Atualmente observa-se que as queixas de afecção física mais comuns do aparelho locomotor na clínica médica e do esporte, entre adultos jovens e adolescentes ativos, estão relacionadas ao joelho, sendo o sintoma de dor femoropatelar, a mais freqüente. Porém, essa condição é uma incógnita, para os especialistas em joelho, quando se tenta definir uma causa específica e de consenso. Como forma de tentar contribuir na elucidação desse problema resolveu-se executar este trabalho investigativo, buscando-se encontrar diferenças clínicas e biomecânicas entre indivíduos do sexo feminino, com e sem o referido sintoma, com idade entre 15 e 20 anos. Foram avaliadas 23 jovens com dor femoropatelar bilateral, sem afecção conhecida presente e 20 sem sintoma (46 joelhos sintomáticos e 40 assintomáticos). Todas foram submetidas a exames radiográficos (incidências: antero-posterior, perfil e axial), onde se verificou o alinhamento femorotibial, a altura patelar, o ângulo do sulco, o ângulo de congruência, e o ângulo femoropatelar lateral. Também se mensurou a retração dos isquiotibiais e o ângulo Q em exame clínico e, os indivíduos da pesquisa ainda se submeteram a avaliação da força, por dinamometria isocinética, dos grupos musculares extensores e flexores do joelho e do quadril, além dos rotadores mediais e laterais e os adutores e abdutores do quadril. Após análise dos resultados, pode ser observado que as diferenças, estatisticamente significativas, entre os grupos estudados, foram quanto ao alinhamento do membro inferior, com o ângulo Q apresentando um p < 0,001, o ângulo femoropatelar lateral com um p = 0,006, o ângulo do sulco com o p < 0,001, o ângulo de congruência com o p = 0,027 e, o único parâmetro diferente estatisticamente na dinamometria isocinética, foi o ângulo do pico de torque da extensão do quadril, com um p = 0,03. De acordo com os resultados da comparação entre o grupo sintomático e o assintomático, observa-se que há uma relação importante do mau alinhamento da articulação do joelho com a sintomatologia estudada, porém não pode ser apontado um ou outro ângulo como o mais importante para o surgimento da dor, ou talvez ainda possa ser dito que estes desalinhamentos predispõem o joelho ao sintoma, mas talvez não sejam as causas primárias da afecção. Ficou demonstrado que o aumento do ângulo Q e o encurtamento dos isquiotibiais não são causas de dor femoropatelar. Foi verificado que indivíduos com e sem o sintoma não apresentam diferença quanto a força muscular de músculos envolvidos na ação do quadril e do joelho. O ângulo femoropatelar lateral apresentou média maior no grupo assintomático, enquanto que a média do ângulo do sulco, no mesmo grupo, foi menor. Já o ângulo de congruência apresentou média positiva no grupo assintomático e negativa no grupo com dor, mostrando que a patela do grupo com dor, tem seu ápice mais medializado que a do grupo controle / Presently it has been observed that the most common physical affection in the locomotor system in medical and sportive clinic, among active young adults and adolescents are related to the knee, being femoropatellar pain symptom the most frequent. Although, this condition is unknown for those who are specialists in knee when they try to identify a specific cause and an agreement. As a way of trying to contribute for the elucidation of this problem, it has been decided to execute this investigative study trying to find clinic, radiographic and isokinetic differences among female individuals, with and without the above mentioned symptom, between 15 and 20 years old. 23 young females with bilateral femoropatellar pain were analyzed, with unknown affection, and 20 without symptoms (46 symptomatic knees and 40 asymptomatic). All of them were submitted to radiographic exams (anteroposterior, profile and axial incidences), were it was verified the femorotibial alignment, the patellar height, the groove angle, the congruence angle and the femoropatellar lateral angle. It was also measured the hamstring shortness and Q angle in clinic exam and, the individuals of this study were submitted to strength evaluation, by isokinetic dynamometry of the extensor and flexor muscles of knees and hips, besides hip medial and lateral rotators and the adducts and abducts. After analyzing the results, it can be observed that the