Bakgrund: Knäskador är vanligt förekommande bland yngre fysiskt aktiva personer. Ofta skadas flera strukturer samtidigt vilket medför att den mekaniska stabiliteten i knäleden försämras samt att den neuromuskulära funktionen i benet försämras, vilket påverkar den posturala kontrollen samt stabiliteten på knät. För att upptäcka instabilitet behövs mer utmanande och specifika test som Star Excursion Balance Test (SEBT). I dagsläget saknas studier gjorda med SEBT på en svensk population. Fysioterapeuter är beroende av tillförlitliga instrument för att kunna göra en korrekt bedömning. Syfte: Syftet med studien var att undersöka test-retest reliabiliteten för SEBT samt att undersöka samtidig validitet mellan SEBT och Unilateral Stance test (UST) för personer med knäproblematik.Syftet var dessutom att undersöka hur den posturala kontrollen var för personer i åldrarna 20-30 år med knäproblematik mätt med SEBT och UST. Metod: Studien var gjord med en icke experimentell design som var både deskriptiv och korrelerande. Alla tester gjordes vid ett tillfälle med 5 minuters vila mellan testerna. I studien ingick 30 personer med diagnostiserad alternativt självupplevd knäproblematik i åldern 20-30 år som studerade på Biomedicinskt centrum vid Uppsala Universitet. Resultat: Den posturala kontrollen för testpersonerna (n=30) var uppmätt till god både mätt med både SEBT och UST. Validiteten mellan SEBT och UST var låg r=0,3 (p=0,12). Test-retest reliabiliteten för SEBT var god r=0,74 (p=0.00013). Konklusion: SEBT har en god interbedömarreliabilitet. Korrelationen mellan UST och SEBT var låg. SEBT är ett test som är ett väldigt specifikt test där man behöver både material och tid för utförandet. Det behövs mer studier för att få fram om testet går att användas effektivt på allmänna kliniker som ett utvärderingsinstrument för postural kontroll. Keywords: Postural balance, Dynamic balance, Reliability, Validity, Star excursion balance test (SEBT), Unilateral stance test (UST), knee injury.

Eine Methode zur Messung der Variabilität des Stabilitätsgrades von Knie-Endo-prothesen. In dieser Arbeit konnte ein valides Messverfahren für die zwangsfreie Messung der Qualität und Quantität der Stabilitätsgrade von Knieendoprothese anhand der AEQUOS-Knieendoprothese entwickelt werden. Dabei galt es, eine Messanordnung und Methodik zu schaffen, die die Messung der Gleichgewichts-lagen ohne Zwangsführung unter Freischaltung aller Freiheitsgrade ermöglicht. Besondere Berücksichtigung fanden in dieser Arbeit die labilen Zustände, da diese für die dynamischen Übergänge zwischen einzelnen Bewegungen nötig sind. Dazu wurde in der vorliegenden Arbeit die Hauptbewegungsrichtung in der Sagittalebene betrachtet. Um zu simulieren, wie der Roll-Gleitvorgang in der AEQUOS-Prothese durch die Inkongruenz der Gelenkflächen realisiert wird, wurden an der Apparatur kleine Flexionswinkel zwischen 15° und 25° eingestellt, wie sie in der Standphase beim Gehen und auch beim Stand auftreten. Größere Winkel zwischen 35° und 90° wurden den Alltagstätigkeiten wie Bücken, Treppensteigen und Hocken zugeordnet, bis hin zum Vorgang des Aufstehens vom Stuhl bei einem Winkel von 105°. Die Erzeugung von Gleichgewichtszuständen wurde erreicht, indem bei einem festen Flexionswinkel Messungen zu den resultierenden Kräften bei unterschiedlichen Kombinationen der Muskelkräfte durchgeführt wurden. Dabei wurden die Muskelgruppen der Extensorengruppe (M. quadriceps), der Flexoren- oder Hamstring-Gruppe, sowie der M. gastrocnemius und der M. popliteus bei jeder Änderung der Kraftvariante in unterschiedlichem Verhältnis zueinander belastet, um die Kraftvektoren zu variieren. Die Gesamtbelastung wurde dabei mit etwa 63 Kilogramm immer konstant gehalten. Die Einzelgewichte wurden für die entsprechende Muskelgruppe unterschiedlich verteilt. Die kleinen Auslenkungsschritte ermöglichten eine isotonische Messung. Eine Zielsetzung bestand darin, die Möglichkeiten der AEQUOS-Prothese zu simulieren und darzustellen, dass Gleichgewichte ohne äußere Einflussnahme nur durch Muskelaktivität unter der Bedingung des Kraftschlusses eingestellt werden. Es wurde erfolgreich gezeigt, dass der Gleichgewichtszustand und der Stabilitätsgrad im Kniegelenk muskulär geändert werden können wie von Nägerl und Kubein-Meesenburg 1993 postuliert.

