva da velocidade de cisalhamento, ou seja, da rigidez das estruturas, com a idade dos cães. O ligamento patelar apresentou aumento gradual de sua rigidez em relação à idade; já o menisco e os ligamentos cruzados mostraram-se mais rígidos nos filhotes do que nos adultos, mas também revelaram suas maiores rigidezes nos animais idosos. Avaliou-se também a diferença de elasticidade das estruturas de acordo com o gênero e a condição reprodutiva dos animais. As fêmeas apresentaram todas as estruturas mais rígidas que os machos, com velocidades de cisalhamento diferindo entre 0,30 e 0,36 m/s dentre os dois gêneros; e apenas o menisco medial não se mostrou mais rígido nos animais castrados em relação aos inteiros, sendo a diferença daquele de apenas 0,02 m/s e a dos ligamentos de 0,40 a 0,47 m/s entre os grupos. Já quanto ao peso, não houve significância estatística em relação à elasticidade das estruturas. Tais achados corroboram os ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study is to establish normal elastographic patterns of the main knee structures of healthy dogs in different age groups. Thirty Beagles (60 joints) without musculoskeletal diseases were divided into three groups: young, adult and elderly. We performed ARFI elastography of the patellar ligament, medial meniscus, caudal cruciate ligament and cranial cruciate ligament. Qualitative and quantitative analyzes were performed, detecting a positive correlation of the shear velocity (rigidity of the structures) and the age of the dogs (p = 0.012). The patellar ligament showed a gradual increase in its rigidity in relation to age; the meniscus and the cruciate ligaments were more rigid in the pups than in adults, but also showed greater rigidity in elderly animals. The difference in elasticity of structures according to sex and reproductive condition was also evaluated. The females had all the structures more rigid than the males, with shear velocities differing between 0.30 and 0.36 m / s between the two groups. Only the medial meniscus did not appear to be more rigid in castrated animals. There was no statistical significance regarding the elasticity of the structures, according to weight. ARFI elastography is feasible technique in canine knees, not only as a method for the early diagnosis of ligament and meniscal alterations, but also to evaluate repercussion of instability in the contralateral limb and the impact of surgical and physiotherapeutic treatments. It is be... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-06-01Bitstream added on 2014-06-13T20:01:41Z : No. of bitstreams: 1 oliveira_ggs_dr_jabo.pdf: 1931508 bytes, checksum: ec37215def296c0d2f60ec5f4d3da9f1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / No presente estudo, objetivou-se avaliar a utilização do enxerto alógeno de ligamento patelar (OLO) conservado em glicerina 98% e fixado por meio de parafusos de interferência como substituto do ligamento cruzado cranial (LCCr) em cães. Observou-se a exeqüibilidade e eficácia desta técnica cirúrgica e o comportamento do enxerto e dos parafusos durante o período de 120 dias, baseandose na capacidade dos exames clínicos, radiográficos e artroscópicos, em detectar o possível início e a progressão de alterações degenerativas secundárias na articulação do joelho. Para tanto foram utilizados oito animais da espécie canina pesando entre 17,2 e 26,4Kg. O enxerto utilizado correspondeu ao segmento composto pelo terço intermédio da patela, ligamento patelar e porção cranial da tuberosidade da tíbia, coletado de cadáveres de cães e conservado em glicerina 98%. Os oito cães foram separados em dois grupos, A e B e cada um contendo quatro animais para avaliação artroscópica (segunda observação) aos 60 e 120 dias do pós-operatório. Todos os cães foram submetidos ao procedimento cirúrgico no joelho direito. Clinicamente, avaliou-se o grau de claudicação, o perímetro muscular da coxa e o movimento de gaveta cranial nos oito cães no pré-operatório e semanalmente, até completarem-se 120 dias. Foi observada diminuição da circunferência da coxa significativa (p<0,05) após o