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The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition., publishedVersion

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Objective To clinically and radiologically evaluate patients who received meniscal suture using the outside-in technique, comparing magnetic resonance imaging (MRI), arthro-magnetic resonance imaging (arthro-MRI), and arthro-computed tomography (arthro-CT) to evaluate the healing of meniscal sutures. Methods We evaluated eight patients with an average follow-up of 15 months. The evaluation analyzed clinical parameters using the Lysholm and IKDC scores as well as MRI, arthro-MRI, and arthro-CT imaging. Results At the end of the follow-up period, mean Lysholm score was 89.5 and mean IKDC score was 78.6. In the MRI, signs of meniscal healing were observed in 50% of the cases. The arthro-MRI and arthro-CT showed signs of healing in 75% of cases. There was a positive correlation between arthro-MRI and arthro-CT results in all the cases studied (kappa correlation index=1). Conclusion Meniscal suture using the outside-in technique presented good or excellent results in 87.5% of our patients. The arthro-CT and arthro-MRI showed the same level of accuracy in detecting healing of the sutured region of the meniscus. Level of Evidence IV; Case series. RESUMO Objetivo Avaliar clinicamente e radiologicamente pacientes submetidos a sutura-meniscal pela técnica outside-in, comparando a Ressonância Magnética (RM), Artro-Ressonância Magnética (Artro-RM) e Artro-Tomografia Computadorizada (Artro-CT), quanto a cicatrização da sutura meniscal. Método Avaliamos oito pacientes com um seguimento médio de 15 meses, clinicamente e por meio de score de Lisholm e IKDC, e realizamos RM, Artro-RM e Artro-CT. Resultados A média do score de Lysholm foi de 89.5 e o score médio do IKDC foi de 78,6. A RNM observou sinais de cicatrização meniscal em 50% dos casos, enquanto a artro-RNM e artro-CT evidenciaram sinais de cicatrização em 75% dos casos. Houve uma correlação entre a artro-RNM e a artro-CT em todos os casos. Conclusão A sutura meniscal pela técnica outside-in apresentou bons e excelentes resultados em 87,5% dos nossos pacientes. A artro-CT e a artro-RNM têm acurácia equivalente na detecção da cicatrização da região suturada do menisco. Nível de Evidência IV; Série de casos.

Objective: To compare the transparent 3D computed tomography (CT) image protocol against conventional 3D-CT image-rendering protocol to assess femoral tunnel position in anatomic anterior cruciate ligament (ACL) reconstructions . Methods: Eight knee CT scans from cadavers were analyzed by image rendering 3D-CT protocol, using Rhinoceros(r) software. The central point of the ACL tunnel was set using the sagittal plane. Same CT scans were analyzed using transparent 3D-CT measurement protocol with OsiriX(r) software. Central point of the ACL tunnel was set using sagittal, coronal and axial planes. The grid system described by Bernard and Hertel was used to compare tunnel positions between protocols, using height and length parameters . Results: There was a significant difference between measurements using image rendering 3D-CT and transparent 3D-CT protocol for height (23.8 ± 7.9mm and 33.0 ± 5.0mm, respectively; p=0.017) and no differences for length (18.6 ± 4.2mm and 18.3 ± 4.5mm, respectively; p=0.560) . Conclusion: Height in transparent CT protocol was different and length was the same as compared to 3D-CT rendering protocol in Bernard and Hertel method for tunnel measurements. Level of Evidence II, Descriptive Laboratory Study. RESUMO Objetivo Comparar o protocolo de tomografia computadorizada (TC) 3D por transparência com o protocolo TC-3D por renderização de imagem na avaliação do posicionamento de túneis femorais na reconstrução anatômica do ligamento cruzado anterior (LCA) . Método: Oito TC de joelho de cadáveres foram analisadas pelo protocolo de renderização de imagem 3D-TC utilizando o software Rhinoceros(r). O ponto central do túnel do LCA foi definido pelo plano sagital. As mesmas tomografias foram analisadas pelo protocolo 3D-TC por transparência, com o software OsiriX(r). O ponto central do túnel do LCA foi definido pelos planos sagital, coronal e axial. O sistema de grade de Bernard e Hertel foi utilizado para comparar a posição dos túneis entre os protocolos, utilizando parâmetros para comprimento e altura. Resultados: Houve diferença significativa entre as medidas dos protocolos de renderização de imagem 3D-TC e 3D-TC por transparência para altura (23,8 ± 7,9mm e 33,0 ± 5,0mm, respectivamente; p=0,017), sem diferenças para comprimento (18,6 ± 4,2mm e 18,3 ± 4,5mm, respectivamente; p=0,560) . Conclusão: A altura no protocolo de TC por transparência foi diferente e o comprimento foi igual quando comparados com o protocolo 3D-TC por renderização de imagem no método de Bernard e Hertel para mensuração dos túneis. Nível de Evidência II, Estudo Laboratorial Descritivo.

