Thesis (doctoral)--Københavns universitet.

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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

O reparo do ligamento cruzado cranial (LCCr) tem sido motivo de preocupação e pesquisas para desenvolver técnica cirúrgica efetiva. Recentemente novas técnicas tem se proposto a reestabelecer a biomecânica e função do joelho, chamadas de técnicas dinâmicas, entre elas Tibial Plateau Leveling Osteotomy (TPLO) e Tibial Tuberosity Advancement (TTA). Embora efetivas, várias são as complicações relatadas, e uma delas é o espessamento e desmite patelar, mais frequente com a técnica de TPLO, mas recentemente também relatada para a técnica de TTA. Vários foram os mecanismos propostos para explicar este fenômeno, embora a causa continue desconhecida. Baseado nisso é que a nossa pesquisa teve como objetivo avaliar de forma biomecânica ex vivo, as mudanças na tensão do ligamento patelar submetido às técnicas de TPLO e TTA, quando comparadas entre elas e com membros pélvicos sem osteotomia (íntegro e RLCCr). Foram testados de forma biomecânica ex vivo dez pares de membros pélvicos de cães entre dois a sete anos de idade e pesos entre 25 a 35 kg, sem predileção de raça ou sexo. As peças foram submetidas à carga de 30% do peso corporal, e testadas em três situações diferentes: a primeira com a articulação fêmoro-tíbio-patelar íntegra, numa segunda etapa com RLCCr, e por último com as técnicas de osteotomia, respeitando a regra, membros pélvicos direitos com TTA e membros pélvicos esquerdos com TPLO, e cada uma delas foi testada em duas situações de ângulos, a primeira 145 graus na articulação fêmoro-tíbio-patelar e 135 graus na articulação tíbio-társica e uma segunda situação invertendo os valores. Os dados foram submetidos a testes pareados não paramétricos de Friedman e Wilcoxon. Em quanto a força do ligamento patelar os resultados permitiram concluir que não existe diferença significativa entre o grupo íntegro e RLCCr, que existe diferença entre as técnicas de TTA e TPLO, quando comparadas com a situação íntegro e RLCCr e que existe diferença de força do ligamento patelar entre TPLO 145 versus TPLO 135 e entre TTA 145 versus TTA 135. / Cranial cruciate ligament repair (RLCCr) has been the focus of research to develop an effective surgical technique. Currently new dynamic techniques such as Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) have been proposed to restore the biomechanical knee function. Several complications have been reported despite of technique effectiveness. Patellar ligament inflammation and desmitis are usually reported as complication for TPLO but it was also reported for TTA. Several mechanisms have been proposed to explain this phenomenon but the cause remains unknown. Based on this complication, our objective was to evaluate the patellar ligament tension changes in the TPLO and TTA using an ex vivo model comparing both techniques one each other and with normal hind limbs. The sample population was ten pairs of cadaveric hind limb from dogs weighing 25 to 35 kg and with two to seven years of age without any predilection for breed or sex. The pieces were axially loaded using a material testing machine with 30% body weight in three different situations. The first test was performed with the CCL intact followed by the second test with the LCC transection and finally with osteotomy techniques for the third test. TPLO and TTA were always performed in the left and right hind limb respectively. The tests were conducted in two variations of angles joints. The first variation maintained a stifle angle of 145 degrees with the tibio-tarsal angle of 135 degrees and the second variation had inverted the values between these joints. Data were analyzed using Friedman and Wilcoxon test with repeated measures. In much the strength of the patellar ligament the results showed that there is no significant difference between the group intact and RLCCr that exists between the different techniques TTA and TPLO, when compared with the situation of integrity and RLCCr and strength that exists apart from the ligament TPLO patellar between 135 and 145 versus TPLO between TTA 145 versus 135.

The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee with over 100,000 injuries occurring annually in the United States alone. Often referred to as a single ligament, anatomically the ACL is composed of two distinct bundles: anteromedial (AM) and posterolateral (PL) To date, the change in position of the AM and PL bundles in the frontal plane during internal and external rotation of the tibia have gone unreported. Therefore, the aim of this study was to quantify and compare the movements of a femoral, midpoint, and tibial marker located on the AM and PL bundles of the ACL during 15° of internal and external rotation, in the presence and absence of an anterior force. Significant differences were found between internal and external rotation for both bundles in the presence and absence of an anterior force. Moreover, the tibial marker had the greatest change in position.

