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Objective To evaluate the effect of newly designed arthroscopic reconstruction of posterior cruciate ligament (PCL) using tibial tendon bolt. Methods The effects of embedded tendon pin were observed by X‐ray of knee joint. From October 2010 to September 2015, 51 PCL injury patients who met the inclusion criteria were enrolled in this retrospective study. The arthroscopically assisted reconstruction of the PCL with tibial tendon bolt was performed on all patients. Visual Analog Scale (VAS) pain score, Tegner activity score, Lysholm score, International Knee Documentation Committee (IKDC) assessment, posterior drawer test (PDT), and KT‐1000 activity score were evaluated preoperatively and at 1‐year postoperative and 3‐year postoperative. Results The preoperative, 1‐year postoperative, and 3‐year postoperative IKDC score (15.8% ± 14.8%, 89.6% ± 5.8%, and 86.8% ± 5.4%), Lysholm score (17.4 ± 10.7, 91.2 ± 2.8, and 88.2 ± 3.1), VAS score (5.8 ± 1.2, 1.3 ± 0.5, and 0.6 ± 0.5), Tegner activity score (1.2 ± 0.8, 8.1 ± 0.8, and 7.4 ± 0.8), and KT‐1000 score (15.6 ± 3.6, 4.5 ± 2.4, and 5.4 ± 1.8) were obtained. There were significant differences in these outcomes among preoperative, 1‐year postoperative, and 3‐year postoperative (all P, The application of tendon pin fixed by tibial inlay “8” shape tibial tunnel to reconstruct PCL was an effective, simple and safe surgical procedure for PCL injury.

Quadriceps active (QA) test has been described and well known for the diagnosis of posterior cruciate ligament (PCL) deficiency. We describe a modification of the QA test to diagnose PCL deficiency. Pushed QA test consists of two components where the examiner pushes the proximal tibia posteriorly with the knee flexed

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.

A 21-year-old man presented with left knee pain and instability that persisted three months after a road traffic accident. Physical examination revealed a positive posterior drawer test. Anterior drawer and pivot tests were negative. Magnetic resonance imaging of the knee demonstrated a complete tear of the posterior cruciate ligament (PCL). Recognition of the normal and injured appearances of the PCL is useful to aid the reader in the detection and characterisation of PCL injuries. Isolated acute PCL tears are usually managed conservatively. However, an active search for associated injuries is essential, as their presence may upstage the patients for surgical management.

Background: Posterior Cruciate Ligament (PCL) is the main posterior stabilizer of the knee. Injuries of the PCL are rare. Isolated PCL disruption most commonly occurs as avulsion at its tibial insertion as compared with its femoral origin or as a mid-substance tear. In PCL bony avulsion, fixation of the avulsed fragment with cancellous screw is a recommended procedure. Objective: To evaluate efficacy of Burk Schaffer’s approach in treatment of PCL tibial avulsion fracture with cancellous screw and evaluation of functional results according to Tegner Lysholm score. Material and Methods: We included 30 patients (Male 26 and Female 4) operated for isolated PCL avulsion from tibia during the period from 2015 to 2017. Patients were evaluated clinically by posterior drawer test, radiologically by X-ray and using functional scale of Tegner-Lysholm. MRI was advised for suspected other ligaments and meniscal injuries. All cases were operated with 4mm cannulated screw fixation by Burk and Schaffer approach. Results: Mean Tegner Lysholm score of 30 patients was 95.37 after 6 months of surgery, which was excellent. After 3 months 75% has grade 0 posterior drawer test, 12.5% has grade 1 and 12.5% has grade 2 laxity. Conclusion: Approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw for tibial avulsion of PCL gives good functional outcome.

