The Anterior Cruciate Ligament (ACL) resists excessive anterior translation and internal rotation of the tibia during athletic activities and stabilizes the knee. In the US, annually, over 200,000 cases of ACL disruption are reported. The impact on the quality of life of the subject and its cost to healthcare is tremendous. The objectives of this study were to determine any significant associations between the size of the tibial eminence and ACL injury and to develop a finite element model for structural analysis. The results suggest that the size of the tibial eminence plays a role in loading the ACL and is therefore a risk factor. In addition to the epidemiological analysis, a finite element model of the knee was developed that with added modifications can be used for complex knee loading situations. The results in this thesis may be used to develop strategies for ACL injury prevention and rehabilitation. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-12-11T13:36:24Z No. of bitstreams: 1 EDUARDO_ANDRE_GOMES_KRIEGER.pdf: 1936090 bytes, checksum: 664d0dac12a0d4a16e41a647af134e1f (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-12-13T16:56:42Z (GMT) No. of bitstreams: 1 EDUARDO_ANDRE_GOMES_KRIEGER.pdf: 1936090 bytes, checksum: 664d0dac12a0d4a16e41a647af134e1f (MD5) / Made available in DSpace on 2018-12-13T17:07:12Z (GMT). No. of bitstreams: 1 EDUARDO_ANDRE_GOMES_KRIEGER.pdf: 1936090 bytes, checksum: 664d0dac12a0d4a16e41a647af134e1f (MD5) Previous issue date: 2018-08-10 / Introduction: Patellar chondropathy has an insidious onset, affecting patients with progressive, diffuse pain on the anterior aspect of the knee joint, and is one of the earliest signs of patellofemoral joint degenerative disease. Its etiology is still ill?defined, although risk factors such as female gender, increased body weight, and older age have been wellstablished in literature. There has been a prevalence of 40?60% under patellar cartilage macroscopic examination. The gold standard method for diagnosis is the arthroscopy; nonetheless, being a surgical procedure with high complication rates, its use is limited. With the advent of newer imaging methods, these modalities have been much more employed than diagnostic arthroscopy. Both conventional radiographs and CT scans provide indirect information on the condition of joint cartilage, whilst MRI provides more accurate data. There are no studies, however, highlighting the prevalence of patellar chondropathy in more recent imaging techniques such as the 3.0 Tesla MRI. Objective: To establish the prevalence of patellar chondropathy in 3.0 Tesla MRIs performed at Instituto do C?rebro da PUCRS between October 2016 and September 2017. Method: Data were collected by 3.0 Tesla MRIs of patients' knees obtained at Instituto do C?rebro da Pontif?cia Universidade Cat?lica do Rio Grande do Sul between September 2016 and August 2017, comprising a period of 12 months. Those MRIs were assessed by an experienced musculoskeletal radiologist, who confirmed the presence of patellar chondropathy and, when present, rated the finding into the four grades ascribed by the International Cartilage Repair Society. Results: A number of 291 patients were assessed during the period with 389 MRI scans. Of those patients, 308 (79.2%) were diagnosed with patellar chondropathy, whilst 81 (20.8%) were not. Chondropathy was more prevalent in the female gender, in subjects above 40 years of age, and in obese patients. When the results were weighed in ICRS classification, the milder grades (1 and 2) were seen in younger man (<30 years of age), while the more severe grades (3 and 4) were present in females, those above 40 years of age, and in obese patients. / Introdu??o: A condropatia patelar ? uma patologia de car?ter insidioso e que cursa com dor difusa na regi?o anterior do joelho, com caracter?stica progressiva, e ? um dos primeiros sinais de doen?a degenerativa na articula??o femoropatelar. A etiologia da doen?a ainda n?o est? bem definida, por?m os fatores de risco, como sexo feminino, alto peso corporal e indiv?duos mais velhos, est?o bem estabelecidos na literatura. Em estudos realizados atrav?s da macroscopia da cartilagem da patela, foi vista a preval?ncia entre 40?60%. O m?todo padr?o ouro para o diagn?stico ? a artroscopia, entretanto, por ser um procedimento cir?rgico, com elevados ?ndices de complica??o, seu uso ? restrito. Com o advento dos exames de imagem, estes passaram