Dissertation (Ph.D.) -- Worcester Polytechnic Institute. / Keywords: Ligament; ACL; Collagen; Fibrin; Microthread; Fiber; Thread; FGF-2; Fibroblast; Tissue regeneration; Tissue engineering. Includes bibliographical references.

Thesis (M. CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references.

The history of total knee arthroplasty stretches back over 70 years. Many studies have shown that TKA is, in general, a successful operation for the relief of joint pain, with patient satisfaction rates of 90-95% and implant survival rates at 10-15 years of greater than 90%. However, a number of studies have also shown the potential for failures or complications arising post-implantation leading to revision surgery. This thesis presents finite element (FE) models of the distal femur following primary and revision total knee arthroplasty. Pre-arthroplasty models are also developed for comparison. Particular attention is given to how femoral component design and method of fixation impacts the mechanical environment of the distal femur and stability of the prosthesis. FE analyses with fully bonded interfaces indicate that femoral components are subject to areas of low stress (stress shielding) immediately under the anterior flange and chamfer regardless of internal implant features. However, internal implant features were found to play a role in the pattern and magnitude of stress concentrations. Both stresses and motions were observed to increase with increasing flexion angle, indicating the importance of testing at multiple angles. The initial models of the distal femur were extended to incorporate the effects of ageing and endosteal thinning of the femoral cortex, through novel application of pre-existing FE modelling techniques, specifically the ability to assign variable material properties corresponding to the nodal temperatures output from a heat transfer analysis. The findings from this study indicate that older patients with osteoporosis may be at increased risk of periprosthetic fracture compared to younger healthy patients. The use of a revision femoral component with a cemented stem as a means to mitigate this fracture risk was also investigated. FE analyses using frictional interfaces were employed to determine the influence of femoral component design on micromotion at the interface. These models showed that all primary implants were subject to similar magnitudes of relative motion at the interface, however, the distinct internal implant features led to very different regional variations. Furthermore, certain internal implant features (i.e. femoral box) were found to be highly sensitive to errors in surgical bone cuts. This aspect of the thesis also concluded that the addition of a stem served to significantly reduce motions at the interface in comparison to primary stemless implants. Long stemmed prostheses were found to result in the smallest levels of interface motion. This study also detailed the design and creation of an in vitro test setup for the purposes of determining the influence of stem length and fixation on the stability of revision prostheses. Experimental results using this test rig showed that a cemented short stem provides as much initial stability as the uncemented long stem, and is easier to fit surgically. Corresponding FE models incorporating a virtual representation of the test rig and in vitro loading conditions revealed that the relative motion at the multi-planar bone-prosthesis interface cannot be adequately described using a single reference point. However, in vitro setups may be used to predict a general measure of implant stability and to provide a source of calibration for FE. The distal femur models were further modified to investigate how the presence of condylar defects as classified by AORI defect classification system (Engh 2006) and weak osseous support due to osteoporosis may adversely affect the survival of the prosthesis. These investigations revealed that fixation of the femoral component, the presence of a large condylar defect and the level of osseous support all had an impact on stress in the implant, it is concluded that a non-modular approach should be adopted in older patient groups with severe osteoporosis to mitigate the risk of component junction failure and distal femoral fracture.