Osteoarthritis is a degenerative disease of joints, which can be solved with implantation of total joints prosthesis. A high-quality proprioception of knee joint protects the joint against possible bending injury, it is also participating in stabilizing the knee in static position and it is important in the process of coordination of the motion system and precise flexibility of the knee joint. In this thesis are summed up the knowledge of osteoarthritis, total joints prosthesis and proprioception, all is taken in context of connection. The research includes comparison of proprioception of knee joint with arthrosis and total joints prosthesis. Also, the research compared mentioned knee joints with the healthy verification group. All monitored individuals absolved a medical examination of the quality of proprioception in the form of move sensitivity in position of 30ř, 50ř and 80ř. Amongst the knees with arthrosis and knees with total joints prosthesis there were not found a differences with static importance in each of the angle test. In the total comparison there was significantly better proprioception of the knees with the total joints prosthesis. The knee joints of the verification group unlike the joints with arthrosis and total prosthesis showed significantly better flexibility in position of...

Title: Knee - straining of modern gymnasts For the basic study of human movements we need to take into consideration geometry of moving units (bodies), kinematics and dynamics. The theoretical part generally describes all the subjects connected to the research project, especially information about functions of human musculoskeletal system, description of basic biomechanics of knee joint,walking and methods of acquiring and processing of data for kinematic analysis of walking. The experimental part focuses on straining on a knee joint of modern gymnasts. It is a methodical analysis of straining on a knee joint. The foundations for this diploma thesis are data recorded by the Kistler system which we used for measuring of the dynamical part of a jump. We also used the swedish Qualysis Motion Capture system for the kinematic analysis. All the data were processed by Qualysis Track Manager software. The results of the research is kinematical - dynamic analysis, which is further used for the result of full - year of legs - straining of selected type of sport movement. Key words: biomechanics of knee joint, walking, kinematic analysis, gymnastic jumps

La rupture du ligament croisé antérieur du genou est très fréquente, notamment dans les activités qui impliquent des contraintes en rotation. Une dégénérescence du cartilage articulaire du genou peut par la suite engendrer une arthrose. Le but de cette étude était d’une part dans les pathologies traumatiques et d’autre part dans les pathologies dégénératives, atteignant cette articulation, d’analyser les facteurs prédictifs du contrôle postural et de la récupération fonctionnelle. Les effets d’une rééducation innovante combinant une rééducation conventionnelle réduite avec une rééducation en milieu aquatique ont été comparés à ceux d’une rééducation conventionnelle définie par la Haute Autorité de Santé, sur la cinétique de récupération des compétences proprioceptives et sur l’amélioration fonctionnelle. Le contrôle postural par posturographie et la motricité au moyen de tests cliniques ont été quantifiés chez 67 patients ayant présenté une rupture du ligament croisé antérieur, avant intervention et jusqu’à six mois après intervention chirurgicale. Les effets des paramètres météorologiques sur le contrôle postural et la douleur dans la gonarthrose ont été évalués chez 113 patients, par posturographie et échelle de douleur. Pour une même qualité globale du contrôle postural six mois après ligamentoplastie du genou, les patients ayant suivi le protocole de rééducation innovant utilisaient davantage la somesthésie que ceux ayant suivi une rééducation conventionnelle, qui devaient recourir plus à un mécanisme de compensation. La proprioception était améliorée deux mois après l’intervention chirurgicale par rapport à l’évaluation pré-opératoire chez les patients ayant suivi le protocole innovant. La force musculaire était plus importante chez les patients ayant suivi le protocole de rééducation innovant un mois, deux mois et six mois après intervention. Un mois après l’intervention, la distance de marche parcourue était plus importante chez les patients ayant suivi la rééducation innovante que chez les patients ayant suivi la rééducation conventionnelle. Chez les patients présentant une gonarthrose, une dégradation du contrôle postural était observée lorsque la pression atmosphérique et l’humidité maximale diminuaient au cours de la matinée et lorsque la pression atmosphérique diminuait au cours de la journée. L’augmentation de la douleur était corrélée avec l’augmentation de la température sur la matinée et avec