statistically significant differences among studied groups were related to the inferior member alignment, with the Q angle presenting p value < 0,001, the femoropatellar lateral angle p value = 0,006, the groove angle p value < 0,001, the congruence angle p value = 0,027 and, the only one statistically different parameter in isokinetic dynamometry was the torque peak angle of hip extension with p value = 0,03. According to the results of comparison between symptomatic and asymptomatic groups there is an important relationship between bad alignment of the knee joint with the studied symptomatology, but it cannot be appointed one or another as the most important for the appearing of the pain, or maybe it still can be said that these disarrangements can predispose the knee to the symptom, but maybe they are not the primary causes of the affection. It was shown that the raise of the Q angle and the hamstring shortness are not the causes of femoropatellar pain. It was verified that individuals with or without the symptom do not show difference in relation to the muscular strength of the involved muscles in movement of the hip and knee. The femoropatellar lateral angle presented higher average in the asymptomatic group, while the average of the groove angle, in the same group, was smaller. Yet the congruence angle presented a positive average in the asymptomatic group and a negative average in the group with pain, showing that the patella in the group with pain has its apex more medially than the control group

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-19T15:01:27Z No. of bitstreams: 1 Gustavo Lacreta Toledo Colonezi.pdf: 608536 bytes, checksum: 6f8b788f6abee5387f62055ac9f34005 (MD5) / Made available in DSpace on 2018-06-19T15:01:27Z (GMT). No. of bitstreams: 1 Gustavo Lacreta Toledo Colonezi.pdf: 608536 bytes, checksum: 6f8b788f6abee5387f62055ac9f34005 (MD5) Previous issue date: 2015-12-15 / INTRODUCTION: Abnormal trunk movements in the sagittal plane during weight-bearing activities can have a direct effect on the joints of the lower limbs. It is known that a greater range of trunk flexion leads to less patellofemoral stress. Assessments of the kinematics of patients who suffer from patellofemoral pain (PFP) during several activities can be found in the literature. However, none of these studies have addressed the effects of trunk flexion during the single leg hop test (SLHT). OBJECTIVE: Therefore, the aim of the present study was to assess the relation of trunk flexion on pain (NPRS 0-10), functional performance (SLHT distance) and the angular kinematics of the lower limbs of women with PFP during the propulsion phase of the SLHT. METHODS: Thirty-four sedentary women, with a mean age of 25.59 (18 - 35 years), were assessed retrospectively in terms of pain, functional performance and three-dimensional kinematics during the propulsion phase of the SLHT. The women were then divided into two groups based on the maximum angular value of the trunk: less trunk flexion (LFT group, n=17) and greater trunk flexion (GFT group, n=17). RESULTS: Differences were found between the groups for pain (P=0.04; Effect Size (ES) =0.70 ; mean difference = 0.88; Confidence Interval (CI) = 95%: 0.01 – 1,75), LFT group presented less pain than GFT group. Therefore women in the GFT group exhibited better functional performance funcional (P=0.01; ES=1.17 mean difference: 16.29cm; 95% CI: 25.95 - 6.62) than those in the LFT group. The GFT group also performed higher values of ipsilateral trunk lean (mean difference: 2.5°; 95% CI: 0.9 a 4.1°), pelvic anteversion (mean difference: 5.8°; 95% CI: 1.7 a 9.8°), hip flexion (mean difference: 8.2°; 95% CI: 2.1 a 14.4°) and ankle dorsiflexion (mean difference: 3.7°; 95% CI: 0.3 a 7.1°) than the LFT group. CONCLUSION: Increases in the sagittal plane trunk flexion shows relation to the functional performance and angular kinematics of proximal segments during the propulsion phase of the SLHT. / INTRODUÇÃO: Alterações dos movimentos do tronco no plano sagital durante atividades com descarga de peso podem ter efeito direto sobre as articulações dos membros inferiores. Sabe-se que maior amplitude de flexão do tronco diminui o estresse femoropatelar. Avaliações cinemática de pacientes que sofrem com dor femoropatelar (DPF) durante várias atividades