Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)-- Springfield College, 2006. / Includes bibliographical references.

Orientador: Sérgio Rocha Piedade / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T00:56:21Z (GMT). No. of bitstreams: 1 Takaes_IgorGiglio_D.pdf: 3495607 bytes, checksum: 997a8e42e41218f941a9801fb74230d6 (MD5) Previous issue date: 2013 / Resumo: INTRODUÇÃO: A Avaliação pós-operatória das lesões ligamentares do joelho realizada por escores clínicos, na maioria das vezes, privilegia a análise subjetiva e não fornece dados do equilíbrio muscular. A dinamometria isocinética fornece dados objetivos do déficit e equilíbrio muscular do joelho e aprimora a análise e a interpretação dos resultados pós-operatórios. OBJETIVOS: Avaliar o equilíbrio funcional do joelho pela dinamometria após reconstrução do complexo bicruzado e sua correlação com escores clínicos. MATERIAL E MÉTODOS: Foram avaliados 21 pacientes (16 homens e 05 mulheres), com idade media de 33 anos, IMC médio de 26,2 ± 3.4. Todos os pacientes foram submetidos à reconstrução cirúrgica do LCP e do LCA em dois tempos, com intervalo médio de 03 meses entre os procedimentos. Com tempo mínimo de 01 ano de pós-operatório, foi realizada a análise isocinética dos joelhos e aplicado o escore de Lysholm, Tegner e SF-36. Os testes isocinéticos foram conduzidos a 05 repetições nas velocidades de 60º/s e 180º/s e 15 repetições a 300º/s. RESULTADOS: A média do escore de Lysholm foi 82,6 ± 16,9 pontos, enquanto o escore de Tegner apresentou redução de 38,6% comparada ao nível pré-lesão. Foram obtidos os seguintes valores médios no SF- 36 nos itens: capacidade funcional (70,71); limitação por aspectos físicos (58,33); dor (73,79); aspectos gerais de saúde (80,71); vitalidade (72,0); aspectos sociais (85,12); aspectos emocionais (85,7); e saúde mental (76,76). Na avaliação isocinética, o lado operado apresentou déficit de torque extensor médio de 20 % a 60º/s, 15% a 180º/s e 14% a 300º/s, enquanto no torque flexor o déficit médio foi de 11% a 60º/s, 12% a 180º/s e 12% a 300º/s. Embora tenha sido registrado menor valor médio de torque nos joelhos operados comparado aos joelhos controle, não houve diferenças estatísticas com relação ao equilíbrio funcional do joelho (isquiotibiais/quadríceps). CONCLUSÃO: Os resultados isocinéticos da reconstrução do complexo bicruzado realizada em dois tempos evidenciaram déficit do torque extensor e flexor no lado operado. Embora, nenhum paciente tenha retornado ao nível pré-lesão, o equilíbrio funcional do joelho (flexor-extensor) pode ter contribuído para avaliação subjetiva regular nos escores clínicos / Abstract: INTRODUCTION: Postoperative evaluation of knee ligament injuries made by clinical scores, in most cases, favors the subjective analysis of the data and does not provide muscular balance. Isokinetic dynamometry provides torque deficit and knee muscle balance and thus enhances analysis and interpretation of clinical results after surgery. OBJECTIVES: To assess the functional balance of the knee after bicruciate reconstruction and its correlation with clinical scores. MATERIALS AND METHODS: We evaluated 21 patients (16 men and 05 women), mean age 33 years, mean BMI of 26.2 ± 3.4. All patients underwent surgical reconstruction of the PCL and ACL in two stages, with a mean interval of 03 months between the procedures. With a minimum of one year postoperatively, the analysis was performed isokinetic knee and applied the Lysholm score, Tegner and SF-36. The isokinetic tests were conducted to 05 repetitions at 60°/s and 180°/s and 15 repetitions at 300°/s. RESULTS: The Lysholm score was 82.6 ± 16.9 points and Tegner scores showed a deficit of 38,6% compared to pre-injury level. We obtained the following average values in items of SF-36: functional capacity (70.71); limitations due to physical aspects (58.33); pain (73.79), general health (80.71), vitality 72, social aspects (85.12), emotional aspects (85.7) and mental health (76.76). In isokinetic evaluation, the deficit of the operated quadriceps average torque was 20% at 60 º/s, 180°/s at 15% and 14% up to 300°/s, while the average flexor torque deficit was 11% at 60°/s, 12% at 180°/s and 12% at 300º /s. Although, it was registered that operated knees presented a minor mean values of torque compared to the control knees, no difference was founded to the knee functional balance (hamstrings/quadriceps). CONCLUSION: The results of isokinetic bicruciate reconstruction, performed at two stages, showed a deficit of extensor and flexor torque in the operated side. Although no patient has returned to pre-injury level, the functional balance of the knee (flexor-extensor) may have contributed to the good subjective Lysholm score / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Introduction: The incidence of anterior cruciate ligament (ACL) injuries in female floorball is relativley high, and the risk for sustaining a second ACL injury is greater compared to previously uninjured. Existing evaluation tests in rehabilition may not be discriminative enough to guide decisions on return to sport Aim: To evaluate the withinAsession and testAretest reliability of knee kinematics in floorball athletes and controls during a hop encompassing a sudden unanticipated change of direction. A second aim was to investigate the discriminative validity by comparing the test outcomes between the athletes and a control group of nonAathletes. Method: 11 elite floorball athletes and 8 controls were tested on two occassions separated by one to three weeks. Knee kinematics, ground contact time and number of succesfull hops were analyzed. Relative reliability was quantifyed by Intraclass correlation coefficient (ICC) and absolute reliability by standard error of measurement (SEM). Results: ICCs for knee kinematics withinAsession reliability were excellent (0.83A0.96) for athletes and poor to excellent (0.40A0.94) for the controls. For the testAretest reliability, the athletes had good to excellent (0.56A0.96) reliability and the controls had poor to excellent (0.26A0.93) reliability. Only two measured kinematic variables were significantly different between the groups. Conclusion: This pilot study indictate good to excellent reliability for the majority of the kinematic variables tested and, therefore, it could be assumed to be adequatley reliable. Discriminative validity needs to be further evaluated in a larger material.