Background. PCL reconstruction is a successful method for enhancing the patient's quality of life but posterior knee laxity and knee stiffness have still occurred surgery. There is no study to evaluate knee laxity or loss of knee range of motion after surgery. Objectives. To assess the outcomes after PCL reconstruction, we: 1) evaluated the range of motion of the knee, 2) evaluated posterior knee laxity, and 3) determined the factors that influence laxity or the loss of range of motion after surgery. Methods. Articles that met the following criteria were enrolled in this review: 1) articles on peer-reviewed level 1 to 4 studies; 2) articles published in English; 3) articles on PCL reconstruction studies; 4) articles on isolated PCL rupture; 5) articles that describe laxity after surgery and 6) articles that describe the degree of range of motion after surgery. Results. Involving a total of 1711 patients. There was a loss of extension and flexion after PCL reconstruction (9.15% and 28.9%, respectively). Knee laxity was still observed at the final examination in the posterior drawer test, KT 1000/2000 test, and Telos radiographic view (64.8%, 42.8%, and 47.9%, respectively). In the subgroup analysis, there was no significant difference in laxity between allograft group vs autograft group using the KT 1000/2000 measurement (mean difference [MD] = -0.42, 95% confidence interval [-1.41, 0.56], p = 0.40), Single Bundle vs Double Bundle (DB) using the KT 1000/2000 measurement (MD = -0.003, 95% CI [-1.35, 1.29], p < 0.00001), and transtibial vs tibial inlay using the Telos radiograph measurement (MD = 0.03, 95% CI [-0.33, 0.39], p = 0.88), but DB significantly improved knee stability using the Telos radiographic measurement (MD = 0.69, 95% CI [0.29,1.09], p = 0.00008).Conclusion. This study demonstrates that the loss of range of motion or laxity is still a problem after PCL reconstruction.

Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of Case: We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, TegnerLysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Discussions: The use of conventional screw on thin, small, and comminuted fragments cannot fix the bone and may causes bone fragmentation. Fixation technique using sutures produces unstable results and does not provide maximum pressure to fix the bone. Augmented PCL reconstruction surgery gives excellent result based on knee scoring system. Conclusion: Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

Introduction Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. PCL reconstruction with augmentation is a rare procedure to be performed in treating PCL avulsion case. This case reported and suggested an augmentation procedure in PCL avulsion case. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of case We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, Tegner-Lysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Conclusion Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

Background: Tear of MCL of the knee is a frequent problem among knee ligaments injuries.Injuries to the MCL are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. Contrary to most other knee ligaments the medial collateral ligament (MCL) has an excellent ability to heal, being fairly large and well vascularised structure. The vast majority of isolated medial ligament injuries heal without significant long-term problems Objectives: is to compare between the early clinical examination, and assessment under general anesthesia (GA), and to find out the best methods to assess the MCL tear especially in suspected cases. Type of the study:Cross- sectional study. Methods: Fifty patients are collected from casualty & outpatient units from November/2014 to October/2016 with MCL injury in AL-Kindy teaching hospital.We decided to evaluate them under general anesthesia by valgus stress test at 30 degrees & 0 degrees to estimate the integrity of MCL, in addition to anterior &posterior Drawer test to evaluate anterior &posterior cruciate ligaments Results: : From the 50 patients we select, there were 21 patients seen in the examination to have MCL tear.1 of them were Grade I ( 4.8% ),14 of them were Grade II (66.7% ),&6 of them were Grade III (28.5%)Associated injuries with ACL injury were 5 patients, with PCL injury were 1 patient and with medial capsular injury were 2 patients. Follow up of case range from (2-10) weeks with an average of 6 weeks combined with physiotherapy programs. Conclusions: Diagnosis of MCL tear by valgus stress test under GA is the best method for the assessment of MCL tear in suspected cases.