l’augmentation de la température et de l’humidité sur la journée. L’environnement dans lequel évolue le sujet (ex : milieu aquatique, ambiance climatique) a donc une influence sur la performance du contrôle postural. Une meilleure prise en charge en rééducation post-ligamentoplastie du genou permettrait de limiter la nécessité de compensation sur le membre contralatéral par une meilleure utilisation de la somesthésie et ainsi prévenir la survenue de l’arthrose et d’une rupture ligamentaire contralatérale. Ceci permettrait de limiter les coûts socio-professionnels / The knee can suffer damage from either traumatic or degenerative pathology. Anterior cruciate ligament (ACL) injuries frequently occur, especially in activities that including rotational stresses. Degeneration of the articular cartilage of the knee can subsequently result in osteoarthritis. The aim of this study was to analyze the predictive factors of postural control and recovery in traumatic injuries and also in degenerative pathologies of the knee. The effects of an innovative rehabilitation protocol combining reduced conventional rehabilitation with aquatic rehabilitation were compared with conventional rehabilitation defined by the National French Health Authority on the kinetics of recovery of proprioceptive skills and functional improvement. Postural control and motor control using clinical tests were quantified in 67 patients with ACL surgery before and up to six months after surgery. The effects of meteorological parameters on postural control and pain in knee osteoarthritis were evaluated in 113 patients, using posturography and also a pain scale. Six months after knee ligament surgery, both groups attained the same quality of postural control. However, patients who followed the innovative protocol made more used of proprioceptive inputs compared to the group who underwent conventional rehabilitation who made more use of a compensation mechanism. In patients following the innovative protocol proprioception was improved two months after surgery compared to before surgery. Muscle strength was higher in patients who followed the innovative rehabilitation protocol at one, two and six months after surgery. One month after surgery, the walking distance traveled was higher in patients who underwent innovative rehabilitation than in patients who had undergone conventional rehabilitation. In patients with knee osteoarthritis, degradation of postural control was observed when atmospheric pressure and maximum humidity decreased during the morning and when atmospheric pressure decreased during the entire day. Increased pain was correlated with increased temperature in the morning and with increased temperature and humidity during the entire day. The environment in which evolves the subject (aquatic, climatic) thus has an influence on postural control performance. A better management in post-ligamentoplasty rehabilitation of the knee would reduce the need for compensation using the contralateral limb, by better use of somesthesia. This could prevent the occurrence of osteoarthritis and a contralateral ACL injury, which would also reduce costs to the society and health care

Os programas de computador têm apoiado o estudo de sistemas biomédicos em que um volume considerável de dados são empregados. Na biomecânica, a análise das influências entre as articulações pode melhorar o conhecimento das lesões relacionadas à corrida associadas ao uso excessivo durante a atividade de corrida. Compreender os padrões de interação entre diferentes articulações anatômicas, durante o movimento, pode contribuir para o aprimoramento de programas de treinamento, reabilitação e prevenção a lesões. Neste trabalho, um software personalizado foi desenvolvido para implementar a Coerência Parcial Direcionada (PDC), uma abordagem no domínio da freqüência da Causalidade de Granger (GC), adequado às especificidades da fisioterapia. Com entradas independentes e padronizadas, modularização e parametrização, as rotinas investigaram a direção de interação entre diferentes canais, registrando e salvando arquivos intermediários. Separados nos três planos anatômicos, sagital, frontal e transverso, foram utilizados dados cinemáticos para analisar as interações entre tornozelo, joelho, quadril, pelve e tronco durante a corrida. Três modificações de técnica de corrida foram abordadas: com aterrissagem iniciada com o antepé, com aumento de 10% na taxa de passo e com aumento de flexão de tronco, além da habitual. As análises foram realizadas para o ciclo completo (apoio e balanço) e com separação da fase de apoio, e revelaram que essas duas estratégias de processamento são complementares. Comparando as influências proximal e distal, os procedimentos sugeriram uma predominância das interações proximal a distal, mostrando uma origem central de movimentos. Dessa forma, destaca-se a relevância em controlar e fortalecer tronco e