No description available.

Canine cruciate ligament (CCL) rupture is a common veterinary orthopaedic problem, and has been associated with problems at the ipsilateral hip joint. However, the relationship between stifle and hip dysfunction has not been fully investigated. The purpose of this study was to establish whether CCL pathology is associated with a limitation in hip extension range large enough to affect gait. In a prospective, crosssectional study, passive and active hip extension range was determined in normal dogs as well as CCL deficient dogs. There was a significant reduction in ipsilateral passive hip extension range in the CCL deficient dogs (18.63º+/-7.57).There was a significant increase in hip extension range of the unaffected leg during gait compared to the normal group (7.03º+/-8.41). It was therefore concluded that canine CCL pathology directly affects hip extension range to a degree sufficient to affect normal gait.

A grande casuística relacionada à afecção ortopédica denominada ruptura do ligamento cruzado cranial na articulação fêmoro tíbio patelar canina tem gerado diversos estudos avaliando a biomecânica articular, fatores extrínsecos ao paciente e características metabólicas que poderiam influenciar na predisposição e no prognóstico dos pacientes acometidos por esta afecção. As dificuldades em identificar os diferentes níveis de instabilidade articular durante o diagnóstico e de estabilidade após o tratamento proposto, seja cirúrgico ou conservativo, provocou o desenvolvimento de diversas técnicas visando um melhor diagnóstico e estabilização articular pós operatória. Apesar da ampla variedade de técnicas cirúrgicas atualmente descritas para a insuficiência do ligamento cruzado cranial (LCC) em cães o tratamento ideal para esta freqüente condição ortopédica permanece indeterminado. Foram avaliados através da termografia infravermelha 30 pacientes caninos acima de 20 quilos sendo divididos em três grupos, o primeiro composto por dez animais hígidos onde foram analisados termograficamente os joelhos bilaterais a fim de padronizar valores térmicos de joelhos caninos normais, o segundo grupo composto por dez pacientes diagnosticados com instabilidade da articulação fêmoro tíbio patelar unilateral que foram submetidos a técnica cirúrgica de TTA para estabilização articular e o terceiro grupo composto por dez animais com diagnóstico de instabilidade da articulação fêmoro tíbio patelar unilateral que foram submetidos a técnica cirúrgica de TPLO para estabilização articular. Os grupos TTA e TPLO foram avaliados termograficamente em período pré operatório e nos momentos 30, 60 e 90 dias de pós operatório. Aos 30 dias de pós operatório houve diferença estatística com o grupo TPLO obtendo valores superiores ao grupo TTA. No período de 60 e 90 dias, não encontramos diferenças estatisticamente significantes nos valores comparativos dos membros operados em relação ao contralateral hígido podendo indicar que as duas técnicas cirúrgicas são capazes de trazer a articulação operada a uma condição de normalidade do ponto de vista termográfico. / The large number of cases related to the orthopedic condition called cranial cruciate ligament rupture in dogs has generated several studies evaluating the joint biomechanics, metabolic and environment characteristics that could influence the susceptibility and prognosis of patients affected by this condition. The difficulties in identifying the different levels of joint instability during diagnosis and joint stability after surgical or conservative treatment led to the development of several surgical techniques aiming a better diagnosis and joint stabilization. Despite the wide variety of surgical techniques currently described for the insufficiency of the cranial cruciate ligament (CCL) in dogs the ideal treatment for this common orthopedic condition remains uncertain. We evaluated using infrared thermography 30 canine patients over 20 kg. They were separated into three groups: the first group were consisted of ten healthy dogs, where we evaluated thermographycally their bilateral stifle in order to acquire thermal values of normal canine knees, the second group had ten patients diagnosed with instability of one stifle and were operated using the surgical technique called TTA and the third group were consisted of ten animals with a diagnosis of instability of unilateral stifle who underwent surgical procedure using the surgical technique called TPLO. The TTA and TPLO groups were evaluated thermographycally before surgery and at times 30, 60 and 90 days postoperatively. At 30 days evaluation we found significant differences between the TPLO and the TTA groups. At 60 and 90 days evaluation there were no significant differences between the operated limb in both groups and their contralateral not affected stifle. This results may indicate that both surgical techniques can bring the stifle back to normal thermographic parameters.