Made available in DSpace on 2014-12-17T14:13:36Z (GMT). No. of bitstreams: 1 GildasioLL_TESE.pdf: 952665 bytes, checksum: 96197adbbfc671543c2756fd03d62d1e (MD5) Previous issue date: 2010-11-17 / Osgood-Schlatter (O-S) syndrome, a pathology of the musculoskeletal system, exhibits high incidence in adolescence, a phase of accelerated bone growth. Detection of physiopathological mechanisms that may cause disorders and dysfunctions in bone growth must be taken into account when planning physical activities, in order to promote normal physiological growth patterns. The aim of this epidemiological investigation was to identify and analyze the relationships between sociodemographic, anthropometric and clinical aspects and O-S. A cross-sectional design was used, with a representative sample of 956 subjects: 474 (49.6%) males and 482 (50.4%) females. Age range varied between 12 and 15 years (mean = 13.7?1.04). We used a battery of tests, previously applied in a pilot study, which met the aims of the investigation. Descriptive statistics (frequency, mean and standard deviation) were used and the odds ratio was calculated from bivariate and multivariate logistic regression (p<0.05). A prevalence of 9.8% was found (n = 94 cases): 11% males and 8.3% females. Hierarchized multivariate analysis showed a significant association between regular physical activities (OR= 1.94; CI 95%, 1.22-3.10) and shortening of the rectus femoris muscle (OR= 7.15; CI 95%, 2.86-17.86). The results may serve as a basis for therapeutic and prophylactic measures, in addition to increasing our knowledge of this syndrome in Brazilian adolescents. This investigation used a multidisciplinary approach, involving elements of anatomy, nutrition, physical education and physical therapy to elucidate the object under study related to Osgood-Schlatter syndrome / A S?ndrome de Osgood-Schlatter (O-S) representa uma enfermidade do sistema m?sculo-esquel?tico com uma incid?ncia elevada na adolesc?ncia, fase onde se evidencia uma acelera??o do crescimento ?sseo. A detec??o de mecanismos fisiopatol?gicos que possam gerar dist?rbios e disfun??es do crescimento ?sseo, representam fatores de prote??o e devem ser considerados nas a??es de planejamento de atividades f?sicas, visando propiciar um crescimento dentro de padr?es fisiol?gicos. O objetivo dessa investiga??o epidemiol?gica foi identificar e analisar as rela??es dos aspectos s?cio-demogr?ficos, antropom?tricos e cl?nicos com a O-S. Este estudo teve um delineamento transversal, com uma amostra representativa 956 sujeitos, sendo 474 (49,6%) do sexo masculino e 482 (50,4%)do sexo feminino. A faixa et?ria variou de 12 a 15 anos (m?dia = 13,7?1,04). Para o exame cl?nico, foi utilizada uma bateria de testes que atendesse aos objetivos da investiga??o; testes estes previamente aplicados em um estudo piloto. Para an?lise foram utilizados procedimentos da estat?stica descritiva (frequ?ncia, m?dia e desvio padr?o) e o c?lculo da raz?o de chance (Odds Ratio) mediante regress?o log?stica bivariada e multivariada; p<0,05. Encontrou-se uma preval?ncia de 9,8% (n=94 casos), sendo 11% para o sexo masculino e 8,3% para o feminino, nos quais, a partir de an?lise multivariada hierarquizada, verificou-se associa??o significativa na pr?tica regular de atividades (OR= 1,94; IC 95%, 1,22-3,10) com o encurtamento do m?sculo reto femoral (OR= 7,15; IC 95%, 2,86-17,86). Os resultados do estudo poder?o servir como base terap?utica e na tomada de medidas profil?ticas, al?m de possibilitar um aprofundamento no que se sabe sobre acerca desta s?ndrome entre os adolescentes brasileiros. Esta investiga??o teve a xv abordagem multidisciplinar, momento em que envolveu elementos da anatomia, nutri??o, educa??o f?sica e fisioterapia na elucida??o do objeto de estudo relacionado ? s?ndrome de Osgood-Schlatter