quadril para a minimização de lesões. Considerando os resultados e a oportunidade de configuração, o software pode ser empregado para estudar outras articulações e aplicações, bem como evoluir para um sistema automatizado de apoio à decisão. / Computer programs have supported the study of biomedical systems in which a considerable amount of data is employed. In biomechanics, analysis of influences between joints can improve the knowledge of the Running-Related-Injuries (RRI) associated to overuse during running activity. Understanding the patterns of interaction among anatomical joints during movement can contribute to the improvement of training, rehabilitation and injury prevention programs. In this work, a customized software was developed to implement Partial Directed Coherence (PDC), an approach in the frequency domain of Granger Causality (GC), adapted to the physical therapy specificities. With independent and standardized inputs, modularization and parameterization, the routines investigated the interaction direction between different channels, logging and saving intermediate files. Separated in the three anatomical planes, sagittal, frontal and transverse, kinematic data were employed to analyze the interactions between ankle, knee, hip, pelvis and trunk during running. Three running technique modifications were addressed: forefoot strike landing pattern, increasing 10% of the step rate and increasing trunk flexion, in addition to usual running. The analyzes were performed for the complete cycle (stance and swing) and with separation of the stance phase, and revealed that these two processing strategies are complementary. Comparing proximal and distal influences, procedures suggested a predominance of proximal to distal interactions, showing a central origin of movements. In this way, the importance of controlling and strengthening trunk and hip to minimize injuries is highlighted. Considering the results and the processing configuration opportunity, the software can be employed to study other joints and applications, as well as evolve to an automated decision support system.

Lesões da cartilagem articular podem ser tratadas por meio de cirurgia de transplante osteocondral autólogo. Esta cirurgia baseia-se na colocação de cilindros osteocondrais em áreas de lesão da cartilagem articular. O objetivo principal deste estudo foi avaliar as consequências histológicas das variações de posicionamento de enxertos osteocondrais cilíndricos: no mesmo nível e desnivelados (salientes ou profundos) em relação à superfície articular. Neste estudo, foram utilizados vinte coelhos fêmeos adultas, albinos, da raça Nova Zelândia. Defeitos cilíndricos osteocondrais de três milímetros de diâmetro e três milímetros de profundidade foram tratados por esta técnica cirúrgica. Os enxertos foram posicionados aleatoriamente em três formas: ao mesmo nível da superfície articular, profundos e salientes em relação à superfície articular. Realizou-se análise macroscópica e histológica após doze semanas de evolução. Como resultados, observamos que as avaliações macroscópicas e histológicas mostraram diferenças entre os três tipos de posicionamentos. Os enxertos posicionados ao mesmo nível da superfície articular obtiveram melhores resultados. Os resultados dos enxertos posicionados salientes à superfície articular foram melhores do que os dos enxertos posicionados profundos em relação ao nível articular / The treatment of symptomatic chondral lesions aims to restore function similar to that observed before the lesion. Autologous osteochondral transplantation is a surgical procedure that consists of filling a full-thickness articular cartilage defect with normal cartilage. The main objective of this study was to evaluate the histological consequences of the positional incompatibilities of cylindrical osteochondral grafts placed either flush with the articular surface or protruding/recessed. Two experimental groups of 10 rabbits each were randomly established regarding the positioning of the osteochondral autograft: in 1 knee, the graft was implanted either protruding or recessed with respect to the articular surface, and the graft was implanted at the level of the articular surface in the other graft. The protruding graft was placed 2 mm above the level of the articular cartilage, and the recessed graft was placed 1 mm below the level of the articular cartilage. After euthanasia, the articular cartilage was macroscopically evaluated according to the scale published by Goebel et al. and histologically evaluated by haematoxylin-eosin and safranin-O staining according to the International Cartilage Repair Society (ICRS) II classification. The evaluated parameters did not significantly differ between the protruding and recessed groups, whereas flush positioning resulted in better scores according to the Goebel et al. scale and the ICRS II classification. Recessed and protruding positioning relative to the articular surface did not produce different results

