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Physical examination of knee ligament injuries often is considered subjective and imprecise as the result of various factors affecting its reliability. Magnetic resonance imaging is widely used but lacks information on ligament function and is costly. Stress radiography is commonly employed, but alternatives are sought because of radiation exposure and the need for a physician's presence during the procedure. Ultrasonography represents a noninvasive, rapid, and cost-effective method for assessing knee injuries. This Technical Note presents stress ultrasonography protocols for evaluating medial and lateral tibiofemoral openings in patients with posteromedial corner and/or posterolateral corner injuries. The ultrasonography examination parameters are detailed for both the medial collateral ligament and lateral collateral ligament evaluation. Studies have associated certain degrees of tibiofemoral opening with knee ligament injuries, aiding surgeons in surgical decision-making. Examination with stress ultrasonography offers a dynamic and reproducible method without adverse effects for patients, potentially expediting the diagnosis and treatment of multiligament knee injuries., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: J.L.R.D.F. reports personal fees from Sintegra Surgical Sciences, outside the submitted work. R.F.L. reports other from Arthrex, Ossur, Smith & Nephew, Elsevier, Linvatec, outside the submitted work. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

Osteoarthritis (OA) of the knee is highly prevalent and causes pain, stiffness, and harms the quality of life of millions of patients. Scientific evidence about radiofrequency ablation or rhizotomy of genicular nerves has been presented with increasing frequency in the literature for the treatment of chronic pain related to knee OA as an alternative to total knee arthroplasty. The main indication for this procedure is symptomatic OA unresponsive to conservative treatment, regardless of the disease evolution, although more common indications are in Kellgren-Lawrence grade III or IV, in post-total knee arthroplasty residual pain without an identified cause, in patients with comorbidities and high surgical risk, and those who do not want to undergo surgery. The aim of this study is to describe the step-by-step rhizotomy technique with pulsed radiofrequency of the 3 genicular nerves, guided by radioscopy and ultrasonography., (© 2021 The Authors.)

The key to preventing early knee osteoarthritis is meniscal preservation. The main functions of the meniscus are impact absorption, mechanical load transmission, lubrication, joint stability, and proprioception. Radial lesions that extend to the joint capsule are called complete radial tears. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and load distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. In the recent past, the treatment of choice for this type of injury was partial meniscectomy. However, several studies have observed progressive joint degeneration after this type of treatment. Recently, different types of meniscal sutures involving radial lesions of the meniscus have been developed. It is believed that such repairs may bring a decrease in future osteoarthritis in this patient profile. The purpose of this article is to describe the steps of continuous meniscal suture for the treatment of radial tears of the medial and lateral menisci., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Orthopaedic surgeries by video arthroscopy have become increasingly popular, as they allow joint treatment through small incisions and minimal tissue damage. However, their execution requires specific skills from the surgeon, different from open surgery, which can only be achieved through practical training. These skills would be ideally performed on human cadaveric anatomical pieces which, however, can be difficult to access for different reasons. Animal anatomical models for surgical skills training have been used for years in medicine, and we observed that the bovine knee has anatomical characteristics quite similar to that of the human knee. In this study, we explain, step by step, the installation and creation of an arthroscopy laboratory with a bovine model, in an effort to contribute to several training centers in arthroscopic surgery around the world, assisting and guiding such centers to install arthroscopy laboratories and facilitating the improvement of more surgeons., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5° for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