BACKGROUND: Incidence of isolated posterior cruciate ligament (PCL) injury is lower than PCL rupture is associated with other knee injuries. Adjustable loop femoral cortical suspension device is commonly used for femoral graft fixation during PCL reconstruction. AIM: This study purpose is to describe the functional outcome of PCL reconstruction using an adjustable loop femoral cortical suspension device. METHODS: This study used prospective design with consecutive sampling. All patients underwent PCL reconstruction with adjustable loop femoral cortical suspension devices using peroneus longus tendon autograft. Patients were evaluated at 6 months after surgery using posterior drawer test and functional outcome scoring system (Lysholm knee score, Cincinnati Score and International Knee Documentation Committee (IKDC) score). RESULTS: 20 patients were enrolled in this study with a mean age of 27.65 ± 9.78. Lysholm knee means the score was improved from 59.80 ± 18.73 pre-operative and 80.55 ± 11.72 post-operative (p < 0.05). Cincinnati mean score was improved from 52.01 ± 20.29 pre-operative to 72.95 ± 15.26 post-operative (p < 0.05). IKDC mean score was improved from 48.36 ± 13.18 at pre-operative to 72.5 ± 13.13 post-operative (p < 0.05). CONCLUSION: PCL reconstruction using adjustable loop femoral cortical suspension device using peroneus longus tendon autograft showed good clinical outcome and knee functional outcome (Lysholm, Cincinnati, and IKDC score) at 6 months follow-up.

The authors present their experience with a posterior approach for fixation of posterior Cruciate ligament avulsion from the tibia. Avulsion usually occurs at the tibial insertion. The approach is easy, safe and demands no great technical prowess or instruments. Some minor modifications and technical tips for a safer exposure and a better fixation are highlighted. This is a reproducible method for achieving good stability in these avulsion fractures, where early intervention prevents significant late disability. A single 4-mm screw gives sufficient initial stabilization to allow supervised mobilization. A high index of suspicion should be maintained in all dashboard injuries presenting with femoral shaft fractures, especially when the patella is also fractured. The patients were objectively (posterior drawer test) and subjectively (Lysholm scale) reevaluated after a minimum follow up period of 12 post operative months.

Posterior cruciate ligament (PCL) injuries are relatively common injuries associated with athletic activities and high-energy trauma. Posterolateral corner (PLC) injuries frequently accompany injury to the PCL. Diagnosis can be challenging and requires a comprehensive history and physical examination. Patients frequently report vague, nonspecific symptoms and the mechanism of injury is often useful in localizing injured structures. Two of the more common mechanisms for PCL injury include a direct blow to the proximal anterior tibia with the knee flexed, as well as a significant knee hyperextension injury. With a PCL tear, patients rarely describe an audible "pop" that is commonly reported in ACL injuries. On physical exam, a frequent finding in PCL tears is a loss of 10 to 20° of knee flexion. Although the most common clinical tests for PCL tears include the posterior drawer test, the posterior sag sign, and the quadriceps active test, there is a lack of high-quality diagnostic accuracy studies.Two cases of U.S. Military Academy Cadets who sustained PCL injuries while removing combat boots during military survival swim training are presented. The results of the clinical examination are accompanied by magnetic resonance imaging results and intraoperative arthroscopic images to highlight key findings.Both patients were evaluated and diagnosed with PCL injures within 10 days of their injuries. Each reported feeling/hearing a "pop," which is atypical in PCL tears. Both patients demonstrated a lack of active and passive knee flexion, which is a commonly reported impairment. One patient was managed nonsurgically with physical therapy and eventually returned to full duty without limitations 9 months after his injury. The other patient, who sustained a combined PCL-PLC injury, underwent a PCL reconstruction and PLC repair and reconstruction 8 weeks after his injury. He returned all training, with the exception of contact/collision sports, 9 months after surgery. Both patient's rehabilitation programs consisted of a progression of exercises to improve range of motion, muscle strength/endurance, motor control, and muscular power.Military and sports medicine professionals should be aware of the potential for PCL injury with this unusual, and previously unreported, mechanism of injury during survival swim training. Prompt diagnosis and appropriate treatment is essential to prevent long-term disability.