a ser mais utilizados do que a artroscopia diagn?stica. As radiografias convencionais e a tomografia computadorizada d?o informa??es indiretas sobre o estado das cartilagens articulares, j? a resson?ncia magn?tica pode prover mais dados. Todavia, n?o h? estudos que mostrem a preval?ncia da patologia em m?todos radiol?gicos mais recentes, como a resson?ncia magn?tica de 3.0 Tesla. Objetivo: Verificar a preval?ncia de condropatia patelar nos pacientes submetidos ao exame de resson?ncia magn?tica do joelho de alt?ssimo campo magn?tico (3.0 Tesla), realizada no Instituto do C?rebro da PUCRS no per?odo de outubro de 2016 a setembro de 2017. M?todo: Foram analisados os exames de resson?ncia magn?tica de joelho realizados no Instituto do C?rebro da Pontif?cia Universidade Cat?lica do Rio Grande do Sul em campo magn?tico de 3.0T, no per?odo de setembro de 2016 at? agosto de 2017, totalizando 12 meses. Estes foram analisados por radiologista com experi?ncia em interpreta??o de exames musculoesquel?ticos, que verificou a presen?a de condropatia patelar e, quando presente, classificou entre os quatro graus, de acordo com a classifica??o preconizada pela International Cartilage Repair Society. Resultados: Foram avaliados 291 pacientes durante o per?odo, com a realiza??o de 389 exames de resson?ncia nuclear magn?tica. Destes, 308 (79,2%) apresentavam condropatia patelar e apenas 81 (20,8%) n?o apresentavam. A patologia foi vista mais frequentemente nas mulheres, em indiv?duos acima de 40 anos e obesos. Quando classificada por graus, os mais leves (1 e 2) foram mais observados em homens e jovens (<30 anos) e os mais severos (3 e 4), no sexo feminino, acima de 40 anos e obesos.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

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)

Enfermidade muito observada nas articulações dos equinos, o processo degenerativo articular crônico na articulação tibio-társica pode ser de origem primária, ou secundária à osteocondrose dissecante. A confirmação diagnóstica é feita por avaliação radiográfica. Importantes aliados diagnósticos são a avaliação do líquido sinovial, a avaliação ultrassonografia e a cirurgia de video-artroscopia, sendo esta última o tratamento para a enfermidade. Por sua evolução crônica e às vezes assintomática, a osteocondrose dissecante causa alterações no ambiente articular, como a perda de matriz cartilagínea, o que limita o potencial atlético do animal, acarretando em queda na performace e perdas econômicas. É comum o uso terapêutico intra-articular no periodo pós operatório recente de substâncias autólogas como o plasma rico em plaquetas (PRP), bem como o uso ácido hialurônico (HA), como adjuvante para o tratamento cirúrgico. O presente trabalho objetiva comparar e avaliar estes tratamentos. Foram utilizados 18 equinos, com idade variando entre 2 a 6 anos de idade, da raça Brasileiro de Hipismo, com peso corpóreo entre 400 e 650 kg, oriundos do mesmo criatório, com osteocondrose dissecante, na crista intermédia do osso tíbia. Estes animais no décimo dia pós operatório são dividos em três grupos experimentais: grupo AH, grupo PRP e grupo RCL como controle. Dados clínicos, ultrassonográficos e laboratoriais foram coletados em tempos definidos. Os resultados demonstraram que os animais do grupo controle - grupo RCL, que receberam solução de ringer com lactato intraarticular, apresentaram respostas clínicas e laboratoriais que indicaram menor indução do processo inflamatório ao ambiente articular quando comparado aos grupos PRP e AH. Os animais que receberam PRP apresentaram maior efusão sinovial e resposta positiva ao teste de flexão quando comparados aos animais que receberam AH; ao passo que a administração intra-articular de AH induziu maiores alteração citológica do líquido sinovial quando comparadas aos animais que receberam PRP. / One of the most commom diseases in the equine joint, the degenerative joint disease in the tibio tarsal joint could be a primary disease, or secondary to osteochondrosis dissecans. The diagnosis is made by radiographic study. Allies in diagnosing this disease includes sinovial fluid evaluation, ultrasonographic evaluation and video arthroscopy surgery, which is the way to treat this disease. The osteochondrosis dissecans has a chronic evolution, and several times asymptomatic, which causes an alteration on articular environment that contributes to a loss in the cartilage matrix. Resulting in the