Made available in DSpace on 2014-06-11T19:31:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:01:25Z : No. of bitstreams: 1 silvares_pra_dr_botfm.pdf: 1865578 bytes, checksum: 5944bbb134ed809f3f7170ccdbc6a33a (MD5) / Com o objetivo de se comparar as propriedades mecânicas do ligamento cruzado anterior (LCA), dos 10 mm do terço central do ligamento da patela (LP), e do tendão do músculo semitendíneo triplicado (STT) do mesmo doador, foram realizados ensaios de tração em material obtido de 19 cadáveres humanos. A idade dos doadores foi de 40 11 anos (18-55 anos), sendo 15 (78,9%) masculinos e 4 (21,1%) femininos, 12 brancos (63,1%) e sete negros (36,9%); 10 (52,6%) joelhos do lado esquerdo e 9 (47,4%) do lado direito. Foi obtida a área de secção dos corpos de prova para que, além das propriedades estruturais, também fossem avaliadas as propriedades materiais. Além do diagrama carga-alongamento, foram estudadas as seguintes variáveis: carga máxima (N), alongamento absoluto (mm) e específico (%) na ruptura, limite de proporcionalidade (N) e respectivos alongamentos, tensão na carga máxima(MPa), módulo de elasticidade (MPa), energia na ruptura (Nm) e energia por área (Nm/m2) . A análise estatística comparativa entre os três materiais mostrou que o LP foi superior ao LCA e ao STT, na carga máxima, tensão na carga máxima, módulo de elasticidade, energia, energia por área e limite de proporcionalidade, caracterizando comportamento de maior estabilidade e rigidez. O LCA e STT apresentaram semelhança com relação à carga máxima, tensão na carga máxima, limite de proporcionalidade e módulo de elasticidade. No STT observou-se valor maior em comparação ao LCA para energia e energia por área, na carga máxima. O STT alongou-se mais que o LCA e LP na ruptura e no limite de proporcionalidade. Não houve associação entre idade e carga máxima, tensão, energia e módulo de elasticidade no LCA, LP e STT. Houve associação entre carga máxima e área de secção no LCA e STT. Concluiu-se que o LP e STT têm comportamento mecânico distinto e que o perfil de ambos justifica a utilização como substitutos do LCA. / The material obtained from 19 human cadavers was submitted to traction-testing with the purpose of comparing the mechanical properties of the 10mm-central third of the patellar ligament (PL), triplicate semitendinosus muscle (TSM) and anterior cruciate ligament (ACL). Mean donor age was 40 11 years; 12 whites (63.1%) and 7 blacks (36.9%); 10 (52.6%) left knees and 9 (47.4%) right knees. The cross-sectional area of the test specimens was obtained so that, besides structural properties, material properties could also be evaluated. In addition to the load-strain diagram, the following variables were studied: ultimate load (N), absolute strain (mm) and relative strain (%) at failure load, yield point (N) and its respective strains, stress at ultimate load (MPa), modulus of elasticity (MPa), energy at failure (Nm) and energy per area (Nm/m2). Comparative statistical analysis of the materials revealed that PL was superior to ACL and TSM in ultimate load, stress at ultimate load, modulus of elasticity, energy, energy per area and yield point, thus featuring a behavior of greater stability and rigidity. ACL and TSM showed similar ultimate load, stress at ultimate load, yield point and modulus of elasticity. In TSM, energy and energy per area at ultimate load were higher than in ACL. Strain was greater in TSM than in ACL and PL at failure load and yield point. No association was observed between age and ultimate load, stress, energy and modulus of elasticity in ACL, PL and TSM. Ultimate load and cross-sectional area are associated in ACL and TSM. In conclusion, PL and TSM present distinct mechanical behaviors and their profiles justify their use as ACL replacements.