período de dez dias em que os cães permaneceram com a bandagem compressiva, sendo recuperada de forma significativa até 13° semana. As pontuações obtidas na avaliação do movimento de gaveta (extensão e flexão) tornaram-se significativamente diferentes da pré-operatória entre a 5° e 15° semanas (p<0,05). Quatro cães apresentaram ao final do experimento ausência de instabilidade articular como na avaliação pré-operatória e os outros... / The aim of this study was to evaluate the use of patelar ligament allograft (BLB) conserved in 98% glycerin and fixated with interferemce screws as a substitute of the cranial cruciate ligament in dogs (CrCL). It was observed the feasibility and efficiency of this surgical technique and the graft and screws conduct along 120 days, basing on clinical, radiographic and arthroscopic capacity in detect the beginning and progress of secondary degenerative stifle joint changes. For this purpose, eight mongrel dogs weighting from 17,2 e 26,4 Kg were used. The graft consisted of the intermediate third of the pattela, patellar ligament and cranial portion of the tibial crest, harvested from dog cadavers and preserved in 98% glycerin.The eight dogs were randomly allocated in two groups, A and B, each one with four dogs for arthroscopic evaluation (second-look) at 60 and 120 days postoperative. All the dogs were submitted to the surgical procedure in the right knee. Clinically, lameness degree, thigh girth measurement and cranial-drawer test were evaluated in the eight dogs in preoperative, and weekly, until complete 120 days. A significant decrease in thigh girth (p<0,05) observed after ten days period that the dogs were using compressive bandage was recovered until the 13th week. The cranial-drawer test scores (flexion and extension) became significantly different between the 5th and 15th weeks postoperative (p>0,05). Four dogs presented at the final study period with no articular instability just like the preoperative evaluation, and the other four with just a slight craniocaudal instability. In the lameness evaluation, from the 4th week, all the dogs presented mean score for stands with equal... (Complete abstract click electronic access below)

INTRODUÇÃO: O plasma rico em plaquetas (PRP) é utilizado em medicina esportiva para aumentar e acelerar o processo de reparação tecidual em lesões tendineas e ligamentares, no intuito de proporcionar um retorno mais rápido às atividades esportivas. No entanto faltam estudos com alto nível de evidência comprovando sua eficácia no tratamento destas lesões. Com o objetivo de estudar o efeito da aplicação do PRP no sitio doador de enxerto do ligamento da patela para reconstrução do ligamento cruzado anterior (LCA), realizamos ressonância magnética aos seis meses de pós-operatório para avaliar o ligamento da patela. Também aplicamos questionários de função do joelho e realizamos teste isocinético após seis meses da cirurgia. MÉTODOS: O presente estudo prospectivo, randomizado, avaliador cego incluiu 27 pacientes. Comparamos doze pacientes em que foi utilizado o PRP no defeito criado no terço central do ligamento da patela para retirada de enxerto com quinze pacientes do grupo controle. Aos seis meses de cirurgia realizamos ressonância magnética, em que foi avaliada a área não regenerada do defeito no terço central do ligamento da patela, a área de secção transversa do ligamento e a altura da patela pelo índice de Insall- Salvati. Realizamos teste isocinético e aplicamos questionários específicos de função do joelho. Quantificamos a dor pós-operatória imediata com escala visual analógica (EVA) de dor. RESULTADOS: Aos seis meses de pós-operatório a área não regenerada do defeito no terço central do ligamento da patela foi 4,95 mm2 no grupo PRP e 9,38 mm2 no grupo controle (p=0,046, teste t de Student). A área de secção transversa do ligamento da patela no grupo PRP foi de 173,05 mm2 e no grupo controle 176,29 mm2 (p=0,856). O índice de Insall-Salvati nos grupos PRP e controle foi de 1,04 e 1,06, respectivamente (p=0,808). Não houve diferença entre os grupos nos resultados dos questionários