Background: Avulsion fractures of tibial insertion of the posterior cruciate ligament are rare among the knee injuries. Purpose of this study is to determine the functional outcome of arthroscopic reattachment of tibial avulsion of the Posterior cruciate ligament by ABS button (Arthrex) and tight rope.Methods: 15 Patients with PCL avulsion fracture were included. The Inclusion criteria were: 1) Displaced avulsion fractures (type-2 and type-3). They were followed at regular intervals using IKDC score, Lysholm score and subjective questionnaire.Results: All cases showed complete osseous union during follow up. All knees are stable on examination by posterior sag sign and posterior drawer test. Two patients had loss of about 100 flexion. According to the IKDC form assessment 13 patients classified as normal and 2 were classified as near normal.Conclusions: Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope gives fairly good clinical outcomes.

Background there is need to ascertain clinical and imaging outcomes after posterior cruciate ligament (PCL) augmentation. Methods we performed a retrospective analysis of clinical, imaging and functional data on 21 physically active males who underwent arthroscopic trans-tibial augmentation of the PCL for symptomatic grade III PCL insufficiency. The average follow-up time was 50 months (24-60 months). The Lysholm knee score was administered to all the patients, ligament laxity was evaluated with the posterior drawer test, the KT-1000 arthrometer, and the anteromedial tibial step-off. Standing antero-posterior, lateral and Merchant's view radiographs were taken preoperatively and at annual follow-up. Results post-operatively, ligament laxity and Lysholm knee scores were significantly improved than at baseline. Sixteen patients (73%) returned to pre-injury sport activity level, 3 patients (14%) returned to a lower level, 2 had to stop. We found radiographic degenerative changes in 5 of 22 affected knees (23%), with evidence of a statistically significant association between the occurrence of degenerative changes and the interval time from injury to surgery and duration of the follow up. Conclusions arthroscopic transtibial single bundle autograft hamstring augmentation significantly improves the function of the knee, with an overall satisfactory outcome of 82% at 2-5 years from surgery.

The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93 mm versus +0.03 mm,P=0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17 mm versus −0.57 mm,P=0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding.

Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:50Z No. of bitstreams: 1 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) Made available in DSpace on 2013-08-22T19:03:50Z (GMT). No. of bitstreams: 1 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) Previous issue date: 2007-01-01 Made available in DSpace on 2013-09-30T20:06:10Z (GMT). No. of bitstreams: 2 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) S1413-78522007000500008.pdf.txt: 18036 bytes, checksum: f9ab6790101113b68758ad8d1414a327 (MD5) Previous issue date: 2007-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:55Z No. of bitstreams: 2 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) S1413-78522007000500008.pdf.txt: 18036 bytes, checksum: f9ab6790101113b68758ad8d1414a327 (MD5) Made available in DSpace on 2014-05-20T15:16:55Z (GMT). No. of bitstreams: 2 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) S1413-78522007000500008.pdf.txt: 18036 bytes, checksum: f9ab6790101113b68758ad8d1414a327 (MD5) Previous issue date: 2007-01-01 Avaliamos 21 pacientes, sendo 16 pacientes do sexo masculino e 5 do feminino, com idade média de 30 anos, foram submetidos à tratamento cirúrgico da fratura-avulsão do LCP. em 57% dos casos a lesão foi secundária a acidente motociclístico e 19% a acidente automobilístico. em 72% dos casos foi identificada uma lesão na face anterior do joelho. O tratamento cirúrgico consistiu na abordagem posterior do joelho e fixação do fragmento ósseo com parafuso e arruela em 18 casos; e amarrilhas trans-ósseas em 3 casos, onde o fragmento ósseo era muito pequeno. em 91% dos casos, a cirurgia foi realizada dentro dos primeiros 15 dias apos a lesão. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm), apos um seguimento pós-operatório mínimo de 12 meses. A análise estatística não mostrou diferença significativa, ao nível de 5%, entre as avaliações objetiva e subjetiva. A ausência de lesão ligamentar periférica pode ter contribuído para que os resultados clínicos pós-operatórios tenham avaliação subjetiva satisfatória; entretanto, a presença de uma posteriorização tibial residual sugere que a fratura-avulsão do ligamento cruzado posterior deve ser abordada não como uma lesão óssea pura, mas sim, como uma lesão ósteo-ligamentar. We assessed 21 patients (16 males and 5 females), with mean age of 30 years who underwent surgical treatment for PCL avulsion fracture. In 57% of the cases, injuries were secondary to motorcycle accidents and 19% resulted from car accidents. Injuries on knee's anterior surface were detected in 72% of the cases. The surgical procedure involved posterior approach and bone fragment fixation using nut and screw in 18 cases, the trans-bone suture loop fixation in 3 cases with small bone fragments. In 91% of the cases, surgery was performed within the first two weeks following injury. The patients were objectively (posterior drawer test) and subjectively (Lysholm scale) re-evaluated after a minimum follow-up period of 12 postoperative months. The statistical analysis of objective and subjective assessments did not demonstrate any significant difference (p = 0.05). The satisfactory results of the subjective clinical postoperative evaluation may have been due to the absence of peripheral ligament injury. However, the presence of residual tibial posteriorization suggests that the avulsion fracture of the PCL should be treated as bone-ligament injury, and not just as a bone lesion. Faculdade de Ciências Médicas Unesp-Botucatu Departamento de Bioestatística Unesp-Botucatu Departamento de Bioestatística