Orientador: Sérgio Swain Müller / Resumo: Com o objetivo de se comparar as propriedades mecânicas do ligamento cruzado anterior (LCA), dos 10 mm do terço central do ligamento da patela (LP), e do tendão do músculo semitendíneo triplicado (STT) do mesmo doador, foram realizados ensaios de tração em material obtido de 19 cadáveres humanos. A idade dos doadores foi de 40 11 anos (18-55 anos), sendo 15 (78,9%) masculinos e 4 (21,1%) femininos, 12 brancos (63,1%) e sete negros (36,9%); 10 (52,6%) joelhos do lado esquerdo e 9 (47,4%) do lado direito. Foi obtida a área de secção dos corpos de prova para que, além das propriedades estruturais, também fossem avaliadas as propriedades materiais. Além do diagrama carga-alongamento, foram estudadas as seguintes variáveis: carga máxima (N), alongamento absoluto (mm) e específico (%) na ruptura, limite de proporcionalidade (N) e respectivos alongamentos, tensão na carga máxima(MPa), módulo de elasticidade (MPa), energia na ruptura (Nm) e energia por área (Nm/m2) . A análise estatística comparativa entre os três materiais mostrou que o LP foi superior ao LCA e ao STT, na carga máxima, tensão na carga máxima, módulo de elasticidade, energia, energia por área e limite de proporcionalidade, caracterizando comportamento de maior estabilidade e rigidez. O LCA e STT apresentaram semelhança com relação à carga máxima, tensão na carga máxima, limite de proporcionalidade e módulo de elasticidade. No STT observou-se valor maior em comparação ao LCA para energia e energia por área, na carga máxima. O STT alongou-se mais que o LCA e LP na ruptura e no limite de proporcionalidade. Não houve associação entre idade e carga máxima, tensão, energia e módulo de elasticidade no LCA, LP e STT. Houve associação entre carga máxima e área de secção no LCA e STT. Concluiu-se que o LP e STT têm comportamento mecânico distinto e que o perfil de ambos justifica a utilização como substitutos do LCA. / Abstract: The material obtained from 19 human cadavers was submitted to traction-testing with the purpose of comparing the mechanical properties of the 10mm-central third of the patellar ligament (PL), triplicate semitendinosus muscle (TSM) and anterior cruciate ligament (ACL). Mean donor age was 40 11 years; 12 whites (63.1%) and 7 blacks (36.9%); 10 (52.6%) left knees and 9 (47.4%) right knees. The cross-sectional area of the test specimens was obtained so that, besides structural properties, material properties could also be evaluated. In addition to the load-strain diagram, the following variables were studied: ultimate load (N), absolute strain (mm) and relative strain (%) at failure load, yield point (N) and its respective strains, stress at ultimate load (MPa), modulus of elasticity (MPa), energy at failure (Nm) and energy per area (Nm/m2). Comparative statistical analysis of the materials revealed that PL was superior to ACL and TSM in ultimate load, stress at ultimate load, modulus of elasticity, energy, energy per area and yield point, thus featuring a behavior of greater stability and rigidity. ACL and TSM showed similar ultimate load, stress at ultimate load, yield point and modulus of elasticity. In TSM, energy and energy per area at ultimate load were higher than in ACL. Strain was greater in TSM than in ACL and PL at failure load and yield point. No association was observed between age and ultimate load, stress, energy and modulus of elasticity in ACL, PL and TSM. Ultimate load and cross-sectional area are associated in ACL and TSM. In conclusion, PL and TSM present distinct mechanical behaviors and their profiles justify their use as ACL replacements. / Doutor

by Pau Hon-Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 146-179). / Abstracts in English and Chinese. / ACKNOWLEDGEMENT --- p.i / ABBREVIATIONS --- p.iii / ABSTRACT (English) --- p.v / ABSTRACT (Chinese) --- p.ix / FLOW CHART --- p.xi / INDEX OF FIGURES --- p.xxi / INDEX OF TABLES --- p.xxiv / PUBLICATION LIST --- p.xxv / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Basic Structure of Tendons --- p.3 / Chapter 1.2 --- Anatomy of Patellar Tendon --- p.9 / Chapter 1.3 --- Cellular Characteristics of Fibroblasts --- p.11 / Chapter 1.4 --- Healing Process in Tendons --- p.13 / Chapter 1.5 --- Chronic Tendon Disorder --- p.19 / Chapter 1.6 --- Aims and Objectives --- p.25 / Chapter 1.7 --- Study Plan --- p.26 / Chapter CHAPRER 2 --- MATERIALS AND METHODOLOGY --- p.35 / Chapter 2.1 --- Collection of human Tissues Samples --- p.38 / Chapter 2.2 --- Tissue Culture --- p.40 / Chapter 2.3 --- Preparation of Conditioned Medium --- p.46 / Chapter 2.4 --- Proliferation Response of Tendon Fibroblasts --- p.48 / Chapter 2.5 --- Invasion Assay --- p.53 / Chapter 2.6 --- Chick Chorioallantonic Membrane Model --- p.56 / Chapter 2.7 --- SDS-PAGE --- p.58 / Chapter 2.8 --- Enzyme Linked Immunosorbent Assay --- p.63 / Chapter 2.9 --- Immunocytochemical Staining --- p.68 / Chapter 2.10 --- Statistical Analysis --- p.69 / Chapter CHAPTER 3 --- RESULTS --- p.74 / Chapter 3.1 --- Patient's Information --- p.76 / Chapter 3.2 --- Primary Explant Cell Culture --- p.77 / Chapter 3.3 --- Proliferation Response of Tendon Fibroblasts --- p.79 / Chapter 3.4 --- Invasion Assay --- p.82 / Chapter 3.5 --- Chick Chorioallantonic Membrane Model --- p.83 / Chapter 3.6 --- SDS-PAGE --- p.85 / Chapter 3.7 --- Enzyme Linked Immunosorbent Assay --- p.86 / Chapter 3.8 --- Immunocytochemical Staining --- p.88 / Chapter CHAPTER 4 --- DISCUSSION --- p.116 / Chapter 4.1 --- Higher Proliferation Capacity of Tendinosis Fibroblasts --- p.118 / Chapter 4.2 --- Tendinosis Fibroblasts Secrete Angiogenesis Factors to Enhance Angiogenesis --- p.123 / Chapter 4.3 --- Tendinosis Fibroblasts Secrete More Proteolytic Enzyme --- p.126 / Chapter 4.4 --- Proinflammatory Characteristics in Tendinosis Fibroblasts --- p.129 / Chapter 4.5 --- Comparison of in vitro and Histological Study --- p.132 / Chapter 4.6 --- Tendinosis Fibroblasts Seems to be Transformed --- p.134 / Chapter 4.7 --- Limitation of Study --- p.136 / Chapter CHAPTER 5 --- FUTURE RESEARCH DIRECTION --- p.140 / Chapter 5.1 --- Further Exploration of the Factors Secreted in Tendinosis Fibroblasts --- p.141 / Chapter 5.2 --- Proteoglycan Synthesis in Tendinosis Fibroblasts --- p.142 / Chapter 5.3 --- Tendinosis Animal Model and Clinical Study --- p.143 / Chapter CHAPTER 6 --- CONCLUSION --- p.144 / BIBLIOGRAPHY --- p.146 / APPENDIX --- p.180

Diss. (sammanfattning) Göteborg : Univ. , 2008. / Härtill 4 uppsatser.