IL-4 coordinates the Th2-type immune response in inflammatory diseases such as asthma. IL-27 can inhibit the development of both Th2 and Th1 cells. However, IL-27 can also drive naïve T cells to differentiate toward the Th1 phenotype. In this study, we investigated the effects of IL-27 on the activation of IL-4-induced human bronchial epithelial cells (BEAS-2B). Compared to controls, both IL-4 and IL-27 (25-100 ng/mL) increased the concentrations of CCL2 and IL-8 in a dose-dependent manner. However, compared to cells stimulated individually with IL-4 or IL-27, treatment with a combination of both cytokines reduced CCL2 and IL-8 concentrations in a dose- and time-dependent manner. IL-4 increased the activation of p38 MAPK, ERK1/2, STAT6 and NF-κB, while IL-27 increased the activation of p38 MAPK and ERK1/2 but not STAT6 and NF-κB. Compared to IL-4-stimulated cells, cells treated with both IL-27 and IL-4 displayed decreased activation of STAT6 and NF-κB but not ERK1/2 and p38 MAPK. Taken together, these results suggest that IL-27 plays a pro-inflammatory role when administered alone but downregulates bronchial epithelial cell activation when combined with IL-4. Therefore, IL-27 may be an interesting target for the treatment of Th2 inflammatory diseases., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Physical examination in the presence of a multiligament knee injury can be complex and challenging. Hence, stress radiography is a useful and inexpensive tool that is widely used in the assessment of this type of injury. It guarantees an objective analysis of the magnitude of knee instability, which may reduce the observer's interpretation bias in relation to the physical examination. However, for the radiographic analysis to be reproducible, it is necessary to standardize the technique to evaluate each of the main knee ligaments. This article aims to describe in detail how to perform stress radiography to assess the sufficiency of the posterior cruciate ligament and collateral ligaments in the context of a multiligament injury., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the "Meniscus 4-All suture device." The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Objetive: To analyze the trends of COVID-19 in Brazil in 2020 by Federal Units (FU)., Method: Ecological time-series based on cumulative confirmed cases of COVID-19 from March 11 to May 12. Joinpoint regression models were applied to identify points of inflection in COVID-19 trends, considering the days since the 50 th confirmed case as time unit., Results: Brazil reached its 50 th confirmed case of COVID-19 in 11 March 2020 and, 63 days after that, on May 12, 177,589 cases had been confirmed. The trends for all regions and FU are upward. In the last segment, from the 31 st to the 63 rd day, Brazil presented a daily percentage change (DPC) of 7.3% (95%CI= 7.2;7.5). For the country the average daily percentage change (ADPC) was 14.2% (95%CI: 13.8;14.5). The highest ADPC values were found in the North, Northeast and Southeast regions., Conclusions: In summary, our results show that all FUs in Brazil present upward trends of COVID-19. In some FUs, the slowdown in DPC in the last segment must be considered with caution. Each FU is at a different stage of the pandemic and, therefore, non-pharmacological measures should be adopted accordingly., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Mental and behavioral disorders result in increased absenteeism and abandonment of work. The objective of this study was to evaluate the anxiety, stress, depression, negative and positive affects, and hematological and autonomic responses of employees in a public hospital exposed to laying on of hands with (LHS) or without Spiritual connection (control-LHW)., Methodology: Eighty-four employees with anxiety/stress were enrolled and randomly allocated into two groups of intervention LHS by Spiritist "passe" and control-LHW by volunteers with healing intent. Anxiety, stress and depression were evaluated by Depression Anxiety and Stress Scale (DASS21). Negative and positive affects by Subjective Well-being Scale (SWS), cardiac autonomic modulation by heart rate variability and cytokines and blood count were assessed by blood sample., Results: Our study showed a significant improvement in the neutrophils (p = 0.041; d = 0.70) and cardiac parasympathetic activity, and reduction in VLF (p < 0.005) in the LHS. There was reduction in erythrocyte parameters and interleukin 10 (p < 0.005) in the control-LHW. In both groups there was a significant reduction in anxiety, stress, depression and negative affects after one session (p < 0.005)., Conclusion: Laying on of hands with Spiritual connection by Spiritist "passe" appears to be effective in increasing cardiac vagal activity and regulation of immune responses of employees in a public hospital with stress/anxiety., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

A greater understanding of the deleterious consequences that a meniscal root tear brings to the knee joint and how its surgical repair can be advantageous over the previously used treatment strategies brings the need for the development of surgical techniques that make the procedure less complex and more reproducible. When meniscal root rupture occurs, a mechanical overload occurs in the affected compartment similar to a total meniscectomy. Several authors have concluded that meniscal root reinsertion significantly improves postoperative outcomes and patient satisfaction, regardless of age or laterality of the meniscal injury. The Meniscus 4 A-II device (Rio de Janeiro, Brazil) allows stitching at the root of the medial and lateral menisci. In this article, we describe the surgical repair technique for posterior-medial and -lateral meniscal root tears using this meniscal suture device. This technique is fast and effective., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

The menisci are fibroelastic structures interposed between the articular surfaces of the femur and tibia. They absorb impact and transmit load. Meniscal injury may compromise function and cause rapid joint degeneration, leading to the development of secondary osteoarthritis. Surgical treatment of meniscal injury is usually performed by arthroscopy, and meniscectomy or meniscal suture may be associated with such treatment. Meniscal suture should be considered when the injury compromises the proper functioning of the meniscus to recover its anatomy and function. Different meniscal suture techniques exist; the most widely used are the inside-out, outside-in, and all-inside techniques. The gold-standard repair technique is the inside-out technique. A drawback of this technique is the need to alternate between intra- and extra-articular structures for every stitch, which makes it even more laborious. We describe the continuous meniscal suture technique, also called "meniscal stitching," for a medial meniscal bucket-handle injury. This technique is performed from the inside out and allows the surgeon to perform multiple stitches with the same thread quickly and effectively. This surgical technique is performed using a single meniscal suture device that was developed by our group, called the "Meniscus 4 A-II" device., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Sand fly saliva presents molecules with potential to development of compounds for treatment of inflammatory diseases. Agaphelin, isolated from the saliva of the mosquito Anopheles gambiae, demonstrates anti-inflammatory properties such as neutrophils chemotaxis inhibition. Here, we extend these results and evaluated the role of agaphelin (0.1-100 nM) in an in vitro model consisting in the activation of human bronchial epithelial cells (BEAS-2B) by IL-4 (50 ng/mL) or lipopolysaccharide (LPS; 10 ng/mL). Agaphelin is non-cytotoxic for BEAS-2B cells. Notably, agaphelin markedly reduces CCL2 and IL-8 production induced by IL-4 or LPS, without altering the IL-10 production. The TLR4 expression and STAT1 phosphorylation induced by LPS were inhibited by agaphlin. In addition, agaphelin decreased the phosphorylation of STAT6 induce by IL-4, whose effect was independent of IL-4-binding activity. Taken together, these findings identify agaphelin as a potential anti-inflammatory therapeutic agent for airway inflammations., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Patellar tendon rupture is an uncommon but disabling lesion. It usually occurs in men younger than 40 years, through direct or indirect trauma. Obtaining satisfactory results with treatment of chronic injuries and re-ruptures in which the patella retracts owing to quadriceps contraction is a challenge. This is of major concern especially in cases in which the patella cannot be positioned in its anatomic position when distal traction is performed. In these cases, V-Y stretching of the quadriceps can be performed in an attempt to perform reconstruction in 1 stage. Instead, a 2-stage procedure can be chosen, in which the first stage relies on patellar trans-skeletal traction to achieve distalization of the patella. In 1981, a technique for the treatment of chronic injuries of the patellar tendon in 2 stages was described. In that procedure, the first stage consisted of transpatellar traction and the second stage was tendon-tendon suturing with fascia lata reinforcement. We describe a surgical technique performed in 2 stages; in the first stage, trans-skeletal traction is performed, and in the second stage, the technique of Kelikian et al. with our modification is performed. This technique is used in patients with chronic rupture of the patellar tendon associated with a high patella with nonreducible quadriceps shortening., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

The persistence of rotational instability after anterior cruciate ligament (ACL) reconstruction has been studied by several authors in the past 10 years. Although ACL lesions are currently treated arthroscopically, in the recent past, they were treated with isolated extra-articular tenodesis alone. Understanding the role and importance of anterolateral structures in the pathophysiology of rotational knee instability has increased since the rediscovery of the anterolateral ligament, and combined intra- and extra-articular reconstructions have been increasingly investigated. We sought to describe an option of lateral tenodesis associated with the ACL reconstruction through an iliotibial band tenodesis, without the need for large incisions or extra fixation devices, in a simple, fast, and reproducible manner., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Background: We analyze the effects of graduated compression stoking (GCS) on walking capacity and oxygen saturation in intermittent claudication (IC) patients., Methods: Eighteen patients with IC performed the 6-minute walking test in 2 conditions in random order: GCS or placebo sock. Onset claudication distance and total walking distance were obtained. The calf muscle oxygen saturation was continuously monitored before, during, and after 6-minute walk test. Comparisons of the walking capacity and StO 2 parameters between GCS and placebo conditions were analyzed by Wilcoxon rank-sum test., Results: The onset claudication distance (GCS: 120 ± 99 meters vs. placebo: 150 ± 126 meters; P = 0.798) and total walking distance (GCS: 330 ± 108 meters vs. placebo: 324 ± 60 meters; P = 0.130) were similar between conditions. There were no differences in StO 2 parameters between conditions (P > 0.05)., Conclusions: GCS does not decrease walking performance and calf muscle oxygenation saturation during 6-minute walk test in patients with IC., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to assess relationships between panoramic indexes, bone mineral density (BMD), and osteoporotic fractures in men >60 years old., Study Design: Body height and weight, body mass index, lumbar spine and hip BMD, and the presence of osteoporotic fractures were determined in the 127 studied men. Dental panoramic radiographs (DPRs) were used for measuring mandibular cortical indexes., Results: BMDs were lower in patients with thinning and resorption of mandibular cortex. No association was found between mandibular indexes and the presence of osteoporotic fractures. In a forward stepwise logistic regression model, the odds of having a T score ≤-2.5 was increased by 1.97 times for every 1-mm reduction in average mandibular cortical width., Conclusions: DPRs could show pronounced thinning of the inferior mandibular cortices in men >60 years old. However, there was no apparent association between vertebral fragility fractures and the appearance of mandibular cortex in elderly men., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objectives: The aim was to test for correlations of 7 panoramic radiomorphometric indices with lumbar spine and hip bone mineral densities (BMDs) and to test the accuracy of these indices for predicting osteoporosis and a T-score < or =-2.0., Study Design: Mandibular cortical indices, simple visual estimations of cortical widths, mental and antegonial indices, antegonial depth, gonial and antegonial angles, and BMD were measured in 351 postmenopausal women., Results: Associations were demonstrated between BMDs, qualitative indices, and cortical measurements. In the case of severely eroded mandibular cortices, the odds ratio (OR) for osteoporosis (according to the World Health Organization criteria) was 4.82 and the OR for a T-score < or =-2.0, the threshold to begin treatment, was 10.87. In the case of very thin mandibular cortices, the ORs were 8.02 and 5.46 for osteoporosis and a T-score < or =-2.0, respectively. The mental index cutoff for osteoporosis was 3.15 mm., Conclusions: Antegonial indices and gonial angles cannot be used as osteoporosis predictors. The most accurate indices were the mental index, mandibular cortical index, and visual estimation of cortical width., (Copyright 2010 Mosby, Inc. All rights reserved.)