Submitted by MARCELLA FERRAZ PAZZINATTO null (ferraz_mar@hotmail.com) on 2016-05-13T17:13:57Z No. of bitstreams: 1 Dissertacao_final.pdf: 1372783 bytes, checksum: 82c520a2d6f64d7158d4001c043c712b (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-05-16T16:48:45Z (GMT) No. of bitstreams: 1 pazzinatto_mf_me_prud.pdf: 1372783 bytes, checksum: 82c520a2d6f64d7158d4001c043c712b (MD5) / Made available in DSpace on 2016-05-16T16:48:45Z (GMT). No. of bitstreams: 1 pazzinatto_mf_me_prud.pdf: 1372783 bytes, checksum: 82c520a2d6f64d7158d4001c043c712b (MD5) Previous issue date: 2016-04-29 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A dor femoropatelar (DFP) é considerada um “enigma ortopédico”, e uma das desordens musculoesqueléticas mais desafiadoras para se gerenciar. Isso porque até o presente momento não se tem definição acerca da(s) causa(s) que podem levar a esta desordem. Há mais de duas décadas têm-se investigado a presença de alterações biomecânicas em indivíduos com DFP durante as mais diversas atividades, como corrida, subida e descida de escada, agachamento e salto. Os parâmetros eletromiográficos (EMG) relacionados ao tempo e amplitude de ativação dos músculos vasto lateral (VL) e vasto medial (VM) são frequentemente abordados em estudos com essa população, no entanto, os resultados são controversos e acredita-se que uma das possíveis causas para essa inconsistência seja a característica intermitente dos sintomas. Ou seja, em determinados momentos a dor está presente e em outros não, independente da atividade que esteja sendo desenvolvida. Sabe-se que a dor recorrente pode levar a alterações no mecanismo central de controle da dor gerando respostas exageradas frente a estímulos dolorosos (hiperalgesia). Acredita-se que mulheres com DFP apresentam hiperalgesia tanto local quanto generalizada, no entanto, não se sabe o quanto a presença da dor no momento da avaliação pode alterar esses mecanismos de hiperalgesia. Diante disso, os objetivos gerais desta dissertação foram analisar o quanto a presença da dor afeta a hiperalgesia e os parâmetros EMG em mulheres com DFP, além de determinar pontos de corte para identificar a presença de hiperalgesia em mulheres com DFP. Os parâmetros EMG foram avaliados durante o gesto de subida de escada, e assim como os limiares pressóricos de dor (LPD) e a escala visual analógica (EVA) de dor, foram coletados em dois momentos antes e após um protocolo de esforço da articulação femoropatelar. Este protocolo foi realizado com o intuito de exacerbar os sintomas específicos da DFP e consistiu em 15 subidas de escada com 35% do peso corporal alocado em uma mochila e com ritmo demarcado por um metrônomo (96 degraus/min). Observou-se que mulheres com DFP apresentam LPDs reduzidos em comparação com mulheres assintomáticas e após o protocolo de esforço os LPDs avaliados ao redor do joelho, no grupo com DFP, reduziram significativamente comparado a avaliação prévia, no entanto, não houve diferença no LPD do ponto distante. Os pontos de corte encontrados apresentaram bons valores de acurácia diagnóstica, podendo ser úteis para a prática clínica na discriminação de indivíduos com e sem hiperalgesia. Já quanto aos parâmetros EMG avaliados em mulheres com DFP antes e após o protocolo de esforço, não houve diferença entre o início da ativação dos músculos VM e VL na presença da dor, mas houve aumento na amplitude do sinal EMG do VL e, consequentemente, redução na razão de ativação VM/VL após o protocolo de esforço. De acordo com estes resultados observa-se que a presença da dor é capaz de alterar os mecanismos centrais de modulação da dor, aumentando a hiperalgesia no local da desordem. A confirmação da presença de hiperalgesia local e generalizada em mulheres com DFP é de fundamental importância para traçar estratégias de tratamento, e a definição de pontos de corte capazes de discriminar os indivíduos quanto a presença de hiperalgesia facilita o gerenciamento desta desordem. E curiosamente os tratamentos visando o equilíbrio na ativação dos músculos VM e VL parecem não ser a melhor opção já que esse quesito não sofreu alteração diante do principal sintoma da DFP. / As there is no definition about etiological factors of patellofemoral pain (PFP), it is considered an “orthopaedic enigma” and one of musculoskeletal disorders most challenging to manage. More than two decades, researchers have investigated the presence of biomechanics alteration in individuals with PFP during different activities as run, stair deambulation, squatting and jump. The electromyographic (EMG) parameters related to timing and amplitude of activation of vastus lateralis (VL) and vastus medialis (VM) muscles are often addressed in studies with PFP. However, the results are controversial and a plausible explanation may be the intermitent characteristic of the symptoms. In other words, at certain times the pain is present and not in others, regardless of the activity that is being developed. It is knowing that recurrent pain may result in dysfunctional analgesic control generating exaggerated responses to painful stimuli (hyperalgesia). Women with FPF present local and widespread hyperalgesia, however, it