INTRODUÇÃO: A ultrassonografia (US) e a ressonância magnética (RM) representam os principais métodos de diagnósticos por imagem na avaliação do mecanismo extensor do joelho. Há carência de trabalhos que avaliem por US e RM a presença de alterações no mecanismo extensor de jogadores de futebol assintomáticos. OBJETIVO: Avaliar, por meio de RM e US, o tendão quadríceps e o ligamento patelar de jogadores de futebol assintomáticos e dos participantes do grupo-controle. Identificar se há alterações de imagens ou lesões. Determinar se essas sofrem influências pelos seguintes critérios: canhoto ou destro, quanto à dominância ao chute, posição em campo, idade do atleta e tempo de prática esportiva. MÉTODO: Foram avaliados um total de 248 joelhos: 112 eram de 56 de jogadores de futebol assintomáticos e 136 eram do grupo-controle. O grupo composto por jogadores de futebol apresentava idades entre 14 e 34 anos. Já o grupo-controle era composto por indivíduos com idade também entre 14 e 34 anos, principalmente, universitários e funcionários do hospital, com gênero igual aos dos jogadores selecionados, mas sem atividades físicas de impacto, como vôlei, futebol e salto, por exemplo. RESULTADO: Constatou-se a presença de alterações de imagens ou de lesões em nove ligamentos patelares e apenas duas nos tendões quadríceps de jogadores de futebol assintomáticos, tanto pela US quanto pela RM, e nenhum caso alterado no grupo-controle. Houve concordância significativa entre RM e US quanto aos resultados obtidos. Além disso, os jogadores de futebol apresentaram anormalidades (alterações de imagens ou lesões) no tendão quadríceps ou no ligamento patelar significativamente (p<0,05) maior do que no grupo-controle; a idade média dos jogadores com alguma anormalidade é significativamente menor do que a dos jogadores sem lesão (p<0,003); o tempo médio de prática desportiva dos jogadores que apresentam anormalidade é menor do que o tempo médio dos jogadores que não têm anormalidade (p<0,001); os jogadores destros apresentaram anormalidades, enquanto que os jogadores canhotos não (p<0,05). Dentre os jogadores, há correlação entre mais alterações de imagem ou lesão de joelho e menor tempo como jogador e menor idade (R² de Nagelkerke = 0,700). Destros têm risco aumentado de ter anormalidade nas referidas estruturas (Razão de Chances = 15,204) quanto menor for o tempo como jogador de futebol. Os jogadores da defesa têm 4,76 vezes mais chance de desenvolver anormalidade do que atacantes e goleiros (p<0,04). CONCLUSÃO: Os jogadores de futebol assintomáticos apresentam anormalidades no tendão do quadríceps e ligamento patelar detectadas pela RM e US. As alterações estão relacionadas a menor idade, menor tempo de prática desportiva, ser destro e ser jogador de defesa / INTRODUCTION: Ultrasonography (US) and magnetic resonance imaging (MRI) are the main diagnostic imaging methods used in evaluation of the extensor mechanism of the knee. Theres a scarcity of works assessing alterations on the extensor mechanism of the knee of asymptomatic soccer players using US and MRI. OBJECTIVE: To assess, by means of MRI and US imaging, the quadriceps tendon and patellar ligament of asymptomatic soccer players and healthy control group; identify abnormal imaging findings or injuries; ascertain whether these are affected by leg dominance (left or right), field position, age, and time spent practicing the sport. METHOD: A total of 248 knees were evaluated: 112 of 56 asymptomatic soccer players and 136 of healthy controls. The players ages ranged from 14 to 34 years. The control group was composed mostly of college students and hospital staff members, also with ages between 14 and 34, matched for gender to the selected soccer players, and who did not engage in high-impact activities such as volleyball, soccer, or jumping. RESULTS: Abnormal imaging findings or injuries were detected, by US and MRI