podem ser encontrados na literatura. No entanto, nenhum estudo abordou a influência da flexão do tronco durante o single leg hop test (SLHT). OBJETIVO: Portanto, o objetivo do presente estudo foi avaliar a relação da flexão do tronco sobre a dor (NPRS 0-10), o desempenho funcional (distancia do SLHT) e da cinemática angular dos membros inferiores em mulheres com DPF durante a fase de propulsão dos SLHT. MÉTODOS: Trinta e quatro mulheres sedentárias, com idade média de 25,59 (18 - 35 anos), foram avaliadas em termos de dor, desempenho funcional e cinemática tridimensional durante a fase de propulsão do SLHT. As voluntárias foram divididas em dois grupos com base no valor angular máximo de flexão de tronco: menor flexão de tronco (MEFT grupo, n = 17), e com maior flexão do tronco (MAFT grupo, n = 17). RESULTADOS: Diferenças foram encontradas entre os grupos para a dor (P=0.04; Effect Size (ES) =0.70 ; diferença média = 0.88; Intervalo de Confiança (IC) = 95%: 0.01 – 1,75), sendo que, o grupo MEFT apresentou menos dor em relação ao grupo MAFT. Entretanto as voluntárias do grupo MAFT exibiram melhor desempenho funcional (P=0.01; ES=1.17 diferença média: 16.29cm; 95% IC: 25.95 - 6.62) do que aquelas do grupo MEFT. O grupo MAFT também apresentou maiores valores de inclinação ipsilateral de tronco (diferença média: 2.5°; 95% IC: 0.9 a 4.1°), anteversão pélvica (diferença média: 5.8°; 95% IC: 1.7 a 9.8°), flexão de quadril (diferença média: 8.2°; 95% IC: 2.1 a 14.4°) e dorsiflexão do tornozelo (diferença média: 3.7°; 95% IC: 0.3 a 7.1°). CONCLUSÃO: O aumento da flexão do tronco no plano sagital mostra relação com melhor desempenho funcional e com a cinemática angular de segmentos proximais durante a fase de propulsão do SLHT.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-16T19:41:25Z No. of bitstreams: 1 Amir Curcio dos Reis.pdf: 1475489 bytes, checksum: 32eea3f7e24896f451e6ba9cb6544786 (MD5) / Made available in DSpace on 2018-07-16T19:41:26Z (GMT). No. of bitstreams: 1 Amir Curcio dos Reis.pdf: 1475489 bytes, checksum: 32eea3f7e24896f451e6ba9cb6544786 (MD5) Previous issue date: 2016-11-29 / Patellofemoral pain (PFP) is one of the main diseases of the lower limbs, especially physically active women. The etiology is multifactorial and is directly linked to biomechanical disorders in the lower limb. Dynamic knee valgus is one of the major lower limb misalignment linked to PFP. Among the biomechanical characteristics in dynamic knee valgus, we highlight the excessive movement of hip adduction and internal rotation during closed kinetic chain activities, especially the squat. In addition to squat, dynamic valgus is described in other activities considered as low impact, such as stair climbing, and descending, walking and step downs tests, however, when we look for comparative information between high and low impact activity there is a gap in the literature. Furthermore, the kinematic behavior of the foot has been frequently associated with patellofemoral pain, however, studies evaluating the kinematic specifically during the functional activities through a multisegmented model are also scarce in the literature. Regarding treatment, there is no consensus about best approach, but the kinematic biofeedback has become an increasingly useful tool. The application can intervene directly in the joints of interest. Therefore, this PhD thesis was divided into 3 studies, with the following objectives: 1: Assess through kinetic and kinematic variables, the phase of high-impact single leg triple hop test (SLTHT) promotes more biomechanical changes in lower limb the phase of the low impact; 2: Compare the women foot kinematics with patellofemoral pain and pronated foot with asymptomatic during the implementation of the previous step down and side; and 3: To assess whether the 20% reduction results hip adduction or an increase of 20% of the anterior trunk tilt through kinematic biofeedback display different results when given the verbal biofeedback to lower hip adduction and most anterior trunk flexion and to evaluate whether these strategies are able to improve the pain immediately of women with patellofemoral pain during the squat. / A dor femoropatelar (DFP) constitui uma das principais afecções dos membros inferiores, sobretudo de mulheres fisicamente ativas. Sua etiologia