ObjectiveTo evaluate thermography application as a complementary method in preventing muscle injury in professional soccer players. Methods A longitudinal prospective study with 28 professional soccer players that composed a first division of Brazilian’s soccer team between 2015 and 2016. In both seasons (2015 and 2016), muscle injuries were documented and classified in grade of severity, by ultrasound. During the following season (2016), infrared medical thermography was applied twice a week (48 hours after game) and if a difference of temperature was detected higher than 0.4°C, a prevention protocol was initiated. Muscle injuries in 2016 were documented.ResultsIn 2015, the total number of muscle injuries was 11. In 2016, the total number of muscle injuries was 4 (p=0.04). It represents an incidence/player of 78% in 2015 and 28% in 2016, corresponding to a decrease of 64% in 2016. Seven players played in the first team in both seasons. Among these seven players, muscle injuries were reduced from 8 (in 2015) to 3 (in 2016)—a decrease of 63% in the season we used thermographic monitoring (p=0.06).ConclusionThe pilot data provide a promising catalyst for a rigorous RCT that could examine whether thermography can contribute to a muscle injury prevention programme.

Objective To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition. Materials and methods The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, bodymass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and flamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis. Results There was an association between pubalgia, high BMI (p = 0.032) andmuscle alterations (p < 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions weremore frequent in patients with pain. The US detection had 44.4% sensitivity and 100% specificity. Conclusion The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are findings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles. Resumo Objetivo Comparar a acurácia da ultrassonografia em relação à ressonância magnética na detecção de lesões da aponeurose do reto abdominal/adutor longo, estudar características dos jogadores e achados de imagem associados à pubalgia e demonstrar a importância de cada método. Materiais e métodos Estudo realizado de 2011 a 2016 com 39 jogadores profissionais de futebol, 15 deles com e 24 sem pubalgia. Foram registrados idade, posição, índice de massa corporal (IMC), carga de treino semanal, tempo de profissão e lesão prévia na coxa/joelho e lombalgia. Os seguintes exames de imagem foram realizados: radiografias (anteroposterior da bacia e flamingo) para avaliar sinais de impacto do quadril, articulações sacroilíacas e instabilidade da sínfise púbica; ultrassonografia para analisar a aponeurose comum do reto abdominal/adutor longo e hérnias inguinais e do esporte; ressonância magnética buscando alterações degenerativas e edema no púbis, lesões musculares dos adutores e retos abdominais e na sua aponeurose. Resultados Observou-se uma associação entre pubalgia e IMC elevado (p = 0,032) e alterações musculares (p < 0,001). Hérnia inguinal foi encontrada em dois casos e hérnia do esporte, em um caso e dois controles. Alterações degenerativas do púbis foram frequentes nos dois grupos. Lesões da aponeurose foram mais comuns nos pacientes com dor e a ultrassonografia teve sensibilidade de 44,4% e especificidade de 100% na detecção. Conclusão A avaliação da pubalgia atlética deve ser realizada com radiografias, ultrassonografia e ressonância magnética. Índice de massa corporal elevado, lesões musculares, geodos e osteófitos são achados associados à pubalgia; a ultrassonografia tem baixa sensibilidade para detectar lesões da aponeurose comum do reto abdominal/ adutor longo.

PurposeTo find a radiographic method that best correlates with the mean subaxial cervical space available for the cord (MSCSAC) by using a fixed size parameter as radiographic reference, in contrast to the use of vertebral bodies as reference in the mean subaxial cervical Torg ratio (MTorg).MethodsThe study was approved by an institutional review board and written informed consent was obtained. Radiographs and cervical neck MRI were obtained from 18 male rugby athletes (age 18–30 years). Rheumatic disease, symptomatic cervical orthopaedic disease and previous cervical injury were used as exclusion criteria. MSCSAC and MTorg were calculated for each individual as the space available for the cord and Torg ratio averages from C3 to C6, respectively. A new radiographic method, using a metal bar as a size parameter (the corrected diameter of the cervical canal - CDCC), was also calculated for each individual, as well as its average from C3 to C6 (mean corrected diameter of the cervical canal - MCDCC). Values obtained for MCDCC and MTorg were correlated with those obtained by the MSCSAC using Pearson’s coefficient.ResultsFour volunteers were excluded due to previous cervical injury. In total, 14 subjects had their radiographs and MRIs analysed. Pearson’s correlation between MSCSAC and MTorg was 0.5706 (p=0.033). The correlation between MSCSAC and MCDCC was 0.6903 (p=0.006).ConclusionMCDCC correlates better than MTorg with MSCSAC and may be a better radiographic option than MTorg for cervical stenosis evaluation.