alike, in nine patellar ligaments and two quadriceps tendons of asymptomatic soccer players. No abnormal findings were detected in the control group. CONCLUSION: There was significant consistency between MRI and US findings. Soccer players were much more likely (p<0.05) to have abnormal imaging findings or injuries of the quadriceps tendon and patellar ligament as compared with the control group; the average age of players presenting some abnormality is significantly lower than of those without injuries (p<0.003); the average time spent practicing the sport for players presenting abnormalities is lower than those who dont present injuries (p<0.001); a correlation between the dominant leg and the affected knee was observed, with the players with a dominant right leg presenting injuries while the ones with a dominant left leg not showing abnormalities (p<0.05). Amongst the players there is a correlation between more abnormal imaging findings or injuries on the knee and less professional practicing time and age (Nagelkerke R² = 0.700).Players with a dominant right leg have an increased chance of presenting abnormalities on the quadriceps tendon and patellar ligament (Odds Ratio = 15.204) with a lower average time spent practicing the sport. Defense players have 4.76 times more chance to develop abnormalities than forward players and goalkeepers (p<0.04). CONCLUSION: The asymptomatic soccer players present abnormalities on the quadriceps tendon and patellar ligament identified using ultrasonography (US) and magnetic resonance imaging (MRI). The alterations are related with less age, less time of professional practice, right leg dominance and defense field position

Li Chi Kei. / Thesis (M.Phil.)--Chinese University of Hong Kong,1995. / Includes bibliogrpahical references (leaves 54-68). / Abstract --- p.1 / Acknowledgments --- p.4 / Lists of Figures --- p.5 / List of Tables --- p.8 / Chapter Chapter 1 --- Introduction --- p.9 / Chapter 1.1 --- Ligamental Injury --- p.9 / Chapter 1.2 --- ACL Injury --- p.10 / Chapter 1.3 --- Patellar Tendon and Anterior Cruciate Ligament --- p.11 / Chapter 1.4 --- Patellar Tendon Bone Graft --- p.13 / Chapter 1.41 --- Strength of the Patellar Tendon Bone Graft --- p.13 / Chapter 1.42 --- Use of the Patellar Tendon Bone Graft --- p.14 / Chapter 1.5 --- Patellar Tendon Bone Graft in Anterior Cruciate Ligament Reconstruction --- p.14 / Chapter 1.6 --- Complications of Anterior Cruciate Ligament Reconstruction after the Use of Patellar Tendon Bone Graft --- p.16 / Chapter 1.7 --- Healing of the Patellar Tendon Donor Site --- p.17 / Chapter 1.8 --- Objective of the Study --- p.22 / Chapter 1.9 --- Significance of the Study --- p.22 / Chapter Chapter 2 --- Material & Method --- p.24 / Chapter 2.1 --- Animal Model --- p.24 / Chapter 2.2 --- Grouping --- p.24 / Chapter 2.3 --- Operative Procedure --- p.24 / Chapter 2.4 --- Method of Assessment --- p.26 / Chapter 2.41 --- Gross Morphology --- p.26 / Chapter 2.42 --- Biomechanical Testing --- p.27 / Chapter 2.43 --- Biochemical Assay --- p.28 / Chapter 2.43.1 --- Water Content --- p.29 / Chapter 2.43.2 --- Collagen Content --- p.29 / Chapter 2.44 --- Histology --- p.30 / Chapter 2.45 --- Immunohistochemistry --- p.31 / Chapter 2.5 --- Statistics --- p.32 / Chapter Chapter 3 --- Results --- p.33 / Chapter 3.1 --- Operation Complications --- p.33 / Chapter 3.2 --- Gross Morphology --- p.33 / Chapter 3.21 --- Dimension of the Patellar Tendon --- p.33 / Chapter 3.22 --- Dimension of the Patellar Tendon Bone Graft --- p.33 / Chapter 3.23 --- Dimension of the Remain Patellar Tendon --- p.34 / Chapter 3.24 --- Gross Appearance of the Patellar Tendon Donor Site --- p.35 / Chapter 3.3 --- Biomechanical Testing --- p.36 / Chapter 3.31 --- Failure Load --- p.36 / Chapter 3.32 --- Ultimate Stress --- p.37 / Chapter 3.33 --- Stiffness --- p.37 / Chapter 3.34 --- Energy Absorbed before Failure --- p.38 / Chapter 3.4 --- Biochemical Assay --- p.38 / Chapter 3.41 --- Water Content --- p.38 / Chapter 3.42 --- Collagen Content --- p.39 / Chapter 3 .5 --- Histology & Immunohistochemistry --- p.39 / Chapter 3.51 --- Morphology of Control Tendon --- p.40 / Chapter 3.52 --- Morphology of Experimental Tendon with 'Open' Procedure --- p.40 / Chapter 3.53 --- Morphology of Experimental Tendon with 'Close' Procedure --- p.41 / Chapter 3.54 --- Healing at the Patellar and Tibial Insertion Site --- p.41 / Chapter 3.55 --- Morphology of the Cartilage Surface --- p.42 / Chapter Chapter 4 --- Discussion & Conclusion --- p.43 / Chapter 4.1 --- Gross Morphology --- p.43 / Chapter 4.2 --- Biomechanical Testing --- p.45 / Chapter 4.3 --- Biochemical Assay --- p.47 / Chapter 4.4 --- Histology & Immunohistochemistry --- p.49 / Chapter 4.5 --- Conclusion --- p.51 / References --- p.54 / Figures / Tables / Appendix

by Wang Wen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 113-124). / Abstracts in English and Chinese. / ABSTRACT --- p.i / FLOWCHART --- p.vi / ACKNOWLEDGEMENT --- p.x / ABBREVIATIONS --- p.xi / INDEX FOR FIGURES --- p.xii / INDEX FOR TABLES --- p.xv / TABLE OF CONTENTS --- p.xvi / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 1.1 --- PATELLAR TENDINOSIS --- p.1 / Chapter 1.1.1 --- Introduction --- p.1 / Chapter 1.1.2 --- Epidemiology of Patellar Tendinosis --- p.3 / Chapter 1.1.3 --- Etiology of Patellar Tendinosis --- p.3 / Chapter 1.1.4 --- Manifestations of Patellar Tendinosis --- p.4 / Chapter 1.1.5 --- Imaging Examination on Patellar Tendinosis --- p.4 / Chapter 1.1.6 --- Clinical Diagnosis of Patellar Tendinosis --- p.6 / Chapter 1.1.7 --- Management of Patellar Tendinosis … --- p.6 / Chapter 1.2 --- ANATOMY AND HISTOLOGY OF PATELLAR TCNDON --- p.7 / Chapter 1.3 --- STRUCTURE AND METABOLISM OF TENDON --- p.9 / Chapter 1.3.1 --- Tenocytes --- p.9 / Chapter 1.3.2 --- Extra-cellular Matrix --- p.11 / Chapter 1.3.2.1 --- Collagen --- p.11 / Chapter 1.3.2.2 --- Proteoglycans --- p.12 / Chapter 1.4 --- ROLES OF GROWTH FACTORS TENDON HEALING AND REPAIR --- p.14 / Chapter 1.4.1 --- Platelet-Derived Growth Factor --- p.14 / Chapter 1.4.2 --- Transforming Growth Factor-beta --- p.15 / Chapter 1.5 --- HISTOPATHOLOGY OF PATELLAR TENDINOSIS --- p.16 / Chapter 1.6 --- STUDY PLAN --- p.17 / Chapter 1.6.1 --- Characterization on Hypercellularity --- p.18 / Chapter 1.6.2 --- Characterization on Disorganization and Loosening of Collagen --- p.18 / Chapter 1.6.3 --- Characterization on Inflammatory Trace --- p.20 / Chapter 1.6.4 --- Characterization on Growth Factors in Tendinosis --- p.21 / Chapter 1.7 --- OBJECTIVES --- p.22 / Chapter 2. --- MATERIALS AND METHODS --- p.27 / Chapter 2.1 --- HUMAN TISSUES --- p.27 / Chapter 2.1.1 --- Patellar Tendinosis Tissues --- p.27 / Chapter 2.1.1.1 --- Diagnosis of patellar tendinosis --- p.27 / Chapter 2.1.1.2 --- Recruitment of patients --- p.27 / Chapter 2.1.4 --- Healthy Patellar Tendon tissues --- p.28 / Chapter 2.2 --- TISSUES COLLECTION AND PREPARATION --- p.28 / Chapter 2.3 --- HISTOLOGICAL STUDY ON HUMAN SPECIMENS --- p.28 / Chapter 2.3.1 --- Haematoxyline and Eosin Staining --- p.29 / Chapter 2.3.2 --- Safranin O Staining --- p.29 / Chapter 2.3.2.1 --- Reagents preparation --- p.29 / Chapter 2.3.2.2 --- Experimental procedure --- p.30 / Chapter 2.3.5 --- Polarization Microscopy --- p.30 / Chapter 2.4 --- IMMUNOHISTOCHEMICAL STAINING --- p.30 / Chapter 2.4.1 --- Reagents Preparation --- p.31 / Chapter 2.4.2 --- Experimental Procedure --- p.33 / Chapter 2.5 --- IMAGE ANALYSIS --- p.35 / Chapter 2.5.1 --- Equipment --- p.35 / Chapter 2.5.2 --- Procedures --- p.35 / Chapter 2.6 --- IN SITU ZYMOGRAPHY --- p.37 / Chapter 2.6.1 --- Reagents Preparation --- p.37 / Chapter 2.6.2 --- Experimental Procedure --- p.38 / Chapter 2.7 --- STATISTIC ANALYSIS.