e teste isocinético. Nos pacientes em que foi utilizado o PRP houve menos dor pós-operatória imediata (p=0,02). CONCLUSÃO: Concluímos, nessa amostra, que o uso do PRP no defeito do terço central do ligamento da patela na reconstrução do LCA, nos primeiros seis meses; determinou maior regeneração do defeito; diminuiu a intensidade da dor pós-operatória imediata; não ocasionou alterações estruturais na avaliação por ressonância magnética; e não modificou os resultados clínicos e funcionais da cirurgia / INTRODUCTION: Platelet-rich plasma (PRP) has been used in sports medicine to improve and accelerate ligaments and tendons healing, in an effort to provide a faster return to sports activities. However there is a lack of high evidence level studies to support its use. With the purpose to study the effect of PRP, patellar ligament was evaluated six months after harvesting its central third with magnetic resonance imaging (MRI). We also applied specific questionnaires of knee function and isokinetic testing. METHODS: This blinded, randomized, prospective study included 27 patients. Twelve patients in whom we added PRP in the patellar ligament after harvesting its central third for ACL reconstruction were compared to fifteen patients in the control group. After six months we evaluated the non-regenerated area of the patellar ligament, the cross section area of the patellar ligament and its length (Insall-Salvati index) with MRI. We also evaluated the results of isokinetic testing and specific questionnaires of knee function. Immediate post-operative pain was evaluated with visual analogical scale (VAS) score. RESULTS: The non-regenerated area of the patellar ligament was 4,95 mm2 in the PRP group and 9,35 mm2 in the control group (p=0,046 test). The cross section area of the patellar ligament in the PRP group was 173,05 mm2 and in the control group 176,29 mm2 (p=0,856). The Insall- Salvati index in the PRP and control group was 1,04 and 1,06, respectively (p=0,806). There was no difference between the groups in the questionnaires and isokinetic testing results. PRP group patients had less post-operative pain (p=0,02). CONCLUSION: We concluded, in this sample, that the use of PRP in the patellar ligament after harvesting its central third for ACL reconstruction, in the first six months: improved the ligament regeneration; reduced the intensity of immediate post-operative pain; did not cause structural changes in the patellar ligament in MRI; and did not modify the clinical and functional results of the procedure

Resumo: No presente estudo, objetivou-se avaliar a utilização do enxerto alógeno de ligamento patelar (OLO) conservado em glicerina 98% e fixado por meio de parafusos de interferência como substituto do ligamento cruzado cranial (LCCr) em cães. Observou-se a exeqüibilidade e eficácia desta técnica cirúrgica e o comportamento do enxerto e dos parafusos durante o período de 120 dias, baseandose na capacidade dos exames clínicos, radiográficos e artroscópicos, em detectar o possível início e a progressão de alterações degenerativas secundárias na articulação do joelho. Para tanto foram utilizados oito animais da espécie canina pesando entre 17,2 e 26,4Kg. O enxerto utilizado correspondeu ao segmento composto pelo terço intermédio da patela, ligamento patelar e porção cranial da tuberosidade da tíbia, coletado de cadáveres de cães e conservado em glicerina 98%. Os oito cães foram separados em dois grupos, A e B e cada um contendo quatro animais para avaliação artroscópica ("segunda observação") aos 60 e 120 dias do pós-operatório. Todos os cães foram submetidos ao procedimento cirúrgico no joelho direito. Clinicamente, avaliou-se o grau de claudicação, o perímetro muscular da coxa e o movimento de gaveta cranial nos oito cães no pré-operatório e semanalmente, até completarem-se 120 dias. Foi observada diminuição da circunferência da coxa significativa (p<0,05) após o período de dez dias em que os cães permaneceram com a bandagem compressiva, sendo recuperada de forma significativa até 13° semana. As pontuações obtidas na avaliação do movimento de gaveta (extensão e flexão) tornaram-se significativamente diferentes da pré-operatória entre a 5° e 15° semanas (p<0,05). Quatro cães apresentaram ao final do experimento ausência de instabilidade articular como na avaliação pré-operatória e os outros... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to evaluate the use of patelar ligament allograft (BLB) conserved in 98% glycerin and fixated with interferemce screws as a substitute of the cranial cruciate ligament in dogs (CrCL). It was observed the feasibility and efficiency of this surgical technique and the graft and screws conduct along 120 days, basing on clinical, radiographic and arthroscopic capacity in detect the beginning and progress of secondary degenerative stifle joint changes. For this purpose, eight mongrel dogs weighting from 17,2 e 26,4 Kg were used. The graft consisted of the intermediate third of the pattela, patellar ligament and cranial portion of the tibial crest, harvested from dog cadavers and preserved in 98% glycerin.The eight dogs were randomly allocated in two groups, A and B, each one with four dogs for arthroscopic evaluation ("second-look") at 60 and 120 days postoperative. All the dogs were submitted to the surgical procedure in the right knee. Clinically, lameness degree, thigh girth measurement and cranial-drawer test were evaluated in the eight dogs in preoperative, and weekly, until complete 120 days. A significant decrease in thigh girth (p<0,05) observed after ten days period that the dogs were using compressive bandage was recovered until the 13th week. The cranial-drawer test scores (flexion and extension) became significantly different between the 5th and 15th weeks postoperative (p>0,05). Four dogs presented at the final study period with no articular instability just like the preoperative evaluation, and the other four with just a slight craniocaudal instability. In the lameness evaluation, from the 4th week, all the dogs presented mean score for stands with equal... (Complete abstract click electronic access below) / Orientador: João Guilherme Padilha Filho / Coorientador: Julio Carlos Canola / Banca: Cintia Lúcia Maniscalco / Banca: Márcia Rita Fernandes Machado / Banca: Patricia Popak Giordano / Banca: Gisleine Cristina Eimantas / Doutor

Introduktion: Många idrottare drabbas av patella tendinopati, framförallt idrotter som inkluderar många hopp och snabba riktningsförändringar. Smärtan som kommer med tillståndet kan påverka en professionell idrottares prestation och karriär.  Syfte: Syftet med denna systematiska litteraturöversikt är att studera effekten av olika behandlingsmetoder avseende på smärta och funktion hos volleybollspelare och basketspelare diagnostiserade med patellar tendinopati.  Metod: Metoden utformades och följde riktlinjerna enligt Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Sökningen gjordes i PubMed och SPORTdiscus med en söksträng framtagen med hjälp av personal från Medicinska biblioteket i Umeå, Sverige. Sammanlagt inkluderades 5 studier i litteraturöversikten. PEDro skalan användes för att kvalitetsgranska samtliga artiklar i litteraturöversikten.  Resultat: Totalt 5 artiklar inkluderades i denna studie. Ingen av studierna uppfyllde kriterierna för låg kvalitet. Fyra av fem studier uppfyllde kriterierna för moderat till god kvalitet och en studie uppnådde hög kvalitet vid kvalitetsgranskningen. Fyra av fem studier utvärderade träning som en behandlingsmetod för patellar tendinopati, en av fem studier utvärderade stötvågsbehandling för patellar tendinopati. Konklusion: Majoriteten av studierna i denna systematiska litteraturöversikt visar på positiva effekter på smärta och funktion av isometrisk, isotonisk och excentrisk träning. Samtliga inkluderande studier uppfyllde moderat till hög kvalitet enligt PEDro skalan. Evidensen i just denna litteraturstudie räcker ej till för att rekommendera en viss behandlingsform till volleyboll-och basketspelare diagnostiserade med patellar tendinopati. Mer forskning kring behandlingsmetoder av patellar tendinopati behövs, specifikt på aktiva volleyboll-och basketspelare.