is unknown how the presence of pain at the moment of evaluation may alter the hyperalgesia. Thus, the overall aims were to analyze how the presence of pain affects hyperalgesia and EMG parameters in women with PFP, moreover, to determine cutoff points to identify the presence of hyperalgesia in women with PFP. EMG parameters were evaluated during stair climbing. EMG parameters, pressure pain thresholds (PPTs) and visual analogue scale of pain (VAS) were collected in two conditions: before and after a patellofemoral joint loading protocol. This protocol aimed to arouse the specific symptoms of PFP and it was composed to 15 stair deambulation with 35% of body mass allocated in a backpack and the rhythm was demarcated by a metronome (96 steps/min). The women presented lower PPTs compared to pain free group. After the protocol, the PPTs around the knee decreased, whereas the PPT at a remote site to the knee not changed in women with PFP. The PPT cutoff points presented good capability to discriminate women with and without PFP. There was no difference in VL and VM onset of activation in presence of pain, however, the VL amplitude increased and VM/VL activation ratio decreased after the patellofemoral joint loading protocol. According to these results, the presence of pain changed the central mechanisms of pain modulation, increasing hyperalgesia at the site of the disorder. The cutoff points can guide clinicians towards identifying the presence of local and widespread hyperalgesia in women with PFP. Thus, clinicians may be able to identify which patients would benefit from non-mechanical interventions focusing on components aimed at pain neuroscience education. Interestingly, the treatments aiming to reduce the imbalance between VM and VL muscles do not seem to be the best option insofar as this parameter did not change in the presence of the main symptom of PFP. / FAPESP: 2014/10839-0

Thesis title: Health Professional-patient communication in relation to weight managementBackground: Global obesity levels have doubled since 1980 and are expected to rise. It is associated with key health risks such as heart disease, some cancers and osteoarthritis and hence has considerable economic consequences for health care resources. Key policy guidelines recommend that all health professionals (HPs) should discuss weight management with their patients making every contact count. However, we know HPs find discussions about weight challenging due to lack of time, training and skills. Knee Osteoarthritis (KO) and obesity are inextricably linked and together with a rise in obesity levels and growing numbers of older citizens rates of KO are set to escalate. As obesity is the key modifiable risk factor for KO, discussions about weight are paramount. This thesis explored this relationship further from the perspectives of patient and HPs, focusing on KO as an exemplar condition where there is scope for improved weight management. Methods: Utilising qualitative methods, three studies were undertaken. Firstly, a systematic review and thematic synthesis was conducted of published literature of physicians' views and experiences of discussing weight management within routine clinical consultations, not specific to KO. Secondly, HPs' experiences of discussing weight in consultations with KO patients through semi-structured interviews were conducted with 26 HPs. Interviews were audio recorded and analysed using TA. A final study recruited 25 overweight/obese patients with KO and investigated their experiences of talking about weight with HPs. Results: Overarching themes were identified across the studies. Firstly, HPs are pessimistic about patients' desire to lose weight and their capacity to help them. Several factors lead physicians and HPs to be reticent to accept responsibility for discussions about weight. Within routine consultations and between HPs and KO patients, weight was viewed as a sensitive topic. Both HPs and patients recognized the difficult cycle of pain, reduced mobility and weight gain. Patients with KO desire patient-centred (PC) care but, despite HPs recognizing its value, they do not receive it. Both physicians and HPs lack communication skills in weight management. Conclusions: The work undertaken in this thesis demonstrates that barriers preventing effective clinical interactions about weight identified in routine consultations still exist, even when two conditions such as KO and obesity are inextricably linked. Although HPs and patients hold similar understanding of these interrelationships and recognise the value of PC discussions, HPs struggle in effective behavior change talk. HPs expressed impatience with the efforts of their patients. To readdress this imbalance all consultations about weight should be PC. Both physicians and HPs were inadequately trained to discuss weight and patients' views supported this. HPs working with overweight patients should be trained in evidence-based behaviour change techniques and PC communication techniques to increase their confidence to support patients in weight management. Finally, health psychologists have the skills to both deliver and guide discussions about weight.