… --- p.39 / Chapter 3. --- RESULTS --- p.42 / Chapter 3.1 --- HUMAN SAMPLES --- p.42 / Chapter 3.1.1 --- Patellar tendinosis patients --- p.42 / Chapter 3.1.2 --- Healthy control group --- p.43 / Chapter 3.2 --- HISTOLOGICAL STUDY ON HUMAN SPECIMENS --- p.43 / Chapter 3.2.1 --- Gross Morphology --- p.43 / Chapter 3.2.2 --- Haematoxyline and Eosin Staining --- p.44 / Chapter 3.2.3 --- Safranin O Staining --- p.44 / Chapter 3.2.4 --- Polarization Microscopy --- p.44 / Chapter 3.3 --- IMAGE ANALYSIS --- p.45 / Chapter 3.3.1 --- Immunohistochemistry of PCNA --- p.45 / Chapter 3.3.2 --- Immunohistochemistry of hsp47 --- p.46 / Chapter 3.3.3 --- Immunohistochemistry of Procollogen Type I --- p.47 / Chapter 3.3.4 --- Immunohistochemistry of MMP1 --- p.47 / Chapter 3.3.5 --- Immunohistochemistry of TIMP1 --- p.48 / Chapter 3.3.6 --- Immunohistochemistry of COX-2 --- p.49 / Chapter 3.3.7 --- Immunohistochemistry of TGFP --- p.49 / Chapter 3.3.8 --- Immunohistochemistry of PDGFbb --- p.50 / Chapter 3.3.9 --- Immunohistochemistry of PDGFRβ --- p.51 / Chapter 3.3.10 --- Summary of Image Analysis of Immunohistochemical staining --- p.51 / Chapter 3.4 --- IN SITU ZYMOGRAPHY --- p.52 / Chapter 4. --- DISCUSSION --- p.93 / Chapter 4.1 --- DIAGNOSIS OF PATELLAR TENDINOSIS --- p.93 / Chapter 4.2 --- HYPERCELLULARITY IN PATELLAR TENDINOSIS --- p.95 / Chapter 4.3 --- COLLAGEN DISTURBANCE IN PATELLAR --- p.97 / Chapter 4.4 --- INFLAMMATORY RESPONSE IN PATELLAR TENDINOSIS --- p.100 / Chapter 4.5 --- THE EXPRESSION OF GROWTH FACTORS IN PATELLAR TENDINOSIS --- p.102 / Chapter 4.6 --- PROPOSED PATHOGENESIS FOR PATELLAR TENDINOSIS --- p.105 / Chapter 4.7 --- LIMITATION OF THIS STUDY --- p.108 / Chapter 4.8 --- FUTURE STUDY --- p.109 / Chapter 5. --- CONCLUSION --- p.111 / BIBLIOGRAPHY --- p.113

Syfte: Sammanställa och granska studier gällande postoperativ behandling vid ruptur av ligament patella. Detta för att beskriva effekt och kvalitet på studier om postoperativ behandling. Metod: En beskrivande litteraturstudie valdes som design, med sökorden: patellar ligament, patellar tendon, rupture, knee injuries, surgery. Av totalt 1240 träffar valdes 13 relevanta artiklar publicerade mellan 1999-2013 efter sökningar i databaserna PubMed, PEDro, COCHRANE, SCOPUS, CINAHL, SPORTDiscus och AMED. Artiklarna kvalitetsgranskades enligt PEDro scale. Resultat: Två postoperativa behandlingar beskrevs, tidig och sen mobilisering. Antingen placeras knäleden i ett stabiliserande knäskydd som till en början låser knäleden i full extension eller så påbörjas tidig mobilisering av den opererade knäleden. Ingen signifikant skillnad påvisades mellan tidig och sen mobilisering vad gäller effekten på muskelstyrka, rörelseomfång och återgång till tidigare aktivitetsnivå. Vidare var kvaliteten på de granskade artiklarna genomgående låg (PEDro scale ≤ 5). Konklusion: Ytterligare forskning krävs för att fastställa vilken postoperativ behandling som ger bäst effekt. / Objective: Summarize and examine studies regarding postoperative treatment following rupture of the patellar ligament. Further the aim was to evaluate the effect of the postoperative treatment and the quality of the studies. Method: As design, a descriptive review was chosen, keywords: patellar ligament, patellar tendon, rupture, knee injuries, surgery. From a total of 1240 items, 13 relevant articles published 1999-2013 were selected after search in the databases PubMed, PEDro, COCHRANE, SCOPUS, CINAHL, SPORTDiscus and AMED. The articles were quality-graded according to PEDro scale. Results: Two postoperative treatments were described, early and delayed mobilization. There was no significant difference between them regarding the effect on muscle strength, range of motion and return to preinjury level of activity. The quality-graded articles had overall low quality (PEDro scale ≤ 5). Conclusion: Further researches are required to determine which postoperative treatment has the best effect.