<p>Studija se sastojala od dva dela &ndash; eksperimentalnog i kliničkog. Eksperimentalni deo je sproveden na Fakultetu tehničkih nauka u Novom Sadu na Departmanu za mehanizaciju i konstrukciono ma&scaron;instvo. Trideset dve zglobne povr&scaron;ine gornjeg okrajka golenjače sa pripojem prednje ukr&scaron;tene veze je uzeto tokom totalne aloartroplastike kolena kod trideset dva pacijenta kod kojih je preoperativno načinjena AP i profilna radiografija sa standardnim uvećanjem u cilju merenja veličine kolena a uz prethodno potpisanu saglasnost pacijenata. Zatim je načinjeno trodimenzionalno skeniranje prostorne povr&scaron;ine pripoja prednje ukr&scaron;tene veze na golenjači u odnosu na ravan zglobne povr&scaron;ine golenjače heptičkim uređajem &bdquo;Phantom Omni&reg;&ldquo; radi utvrđivanja korelacije između povr&scaron;ine pripoja prednje ukr&scaron;tene veze na golenjači i veličine platoa golenjače. U eksperimentalni deo su bili uključeni pacijenti oba pola metodom slučajnog izbora kod kojih je ugrađivana totalna proteza kolena a koji su prethodno potpisali informisani pristanak pacijenta na operativni zahvat na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine. Klinički deo studije je bio retrospektivno-prospektivnog karaktera i obuhvatio je ukupno 60 pacijenata izabranih metodom slučajnog izbora od kojih je ispitivanu grupu činilo 30 pacijenata u kojih je do&scaron;lo do ponovne rupture prednje ukr&scaron;tene veze levog ili desnog kolena nakon urađene primarne rekonstrukcije te je načinjena ponovna rekonstrukcija veze, i kontrolnu grupu koju je činilo 30 pacijenata u kojih je zbog rupture prednje ukr&scaron;tene veze načinjena primarna rekonstrukcija nakon koje nije do&scaron;lo do ponovne rupture. Kod svih pacijenata je rekonstrukcija prednje ukr&scaron;tene veze kolena rađena kalemom kost-tetiva-kost. Ishod rekonstrukcije je procenjivan na osnovu Tegner bodovne skale, Lysholm i IKDC bodovne skale za koleno, artrometrijskog merenja Lachman testa, Pivot shift testa, poloţaja kalema i urađeno je poređenje dobijenih rezultata u ispitivanoj (revizionoj) i kontrolnoj grupi. U klinički deo istraţivanja su bili uključeni pacijenti oba pola, ţivotne dobi od 18 do 40 godina koji su operisani na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine u Novom Sadu a koji su dali informisani pristanak za uključivanje. Kriterijumi za isključivanje pacijenata iz kliničkog dela istraživanja su bili životna dob manja od 18 i veća od 40 godina, pojava težih op&scaron;te-hirur&scaron;kih komplikacija i prestanak želje pacijenta da dalje učestvuje u ovom istraživanju. Nakon sveobuhvatne analize dobijenih rezultata istraţivanja, zaključeno je da postoji korelacija između povr&scaron;ine pripoja prednje ukr&scaron;tene veze na golenjači i veličine platoa golenjače. Formula, načinjena matematičko-statističkim metodama za ovo istraživanje, adekvatna je i praktično primenljiva za predikciju povr&scaron;ine pripoja prednje ukr&scaron;tene veze na golenjači u velikom procentu slučajeva a na osnovu samo dva radiografska parametra izmerenih preoperativno &ndash; prednje-zadnjeg i unutra&scaron;nje-spolja&scaron;njeg dijametra platoa golenjače. Kori&scaron;ćenje ove formule može da doprinese pobolj&scaron;anju rezultata hirur&scaron;kog lečenja pacijenata sa pokidanom prednjom ukr&scaron;tenom vezom kolena. Takođe, zaključeno je da je uzrok neuspeha primarne rekonstrukcije multifaktorijalan kao i da nema statistički značajne razlike u ishodu između ispitanika sa dobrom i ispitanika sa lo&scaron;om pozicijom kalema. Potvrđena je pretpostavka da je ishod ponovne rekonstrukcije prednje ukr&scaron;tene veze kolena slabiji u odnosu na ishod primarne.</p> / <p>This study consisted of two parts &ndash; experimental and clinical. Experimental part was conducted at the Department of Mechanization and Design Engineering of The Faculty of Technical Sciences, University of Novi Sad. Thirty two proximal tibial articular surfaces together with the anterior cruciate ligament insertion of thirty two patients were harvested during total knee arthroplasty. All patients had standard preoperative AP and profile radiographs with standard magnification in order to acquire the knee measurements. All patients previously signed the informed consent. The harvested proximal tibial articular surfaces were 3D scanned by a haptic device called &bdquo;Phantom Omni&reg;&ldquo; in order to determine the correlation between the size of the anterior cruciate ligament insertion site and the size of the tibial