O reparo do ligamento cruzado cranial (LCCr) tem sido motivo de preocupação e pesquisas para desenvolver técnica cirúrgica efetiva. Recentemente novas técnicas tem se proposto a reestabelecer a biomecânica e função do joelho, chamadas de técnicas dinâmicas, entre elas Tibial Plateau Leveling Osteotomy (TPLO) e Tibial Tuberosity Advancement (TTA). Embora efetivas, várias são as complicações relatadas, e uma delas é o espessamento e desmite patelar, mais frequente com a técnica de TPLO, mas recentemente também relatada para a técnica de TTA. Vários foram os mecanismos propostos para explicar este fenômeno, embora a causa continue desconhecida. Baseado nisso é que a nossa pesquisa teve como objetivo avaliar de forma biomecânica ex vivo, as mudanças na tensão do ligamento patelar submetido às técnicas de TPLO e TTA, quando comparadas entre elas e com membros pélvicos sem osteotomia (íntegro e RLCCr). Foram testados de forma biomecânica ex vivo dez pares de membros pélvicos de cães entre dois a sete anos de idade e pesos entre 25 a 35 kg, sem predileção de raça ou sexo. As peças foram submetidas à carga de 30% do peso corporal, e testadas em três situações diferentes: a primeira com a articulação fêmoro-tíbio-patelar íntegra, numa segunda etapa com RLCCr, e por último com as técnicas de osteotomia, respeitando a regra, membros pélvicos direitos com TTA e membros pélvicos esquerdos com TPLO, e cada uma delas foi testada em duas situações de ângulos, a primeira 145 graus na articulação fêmoro-tíbio-patelar e 135 graus na articulação tíbio-társica e uma segunda situação invertendo os valores. Os dados foram submetidos a testes pareados não paramétricos de Friedman e Wilcoxon. Em quanto a força do ligamento patelar os resultados permitiram concluir que não existe diferença significativa entre o grupo íntegro e RLCCr, que existe diferença entre as técnicas de TTA e TPLO, quando comparadas com a situação íntegro e RLCCr e que existe diferença de força do ligamento patelar entre TPLO 145 versus TPLO 135 e entre TTA 145 versus TTA 135. / Cranial cruciate ligament repair (RLCCr) has been the focus of research to develop an effective surgical technique. Currently new dynamic techniques such as Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) have been proposed to restore the biomechanical knee function. Several complications have been reported despite of technique effectiveness. Patellar ligament inflammation and desmitis are usually reported as complication for TPLO but it was also reported for TTA. Several mechanisms have been proposed to explain this phenomenon but the cause remains unknown. Based on this complication, our objective was to evaluate the patellar ligament tension changes in the TPLO and TTA using an ex vivo model comparing both techniques one each other and with normal hind limbs. The sample population was ten pairs of cadaveric hind limb from dogs weighing 25 to 35 kg and with two to seven years of age without any predilection for breed or sex. The pieces were axially loaded using a material testing machine with 30% body weight in three different situations. The first test was performed with the CCL intact followed by the second test with the LCC transection and finally with osteotomy techniques for the third test. TPLO and TTA were always performed in the left and right hind limb respectively. The tests were conducted in two variations of angles joints. The first variation maintained a stifle angle of 145 degrees with the tibio-tarsal angle of 135 degrees and the second variation had inverted the values between these joints. Data were analyzed using Friedman and Wilcoxon test with repeated measures. In much the strength of the patellar ligament the results showed that there is no significant difference between the group intact and RLCCr that exists between the different techniques TTA and TPLO, when compared with the situation of integrity and RLCCr and strength that exists apart from the ligament TPLO patellar between 135 and 145 versus TPLO between TTA 145 versus 135.

Thesis (doctoral)--University of Uppsala, 1983. / Includes bibliographical references (p. 36-41).

Master of Science in Biomedical Sciences / Department of Clinical Sciences / James K. Roush / Interday and intraday stance analysis variability in dogs with hindlimb lameness Objective: The purpose of this study was to assess the same day and next-day repeatability of data collected with a Pet Safe Stance Analyzer on animals with naturally-occurring lameness presented for veterinary orthopedic examination. Our hypothesis was that dogs would show consistent repeatability with regards to body weight distribution on the Pet Safe Stance analyzer. Materials and Methods: Interday Variability Trial: Thirty-one consecutive dogs presenting for hindlimb lameness were included. The PetSafe Stance Analyzer was used with the dog standing in their natural standing position with each foot placed in its respective quadrant on the Stance Analyzer. A minimum of 5 valid measurements were collected and averaged to find the mean distribution of weight on each limb. This process was repeated the following day with the same handler and recorder. Intraday Variability Trial: Fifteen consecutive dogs were placed on the Pet Safe Stance analyzer and measurements were collected for each of 5 trials identical to the interday group. Four additional assessment trials followed with reintroduction of the animal to the room at each assessment. Results: Interday Variability Trial: There were no significant differences between Day 1 and Day 2 measured variables except for a significant increase in the Forelimb Symmetry index on Day 2 compared to Day 1. Lin’s Correlation Coefficients % body weight measured on Day 1 compared to Day 2 were significantly correlated on the lame hindlimb (0.524) and contralateral hindlimb (0.733). Intraday Variability Trial: There were no significant differences across trials for measured variables of % weight on the lame hindlimb, contralateral hindlimb, ipsilateral forelimb, or contralateral forelimb. Lin’s Correlation coefficients showed strong correlation between trials for the lame hindlimb (0.682), contralateral hindlimb (0.817), body weight (0.863), and hindlimb symmetry index (0.726). Clinical Significance: A commercial stance analyzer is a repeatable method of measurement of weight-bearing on lame hindlimbs of dogs between days and in repeated trials over one day. Day-to-day forelimb weight-bearing in dogs who are lame on a hindlimb is more variable, likely because of trial to trial changes in weight redistribution from lameness. Comparison of the effect of dog, surgeon, and TPLO surgical procedure variables on improvement of eight-week post-operative static weight-bearing Objective: To compare the effect of surgeon and tibial plateau leveling osteotomy (TPLO) procedure variations on the outcome of TPLO in naturally-occurring cranial cruciate-deficient stifles. Materials and methods: Records from 142 dogs receiving a TPLO were reviewed for information regarding surgical procedure, status of meniscus at the time of surgery, surgeon identity, ACVS diplomate or resident, meniscal release, progression of healing at the progress evaluation based on radiographic interpretation, and complications encountered. The primary outcome measure was static force on the operated limb at recheck on a PetSafe Stance Analyzer ͣ. Results: Recheck tibial plateau angle (TPA) was negatively and significantly correlated with improvement (r=-0.2132, p=0.013). Post-operative, and Recheck TPA’s were all significantly correlated with one another. The amount of TPA change from initial to immediate post-operative values was significantly correlated with the Initial TPA (r=0.628, p<0.001). Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, post-operative TPA, and initial TPA had no significant effect on weight-bearing at recheck. Clinical Significance: TPLO’s show improvement of 4.58% BW on the operated limb at 6-12 week rechecks on a stance analyzer. Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, post-operative TPA, and initial TPA have no effect on surgical outcome.