O estudo das forças que envolvem a articulação do joelho depende da determinação de alguns parâmetros biomecânicos. Muitas vezes alguns dos parâmetros utilizados são obtidos por meio da literatura. A distância perpendicular é um parâmetro freqüentemente utilizado de dados provenientes da literatura, pois sua determinação está associada a uma grande dificuldade metodológica. Muitos autores utilizam medidas em cadáveres ou medidas em imagens radiográficas estáticas, geralmente apresentam seus resultados na forma de gráficos e/ou tabelas. Entretanto, ambas fogem da situação onde são utilizadas, in vivo e dinâmica. Sendo assim, o objetivo deste estudo foi estimar a linha de ação e a distância perpendicular das estruturas que cruzam a articulação do joelho. Especificamente, desenvolver equações de regressão para estimar a linha de ação e a distância perpendicular destas estruturas, utilizando variáveis antropométricas tais como: massa, estatura e tamanho da tíbia, como variáveis explicativas nos modelos de regressão. Foram determinadas as linhas de ação e a distância perpendicular das seguintes estruturas: o ligamento patelar, o tendão do quadríceps femoral, o tendão do semimembranoso, o tendão do semitendinoso, o tendão do bíceps femoral, o tendão proximal do gastrocnêmio, o ligamento cruzado anterior e o ligamento cruzado posterior. Além das estruturas mensuradas foi calculada a distância perpendicular efetiva do mecanismo extensor do joelho. As medidas foram realizadas em imagens radiográficas dinâmicas, por meio de videofluoroscopia, em vinte e um (21) indivíduos saudáveis executando três repetições do exercício de extensão de joelho em cadeia cinética aberta, sem carga aplicada à tíbia. Foi utilizado o método automático "stepwise" para seleção das melhores variáveis explicativas para cada equação de regressão. Por meio de modelos de regressão linear foi possível estimar as linhas de ação e as distâncias perpendiculares das estruturas que cruzam a articulação do joelho, assim como estimar a distância perpendicular efetiva do mecanismo extensor do joelho. Além do ângulo de flexão, foi possível utilizar variáveis antropométricas como variáveis explicativas do modelo de regressão. / The study of forces involving the knee joint depends on the determination of some biomechanical parameters. Often some of the parameters used are obtained through literature. The moment arm is a parameter frequently used data in the literature, it is difficult to determine. Many authors use measures in cadavers or measures in radiographic images from static to determine its values and its results as graphs and / or as the regression equations. Meanwhile, both fleeing the situation where they are used, in vivo and dynamic. Therefore, the purpose of this study was to estimate the line of action and moment arm structures that cross the knee joint. Specifically, the regression equations developed to estimate the line of action and moment arm of these structures. Using anthropometric variables, such as weight, height and length of the tibia as explanatory variables in the regression models. There were certain lines of action and moment arm of the following structures, the patellar ligament, the femoral quadriceps tendon, the tendon semimembranoso, the semitendinosus tendon, the femoral biceps tendon, the tendon proximal the gastrocnemius, the anterior cruciate ligament and posterior cruciate ligament. In addition to the structures was estimated measured the effective moment arm mechanism of the knee extensor. To define the centre of rotation was the method used snapshot, to measure the moment arm geometric method was used. The measures were taken in radiographic images dynamic, through videofluoroscopic, and one in twenty (21) healthy individuals running three repetitions of the exercise of the extension of knee in open kinetic chain, no load applied to the tibia. It was the method used automatic "stepwise" to select the best explanatory variables for each regression equation. Through linear regression models were unable to estimate the lines of action and the moment arm structures that cross the knee joint, and estimate the moment arm effective mechanism of the knee extensor. Besides the angle of bending, it was possible to use anthropometric variables as explanatory variables in the regression model.