plateau. Thirty two randomly chosen patients of both sexes which had a knee arthroplasty were included in the experimental part of this study. All of the patients signed the informed consent at The Clinic for Orthopedic Surgery and Traumatology of The Clinical Centre of Vojvodina. The clinical part was a retrospective-prospective study. This part included 60 randomly chosen patients divided into two groups. The test group consisted of 30 patients who had undergone a revision anterior cruciate ligament reconstruction. The control group consisted of 30 patients who had undergone only primary anterior cruciate ligament reconstruction. A bone-tendon-bone graft was used for the reconstruction in all cases. The outcome was assessed by using Tegner activity scale, Lysholm knee scoring scale, IKDC score, arthrometric evaluation, Pivot shift test and the position of the graft. The results were compared between the test group and the control group. The clinical part of the study included 60 patients of both sexes, age 18-40 which were operated at The Clinic for Orthopedic Surgery and Traumatology of The Clinical Centre of Vojvodina. All of the patients signed the informed consent for participation in this study. The exclusion criteria were age under 18 and above 40, occurrence of severe general surgical complications and a patient wish to be excluded from further investigation. After a thorough analysis of the results, we concluded that the correlation between the size of the anterior cruciate ligament tibial insertion site and the size of the tibial plateau exists. Formula which was created for this study by using mathematical and statistical methods, is adequate and practically applicable for the prediction of size of the anterior cruciate ligament tibial insertion site in the majority of cases based on just two preoperative radiographic parameters &ndash; AP and profile diameter of the tibial plateau. The use of this formula may improve the outcome of the anterior cruciate ligament reconstruction. We also concluded that the cause of the primary anterior cruciate ligament reconstruction failure is multifactorial as well as that there is no statistically significant difference between the patients with good and the patients with poor graft position. We confirmed the assumption that the outcome of the revision anterior cruciate ligament reconstruction is poorer than the outcome of the primary anterior cruciate ligament reconstruction.</p>

O autor estudou as propriedades biomecânicas dos tendões dos músculos tibial anterior e tibial posterior congelados a -20°C e a -86°C extraídos de cadáveres humanos frescos. Foram realizados ensaios mecânicos de tração até a ruptura e determinadas as seguintes propriedades: resistência máxima, coeficiente de rigidez, módulo de elasticidade e alongamento máximo relativo. Os dados obtidos foram comparados aos existentes na literatura relativos ao ligamento cruzado anterior, ligamento da patela e aos tendões dos músculos grácil e semitendíneo / The author studied the mechanical properties of the anterior and posterior tibialis muscle tendons frozen at -20°C and -86°C obtained from fresh-frozen human cadavers. The tendons were submitted to axial traction until failure and the following properties were determined: ultimate load, stiffness, modulus of elasticity and relative strain. Data obtained were compared to those from the literature related to the anterior cruciate ligament, patellar tendon, gracilis and semitendinous tendons

O autor estudou as propriedades biomecânicas dos tendões dos músculos tibial anterior e tibial posterior congelados a -20°C e a -86°C extraídos de cadáveres humanos frescos. Foram realizados ensaios mecânicos de tração até a ruptura e determinadas as seguintes propriedades: resistência máxima, coeficiente de rigidez, módulo de elasticidade e alongamento máximo relativo. Os dados obtidos foram comparados aos existentes na literatura relativos ao ligamento cruzado anterior, ligamento da patela e aos tendões dos músculos grácil e semitendíneo / The author studied the mechanical properties of the anterior and posterior tibialis muscle tendons frozen at -20°C and -86°C obtained from fresh-frozen human cadavers. The tendons were submitted to axial traction until failure and the following properties were determined: ultimate load, stiffness, modulus of elasticity and relative strain. Data obtained were compared to those from the literature related to the anterior cruciate ligament, patellar tendon, gracilis and semitendinous tendons