BEZERRA, Marcelo José Cortez. Liberação do túnel do tarso pela tecnica endoscópica : uma proposta de acesso cirúrgico. 2005. 27 f. Dissertação (Mestrado em Cirurgia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2005. / Submitted by denise santos (denise.santos@ufc.br) on 2014-03-10T15:39:37Z No. of bitstreams: 1 2005_dis_mjcbezerra.pdf: 121982 bytes, checksum: 7c3d1a86653eb7cc29a19b66be41c180 (MD5) / Approved for entry into archive by denise santos(denise.santos@ufc.br) on 2014-03-10T15:48:47Z (GMT) No. of bitstreams: 1 2005_dis_mjcbezerra.pdf: 121982 bytes, checksum: 7c3d1a86653eb7cc29a19b66be41c180 (MD5) / Made available in DSpace on 2014-03-10T15:48:47Z (GMT). No. of bitstreams: 1 2005_dis_mjcbezerra.pdf: 121982 bytes, checksum: 7c3d1a86653eb7cc29a19b66be41c180 (MD5) Previous issue date: 2005 / Establish two portals in cadaver specimens, using anatomical delimitation points and geometrical lines, which allow the access to the tarsal tunnel by the video-endoscopic technique and the comparison between the proximal-distal direction approach with the reverse one. This trial has included 18 cadavers and 36 ankles were the total amount that was studied. Starting with the biportal endoscopic technique, initially described and modified in this trial through geometrical lines and anatomical points delimitation, the tarsal tunnel was released in left ankles with the insertion of instruments using proximal-distal direction and the opposite to the right ankles. There were, in the right ankles, complete section of flexor retinaculum in 15 cases (83,3%) and partial section in 3 cases (16,67%). In the left ankles there were complete section of flexor retinaculum in 16 (88,89%) and partial section in 2 cases (11,11%). The average operative time was 19,44 minutes for the right limb and 18,33 minutes for the left limb. No damage to neurovascular structures has been observed in any case. According to the suggested technique, the total section of flexors retinaculum was obtained in all the cases after learning curve period without lesion of anatomical structures in the tarsal tunnel, independent of whatever be the direction chosen in the access way. / Estabelecer em cadáveres, dois portais, através da delimitação de pontos anatômicos e linhas geométricas, que permitam o acesso ao Túnel do Tarso pela técnica videoendoscópica e comparar a abordagem no sentido proximal para distal com a reversa. Fizeram parte do estudo 18 cadáveres, com um total de 36 tornozelos. Partindo da técnica endoscópica bi-portal inicialmente descrita, e modificada neste estudo através da padronização de pontos anatômicos e linhas geométricas, o Túnel do Tarso foi liberado nos tornozelos esquerdos com a inserção do instrumental no sentido proximal para distal e o inverso nos direitos. Nos tornozelos direitos, houve secção completa do retináculo flexor em 15 casos (83,3%) e parcial em 3 casos (16,67%). Nos esquerdos, a secção foi completa em 16 casos (88,89%) e parcial em 2 casos (11,11%). O tempo operatório no lado direito foi em média 19,44 minutos e no esquerdo 18,33 minutos. Em nenhum caso foi observada lesão de estruturas neurovasculares. Com a técnica proposta a secção total do retináculo dos flexores foi obtida em todos os casos após a curva do aprendizado, sem lesão de estruturas anatômicas do túnel do Tarso, independente do sentido utilizado na via de acesso.