Thesis--Auburn University, 2009. / Abstract. Includes bibliographic references (p.115-

Anterior cruciate ligament (ACL) rupture is a major clinical problem in sports medicine. The current mainstay of treatment is arthroscopic-assisted ACL reconstruction with a soft tissue tendon graft. However, the affected patients are required to abstain from any pivoting activity for at least six to nine months after the operation to protect the graft-host bone interface in order to allow the graft to heal. In this study, a method to accelerate the graft healing within the bone tunnel is proposed by using a local application of an osteoconductive bone cement (Strontium enriched calcium phosphate cement, Sr-CPC) at the graft-host bone interface. It is postulated that Sr-CPC can induce earlier new bone formation in the gap between the graft and host bone tunnel and hence can result in an accelerated healing of the graft within the bone tunnel in ACL reconstruction. Preparation of Sr-CPCs using the conventional setting method (a dissolution/precipitation process) leads to a delay in setting. This study adopted a new setting reaction, a chelate reaction, to manufacture a Sr-CPC system. The Sr-CPC system was fast-setting, injectable and cohesive, and it was suitable for use in minimally invasive orthopaedics surgeries (e.g. arthroscopic-assisted ACL reconstruction). In order to investigate the biocompatibility and osteoconductivity of the Sr-CPC, in vitro cell experiments and an in vivo animal study were carried out. The in vitro experiments showed that the Sr-CPC was biocompatible with no local toxicity. In addition, a higher proliferation rate of osteoblastic-like MG-63 cells, accompanying higher alkaline phosphatase activity, was found in the Sr-CPC group. The in vivo study using a rat femur metaphyseal bone defect model showed evidence of earlier endochondral ossification which was noted at 2 weeks post operation. Moreover, a higher peri-cement bone formation rate, accompanied by a higher cement resorption rate, was found in the Sr-CPC group at 32 weeks after the operation compared with the convention calcium phosphate cement group. To study the effect of the Sr-CPC on the graft healing within the bone tunnel, a one-stage bilateral ACL reconstruction using an Achilles tendon allograft was performed in 30 rabbits. One study (15 rabbits) was to investigate the effect of the Sr-CPC on the healing of a soft tissue tendon graft within the bone tunnel, and the other study (15 rabbits) was to study the difference between the Sr-CPC and the conventional CPC in the healing of a soft tissue tendon graft within the bone tunnel. The Sr-CPC treated graft showed an accelerated healing at all of the time points when compared with the non-treated graft; and at time points of 3 to 12 weeks when compared with the CPC treated graft. In conclusion, a strontium enriched calcium phosphate cement, which is suitable for the arthroscopic use, was manufactured. It is biocompatible, osteoconductive and degradable. It accelerates the graft healing within the bone tunnels in a rabbit ACL reconstruction model using an Achilles tendon allograft when compared with both of the non-treated group and the conventional CPC-treated group. / published_or_final_version / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy