Acta Ortopedica Brasileira最新文献

Objective: To evaluate isometric and isokinetic ankle strength in of dorsiflexion (DF), plantar flexion (PF), inversion (INV), and eversion (EVE) in healthy individuals.

Methods: A cross-sectional study was conducted with individuals aged 18 to 60 years, of both sexes. The Lafayette® isometric manual dynamometer was used to evaluate isometric strength, the Humac Norm® isokinetic dynamometer to evaluate isokinetic strength, and the IPAQ questionnaire (International Physical Activity Questionnaire) for the level of physical activity. Statistical analysis compared sex, dominance, and physical activity level with isometric and isokinetic strengths using the Spearman coefficient and the Mann-Whitney test.

Results: There was a difference between genders for dominant and non-dominant limbs in isokinetic strength and not in isometric strength. There was a difference between isokinetic strength variables and physical activity levels. The isokinetic strength of dominant PF (p=0.0153), non-dominant (p=0.0287), and non-dominant INV (p=0.0183) demonstrated that very active individuals have a higher torque peak than irregularly active and sedentary individuals.

Conclusion: The results demonstrated greater isokinetic strength in men than in women and active individuals compared to sedentary ones. However, it was not possible to establish an association between isometric and isokinetic ankle measurements. Level of Evidence IV, Cross-Sectional Study.

Introduction: The treatment of large and massive rotator cuff tears remains challenging. This study evaluates the efficacy and safety of reinforcement with the long head of the biceps tendon (LHBT) in patients with large and massive repairable rotator cuff tears.

Methods: This is a prospective case series involving 25 patients who underwent open repair of large and massive rotator cuff tears with LHBT reinforcement. All patients were operated by the same surgeon and followed up for one year.

Results: Pain scores (VAS: 6.6 ± 2.30 vs. 2.68 ± 2.73; p<0.001) and function scores (ASES: 36.86 ± 19.27 vs. 73.96 ± 23.73; p<0.001; UCLA: 13.04 ± 3.83 vs. 26.04 ± 7.39; p<0.001) improved significantly postoperatively compared to preoperatively. The biceps healing rate was 84%, while the rotator cuff retear rate was 60%. No complications related to the biceps or surgical site infections were documented.

Conclusion: Reinforcement with the long head of the biceps tendon in the repair of large and massive rotator cuff tears shows satisfactory clinical outcomes and a low complication rate. Level of Evidence: IV, Case Series.

Objective: The presence of popliteal cysts is common, although often unkown to the patient. When spontaneous rupture occurs, the clinical presentation is typically dramatic, frequently prompting the patient to seek emergency care. Eventually the condition can be mistaken for other pathologies, more commonly deep vein thrombosis, leading to inappropriate treatment. The objective of this study is to describe a case series of spontaneous Baker's cyst ruptures, with a 2-year follow-up.

Methods: Sixteen consecutive patients with symptomatic ruptured popliteal cyst were treated acutely with anti-inflammatory measures and physical therapy.

Results: All patients had a good resolution of their cases with conservative treatment over an average period of one week, and there was no recurrence of cyst rupture.

Conclusion: Spontaneous rupture of Baker's cyst in adult patients can be very symptomatic and disabling; however, once diagnosed, it responds well to conservative treatment and rarely recurs. Level of Evidence IV; Case Series.

Objective: The aim of this study is to investigate the number of surgeries necessary for an orthopedic surgeon specialized in shoulder surgery to become proficient in performing arthroscopy. This is an original article with level V evidence.

Methods: A cross-sectional study was designed to examine the perspectives of surgeons at various stages of their careers, using an online questionnaire.

Results: A total of 251 participants responded. The most prevalent training period was more than 15 years of experience. The proficient level was the most prevalent. In evaluating the number of arthroscopies by proficiency level, all agreed that for the specialist level, a total of over 500 arthroscopies is necessary. Most respondents judged 31 to 50 arthroscopies as necessary to perform safely. According to the methodologies, the best-rated were acting as the lead surgeon and training on cadavers.