limited development of the athletic potential of the animal, poor performance and economic losses. Is common to use therapeutical autholog substances intra articular as the platelet rich plasma, and hialuronic acid, in the early post surgical treatment as an adjuvant therapy to the surgical treatment. This study reaches to compare and evaluate those treatments. Were used 18 horses, with ages between 2 to 6 years old, Brasileiro de Hipismo breed, weighting between 400 and 650 kg, from the same breeding center, with osteochondrosis dissecans fragments from the intermediate tibial crest. Those patients, 10 days after the video arthroscopy surgery, were divided in three experimental groups: AH group, PRP group, and RCL group as control group. Laboratorial data, clinical signs and ultrassonographic exam were performed. The results proved that RCL group had show less induction of inflamatory process on articular enviroment, when we compare with PRP group and AH group. The PRP group had shown more synovial effusion, and more sensibility to the flexion test when we compare to AH group; but the AH group had shown more laboratorial alterations when we compare to the PRP group.

Abstract Excessive pain after surgery causes many kinds of endocrine, metabolic and inflammatory responses, which may increase postoperative morbidity and mortality - especially among elderly patients. This study evaluated the effect of peripheral and central pain relief techniques after joint surgery. Intravenously administered doses of 100 mg, 200 mg and 300 mg of ketoprofen decreased the requirement for opioid (fentanyl) in a dose-dependent manner by 38%, 45% and 53%, respectively, compared with a placebo, without any noticeable ceiling-effect, when administered after hip and knee arthroplasty. Patients receiving a 300 mg dose of ketoprofen had significantly lower postoperative pain scores than those receiving a placebo. There were no significant differences in incidences of nausea and vomiting, or in the amount of bleeding between the ketoprofen and placebo groups. Intravenous doses of 200 mg of ketoprofen, 150 mg of diclofenac, and 120 mg of ketorolac produced similar postoperative pain scores and requirement for opioid (fentanyl) with no intergroup differences in the incidence of nausea and vomiting and in the amount of bleeding, when administered after hip arthroplasty. The addition of ropivacaine, 1 mg·ml-1, did not decrease the requirement for epidural fentanyl administered via a patient-controlled analgesia device for postoperative pain relief after hip arthroplasty. Both drug infusions provided effective pain relief. The most common adverse effect was pruritus, which occurred in a similar number of patients in both groups. An interscalene brachial plexus block with ropivacaine decreased the dose of PCA-delivered oxycodone by 78% after arthroscopic shoulder surgery while subacromial bursa blockade with ropivacaine decreased it by only 11 % compared to a placebo during the 20 hour study period. Postoperative pain scores were significantly lowest with a interscalene brachial plexus block.

The paper presents the development of instrumentaria designed to solve ACL lesions using hamstrings (tendons of semitendinosus and m. gracilis - ST / G). The work itself took place in two phases. Part of the first phase was the development of its own instrumentation, including the implant designed to fix hamstrings tendons. The inherent part of the development was the performance of both mechanical and functional tests. The most tested element of the instrumentation was the screw with eye. In the course of its development, mechanical tests of tensile strength were carried out on the individual variants of the solution, and then the rapture of the screw with the eye from animal bone - simulating the function of the product in a real environment. Part of this was the development of methodology and work with new instrumentation. Clinical testing was performed in the second stage and the results of the operations are part of the work. The self-developed ACL lesion reconstruction toolkit is designed to use a graft made up of four strands of the above tendons. In the experimental part of the instrumentation development, the suitability of the implant for clinical use has been demonstrated. The newly developed instrumentation for ACL reconstruction, using the test implant for fixation of the hamstrings...

No description available.

INTRODUÇÃO: A precisão no posicionamento dos túneis ósseos na reconstrução do ligamento cruzado anterior do joelho (LCA) é considerado um dos fatores fundamentais para o bom resultado dessa cirurgia. A cirurgia ortopédica auxiliada por computador (computer aided orthopedic surgery CAOS) é um avanço tecnológico que tem como um dos principais objetivos exatamente o aumento da precisão. OBJETIVO: comparar o posicionamento do centro dos túneis e a isometria do enxerto obtidos com o uso de um sistema de navegação computadorizada (Orthopilot) e com o uso de guias cirúrgicos convencionais. MÉTODOS: 36 joelhos pareados de cadáveres tiveram o LCA ressecado por artroscopia no Laboratório de Artroscopia do Departamento de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo. Um joelho de cada par foi ramdomizado para o grupo 1 (guias cirúrgicos convencionais) e o outro para o grupo 2 (Orthopilot). Um fio de sutura inelástico foi passado pelo centro dos túneis tibial e femoral confeccionados para a reconstrução do LCA, sem que os túneis fossem finalmente brocados. Todos os joelhos foram então analisados quanto ao posicionamento do centro do túnel tibial (distância do LCP, distância da tubérculo intercondilar medial da tíbia e distância do corno anterior do menisco lateral), do centro do túnel femoral (distância da cortical posterior e angulação coronal na fossa intercondilar do fêmur) e a variação da distância entre os pontos centrais do túnel femoral para o túnel tibial em flexão de 90º e em extensão (isometria). Os dados foram analisados segundo o teste de Wilcoxon para comparação de duas amostras pareadas. RESULTADOS: A variação da distância entre o tunel femoral e tibial em flexão e extensão (isometria) foi maior no grupo 1 convencional, do que no grupo 2 Orthopilot (grupo 1: média 4,2mm com intervalo de 1,1mm a 9,4mm versus grupo 2: média 2,8mm com intervalo de 0,3mm a 6,7mm; p<0,05). Os outros parâmetros analisados não tiveram diferença estatística entre os grupos e demonstraram que todos os túneis dos dois grupos estavam bem posicionados de acordo com os critérios adotados. CONCLUSÕES: O emprego de instrumental cirúrgico navegado pelo sistema Orhtopilot permitiu o posicionamento dos túneis ósseos da reconstrução do LCA de maneira tão precisa quanto os guias cirúrgicos convencionais utilizados. Mais do que isso, proporcionou um posicionamento significativamente mais isométrico nessa série / INTRODUCTION: Precise tunnel location has been considered to be very important to achieve good results in anterior cruciate ligament (ACL) reconstruction surgery. Computer Aided Orthopedic Surgery (CAOS) is a technology improvement whose main objective is to enhance precision. PURPOSE: To compare the accuracy of tunnel placement and graft isometry for ACL reconstruction performed with the use of a computer-assisted navigation system (Orthopilot) and with traditional instruments. METHODS: 36 matched-paired cadaveric knees had their intact ACL removed by arthroscopy at the Arthroscopy Laboratory Orthopedic Department of University of São Paulo Medical School. One knee of each pair was randomized to group 1 (traditional instruments) or group 2 (Orthopilot). An inelastic suture was then passed through the center of where would be the tibial tunnel and then through the center of where would be the femoral tunnel. None of the tunnels were actually drilled. All knees were then dissected and 6 parameters were obtained: The distance from the tibial tunnel center to: 1) the PCL; 2) the lateral meniscus anterior horn; 3) the medial tibial spine. 4) The distance from the femoral tunnel center to the posterior femoral cortex. 5) The femoral tunnel coronal angle. 6) The variation of the distance from the femoral to the tibial tunnels with the knee extended and in 90 degree flexion. The data were submitted to statistical analysis and compared with the Wilcoxon Matched Pairs Test. RESULTS: The variation of the distance from the femoral to the tibial tunnels in flexion and extension was smaller in the Orthopilot group (better isometry): group 1: mean 4.2 mm (1.1-9.4 mm); group 2: mean 2.8 mm (0.3-6.7 mm) p<0,05. All other parameters showed no statistical difference between the groups and all tunnels were considered to be in satisfactory positions. DISCUSSION: There was no difference in tunnel position between the groups. Better isometry was achieved in the Orthopilot group compared to conventional instruments