Objectives Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. Methods The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. Results Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation. Conclusion The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series. RESUMO Objetivos Diversos casos de sinovite vilonodular pigmentada difusa bilateral (SVNP) ou tumor de células gigantes tenossinoviais foram descritos na literatura. Entretanto, algumas apresentações são raras e o diagnóstico diferencial é necessário. Métodos O objetivo do estudo foi realizar uma revisão da literatura relacionada à SVNP e relatar uma apresentação de forma bilateral e localizada rara na região supra-patelar. Foi realizada uma revisão dos bancos de dados do Pubmed Clinical Queries, MeSH e unitermos relacionados com SVNP e tumor de células gigantes tenossinoviais. Resultados Dois casos de SVNP bilateral e local foram descritos anteriormente. No entanto, nenhum deles foi localizado no compartimento supra-patelar. Até onde sabemos, este relato é o primeiro caso descrito de SVNP bilateral localizada supra-patelar. Apresentamos uma mulher de 28 anos com SVNP bilateral no recesso supra-patelar do joelho. A RM mostrou baixo sinal dos nódulos nas imagens ponderadas em T1 e T2, associados ao pigmento hemossiderina. Conclusão O achado mais importante está relacionado à raridade e localização. A histopatologia confirmou um caso raro de pigmento de hemossiderina no nódulo da cápsula com conteúdo viloso não pigmentado internamente. O diagnóstico diferencial com lipoma arborescens na forma supra-patelar é necessário devido à localização comum. Nível de Evidência IV; Série de casos.

Although anterior cruciate ligament (ACL) reconstruction is considered a successful procedure in restoring knee stability, few studies have addressed the issue of aerobic capacity after ACL surgery. Soccer players need technical, tactical and physical skills to succeed, such as good knee function and aerobic capacity. Our purpose is to evaluate aerobic fitness in ACL injured professional football players and six months after ACL reconstruction compared to a control group. Twenty athletes with ACL injury were evaluated and underwent ACL reconstruction with hamstrings autograft, and were compared to twenty healthy professional soccer players. The methods used to evaluate aerobic fitness were maximum oxygen uptake (VO2max) and ventilatory thresholds with a treadmill protocol, before and six months after surgery, compared to a control group. Knee function questionnaires, isokinetic strength testing and body composition evaluation were also performed. Results: Median ACL-injured patients age was 21 years old, and controls 20.5 years old. (n.s.). Preoperative VO2max in the ACL injured group was 45.2 ± 4.3 mL/kg/min, postoperative 48.9 ± 3.8 mL/kg/min and controls 56.9 ± 4.2 mL/kg/min. (p< .001 in all comparisons). Body composition evaluation was similar in all situations. Knee function questionnaires and quadriceps peak torque deficit improved after surgery but were significantly lower compared to controls. Conclusion: Aerobic fitness is significantly reduced in professional soccer players with ACL injury, and six months of rehabilitation was not enough to restore aerobic function after ACL reconstruction, compared to non-injured players of the same level.

OBJECTIVE: To determine running economy in a large sample of elite soccer and futsal players to obtain benchmarks in different positions. METHODS: Running Economy is the energy demand at a submaximal running velocity. Players were divided into 6 subgroups. Soccer: defenders, midfielders, and strikers; futsal: defenders, wingers, and pivots. Elite soccer players (n=129) and elite futsal players n=72 performed an incremental running test starting at 8.4 km.h-1 with increments of 1.2 km.h-1 every two minutes on a treadmill until exhaustion. Running Economy was determined by interpolation between ventilatory thresholds 1 and 2 (VT1 and VT2). RESULTS: Running Economy (measured as mL.kg-1.km-1) was compared between the playing positions in the two team sports. In soccer, running economy was 222.7 (defenders), 227.0 (midfielders), and 219.8 (strikers) mL.kg-1.km-1, respectively. In futsal, the corresponding values were 198.5 (defenders), 196.9 (wingers), and 190.5 (pivots) mL.kg-1.km-1, respectively. We no found significantly differences between the three positions in both sports. The Running Economy of futsal players was 12.5% better than that of soccer players. Running Economy correlated positively with oxygen uptake at VT2 in both sports and in all positions. CONCLUSION: Futsal players exhibited better Running Economy than soccer players; this should be considered as a factor in the athlete's training plan. OBJETIVO: Determinar a Economia de Corrida numa grande amostra de jogadores de futebol e futsal de elite em diferentes posições do campo. METODOS: Os jogadores foram subdivididos em três subgrupos: futebol (jogadores de defesa, meio-campistas e atacantes) e futsal (jogadores de defesa, alas e pivôs). Foram 129 jogadores de futebol e 72 jogadores de futsal, que competem nas respectivas primeiras divisões do Brasil. Os jogadores foram submetidos a teste de esforço em esteira (8,4 km-1.h+1,2km-1.h a cada dois minutos) até a exaustão. Consumo máximo de oxigênio, limiares ventilatórios e Economia de Corrida foram registrados por análise de troca gasosa respiratória. A Economia de Corrida foi determinada por interpolação utilizando as velocidades dos limiares ventilatórios 1 e 2 e o consume de oxigênio nas duas velocidades. RESULTADOS: Os valores de Economia de Corrida entre as posições nos dois esportes foram os seguintes: Futebol, jogadores de defesa (222,7±16,7mL.kg-1.km-1), meio-campistas (227±19,9mL.kg-1.km-1), e atacantes (219,8±17,2mL.kg-1.km-1). Futsal, jogadores de defesa (198,5±10,8mL.kg-1.km-1), alas (196,9±16,2mL.kg-1.km-1), e pivôs (190,5±11,8mL.kg-1.km-1). Não foram encontradas diferenças significativas entre as três posições em ambos os esportes. A Economia de Corrida dos jogadores de futsal foi 12,5% melhor do que dos jogadores de futebol. Neste estudo, os jogadores da posição pivô no futsal tiveram os melhores valores de Economia de Corrida (custo de oxigênio mais baixo). Embora o consumo máximo de oxigênio (VO2max) e o limiar ventilatório 2 (LV2) fosse maior nos jogadores de futebol, a Economia de Consumo foi pior. Esta correlacionou-se positivamente com o VO2 no LV2 em ambos os esportes e em todas as posições CONCLUSÃO: Futsal tem melhor Economia de Consumo do que futebol. O presente estudo aponta a importância dos índices Economia de Consumo no plano de treinamento físico dos atletas.

OBJECTIVE: We hypothesize that in players with better aerobic fitness, lactate production was not inhibited after high-intensity exercise, regardless of the footballer's position on the field. METHOD: Sixty professional male soccer players performed cardiopulmonary exercise tests on an ergometric treadmill; respiratory gas exchanges were monitored throughout and blood lactate levels at peak effort was measured, using a portable device. The heart rate response was determined by computerized EKG. Training sessions took place over an average of ten hours per week, and the players had 6.8 years of experience in competitive soccer; they were tested a third of way into the season. The positions tested were (centerback, fullback, midfielder and striker). RESULTS: The following results (mean ± std. dev.) were obtained: (1) peak oxygen consumption of 58.8 ± 4.5 ml.kg-1.min.-1; (2), blood peak lactate of 12.3 ± 1.6 mmol.L-1; (3) maximum heart rate of 193 ± 3.3 beats. min-1; (4); oxygen consumption at the second ventilatory threshold of 49.6 ± 5.0 mL. kg-1.min-1; (5); running speed at the second ventilatory threshold of 13.3 ± 0.8 km.h-1; (6) percentage of oxygen consumption in the second ventilatory threshold of 84 ± 6%. There was no correlation between maximum aerobic level vs. peak lactate concentration (r = -0,031; p = 0.812), nor between submaximal aerobic level vs. peak lactate concentration (r = -0.146; p = 0.335) in the positions tested. CONCLUSION: Better or worse aerobic profiles according to game positions in soccer players do not influence peak lactate levels following high-intensity exercise, and confirms the study hypothesis. OBJETIVO: Nossa hipótese era que em jogadores com melhor condicionamento aeróbio, a produção de lactato não seria inibida após o exercício de alta intensidade, independentemente da posição do jogador no campo. MÉTODOS: Sessenta jogadores de futebol profissional masculino foram submetidos a testes de exercício cardiopulmonar em um analisador metabólico troca gasosa respiratória em esteira ergométrica, com medição dos níveis de lactato no sangue no pico do esforço, usando um dispositivo portátil. A resposta da frequência cardíaca foi determinada por eletrocardiograma computadorizado. As sessões de treinamento duraram uma média de dez horas por semana, e os jogadores participantes tinham 6,8 anos de experiência no futebol competitivo. Os jogadores foram testados a um terço para o final da temporada. As posições testadas foram (defesa-central, defesa lateral, meio-campista e atacante). RESULTADOS: Os resultados obtidos foram: consumo de oxigênio pico de 58,8 ± 4,5 mL.Kg-1min-1, pico de lactato no sangue 12,3 ± 1,6 mmol.L-1; frequência cardíaca máxima de 193 ± 3,3 batimentos.min-1; consumo de oxigênio no segundo limiar ventilatório de 49,6 ± 5,0 mL.Kg-1min-1; velocidade de corrida no segundo limiar ventilatório de 13,3 ± 0,8 km.h-1 e porcentual do consumo de oxigênio no segundo limiar ventilatório de 84 ± 6%. Não houve correlação entre o nível de aeróbio máximo (r = -0,031; p = 0,812) e o nível de aeróbio submáximo (r = -0,146; p = 0,335) nas posições testadas e na concentração pico de lactato. CONCLUSÃO: Melhor ou pior perfil aeróbio nas posições de jogo em jogadores de futebol não influenciam os níveis de lactato de pico durante a realização de exercício de alta intensidade, e confirmam a hipótese do estudo.

Os limiares de lactato são utilizados para a avaliação da capacidade aeróbia em diferentes idades. Estudos demonstram que crianças e adolescentes apresentam menores concentrações sanguíneas de lactato [La], para mesma carga de esforço, do que adultos. Existem evidências de que isto está relacionado ao desenvolvimento maturacional das mesmas. OBJETIVO: Verificar a associação entre a maturação sexual e o limiar de lactato de atletas de futebol de 12 a 15 anos de idade. MÉTODO: A amostra foi do tipo intencional, não probabilística, com um total de 36 meninas, entre 12 a 15 anos, participantes de escolinhas de futebol da prefeitura da cidade de São Paulo. Foram obtidas da amostra a massa corporal, a estatura e a tomada de dobras cutâneas triciptal e panturrilha. A maturação sexual foi feita através da observação direta, por uma médica, do desenvolvimento de órgãos genitais e de pilosidade púbica, por meio de planilhas propostas por Tanner. Para determinação do limiar de lactato foi realizado teste progressivo em pista, onde as jovens realizaram três corridas de 800 metros, com a intensidade do esforço sendo controlada por zonas de frequência cardíaca pré-estabelecidas, com mensurações das [La] no final de cada corrida. Através da interpolação linear foi encontrada a velocidade correspondente a [La] de 2,5mmol (V2,5). Para compreender melhor a natureza das associações entre as variáveis foi utilizada a regressão linear múltipla, tendo como variável dependente o limiar de lactato (V2,5), e como variáveis independentes idade (anos), IMC (kg/m²), estatura (cm) e somatório de dobras cutâneas (mm). RESULTADO: Em mais jovens, pré-púbere, as variáveis de crescimento e a maturação sexual tem pouca associação com o limiar de lactato. Sendo importante uma ponderação sobre a influência da maturação sexual no limiar de lactato. CONCLUSÃO: Levando em consideração a homogeneidade do grupo e o fato de a idade entre 12 e 15 anos ser um período de diversas modificações, o desenvolvimento maturacional, e não a idade cronológica, mostrou uma diferença significante nas variáveis analisadas.The lactate thresholds are used to assess the aerobic capacity in different ages. Studies show that children and adolescents present less lactate blood concentrations [La] than adults under certain effort loads. There are evidences that this is related to their maturational development. OBJECTIVE: To verify the association between the sexual maturation and the lactate threshold in some adolescent soccer players ranging from 12 to 15 years old. METHOD: The sample was related to the intentional and not probabilistic type involving 36 girls, from 12 to 15 years old, members of the soccer schools held by the Mayority of São Paulo. The body weight, height and the sum of two skinfolds - calf and triceps were obtained from the sample. A physician directly observed the sexual maturation of the genitals and pubic hair development through the Tanner index.To determine the lactate threshold a progressive test, a 3x800m in running track, was performed by adolescents, their effort intensity was controlled by pre-established heart rate zones and the lactate blood concentrations [La] were measured at the end of each run. The velocity corresponding to lactate blood concentrations [La] of 2,5mmol (V2,5) was obtained through the linear interpolation.The multiple linear regression was used to better understand the nature of these associations between the variables, considering the lactate threshold (V2,5) as a dependent variable and the age (years), the body weight index (kg/m2), height (cm) and the sum of the skinfolds (mm) as independent variables. RESULT: The growth variables and the sexual maturation have little association with the lactate threshold in the youngest and pre-adolescent girls. It is important to take in consideration the sexual maturation influence on the threshold lactate. CONCLUSION: Taking in account the group homogeneity and being the range between 12 and 15 years old a period susceptible to many modifications, the maturational development and not the chronological age showed to be reponsible for a significative difference in the analysed variables.

O objetivo deste estudo foi traduzir e adaptar culturalmente o Functional Measure for Amputees Questionnaire (FMA) para a população brasileira e analisar sua validade e eficácia quando aplicado em pacientes amputados de membro inferior. O procedimento seguiu as etapas de tradução, retro-tradução, análise das versões português e inglês por um comitê multidisciplinar, e pré-teste. O questionário traduzido foi aplicado em 44 pacientes (39 homens e 5 mulheres) com amputação em nível transtibial (N=27) e transfemoral (N=17), com idade média de 47,5±17,2 anos. No estudo da confiabilidade, em média, os coeficientes Kappa foram superiores a 0,80; e 25% deles foram iguais a 1,0, indicando haver excelente concordância inter e intra-entrevistadores. Na análise da consistência interna, o valor do coeficiente para a questão sobre o Índice de Capacidade Locomotora foi igual a 0,79, demonstrando haver consistência no bloco de questões relacionadas à mobilidade. A adaptação transcultural foi satisfatória; algumas modificações foram necessárias, porém sem implicar mudança na estrutura ou no conteúdo do questionário original. Os resultados sugerem que a versão brasileira do FMA, MFA - questionário de Medida Funcional para Amputados pode ser um instrumento confiável para medir o resultado funcional de pacientes brasileiros reabilitados após amputação de membro inferior.The aim of this study was to translate into Brazilian-Portuguese and culturally adapt the Functional Measure for Amputees Questionnaire (FMA), also testing its reliability and validity for assessing lower-limb amputees functional capacity. The FMA was translated, back-translated, evaluated by a multidisciplinary committee, and pre-tested. The final version was submitted to field test on a group made up of 44 subjects (39 men and 5 women) with transtibial (N= 27) and transfemoral (N=17) amputation level. The inter- and intra-examiner test showed high reliability; Kappa mean values were higher than 0.80; and in 25% of the items values reached 1.0, thus suggesting excellent examiner agreement. Question 2 (which determines the Locomotor Capabilities Index) internal consistency value found was 0.79, showing consistency as to mobility assessment. The FMA cultural adaptation was satisfactory; a few changes were needed, without altering the original structure or content. Results suggest that the FMA Brazilian-Portuguese version is a reliable instrument to measure functional outcomes of Brazilian lower limb amputees having undergone rehabilitation.

ResumoO tratamento por ondas de choque é uma opção na ortopedia. O mecanismo exato pelo qual funcionam as ondas de choque para tratar doenças musculoesqueléticas não é conhecido. O objetivo deste trabalho é fazer a análise qualitativa da efetividade do tratamento por ondas de choque em pacientes com patologias musculoesqueléticas e pseudoartroses. A pesquisa foi feita nas bases de dados Cochrane Library, Medline e Lilacs. Encontrou 39 estudos que relatam o tratamento por ondas de choque de doenças musculoesqueléticas. Os resultados são muito variados, assim como os tipos de protocolo. Os estudos que avaliaram a efetividade do tratamento por ondas de choque para epicondilite lateral, tendinopatias do ombro, osteoartrose do joelho, osteonecrose da cabeça do fêmur e bursite trocanteriana relataram resultados inconsistentes para a melhoria dos pacientes. Os que avaliaram pacientes com tendinopatia calcária, fascite plantar, tendinopatia do tendão calcâneo e patelar e pseudoartrose mostraram benefício. O tratamento por ondas de choque é um método seguro e não invasivo para os casos crônicos em que os convencionais não tenham sido satisfatórios e deve ser associado aos outros métodos de tratamento das tendinopatias. Novos estudos de qualidade são necessários.AbstractShockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty‐nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non‐invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed.

Nowadays, the sport practice has been initiated precociously. These precocious beginning of competitive sports may result in changes on the young athletes' posture alignment, because the child's bone and muscle systems are still developing and these systems are more susceptible to stress and injuries. The purpose of this study was to verify the indoor soccer (Futsal) injuries and the changes of posture alignment in players between 9 to 16 years old. We examined the posture of 50 volunteers young futsal male players, volunteers, from a first division club team. These athletes were divided in two different groups: the group one (G1) was formed by those players who have suffered injuries related to Futsal; and group two (G2) was composed by athletes who did not have injuries related to futsal. First, the athletes or their parents answered a questionnaire about anthropometric characteristics of the subjects, player position, how long they have been practicing Futsal, how often they practiced Futsal and previous injuries related to Futsal practice. Then, we evaluated the postural alignment using an specific protocol to check the postural alterations. Both groups showed changes on the body alignment. The most common changes seen were in ankle and knee in both groups. The changes of the alignment in lumbar spine was more common in group 1. Considering injuries in group 1, the most common injury was in ankle (45.2% of all injuries) and the second most common injury was in knee (19% of all injuries). Considering the kind of injury, sprain and fracture/dislocate were the two most common (26.2% each one) and muscle injury comes in second with 21.4% of all kinds of injuries. We could discuss the relationship between the changes of posture alignment and sports injuries, once the changes of posture alignment result in stress in muscle and ligaments and it may result in injuries. We couldn't find a relationship between the cause and the consequence of these factors.