INTRODUÇÃO: Estudos têm apontado para a manutenção do déficit do controle postural após a reconstrução do Ligamento Cruzado Anterior (LCA), além de uma eventual instabilidade rotatória. Acredita-se que a lesão do Ligamento Antero Lateral (LAL) possa ter influência na manutenção dessa instabilidade após a reconstrução isolada do LCA. Não há esclarecimento acerca de como indivíduos com indicação da reconstrução combinada desses dois ligamentos se comportam do ponto de vista do controle postural. OBJETIVO: Verificar se há diferença no controle postural de pacientes com indicação cirúrgica de reconstrução combinada desses dois ligamentos (Grupo LCA+LAL), quando comparados aos indivíduos com indicação de reconstrução isolada do LCA (Grupo LCA). O objetivo secundário foi o de realizar uma avaliação clínica e da funcionalidade. MÉTODOS: Foi avaliado o controle postural estático por meio de plataformas de força. Foram realizados testes bipodais e unipodais com olhos abertos e olhos fechados. Para avaliação da funcionalidade foram realizados testes funcionais no aparelho Balance Master, aplicada a escala de Lysholm, além do Single Hop Test e Crossover Hop Test. A avaliação clínica se deu por meio da aplicação da Escala Visual Analógica e a translação anterior da tíbia por meio do artrômetro KT- 1000. Os achados foram comparados ao de um grupo controle. RESULTADOS: Não houve diferença estatística significativa entre os grupos para os testes de controle postural de olhos abertos e fechados. Uma maior porcentagem do Grupo do LCA+LAL (48%) quando comparado ao Grupo LCA (27%) e ao Grupo Controle (0%) não conseguiu realizar o teste unipodal de olhos fechados. O Grupo LCA+LAL apresentou maior translação anterior da tíbia que o Grupo LCA. Quanto aos Hop Tests, mais indivíduos do grupo LCA+LAL (67% versus 33% do Grupo LCA) apresentaram dor no Single Hop Test. CONCLUSÕES: Um número maior de indivíduos do grupo LCA+LAL não conseguiu realizar o teste unipodal com olhos fechados, indicando possivelmente uma instabilidade postural nessa condição. Os indivíduos desse grupo também apresentaram maiores valores de translação anterior da tíbia indicando uma pior instabilidade anteroposterior / INTRODUCTION: Studies have shown a postural control deficit after anterior cruciate ligament (ACL) reconstruction and a persistent rotational instability in some cases. It has been argued that an anterolateral ligament (ALL) injury could be responsible for such instability after an isolated ACL reconstruction. There are no further evidences in order to understand how patients in the preoperative period of a combined surgery of these two ligaments behave regarding postural control. PURPOSE: To verify the postural control of patients in ACL + ALL Group, when compared to the isolated ACL reconstruction indication (ACL Group). As a secondary purpose, the research aims to perform a clinical and functional evaluation. METHODS: An assessment of static postural control was performed using the force plane. Doubleleg and single-leg tests were performed with eyes open and closed. Functionality was assessed by perfoming tests in the Balance Master equipment. The Lysholm scale was applied, and the Single Hop Test and Crossover Hop Test were performed. The clinical evaluation consisted of the Visual Analogue Scale for pain and the anterior tibial translation was measures with a KT-1000 arthrometer. Both groups were compared to a control group. RESULTS: There was no statistical difference between groups regarding postural control in any of the tests. A higher percentage of the ACL + ALL Group (48%), when compared to ACL Group (27%) and Control Group (0%), was not able to perform the single-leg test with eyes closed. The ACL + ALL Group had greater anterior tibial translation than the ACL Group. Regarding the hop tests, a greater number of patients in the ACL + ALL Group (67% versus 33% of the ACL Group) reported pain during the Single Hop test. CONCLUSION: Most patients in the ACL + ALL Group were not able to perform the single-leg test with eyes closed, showing a possible postural instability in this condition. The higher values in anterior tibial translation may also indicate greater anteroposterior instability