Made available in DSpace on 2015-08-20T17:09:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-28. Added 1 bitstream(s) on 2015-08-20T17:26:45Z : No. of bitstreams: 1 000835475.pdf: 2021131 bytes, checksum: 80090bd1061f1d22ca9d99e0a6a28a2c (MD5) / Com o presente estudo objetivou-se avaliar a longo prazo, clínica e radiograficamente, os joelhos de cães submetidos à técnica de avanço da tuberosidade tibial modificada (TTAm). Foram realizadas avaliações da deambulação dos animais, avaliação física, exame radiográfico, goniometria dos joelhos, perimetria da coxa e da perna e questionário aos proprietários, aproximadamente, aos cinco anos pós-cirúrgicos. Os exames radiográficos na avaliação a longo prazo foram analisados comparativamente aos dos momentos pós-operatórios imediatos e 120 dias pós-operatórios. Ao exame físico notou-se que a maioria dos animais teve resposta positiva para os testes de gaveta cranial e compressão tibial no membro operado, e negativa no contralateral. Nas avaliações de goniometria e perimetria foram observadas diferenças entre os joelhos operados e os joelhos contralaterais apresentando diminuição nos joelhos operados em relação ao controle para a goniometria e circunferência da coxa e aumento na circunferência da perna. Em relação à avaliação radiográfica observou-se progressão na maioria dos parâmetros de osteoartrose avaliados, principalmente em relação ao pós-operatório imediato e cinco anos pós-operatórios. De acordo com a avaliação da deambulação a maioria dos animais apresenta algum grau de claudicação, diferentemente do questionário aos proprietários que indicou a maioria dos animais não apresentando claudicação. Conclui-se que a osteoartrose progride com o passar do tempo mesmo após a realização da cirurgia de TTAm em joelhos com ruptura de ligamento cruzado cranial (RLCCr). Os valores de perimetria da coxa e da perna e goniometria do joelho não retornam aos valores dos membros contralaterais após cinco anos da cirurgia de TTAm. Após cinco anos de pós-operatório, os proprietários se mostraram satisfeitos com a recuperação dos animais e operariam com a técnica de TTAm o mesmo ou outro... / The purpose of the present study was to evaluate the long-term clinical and radiographic aspects of the knees of dogs submitted to the modified tibial tuberosity advancement technique (TTAm). Gait analysis, physical evaluation, radiographic examination, goniometry of the knee, thigh circumference of girth and leg of the patients and questionnaire to owners were performed, approximately five years post-operatively. Current radiographic examinations were compared to those taken prior to surgery and 120 days postoperatively. Physical examination revealed that most animals presented positive response to cranial drawer and tibial compression tests on the operated knees and negative in the contralateral limb. In reviews of goniometry and perimetry significant differences between the operated and contralateral knee were observed showing decrease in operated knees compared to control for goniometry and thigh circumference, and increase in leg circumference. Regarding radiographic assessment, progression in most osteoarthritis parameters was observed, especially in the moments early postoperatively and five years postoperatively. Considering the gait analyses, most animals presented some degree of lameness, in contrast to the owners' assessment, which indicated most animals not showing lameness. In conclusion, osteoarthritis progresses with the time even after TTAm surgery in cases of cranial cruciate ligament rupture (CCRL). The thigh and leg circumference and knee goniometry values did not return to the normal biometry in comparison to the contralateral non-affected limb values following five years of TTAm surgery. However, the owners were satisfied with the recovery of the animals and would be willing to accept TTAm indication for the same dog or for another one bearing CCRL. Different methodologies of scales have been used for both gait and osteoarthritis assessment in several papers, which impaired comparison with the results of the ...

O estudo das forças que envolvem a articulação do joelho depende da determinação de alguns parâmetros biomecânicos. Muitas vezes alguns dos parâmetros utilizados são obtidos por meio da literatura. A distância perpendicular é um parâmetro freqüentemente utilizado de dados provenientes da literatura, pois sua determinação está associada a uma grande dificuldade metodológica. Muitos autores utilizam medidas em cadáveres ou medidas em imagens radiográficas estáticas, geralmente apresentam seus resultados na forma de gráficos e/ou tabelas. Entretanto, ambas fogem da situação onde são utilizadas, in vivo e dinâmica. Sendo assim, o objetivo deste estudo foi estimar a linha de ação e a distância perpendicular das estruturas que cruzam a articulação do joelho. Especificamente, desenvolver equações de regressão para estimar a linha de ação e a distância perpendicular destas estruturas, utilizando variáveis antropométricas tais