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average interval between occurrence of the injury and assessment was 10.2 months (range 2 - 48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60°/sec and 240°/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60°/sec was greater than that at 240°/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60°/sec or at 240°/sec. The average value for the flexor-extensor relationship at 60°/sec on the injured was 60% (( 6), compared to 57% (( 10) on the contra-lateral side. At 240°/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60°/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.O objetivo desse estudo foi avaliar o grupo muscular flexo-extensor do joelho de esportistas jovens que tiveram diagnóstico de ruptura completa do ligamento cruzado anterior (LCA). Dezoito joelhos de 18 atletas (14 homens e 4 mulheres) com idade média de 21,6 anos (16 - 32) foram avaliados com aparelho isocinético modelo Cybex 6000. O intervalo médio entre a lesão e a avaliação foi de 10,2 meses (2 - 48). Houve lesão meniscal associada em oito joelhos. Demais atletas com outro tipo de lesão associada, limitação ou bloqueio da amplitude articular, dor importante durante o exame e tempo de lesão com menos de dois meses foram excluídos do estudo. O parâmetro estudado foi o pico de torque (PT) e a relação flexo-extensora do PT nas velocidades angulares constantes de 60º/seg e 240º/seg . Foi realizado um aquecimento prévio com bicicleta ergométrica e adaptação com três repetições submáximas. O lado contra-lateral, que não apresentava lesão, foi usado como controle. O PT na velocidade constante de 60°/seg foi maior do que na velocidade de 240°/seg, seja nos joelhos com ou sem lesão. Não houve diferença significante entre o lado com e sem lesão, tanto a 60°/seg como a 240°/seg. O valor médio da relação flexo-extensora do PT na velocidade de 60º/seg no lado com lesão foi de 60 % (± 6) e no lado contra-lateral 57 % (±10). A 240º/seg no lado com lesão foi de 75 % (± 10) e no contra-lateral foi de 65 % (± 12). Como conclusões observou-se que os valores do equilíbrio flexo-extensor foram semelhantes na velocidade de 60º/seg, apesar da ruptura completa do LCA. À medida que ocorreu aumento da velocidade, ocorreu também um aumento da relação flexo-extensora do joelho, indicando leve tendência do grupo muscular flexor se aproximar do extensor, mais pronunciada no lado com lesão.

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average interval between occurrence of the injury and assessment was 10.2 months (range 2 - 48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60°/sec and 240°/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60°/sec was greater than that at 240°/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60°/sec or at 240°/sec. The average value for the flexor-extensor relationship at 60°/sec on the injured was 60% (( 6), compared to 57% (( 10) on the contra-lateral side. At 240°/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60°/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury. O objetivo desse estudo foi avaliar o grupo muscular flexo-extensor do joelho de esportistas jovens que tiveram diagnóstico de ruptura completa do ligamento cruzado anterior (LCA). Dezoito joelhos de 18 atletas (14 homens e 4 mulheres) com idade média de 21,6 anos (16 - 32) foram avaliados com aparelho isocinético modelo Cybex 6000. O intervalo médio entre a lesão e a avaliação foi de 10,2 meses (2 - 48). Houve lesão meniscal associada em oito joelhos. Demais atletas com outro tipo de lesão associada, limitação ou bloqueio da amplitude articular, dor importante durante o exame e tempo de lesão com menos de dois meses foram excluídos do estudo. O parâmetro estudado foi o pico de torque (PT) e a relação flexo-extensora do PT nas velocidades angulares constantes de 60º/seg e 240º/seg . Foi realizado um aquecimento prévio com bicicleta ergométrica e adaptação com três repetições submáximas. O lado contra-lateral, que não apresentava lesão, foi usado como controle. O PT na velocidade constante de 60°/seg foi maior do que na velocidade de 240°/seg, seja nos joelhos com ou sem lesão. Não houve diferença significante entre o lado com e sem lesão, tanto a 60°/seg como a 240°/seg. O valor médio da relação flexo-extensora do PT na velocidade de 60º/seg no lado com lesão foi de 60 % (± 6) e no lado contra-lateral 57 % (±10). A 240º/seg no lado com lesão foi de 75 % (± 10) e no contra-lateral foi de 65 % (± 12). Como conclusões observou-se que os valores do equilíbrio flexo-extensor foram semelhantes na velocidade de 60º/seg, apesar da ruptura completa do LCA. À medida que ocorreu aumento da velocidade, ocorreu também um aumento da relação flexo-extensora do joelho, indicando leve tendência do grupo muscular flexor se aproximar do extensor, mais pronunciada no lado com lesão.

Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides such injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by: ultrasound, which is dynamic and cheap, but examiner dependent; and tomography or magnetic resonance, which gives better anatomical definition, but is static. Initial phase of the treatment can be summarized as the “PRICE” protocol. NSAIDs, ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

OBJECTIVE: Develop an epidemiological study of injuries occurred among male professional football players during the Copa America 2011, held in Argentina. METHODS: We conducted a retrospective study of injuries sustained during the 43rd edition of the Copa America football in Argentina, in 2011. The lesions were evaluated by the medical department of the selections and reported to the CONMEBOL. The data were compiled and reported in accordance with rules established by the FIFA Medical Assessment and Research Centre (F-MARC) in 2005. RESULTS: There was a higher prevalence of lesions in the lower limbs. Thighs and knees were the most affected segments. The most frequent diagnoses were muscle injuries. The injuries were mostly minor degrees of severity and there was little difference in the prevalence of lesions according to the stages of the match, with slight predominance in the final 15 minutes. The incidence of lesions per 1,000 game hours was similar to the average found in the literature. CONCLUSIONS: The results obtained allowed us to outline a profile of the prevalence, distribution per body segment, minute in which occurred and severity of injuries in professional football players of participating teams in the Copa America 2011 in Argentina. The extreme rigor of referees may be partly attributed to the highly competitive nature of international tournaments. However, this results cannot be considered definitive because of the need to be compared to other epidemiological studies with same design using similar concepts and criteria. OBJETIVO: Desenvolver estudo epidemiológico sobre as lesões ocorridas entre os jogadores profissionais de futebol masculino durante a Copa América de 2011, na Argentina. MÉTODOS: Fez-se estudo retrospectivo das lesões ocorridas durante a 43ª edição da Copa América de Futebol na Argentina, em 2011. As lesões foram avaliadas pelo departamento médico das seleções e reportadas à Conmebol. Os dados foram compilados e descritos de acordo com as normas estabelecidas pelo Centro de Pesquisas e Avaliações Médicas (F-Marc) da Fédération Internationale de Football Association (Fifa) em 2005. RESULTADOS: Ocorreu maior prevalência de lesões nos membros inferiores, sendo coxas e joelhos os segmentos mais acometidos. Os diagnósticos mais frequentes foram lesões musculares. As lesões apresentaram em sua maior parte grau leve de severidade e ocorreu pequena diferença na prevalência de lesões de acordo com as etapas da partida, havendo discreto predomínio nos 15 minutos finais. A incidência de lesões por 1.000 horas de jogo foi similar à média encontrada na literatura. CONCLUSÕES: A análise dos resultados obtidos permitiu traçar um perfil da prevalência, distribuição por segmento corporal, minuto em que ocorreram e severidade das lesões dos jogadores de futebol profissional das seleções participantes da Copa América de 2011 na Argentina. O maior rigor dos árbitros pode ser em parte atribuído à grande competitividade de torneios internacionais. Entretanto, esses resultados não podem ser considerados definitivos em virtude da necessidade de ser comparados a outros estudos epidemiológicos de mesmo espectro que usem conceitos e critérios semelhantes.

Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed.O tratamento por ondas de choque é uma opção na ortopedia. O mecanismo exato pelo qual funcionam as ondas de choque para tratar doenças musculoesqueléticas não é conhecido. O objetivo deste trabalho é fazer a análise qualitativa da efetividade do tratamento por ondas de choque em pacientes com patologias musculoesqueléticas e pseudoartroses. A pesquisa foi feita nas bases de dados Cochrane Library, Medline e Lilacs. Encontrou 39 estudos que relatam o tratamento por ondas de choque de doenças musculoesqueléticas. Os resultados são muito variados, assim como os tipos de protocolo. Os estudos que avaliaram a efetividade do tratamento por ondas de choque para epicondilite lateral, tendinopatias do ombro, osteoartrose do joelho, osteonecrose da cabeça do fêmur e bursite trocanteriana relataram resultados inconsistentes para a melhoria dos pacientes. Os que avaliaram pacientes com tendinopatia calcária, fascite plantar, tendinopatia do tendão calcâneo e patelar e pseudoartrose mostraram benefício. O tratamento por ondas de choque é um método seguro e não invasivo para os casos crônicos em que os convencionais não tenham sido satisfatórios e deve ser associado aos outros métodos de tratamento das tendinopatias. Novos estudos de qualidade são necessários.