INTRODUÇÃO: A ultrassonografia (US) e a ressonância magnética (RM) representam os principais métodos de diagnósticos por imagem na avaliação do mecanismo extensor do joelho. Há carência de trabalhos que avaliem por US e RM a presença de alterações no mecanismo extensor de jogadores de futebol assintomáticos. OBJETIVO: Avaliar, por meio de RM e US, o tendão quadríceps e o ligamento patelar de jogadores de futebol assintomáticos e dos participantes do grupo-controle. Identificar se há alterações de imagens ou lesões. Determinar se essas sofrem influências pelos seguintes critérios: canhoto ou destro, quanto à dominância ao chute, posição em campo, idade do atleta e tempo de prática esportiva. MÉTODO: Foram avaliados um total de 248 joelhos: 112 eram de 56 de jogadores de futebol assintomáticos e 136 eram do grupo-controle. O grupo composto por jogadores de futebol apresentava idades entre 14 e 34 anos. Já o grupo-controle era composto por indivíduos com idade também entre 14 e 34 anos, principalmente, universitários e funcionários do hospital, com gênero igual aos dos jogadores selecionados, mas sem atividades físicas de impacto, como vôlei, futebol e salto, por exemplo. RESULTADO: Constatou-se a presença de alterações de imagens ou de lesões em nove ligamentos patelares e apenas duas nos tendões quadríceps de jogadores de futebol assintomáticos, tanto pela US quanto pela RM, e nenhum caso alterado no grupo-controle. Houve concordância significativa entre RM e US quanto aos resultados obtidos. Além disso, os jogadores de futebol apresentaram anormalidades (alterações de imagens ou lesões) no tendão quadríceps ou no ligamento patelar significativamente (p<0,05) maior do que no grupo-controle; a idade média dos jogadores com alguma anormalidade é significativamente menor do que a dos jogadores sem lesão (p<0,003); o tempo médio de prática desportiva dos jogadores que apresentam anormalidade é menor do que o tempo médio dos jogadores que não têm anormalidade (p<0,001); os jogadores destros apresentaram anormalidades, enquanto que os jogadores canhotos não (p<0,05). Dentre os jogadores, há correlação entre mais alterações de imagem ou lesão de joelho e menor tempo como jogador e menor idade (R² de Nagelkerke = 0,700). Destros têm risco aumentado de ter anormalidade nas referidas estruturas (Razão de Chances = 15,204) quanto menor for o tempo como jogador de futebol. Os jogadores da defesa têm 4,76 vezes mais chance de desenvolver anormalidade do que atacantes e goleiros (p<0,04). CONCLUSÃO: Os jogadores de futebol assintomáticos apresentam anormalidades no tendão do quadríceps e ligamento patelar detectadas pela RM e US. As alterações estão relacionadas a menor idade, menor tempo de prática desportiva, ser destro e ser jogador de defesa / INTRODUCTION: Ultrasonography (US) and magnetic resonance imaging (MRI) are the main diagnostic imaging methods used in evaluation of the extensor mechanism of the knee. Theres a scarcity of works assessing alterations on the extensor mechanism of the knee of asymptomatic soccer players using US and MRI. OBJECTIVE: To assess, by means of MRI and US imaging, the quadriceps tendon and patellar ligament of asymptomatic soccer players and healthy control group; identify abnormal imaging findings or injuries; ascertain whether these are affected by leg dominance (left or right), field position, age, and time spent practicing the sport. METHOD: A total of 248 knees were evaluated: 112 of 56 asymptomatic soccer players and 136 of healthy controls. The players ages ranged from 14 to 34 years. The control group was composed mostly of college students and hospital staff members, also with ages between 14 and 34, matched for gender to the selected soccer players, and who did not engage in high-impact activities such as volleyball, soccer, or jumping. RESULTS: Abnormal imaging findings or injuries were detected, by US and MRI alike, in nine patellar ligaments and two quadriceps tendons of asymptomatic soccer players. No abnormal findings were detected in the control group. CONCLUSION: There was significant consistency between MRI and US findings. Soccer players were much more likely (p<0.05) to have abnormal imaging findings or injuries of the quadriceps tendon and patellar ligament as compared with the control group; the average age of players presenting some abnormality is significantly lower than of those without injuries (p<0.003); the average time spent practicing the sport for players presenting abnormalities is lower than those who dont present injuries (p<0.001); a correlation between the dominant leg and the affected knee was observed, with the players with a dominant right leg presenting injuries while the ones with a dominant left leg not showing abnormalities (p<0.05). Amongst the players there is a correlation between more abnormal imaging findings or injuries on the knee and less professional practicing time and age (Nagelkerke R² = 0.700).Players with a dominant right leg have an increased chance of presenting abnormalities on the quadriceps tendon and patellar ligament (Odds Ratio = 15.204) with a lower average time spent practicing the sport. Defense players have 4.76 times more chance to develop abnormalities than forward players and goalkeepers (p<0.04). CONCLUSION: The asymptomatic soccer players present abnormalities on the quadriceps tendon and patellar ligament identified using ultrasonography (US) and magnetic resonance imaging (MRI). The alterations are related with less age, less time of professional practice, right leg dominance and defense field position