A evolução do conhecimento acerca das funções dos meniscos e do tratamento das suas lesões, impulsionada pelo advento da cirurgia artroscópica, consagrou e popularizou a meniscectomia por esta via, por ser uma técnica menos invasiva, com menor morbidade e menores custos hospitalares, a ponto de torná-la, atualmente, a cirurgia ortopédica mais frequentemente realizada no mundo. Embora a maior parte dos pacientes submetidos a esta intervenção cirúrgica tenha resultados favoráveis e resolução rápida dos sintomas, percebe-se que parte considerável dos pacientes, especialmente os mais idosos, não apresenta uma evolução póscirúrgica satisfatória, apresentando piora dos sintomas e, eventualmente, necessitando de nova cirurgia. Partindo da hipótese que em determinados pacientes a meniscectomia, em vez de tratar, precipita e acentua um desequilíbrio biomecânico do joelho, o autor realizou estudo observacional prospectivo não-controlado com 86 pacientes de ambos os gêneros, com idade superior a 50 anos (média de 60,2 ± 7,1 anos), submetidos à meniscectomia artroscópica para tratamento de lesão do menisco medial de natureza degenerativa, com o objetivo de determinar variáveis demográficas, clínicas, anatômicas e cirúrgicas relacionadas aos resultados desfavoráveis. As avaliações funcionais pré e pós-operatórias foram realizadas utilizandose o Índice do KOOS (Knee Injury and Osteoarthritis Outcome Score), aplicado a todos os pacientes antes da cirurgia e 60 meses depois. Após análise estatística dos resultados obtidos, o autor verificou que 10 fatores podem ser considerados preditivos das meniscectomias mediais artroscópicas neste grupo etário, sendo quatro fatores fortemente associados aos resultados desfavoráveis: lesão da raiz posterior do menisco medial, dor pré-operatória intensa, claudicação antes da cirurgia e tempo decorrido entre o início dos sintomas e a cirurgia; dois fatores foram considerados moderadamente associados aos resultados desfavoráveis: presença de edema de medula óssea na ressonância magnética (RM) préoperatória e duração da cirurgia; quatro fatores foram considerados associados de modo fraco aos resultados desfavoráveis: Índice de Massa Corporal (IMC) >= 30 kg/m2 , varismo do joelho, presença de cisto poplíteo na RM pré-operatória e extensão da ressecção do menisco medial / The evolution of knowledge concerning meniscal functions and the treatment of their injuries, boosted by the development of arthroscopic surgery, has established and popularized arthroscopic meniscectomy due to its less invasiveness, less post-operative morbidity and lower hospital costs, to the point it has become, nowadays, the most frequently performed orthopedic procedure in the world. Although the majority of patients undergoing this operation is quite pleased with the outcomes and with the prompt resolution of their symptoms, it is noticeable that a considerable amount of patients with meniscal injuries, mainly the older, does not have a satisfactory postoperative outcome, with worsening of symptoms after being operated on and occasionally requiring another surgery. Based on observations of his medical practice and on the assumption that meniscectomy, rather than treat, can hasten and accentuate a biomechanical imbalance of the knee in those patients, the author conducted an observational prospective uncontrolled study with 86 patients of both genders, aged over 50 years old (average 60.2 ± 7.1 years), who underwent arthroscopic meniscectomy for the treatment of degenerative medial meniscal lesions, aiming to determine demographic, anatomical, clinical and surgical variables related to poor outcomes. The functional pre and post-operative evaluations were performed using the KOOS index (Knee Injury and Osteoarthritis Outcome Score) applied to all patients before surgery and 60 months later. After statistical analysis of the results, the author found that 10 factors can be considered predictors of arthroscopic medial meniscectomy in this age group: four factors were strongly associated with unfavorable results - posterior root lesion of the medial meniscus, intense pre-operative pain, claudication before surgery and time elapsed between onset of symptoms and surgery; two factors were moderately associated with unfavorable results - bone marrow edema in preoperative magnetic resonance imaging (MRI) and surgery time length; four factors that were weakly associated with poor results - bone mass index (BMI) >= 30 kg/m2, varus knee, poplyteal cyst in pre-operative MRI and extension of meniscal ressection