Revista Brasileira de Ortopedia最新文献

Objective: To determine the positioning of the knee joint line height based on anatomical references, that is, the distance of the femoral condylar bicortical axis and the medial and lateral epicondylar distances in the Brazilian population.

Methods: We analyzed 500 magnetic resonance imaging tests of the knees of 250 women and 250 men to measure the condylar bicortical axis (CBA) and the distance of the joint height to the medial epicondyle (MED) and to the lateral epicondyle (LED).

Results: The mean age of the patients was 50.91 years old, with a standard deviation (SD) of ± 14.76. The mean CBA distance was 72.11 ± 5.93 mm. The mean MED and LED values were 33.39 ± 3.50 mm and 26.32 ± 4.08 mm, respectively. The formulas to estimate the distance of the joint line from the medial and lateral epicondyles were MED = 0.4618 x CBA and LED = 0.3615 x CBA for male subjects and MED = 0.4653 x CBA and LED = 0.3767 x CBA for female subjects using a 95% confidence interval.

Conclusion: The distance to the femoral CBA can be a reference for determining the joint line positioning from the distances of the medial and lateral femoral epicondyles.

Low back pain (LBP) is a very prevalent clinical condition worldwide. Approximately 90% of the cases are of nonspecific LBP, due to the lack of anatomopathological changes as potential causes of pain. A more assertive therapeutic approach requires identifying red or yellow flags and diagnosing the pain pattern (nociceptive, neuropathic, nociplastic, or mixed pain). Acute LBP prognosis is favorable in most cases, and the therapeutic objective is to prevent chronicity. For chronic LBP, the goals include pain reduction and improvements in functionality and quality of life. In acute and chronic cases, the principle of multimodal analgesia guides the treatment, which combines pharmacological, non-pharmacological, and interventional methods. The most common medications for LBP are simple analgesics, such as paracetamol, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioid analgesics. Opioids and NSAIDs should be prescribed at the lowest dose and for the shortest possible time. Patients with neuropathic components may receive adjuvant drugs. Phytocannabinoids may play a role when the previous pharmacological treatment fails. Physical methods, including heat, laser, and extracorporeal shock wave therapy, improve local circulation, produce muscle relaxation, and treat the myofascial component. Interventions such as acupuncture and radiofrequency promote peripheral and/or central neuromodulation. Aligning the patient's expectations to the outcomes of the proposed treatments is essential; to do so, we must consider the educational measures, behavioral therapies, and physical rehabilitation.

Total knee arthroplasty (TKA) is the gold standard to treat degenerative knee joint conditions that do not improve with conservative treatment, and it yields excellent clinical and functional outcomes. However, a small proportion of patients report some dissatisfaction with their knees after surgery. Recently, TKA underwent significant technological development with the introduction of new biomechanical concepts and the incorporation of techniques to improve surgical procedures. Moreover, the evolution in implant designs optimized for the individual characteristics of the patients enables better surgical customization. The current article presents the concepts, advantages, and limitations to the development of customized implants, as well as TKA surgical techniques involving automation (robotics) and computer-assisted navigation. Although the medical literature showing promising outcomes with new TKA technologies is extensive, studies with longer follow-up and appropriate methodologies are required to contribute to the demonstration of advantages in knee arthroplasty outcomes.

Low back pain (LBP) is a very prevalent clinical condition worldwide. Approximately 90% of the cases are of nonspecific LBP, due to the lack of anatomopathological changes as potential causes of pain. A more assertive therapeutic approach requires identifying red or yellow flags and diagnosing the pain pattern (nociceptive, neuropathic, nociplastic, or mixed pain). Acute LBP prognosis is favorable in most cases, and the therapeutic objective is to prevent chronicity. For chronic LBP, the goals include pain reduction and improvements in functionality and quality of life. In acute and chronic cases, the principle of multimodal analgesia guides the treatment, which combines pharmacological, non-pharmacological, and interventional methods. The most common medications for LBP are simple analgesics, such as paracetamol, muscle relaxants, nonsteroidal antiinflammatory drugs (NSAIDs), and opioid analgesics. Opioids and NSAIDs should be prescribed at the lowest dose and for the shortest possible time. Patients with neuropathic components may receive adjuvant drugs. Phytocannabinoids may play a role when the previous pharmacological treatment fails. Physical methods, including heat, laser, and extracorporeal shock wave therapy, improve local circulation, produce muscle relaxation, and treat the myofascial component. Interventions such as acupuncture and radiofrequency promote peripheral and/or central neuromodulation. Aligning the patient's expectations to the outcomes of the proposed treatments is essential; to do so, we must consider the educational measures, behavioral therapies, and physical rehabilitation.

Objective: To determine the positioning of the knee joint line height based on anatomical references, that is, the distance of the femoral condylar bicortical axis and the medial and lateral epicondylar distances in the Brazilian population.

Methods: We analyzed 500 magnetic resonance imaging tests of the knees of 250 women and 250 men to measure the condylar bicortical axis (CBA) and the distance of the joint height to the medial epicondyle (MED) and to the lateral epicondyle (LED).