Contexte et objectif – Les patients âgés gonarthrosiques présentent une dégradation du contrôle postural. Les méthodes non pharmacologiques sont aujourdhui recommandées comme option de première intention dans la gestion de l’arthrose. L’hydrothérapie fait partie des moyens de rééducation à disposition des patients âgés atteints d’arthrose du genou pour ses effets antalgiques et musculaires. Cependant, peu d’études sont actuellement disponibles concernant l’effet de l’hydrothérapie sur le contrôle postural, associée ou non à des programmes de rééducation individuels ciblés. Par ailleurs, le contrôle postural est susceptible de variations diurnes. Cette étude a eu pour objet de décrire le contrôle postural des personnes gonarthrosiques à quatre périodes de la journée, puis de comparer l’amélioration du contrôle postural au cours de deux programmes de rééducation différents recourant à l’hydrothérapie. Matériel et méthodes - Deux-cent-quatre-vingt quatre patients souffrant d’arthrose du genou ont été inclus dans cette étude. Le bilan posturographique a été réalisé une semaine avant la cure thermale en condition simple (yeux ouverts, support stable) et en conditions sensorielles contradictoires (vision faussée ou indisponible, proprioception perturbée). Pour évaluer les variations diurnes de la stabilité posturale, les patients ont été randomisés à quatre périodes d’essai dans la journée définies comme suit : 8h-10h, 10h-12h, 13h-15h, 15h-17h. L’influence du sexe, de l’âge, de la taille, du poids et de l’indice de masse corporelle sur la stabilité posturale a été évaluée. La gonalgie a également été évaluée à quatre périodes d’essai. Par la suite, les patients ont été randomisés en deux groupes de rééducation différents pour recevoir des traitements aquatiques : groupe cure classique (hydrothérapie efficace prouvée, c’est-à-dire groupe témoin) et groupe cure active (hydrothérapie combinant des programmes de réhabilitation individuels ciblés). Les bilans de posturographie statique ont été réalisés respectivement à 21 jours, 42 jours et 90 jours après le début de l’hydrothérapie. Résultats –Les tests posturographiques ont été réalisés chez 241 patients (âge moyen : 64,8 + 8,7 ans ; 82 hommes). Le contrôle de l’équilibre était plus efficace l’après-midi que le matin à la fois dans les conditions simple (p = 0,012) et sensorielle contradictoire (p = 0,047), en particulier en début d’après-midi lorsque la vision et la proprioception étaient disponibles (p = 0,026) ou perturbées (p = 0,019). La gonalgie a été plus prononcée le matin que l’après-midi (p < 0,001). La variation diurne du contrôle postural était plus marquée chez les patients plus âgés, de poids plus élevé, de sexe masculin, dans les conditions d’essais différentes (p < 0,05). Les deux cures d’hydrothérapie ont eu des effets curatifs considérables sur la restauration du contrôle de l’équilibre. Une meilleure précision des oscillations posturales a été constatée dans le groupe cure active par rapport au groupe cure classique, 42 jours après le début de l’hydrothérapie (p = 0,020), en particulier lorsque la proprioception a été perturbée avec (p = 0,028) ou sans (p = 0,025) vision disponible. Dans les deux groupes a été observée une stabilité posturale comparable dans un délai de trois mois. Conclusions - Cette étude a montré une meilleure stabilité posturale chez les patients atteints d’arthrose du genou, en début d’après-midi par rapport à la fin de matinée dans les situations sensorielles simples ou contradictoires. Il a été constaté que ces variations étaient également liées à l’âge, au sexe, au poids et pourraient être expliquées par la douleur articulaire fluctuante dans la journée. Considérée comme un traitement non pharmacologique applicable et recommandé, l’hydrothérapie est bénéfique à l’amélioration de la stabilité posturale chez les patients âgés atteints d’arthrose du genou, en particulier combinant un programme de réhabilitation individuel ciblé. [...] / Background and Objective – Increasing evidence supports balance control impairment in elderly patients with knee osteoarthritis (OA). Current guidelines recommend non-pharmacologic methods as first-line options in the management of OA. Hydrotherapy is a beneficial training medium for rehabilitation in elderly knee OA patients. However, few indications at present are available concerning the effect of hydrotherapy combining with targeted individual rehabilitation programs to improve balance control. Meanwhile, there is limited data on diurnal variation of balance control in these patients. This study aimed to investigate postural stability in elderly patients with symptomatic knee OA during different periods in a daytime before the spa therapy, then to study the results obtained before and after hydrotherapy to compare the improvement of balance control in these patients in two different water-based rehabilitation programs. Materials and Methods – Two-hundred and eighty-four knee OA patients were enrolled in this study. Static posturography using a vertical force platform was performed one week before spa therapy in simple (eyes open, firm support) and conflicting sensory (vision altered or unavailable, proprioception altered) conditions. To assess diurnal postural variations, patients were randomized to four testing sessions in a daytime defined as follows: 8-10am, 10-12am, 1pm-3pm, 3pm-5pm. Influence of sex, age, height, weight, and body mass index on postural stability was evaluated. Knee pain was also assessed in four testing