como: massa, estatura e tamanho da tíbia, como variáveis explicativas nos modelos de regressão. Foram determinadas as linhas de ação e a distância perpendicular das seguintes estruturas: o ligamento patelar, o tendão do quadríceps femoral, o tendão do semimembranoso, o tendão do semitendinoso, o tendão do bíceps femoral, o tendão proximal do gastrocnêmio, o ligamento cruzado anterior e o ligamento cruzado posterior. Além das estruturas mensuradas foi calculada a distância perpendicular efetiva do mecanismo extensor do joelho. As medidas foram realizadas em imagens radiográficas dinâmicas, por meio de videofluoroscopia, em vinte e um (21) indivíduos saudáveis executando três repetições do exercício de extensão de joelho em cadeia cinética aberta, sem carga aplicada à tíbia. Foi utilizado o método automático "stepwise" para seleção das melhores variáveis explicativas para cada equação de regressão. Por meio de modelos de regressão linear foi possível estimar as linhas de ação e as distâncias perpendiculares das estruturas que cruzam a articulação do joelho, assim como estimar a distância perpendicular efetiva do mecanismo extensor do joelho. Além do ângulo de flexão, foi possível utilizar variáveis antropométricas como variáveis explicativas do modelo de regressão. / The study of forces involving the knee joint depends on the determination of some biomechanical parameters. Often some of the parameters used are obtained through literature. The moment arm is a parameter frequently used data in the literature, it is difficult to determine. Many authors use measures in cadavers or measures in radiographic images from static to determine its values and its results as graphs and / or as the regression equations. Meanwhile, both fleeing the situation where they are used, in vivo and dynamic. Therefore, the purpose of this study was to estimate the line of action and moment arm structures that cross the knee joint. Specifically, the regression equations developed to estimate the line of action and moment arm of these structures. Using anthropometric variables, such as weight, height and length of the tibia as explanatory variables in the regression models. There were certain lines of action and moment arm of the following structures, the patellar ligament, the femoral quadriceps tendon, the tendon semimembranoso, the semitendinosus tendon, the femoral biceps tendon, the tendon proximal the gastrocnemius, the anterior cruciate ligament and posterior cruciate ligament. In addition to the structures was estimated measured the effective moment arm mechanism of the knee extensor. To define the centre of rotation was the method used snapshot, to measure the moment arm geometric method was used. The measures were taken in radiographic images dynamic, through videofluoroscopic, and one in twenty (21) healthy individuals running three repetitions of the exercise of the extension of knee in open kinetic chain, no load applied to the tibia. It was the method used automatic "stepwise" to select the best explanatory variables for each regression equation. Through linear regression models were unable to estimate the lines of action and the moment arm structures that cross the knee joint, and estimate the moment arm effective mechanism of the knee extensor. Besides the angle of bending, it was possible to use anthropometric variables as explanatory variables in the regression model.

Made available in DSpace on 2014-06-11T19:23:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-07-30Bitstream added on 2014-06-13T19:30:07Z : No. of bitstreams: 1 rocha_ag_me_jabo.pdf: 1567113 bytes, checksum: f23fbf92316999fff84c88431d3412ac (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / A ruptura do ligamento cruzado cranial (RLCCr) é a afecção ortopédica mais comumente diagnosticada em pequenos animais, causando instabilidade articular. Não menos incidente é a luxação patelar (LP) medial em cães de raças miniatura também chamadas raças “toy”. Cães portadores de LP têm maior probabilidade de sofrerem a RLCCr, por isso é muito frequente o atendimento de cães com RLCCr associado a LP. Inúmeras técnicas cirúrgicas foram desenvolvidas para restituir a estabilidade da articulação do joelho de cães com RLCCr e muitas outras para tratar a LP. O Objetivo desse trabalho foi desenvolver e avaliar clinicamente a técnica de TTTA que é uma associação das técnicas de Transposição da Tuberosidade Tibial (TTT) e Avanço da Tuberosidade Tibial (TTA). Essa associação foi utilizada no tratamento de 21 joelhos com Ruptura do Ligamento Cruzado Cranial associado à Luxação Patelar medial de cães atendidos pelo Setor de Cirurgia de Pequenos Animais do Hospital Veterinário Governador Laudo Natel da FCAV – UNESP Jaboticabal. Foram utilizados como espaçador na técnica de TTTA dois tipos de cunha de polímero de mamona. Após a colocação da cunha no interior da linha de osteotomia o ligamento patelar foi alinhado com o sulco troclear através da transposição lateral da tuberosidade tibial e fixado ao corpo da tíbia com um ou