é multifatorial e está diretamente ligada à desarranjos biomecânicos que envolvem o membro inferior, sendo o valgo dinâmico do joelho uma das principais alterações ligadas à ela. Dentre as características biomecânicas, destacamos a movimentação excessiva de adução e rotação medial do quadril durante atividades em cadeia cinética fechada, sobretudo o agachamento unipodal. Além do agachamento unipodal, o valgo dinâmico é descrito em outras atividades consideradas de baixo impacto, como a subida de escadas, descida de escadas, marcha, corrida e step downs tests, entretanto, quando se busca informações comparativas entre atividades de alto versus baixo impacto, há ima importante lacuna na literatura. Além disso, o comportamento cinemático do pé tem sido frequentemente associado à dor femoropatelar, entretanto, estudos que avaliem especificamente a cinemática durante as atividades funcionais por meio de um modelo multisegmentar também são escassos na literatura. Em relação ao tratamento, não existe um consenso sobre a melhor conduta, mas o biofeedback cinemático tem se tornado uma ferramenta cada vez mais útil. Sua aplicação pode intervir de forma direta nas articulações de interesse. Sendo assim, essa tese de Doutorado foi dividida em 3 estudos, com os seguintes objetivos: 1: Avaliar através de variáveis cinéticas e cinemáticas, se a fase de alto impacto do single leg triple hop test (SLTHT) promove mais alterações biomecânicas no membro inferior do que a fase de baixo impacto; 2: Comparar a cinemática do pé de mulheres com dor femoropatelar e o pé pronado com as assintomáticas durante a execução do do step down anterior e lateral; e 3: Avaliar se os resultados da redução de 20% da adução de quadril ou um aumento de 20% da inclinação anterior do tronco através do biofeedback cinemático apresentam resultados diferentes quando dado o biofeedback verbal para menor adução do quadril e maior flexão anterior do tronco, assim como avaliar se essas estratégias são capazes de melhorar a dor de forma imediata das mulheres com dor femoropatelar durante o agachamento unipodal.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-17T20:24:08Z No. of bitstreams: 1 Aline de Almeida Novello.pdf: 1138078 bytes, checksum: 601d6ef4a7fc406204ec932dce901793 (MD5) / Made available in DSpace on 2018-07-17T20:24:08Z (GMT). No. of bitstreams: 1 Aline de Almeida Novello.pdf: 1138078 bytes, checksum: 601d6ef4a7fc406204ec932dce901793 (MD5) Previous issue date: 2016-12-13 / Evidences found in the literature are inconsistent and there is no consensus about the kinematic differences performed by women with patellofemoral pain (PFP) during stair descent, and there are no studies that have evaluated the tridimensional kinematics of the trunk, pelvis, hip, knee and ankle using a multisegmental model of the foot, simultaneously during this task in patients with PFP and evaluated separately the sub phases of stair descent. Therefore, the aim of this study was to compare the tridimensional kinematics of the trunk, pelvis and lower limbs in different sub phases of stair descent and identify the discriminatory capability of the kinematic variables among PFP and healthy women during this task. In this cross-sectional study, thirty-four women with PFP (PFP group) and thirty-four painless women (control group) between 18 and 35 years-old underwent kinematic evaluation during the stair descent. It was observed that kinematic differences between groups occurred only in the first double support phase of the stair descent and the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact, the contralateral pelvic drop in the load-response, external rotation range of motion of the hindfoot in relation to the tibia and dorsiflexion of the forefoot in relation to the hindfoot were the variables that presented the best capacity to discriminate women with and without PFP. Therefore, our results provided a better understanding of the trunk, pelvis and lower limbs kinematics in different subphases of the support phase of stair descent in women with PFP. / As evidências encontradas na literatura são inconsistentes e não há consenso sobre as alterações cinemáticas em mulheres com dor femoropatelar (DFP) durante a descida de escadas. Além disso, não há estudos que tenham avaliado a cinemática tridimensional do