Conclusion: The study showed that 31 to 50 cases are necessary to perform shoulder arthroscopy safely, and over 500 cases to reach the specialist level. Participation as the lead surgeon and training on cadavers were rated as very important in specialist training. Evidence Level V; Expert Opinion.

Objective: To investigate the efficacy and safety of anterior cervical mini-incision vertebroplasty in the treatment of vertebral metastases.

Methods: From July 2009 to March 2013, seven cases of vertebral metastases were treated by using vertebroplasty through an anterior cervical paratracheal mini-incision guided by C-arm X-ray in Beijing friendship hospital, Capital medical university. Among them, three were male and four were female, aged 51 to 74 years with an average age of 61.7 years. Preoperative and postoperative Visual Analog Scale (VAS) scores and analgesic medication usage were evaluated, and postoperative pain relief was assessed using the World Health Organization (WHO) criteria.

Results: All seven surgeries were successful without any occurrences of complications such as nerve or vascular injury, pulmonary embolism, or hematoma. The average cement injection volume was 1.8ml, and postoperative X-rays and CT scans indicated satisfactory cement filling, with two cases showing paravertebral cement leakage, but without clinical symptoms. One week postoperatively, the VAS score decreased from a preoperative average of 8.86 to 2.14, with complete pain relief in three cases, leading to the cessation of analgesic drugs, and partial pain relief in four cases, resulting in a reduction or downgrade of analgesic medications. Follow-ups ranged from 3 to 28 months, with one patient dying at 3 months postoperatively, one at 4 months, two at 6 months, one at 8 months, and one at 17 months, while one patient survived 28 months postoperatively. Postoperatively, all patients showed no worsening of local pain symptoms, and the surgical efficacy remained stable.

Conclusion: Anterior cervical mini-incision vertebroplasty is a precise and effective method for pain relief in the treatment of vertebral metastases, providing a safe approach that reduces the risk of damaging critical cervical tissues during the puncture procedure and postoperative hematoma formation. Level of Evidence lll; Retrospective Study.

Objectives: this study aimed to compare the radiographic, functional and isokinetic results of the early repair of quadriceps tendon rupture (QTR) and patellar tendon rupture (PTR).

Methods: We conducted a prospective observational study at a level one urban university trauma center from January 2022 to March 2023. The study included patients aged 18 years and older who underwent surgery within three weeks of injury and had at least one year of follow-up. The evaluation used the patellar indices (Insall-Salvati, Blackburn Peel and Caton Deschamps), functional (Lysholm and PCS-12) and isokinetic assessment.

Results: the study involved 20 patients, predominantly male, with a slight predominance of left-sided injuries. The mean age was 39.4 years. Surgical outcomes showed no significant radiographic differences post-repair. Functionally, the PTR group exhibited better recovery compared to the QTR group, particularly in returning to sports and work. Isokinetic testing revealed a substantial reduction in strength on the injured side compared to the uninjured side across both groups.

Conclusion: early surgical intervention leads to favorable radiographic and functional outcomes. The PTR group showed better functional recovery, especially in return to work and sports. No significant differences were found in isokinetic strength recovery between the QTR and PTR groups. Level of Evidence III; Prospective Observational Study.