dois parafusos corticais aplicados em sentido crânio caudal. Os pacientes foram distribuídos aleatoriamente em dois grupos experimentais, sendo o Grupo 1 composto por joelhos submetidos somente à TTTA, e o Grupo 2 por joelhos submetidos à TTTA e artrotomia com imbricação lateral, trocleoplastia por abrasão e pateloplastia. A TTTA mostrou ser uma ótima alternativa para o tratamento de Ruptura do Ligamento Cruzado Cranial associado à Luxação Patelar medial em cães. O Grupo 1 mostrou melhores resultados que o Grupo 2 / The rupture of the cranial cruciate ligament (RLCCr) is the most commonly diagnosed orthopedic disorder in small animals resulting in instability. Not least is the incidence of medial patellar luxation (PL) in miniature breeds also called toy breeds. Dogs with PL are more likely to suffer RLCCr, so it is very common for these dogs to be affected by RLCCr associated with LP. Several surgical techniques have been developed to restore the stability of the canine stifle affected by RLCCr and many others to treat PL. The aim of this study was to develop and clinically evaluate the TTTA technique that consists of a combination of techniques Transposition of Tibial Tuberosity (TTT) and Tibial Tuberosity Advancement (TTA). This combination of techniques was used in the treatment of 21 canine stifles with RLCCr concurrent with medial LP attended at the Service of Small Animal Surgery of the Veterinary Hospital “Governor Laudo Natel” of the São Paulo State University campus of Jaboticabal. Two different models of castor oil polymer wedge were used as spacer in TTTA. After placement of the wedge within the osteotomy line the patellar ligament was aligned with the trochlear groove by lateral tibial tuberosity transposition and finally fixed to the body of the tibia with one or two cortical screws craniocaudally applied. The patients were randomly divided into two experimental groups: Group 1 consists of the knees treated only by TTTA, and in the Group 2 the knees underwent TTTA and arthrotomy with lateral imbrication, trochleoplasty and pateloplasty. The TTTA proved to be a great alternative for the treatment of Rupture of the Cranial Cruciate Ligament in combination with Medial Patellar Luxation in dogs. Group 1 showed better results than Group 2

Made available in DSpace on 2014-06-11T19:23:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-24Bitstream added on 2014-06-13T19:07:16Z : No. of bitstreams: 1 medeiros_rm_me_jabo.pdf: 4576402 bytes, checksum: 4df7cf376e215b11cedb7a4eaf1dd5b9 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / A Ruptura de Ligamento Cruzado Cranial (RLCCr) é a afecção articular que mais acomete os cães. O Avanço da Tuberosidade Tibial (TTA) é uma nova técnica desenvolvida para sua correção. Ela anula a função do ligamento por meio de alteração na biomecânica do joelho. O presente estudo objetivou avaliar, em cães com RLCCr, o uso da técnica de TTA modificada (TTAm) substituindo o espaçador original de titânio por um confeccionado com polímero de mamona fixado com dois parafusos no sentido craniocaudal, dispensando o uso da placa e do “garfo”. Os implantes foram confeccionados nas mesmas medidas e ângulos dos “cages” originais, sendo apenas a porção distal alongada. A técnica de TTAm foi realizada em 35 cães (42 joelhos) com RLCCr. Foram feitas análises da marcha e radiográfica no pré-operatório, pós-operatório imediato e após 30, 60, 90 e 120 dias. Por meio de questionário de avaliação, preenchido pelos proprietários, inferiu-se que todos os proprietários ficaram satisfeitos com a recuperação dos animais. Os animais apresentaram boa evolução radiográfica e obtiveram melhora na marcha e a maioria teve retorno funcional total. O TTAm foi utilizado em cães de tamanhos variados, mostrando-se mais versátil que o TTA convencional, menos invasivo e mais simples de ser realizado / Cranial Cruciate Ligament Rupture (CCLR) is the articular disorder that most affects dogs. The tibial tuberosity advancement (TTA) is a new technique developed to repair the CCLR. It cancels the ligament function through a change in the biomechanics of the knee. This study aimed to evaluate, in dogs with CCLR, the use of the modified TTA technique (TTAm) replacing the original titanium “cage for castor oil polymer fixed by two screws in the craniocaudal direction, eliminating the use of the plate and “fork”. The implants were manufactured on the same measures and angles of the original cages being only the distal elongated. TTAm technique was performed in 35 dogs (42 knees) with CCLR. Analyses of gait and radiographic occurred preoperatively , the immediate postoperative and after 30, 60, 90 and 120 days. An evaluation questionnaire, filled by the owners, inferred that all owners were pleased with the recovery of their animals. The animals had good radiographic outcome and showed improvement in gait, and most had full functional return. The TTAm was used in dogs of many sizes, being more versatile than the conventional TTA, less invasive and simpler to be performed