tronco, pelve, quadril, joelho e tornozelo, utilizando um modelo multisegmentar do pé, simultaneamente durante esta tarefa em pacientes com DFP e que tenha avaliado separadamente as subfases da descida de escadas. Portanto, os objetivos deste estudo foram comparar a cinemática tridimensional do tronco, pelve, e membros inferiores em diferentes subfases da descida de escadas e identificar a capacidade discriminatória das variáveis cinemáticas entre mulheres com DFP e saudáveis nesta tarefa. Neste estudo transversal trinta e quatro mulheres com DFP (grupo DFP) e trinta e quatro mulheres sem dor (grupo controle) entre 18 e 35 anos foram submetidas à avaliação cinemática durante a descida de escadas. Foi observado que diferenças cinemáticas entre os grupos ocorreram somente na fase de primeiro duplo apoio da descida de escadas, sendo que as variáveis de rotação interna do retropé em relação à tíbia no contato inicial, a queda contralateral da pelve na resposta à carga, a amplitude de rotação externa do retropé em relação à tíbia e de dorsiflexão do antepé em relação ao retropé foram as variáveis que apresentaram melhor capacidade de discriminar mulheres com e sem DFP. Sendo assim, nossos resultados proporcionaram maior entendimento da cinemática do tronco, pelve e membros inferiores em diferentes subfases do apoio na descida de escadas em mulheres com DFP.

Bakgrund: Patellar tendinopati (PT) är framförallt en vanlig diagnos bland aktiva inom idrotter där hopprörelser ofta förekommer. Diagnosen innebär ofta överbelastning av knäskålsenan, vilket leder till smärta och nedsatt funktionsförmåga. Fysioterapeutisk behandling syftar till att minska smärtan och återställa funktionsförmågan. Infrapatellara remmar (IPR) har använts sedan många år för symptomlindring vid idrottsaktiviteter men det saknas forskning som har sammanställt effekter av användning, vilket föranleder behovet av en systematisk litteraturöversikt. Syftet var att genom en systematisk litteraturstudie beskriva hur IPR används och utvärderas i studier vid PT, rapporterade effekter samt studiekvalitet och preliminär evidensstyrka. Metod: Artikelsökning genomfördes i databaserna PubMed och PEDro. Fem studier analyserades utifrån litteraturstudiens syfte och frågeställningar samt kvalitetsgranskades enligt SBU:s granskningsmallar. Resultat: Av studierna undersökte tre IPR:s effekt på smärtintensitet, två proprioception och två indirekt uppmätt senbelastning. Endast kortsiktiga utfall mättes och när dessa var statistiskt signifikanta var kliniska relevansen ofta oklar. Sammantagen preliminär evidensstyrka bedömdes som måttligt stark. Slutsatser: Studierna visade på varierande effekt av att använda IPR avseende förbättring av proprioception, smärtintensitet och indirekt uppmätt senbelastning. Fler högkvalitativa randomiserade studier behövs och framtida forskning bör undersöka långsiktiga effekter vid användning av IPR. / Background: Patellar tendinopathy (PT) is common in jumping athletes. It’s mostly related to excessive loading of the patellar tendon, which leads to pain and decreased functional capacity. Physiotherapy treatment aims to reduce pain and restore functional capacity. Infrapatellar straps (IPS) have been utilized for many years to alleviate symptoms during sports activities but there is a lack of research that has compiled reports on effects of usage, which leads to the need of a systematic review. Objective: To describe use and evaluation of IPS in studies on patients with PT and describe reported effects, study quality and preliminary strength of evidence. Method: The PubMed and PEDro databases were searched for articles. Five studies were analyzed considering the review’s objective. Study quality was assessed according to SBU’s checklists. Results: Among the studies three investigated the effect of IPS on pain intensity, two on proprioception and two on indirectly measured tendon load. Short-term outcomes were investigated and the clinical relevance was often unclear when outcomes were statistically significant. Total preliminary strength of evidence was assessed as moderate. Conclusion: Variable effects are shown from IPS usage regarding pain intensity, proprioception and indirectly measured tendon load. More high-quality randomized trials and investigations of long-term effects are needed.