sessions. Patients were then randomized to two different rehabilitated groups to receive spa therapies. Classic treatment group as a control received the efficacy proven spa water therapy, and active treatment group received spa water therapy combining with targeted individual rehabilitation programs. Static posturographies were carried out respectively in 21 days, 42 days and 90 days after the beginning of hydrotherapy. Results – Posturographic tests were completed for 241 patients (mean age: 64.8 + 8.7 years; 82 males). Balance control was more efficient in the afternoon than in the morning both in simple (p = 0.012) and conflicting sensory conditions (p = 0.047), especially in early afternoon when vision and proprioception were available (p = 0.026) or disturbed (p = 0.019). Patients’ knee pain was more pronounced in the morning than in the afternoon (p < 0.001). Diurnal variation of balance control was more noticeable in older, heavier, and male patients under different testing conditions (p < 0.05). Both the water-based therapies had considerable curative effect on balance control restoration. Better postural sway precision were found in active group than classic group 42 days after the beginning of hydrotherapy (p = .020), especially when proprioception was interfered with (p = .028) or without (p = .025) an available vision. Both of the groups have been observed a comparable postural stability in a three-month term. Conclusions – This study showed that better postural stability was observed in patients with knee OA in early afternoon than in late morning in simple and conflicting sensory situations. These variations appeared also to be related to age, sex, and weight and could be explained by fluctuant joint pain in a daytime. As feasible and recommended non-pharmacologic treatment, hydrotherapy is beneficial to the improvement of postural stability in elderly patients with knee OA, especially combining with targeted individual rehabilitation programs. These findings are important for future studies aiming at enhancing postural stability in knee OA patients and should be taken into account in the management of knee OA to generate applicative approaches to prevent the occurrence of adverse events in patient’s daily life.

As estruturas de madeira composta com alma em compensado já vem sendo amplamente utilizadas em diversos países onde as estruturas de madeira estão tecnologicamente mais desenvolvidas, oferecendo aos engenheiros civis mais uma opção de sistema construtivo eficiente, seguro e duradouro. Nesse trabalho são apresentados estudos teóricos e experimentais referentes às estruturas de madeira compostas utilizando compensado nas almas, e em especial as estruturas cuja ligação alma mesa é feita por pinos metálicos. O objetivo desse trabalho é desenvolver critérios de dimensionamento dessas estruturas para serem aplicados no Brasil. Vários critérios de dimensionamento de elementos compostos foram encontrados na bibliografia, alguns com simplificações que desconsideram efeitos de composição parcial e outros mais completos, que consideram deformações por cisalhamento, composição parcial etc. Com os resultados dos ensaios de vigas compostas pregadas foi possível comparar valores experimentais com resultados teóricos, concluiu-se que os critérios de dimensionamento do EUROCODE 5 são adequados. Os ensaios de rigidez de nó de pórtico de seção composta permitiram o desenvolvimento de metodologia para o cálculo da rigidez dessas ligações, visto que não existe formulação equivalente na bibliografia internacional. Concluiu-se que as ligações por pinos metálicos apresentam boa eficiência para serem utilizadas nas seções compostas com alma em compensado. As ligações de nó de pórtico com ligação alma/mesa pregadas podem ser consideradas rígidas na maioria dos casos estudados. / Plywood webbed structures have been applied in at several countries where timber structures are commonly used, giving civil engineers and builders one more option when looking for a safe, efficient and durable construction system. This work presents theoretical and experimental studies about plywood-webbed structures, with emphasis on nailed plywood webbed structures. The aim of this work is to develop design criteria for these structures to be used in Brazil. Several design criteria where found in the bibliography, some of them using simplifications for shear deflexions and joint deformations. Experimental results of nailed plywood webbed beams were compared with theoretical values from formulations found in the bibliography, concluding that EUROCODE 5 gives the best design criteria for nailed composite beams. Based on plywood webbed knee joints tests, a methodology to calculate the joint rigidity was proposed. The conclusions show the efficiency of this system and that nailed plywood webbed knee joints can be considered fixed for the majority of the specimens tested.