Results: The mean age of the patients was 50.91 years old, with a standard deviation (SD) of ± 14.76. The mean CBA distance was 72.11 ± 5.93mm. The mean MED and LED values were 33.39 ± 3.50mm and 26.32 ± 4.08mm, respectively. The formulas to estimate the distance of the joint line from the medial and lateral epicondyles were MED = 0.4618 x CBA and LED = 0.3615 x CBA for male subjects and MED = 0.4653 x CBA and LED = 0.3767 x CBA for female subjects using a 95% confidence interval.

Conclusion: The distance to the femoral CBA can be a reference for determining the joint line positioning from the distances of the medial and lateral femoral epicondyles.

Total knee arthroplasty (TKA) is the gold standard to treat degenerative knee joint conditions that do not improve with conservative treatment, and it yields excellent clinical and functional outcomes. However, a small proportion of patients report some dissatisfaction with their knees after surgery. Recently, TKA underwent significant technological development with the introduction of new biomechanical concepts and the incorporation of techniques to improve surgical procedures. Moreover, the evolution in implant designs optimized for the individual characteristics of the patients enables better surgical customization. The current article presents the concepts, advantages, and limitations to the development of customized implants, as well as TKA surgical techniques involving automation (robotics) and computer-assisted navigation. Although the medical literature showing promising outcomes with new TKA technologies is extensive, studies with longer follow-up and appropriate methodologies are required to contribute to the demonstration of advantages in knee arthroplasty outcomes.

Objective: To investigate the clinical correlation between internal knee rotation and the association of injuries between anterolateral (ALL) and anterior cruciate (ACL) ligaments.

Methods: Thirty-eight knees of 19 fresh corpses (all males, mean age: 28-years-old) were evaluated by simulating physical examination through manual rotational tests at 90 degrees of flexion. Kirschner wires were placed in parallel in the femur and tibia, and measurements were obtained using a goniometer. The obtained data were compared against the intact ACL, then to progressive sections of the ACL, iliotibial tract, and anterolateral ligament.

Results: Isolated release of the ACL induced an increase (+55.6%, p  < 0.001) in internal rotation at 90 degrees of flexion, when compared to the the intact knee. After ACL release, associated release of the iliotibial tract (ITT) induced an increase (+31.6%, p  < 0.001) in the internal rotation of the knee at 90 degrees of flexion, and a marked increase (+104%, p  < 0.001) when compared to the ACL-intact knee. After ACL and ITT release, ALL release induced a significant increase (+27.8%, p  < 0.001) in the internal rotation of the knee at 90 degrees of flexion, and in comparison with the intact ACL knee (+162%, p  < 0.001).

Conclusion: There is an increase in internal rotation of the knee in the ACL injury. The association with ALL injury leads to a pronounced increase of internal rotation when compared to the uninjured knee. Therefore, the presence of pronounced internal knee rotation is a clinical sign of associated injury to these structures.

Objective: To investigate the clinical correlation between internal knee rotation and the association of injuries between anterolateral (ALL) and anterior cruciate (ACL) ligament.

Methods: Thirty-eight knees of 19 fresh corpses (all males, mean age: 28-years-old) were evaluated by simulating physical examination through manual rotational tests at 90 degrees of flexion. Kirschner wires were placed in parallel in the femur and tibia, and measurements were obtained using a goniometer. The obtained data were compared against the intact ACL, then to progressive sections of the ACL, iliotibial tract, and anterolateral ligament.

Results: Isolated release of the ACL induced an increase (+55.6%, p  < 0.001) in internal rotation at 90 degrees of flexion, when compared to the internal rotation of the intact knee. After ACL release, associated release of the iliotibial tract (ITT) induced an increase (+31.6%, p  < 0.001) in the internal rotation of the knee at 90 degrees of flexion, and a marked increase (+104%, p  < 0.001) when compared to the ACL-intact knee. After ACL and ITT release, an additional ALL release induced a significant increase (+27.8%, p  < 0.001) in the internal rotation of the knee at 90 degrees of flexion, and in comparison with the intact ACL knee (+162%, p  < 0.001).

Conclusion: There is an increase in internal rotation of the knee in the ACL injury. The association with ALL injury leads to a pronounced increase of internal rotation when compared to the uninjured knee. Therefore, the presence of pronounced internal knee rotation is a clinical sign of associated injury to these structures.

Objective: This study aimed to evaluate the influence of computed tomography (CT) on the preoperative planning of posterior malleolus (PM) fractures of the ankle, comparing its information with that of conventional radiographs and assessing its impact on surgical treatment.

Methods: The study included 81 patients with PM fractures, whose radiological and CT images were analyzed by 33 specialized orthopedic surgeons. The study had two stages, with a radiological assessment on the first, and the second having radiological plus CT evaluation. In both stages, we asked surgeons about the PM size, fracture stability, preoperative management, and potential modifications after CT analysis.

Results: Considering only radiographs, 83.5% of the evaluators selected PM fixation. However, CT addition modified this choice in 49.1% of the cases, influencing the surgical access route and the type of osteosynthesis. In 34.7% of cases, CT revealed a larger PM fragment than radiographs, demonstrating that it is superior in evaluating fracture size and morphology.

Conclusion: The surgical planning of ankle fractures with PM involvement should routinely include CT scans for a more precise fracture line assessment and a potential change in the therapeutic decision based on simple radiography alone.