No description available.

Osteoarthritis (OA) is a debilitating disease affecting roughly 31 million Americans. The incidence of OA is significantly higher for persons who have suffered a transtibial amputation. Abnormal cartilage stress can cause higher OA risk, however it is unknown if there is a connection between exercise type and cartilage stress. To help answer this, a tibiofemoral FEA model was created. Utilizing linear elastic isotropic materials and non-linear springs, the model was validated to experimental cadaveric data. In a previous study, 6 control and 6 amputee subjects underwent gait and cycling experiments. The resultant knee loads were analyzed to find the maximum compressive load and the respective shear forces and rotation moments for each trial, which were then applied to the model. Maximum tibial contact stress values were extracted for both the medial and lateral compartments. Only exercise choice in the lateral compartment was found to be a significant interaction (p<0.0001). No other interactions in either compartment were significant. This suggests that cycling reduces the risk for lateral OA regardless of amputation status and medial OA risk is unaffected. This study also developed a process for creating subject-specific FEA models.

Background: Knee osteoarthritis (OA) is the most common type of OA and is a major cause of pain and thus results in disability for daily activities among persons living in the community. OA currently has no cure. In addition to the conflicting recommendations from clinical guidelines, evidence about the extent to which long-term use of intra-articular injections improves patient outcomes is also lacking. Methods: Using data from the Osteoarthritis Initiative (OAI), marginal structural models (MSMs) applying inverse probability treatment weights (IPTW) were used to examine the effectiveness of intra-articular injections and changes in symptoms over time. The specific aims of this dissertation were to: 1) evaluate longitudinal use of intra-articular injections after treatment initiation among persons with radiographic knee OA; 2) quantify the extent to which intra-articular injection relieves symptoms among persons with radiographic knee OA; and 3) evaluate the performance of missing data techniques under the setting of MSMs. Results: Of those initiating injections, ~19% switched, ~21% continued injection type, and ~60% did not report any additional injections. For participants initiating corticosteroid (CO) injections, greater symptoms post-initial injection rather than changes in symptoms over time were associated with continued use compared to one-time use. Among participants with radiographic evidence of knee OA, initiating treatments with either CO or hyaluronic acid (HA) injections was not associated with reduced symptoms compared to non-users over two years. Compared to inverse probability weighting (IPW), missing data techniques such as multiple imputation (MI) produced less biased marginal causal effects (IPW: -2.33% to 15.74%; -1.88% to 4.24%). For most scenarios, estimates using MI had smaller mean square error (range: 0.013 to 0.024) than IPW (range: 0.027 to 0.22). Conclusions: Among participants with radiographic evidence of knee OA living in the community, the proportion of those switching injection use and one-time users was substantial after treatment initiation. In addition, initiating injection use was not associated with reduced symptoms over time. With respect to issues of missing data, using MI may confer an advantage over IPW in MSMs applications. The results of this work highlight the importance of using comparative effectiveness research with non-experimental data to study these commonly used injections and may help to understand the usefulness of these treatments for patients with knee OA.

No description available.

The work deals with the lubrication of total knee replacement using fluorescence microscopy method, which allows unique insight into the contact between femoral and tibial component. The aim was to determine the effect of composition of synovial fluid (i.e. albumin, -globulin, hyaluronic acid and phospholipids) on film thickness and protein behaviour in contact, and also to determine changes of contact area during rotation. Since this is the first experimental work dealing with a knee replacement lubrication primarily, only simple rotation and load cycles were applied by the knee simulator. The output of the experiments was fluorescence intensity, which corresponds to dimensionless film thickness, over time. Another important output are the images directly showing the fluorescently labelled proteins in the contact area. The results show, there are fundamental differences in lubrication in different positions of rotation, due to changes of position, shape and behaviour of the contact area. The composition of the lubricant is also essential, since the proteins themselves form a relatively strong lubricating film and their mixture leads to a substantial reduction of film thickness, due to significant formation of clusters. Complex fluid, although it does not form the strongest layer, is able to create a quite continuous film.