Osteosarcoma is the most common aggressive primary bone tumor in children and adolescents. Angiogenesis, induced by vascular endothelial growth factor (VEGF) and its receptor (kinase insert domain receptor - KDR) is involved in tumor development. Both genes (VEGF and KDR) are polymorphic, and their association with osteosarcoma remains unclear. A systematic review of observational studies was performed to evaluate the association between polymorphisms in these genes and osteosarcoma development. Pubmed, Medline, Lilacs, and Scielo databases were searched for observational studies published up to April 2024. Eight publications of case-control studies were included, with quality ranging from 82% to 95%. All subjects were from the Chinese population: 1,681 cases and 2,049 controls. A total of six VEGF polymorphisms were analyzed. For osteosarcoma susceptibility, three studies found an increased risk with VEGF rs699947, four with VEGF rs2010963, two with VEGF rs3025039, one with VEGF rs833061, and no studies found an association with the VEGF rs1570360 and VEGF rs10434 SNPs. In addition, no studies evaluated SNPs in the KDR gene and osteosarcoma susceptibility. Further studies in diverse populations, particularly in Brazil, are necessary to clarify the role of VEGF and KDR polymorphisms in osteosarcoma development and prognosis. Level of evidence III; Systematic Review.

Introduction: The primary objective was to evaluate the efficacy of hyaluronic acid injections for lateral epicondylitis. Secondary objectives included assessing pain and functional outcomes at various time points following the injection.

Methods: This prospective cohort study included patients who received two hyaluronic acid injections one week apart after prior conservative treatment. Assessments were conducted at two and six weeks, and at three, six, and 12 months post-injection. Outcome measures were pain scores (Visual Analogue Scale), functional assessment (Single Assessment Numeric Evaluation), and injection site complications.

Results: A total of 46 patients (52 elbows) were included. Significant improvements were observed in pain scores measured by VAS at rest, from 4.5±2.8 initially to 2.7±2.8 at 3 months and 2.3±3.0 at 12 months (p<0.001). Similar improvements were seen in VAS scores during maximum hand grip strength, from 5.8±3.1 initially to 2.8±3.4 at 12 months (p<0.001). SANE score also improved significantly. No complications were reported.

Conclusions: Treatment of lateral epicondylitis with hyaluronic acid showed statistically significant improvement in VAS scores at rest and during maximum hand grip strength, as well as in SANE scores, with no reported complications. Level of Evidence IV; Case Series.

Objective: To examine the relationship between place of residence, social vulnerability, and telemedicine access among orthopedic patients at a tertiary hospital in São Paulo, Brazil.

Methods: A cross-sectional, comparative study analyzing sociodemographic, economic, and geographic characteristics of 475 patients who attended telemedicine consultations between August 2022 and August 2023. Patients were grouped by their Social Vulnerability Index (IVS) to assess differences in travel distances, costs, and accessibility challenges. The analysis included comparisons of demographic factors, financial burdens, and telemedicine's impact on reducing travel constraints.

Results: Telemedicine consultations avoided an average travel distance of 211 km and saved approximately 44 USD per consultation. Patients from higher IVS regions had significantly greater travel distances, longer travel times, lower formal education levels, and were more likely to be younger, male, and of non-White race. Additionally, these patients more frequently reported missing work for in-person visits. Telemedicine access disparities reflect broader socioeconomic and geographic inequalities.

Conclusions: This study highlights how spatial and socioeconomic vulnerabilities shape telemedicine access in Brazil. Travel burdens and job insecurity disproportionately affect vulnerable groups, while social support mitigates barriers for older adults. Level of Evidence III; Cross-Sectional Study.

Objective: The aim of this study was to evaluate the effect of surgical procedures on maintaining ambulation for Duchenne patients.

Methods: This retrospective cohort study evaluated 35 patients for whom surgery was recommended at our institution from 2012 to 2020.

Results: Twenty-seven patients were operated on before gait loss, and eight after. In this study, surgical treatment allowed recovery and prolongation of gait for 38.6 months, on average. The sooner the surgery was performed, the better the results were; logistic regression analysis showed that each day of delay after gait loss decreased the chances of success by 0.2%. The optimal interval for intervention was up to 12 months after gait loss.

Conclusion: Our results thus corroborate the evidence that surgical interventions are beneficial for these patients and suggest a not previously described time window for achieving better outcomes. Level of Evidence lll; Retrospective, Comparative Study of Surgical Interventions.