INTRODUÇÃO: O plasma rico em plaquetas (PRP) é utilizado em medicina esportiva para aumentar e acelerar o processo de reparação tecidual em lesões tendineas e ligamentares, no intuito de proporcionar um retorno mais rápido às atividades esportivas. No entanto faltam estudos com alto nível de evidência comprovando sua eficácia no tratamento destas lesões. Com o objetivo de estudar o efeito da aplicação do PRP no sitio doador de enxerto do ligamento da patela para reconstrução do ligamento cruzado anterior (LCA), realizamos ressonância magnética aos seis meses de pós-operatório para avaliar o ligamento da patela. Também aplicamos questionários de função do joelho e realizamos teste isocinético após seis meses da cirurgia. MÉTODOS: O presente estudo prospectivo, randomizado, avaliador cego incluiu 27 pacientes. Comparamos doze pacientes em que foi utilizado o PRP no defeito criado no terço central do ligamento da patela para retirada de enxerto com quinze pacientes do grupo controle. Aos seis meses de cirurgia realizamos ressonância magnética, em que foi avaliada a área não regenerada do defeito no terço central do ligamento da patela, a área de secção transversa do ligamento e a altura da patela pelo índice de Insall- Salvati. Realizamos teste isocinético e aplicamos questionários específicos de função do joelho. Quantificamos a dor pós-operatória imediata com escala visual analógica (EVA) de dor. RESULTADOS: Aos seis meses de pós-operatório a área não regenerada do defeito no terço central do ligamento da patela foi 4,95 mm2 no grupo PRP e 9,38 mm2 no grupo controle (p=0,046, teste t de Student). A área de secção transversa do ligamento da patela no grupo PRP foi de 173,05 mm2 e no grupo controle 176,29 mm2 (p=0,856). O índice de Insall-Salvati nos grupos PRP e controle foi de 1,04 e 1,06, respectivamente (p=0,808). Não houve diferença entre os grupos nos resultados dos questionários e teste isocinético. Nos pacientes em que foi utilizado o PRP houve menos dor pós-operatória imediata (p=0,02). CONCLUSÃO: Concluímos, nessa amostra, que o uso do PRP no defeito do terço central do ligamento da patela na reconstrução do LCA, nos primeiros seis meses; determinou maior regeneração do defeito; diminuiu a intensidade da dor pós-operatória imediata; não ocasionou alterações estruturais na avaliação por ressonância magnética; e não modificou os resultados clínicos e funcionais da cirurgia / INTRODUCTION: Platelet-rich plasma (PRP) has been used in sports medicine to improve and accelerate ligaments and tendons healing, in an effort to provide a faster return to sports activities. However there is a lack of high evidence level studies to support its use. With the purpose to study the effect of PRP, patellar ligament was evaluated six months after harvesting its central third with magnetic resonance imaging (MRI). We also applied specific questionnaires of knee function and isokinetic testing. METHODS: This blinded, randomized, prospective study included 27 patients. Twelve patients in whom we added PRP in the patellar ligament after harvesting its central third for ACL reconstruction were compared to fifteen patients in the control group. After six months we evaluated the non-regenerated area of the patellar ligament, the cross section area of the patellar ligament and its length (Insall-Salvati index) with MRI. We also evaluated the results of isokinetic testing and specific questionnaires of knee function. Immediate post-operative pain was evaluated with visual analogical scale (VAS) score. RESULTS: The non-regenerated area of the patellar ligament was 4,95 mm2 in the PRP group and 9,35 mm2 in the control group (p=0,046 test). The cross section area of the patellar ligament in the PRP group was 173,05 mm2 and in the control group 176,29 mm2 (p=0,856). The Insall- Salvati index in the PRP and control group was 1,04 and 1,06, respectively (p=0,806). There was no difference between the groups in the questionnaires and isokinetic testing results. PRP group patients had less post-operative pain (p=0,02). CONCLUSION: We concluded, in this sample, that the use of PRP in the patellar ligament after harvesting its central third for ACL reconstruction, in the first six months: improved the ligament regeneration; reduced the intensity of immediate post-operative pain; did not cause structural changes in the patellar ligament in MRI; and did not modify the clinical and functional results of the procedure