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:48Z No. of bitstreams: 1 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) Made available in DSpace on 2013-08-22T19:03:48Z (GMT). No. of bitstreams: 1 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) Previous issue date: 2006-01-01 Made available in DSpace on 2013-09-30T20:06:08Z (GMT). No. of bitstreams: 2 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) S1413-78522006000200007.pdf.txt: 20380 bytes, checksum: fbd15ad5ebd114784338b8e06fae4cdf (MD5) Previous issue date: 2006-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:54Z No. of bitstreams: 2 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) S1413-78522006000200007.pdf.txt: 20380 bytes, checksum: fbd15ad5ebd114784338b8e06fae4cdf (MD5) Made available in DSpace on 2014-05-20T15:16:54Z (GMT). No. of bitstreams: 2 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) S1413-78522006000200007.pdf.txt: 20380 bytes, checksum: fbd15ad5ebd114784338b8e06fae4cdf (MD5) Previous issue date: 2006-01-01 A reconstrução cirúrgica do ligamento cruzado posterior (L.C.P.) do joelho ainda permanece como um grande desafio terapêutico. Neste trabalho avaliamos 30 pacientes submetidos à reconstrução cirúrgica do L.C.P. com a técnica de fixação do enxerto tendíneo no leito tibial por abordagem direta (INLAY). 28 pacientes eram do sexo masculino e 2 do feminino, com idade média de 31,10 anos. O tempo médio de lesão foi de 34,24 meses em 67% dos casos a lesão foi secundária a acidente motociclístico. As lesões condrais e do ligamento cruzado anterior (L.C.A.) do joelho estavam presentes em 67% e 33% dos casos, respectivamente. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm). O seguimento pós-operatório médio foi de 21,7 meses. Cerca de 66% dos casos foram classificados como bom e excelente na avaliação subjetiva e objetiva. A análise estatística apresentou comportamento semelhante para as duas avaliações.Os resultados clínicos pós-operatórios obtidos neste trabalho têm nos encorajado a seguir com esta técnica cirúrgica. Surgical reconstruction of the knee posterior cruciate ligament (P.C.L.) still remains as a major therapeutic challenge. In this paper, we assessed 30 patients submitted to surgical reconstruction of the P.C.L. with a technique of tendinous graft fixation on tibial bed by direct approach (INLAY). Twentyeight male patients and 2 female patients, with mean age of 31.10 years, participated on the study. The average injury time was 34.24 months. In 67% of the cases, injury was secondary to motorcycle accidents. Chondral injuries and knee anterior cruciate ligament (ACL) injuries were present in 67% and 33% of the cases, respectively. Patients were assessed objectively (posterior drawer test) and subjectively (Lysholm's Scale). Mean post-operative follow-up time was 21.7 months. About 66% of the cases were rated as good and excellent at the subjective and objective evaluation. The statistical analysis showed a similar behavior for both evaluations. Post-operative clinical outcomes achieved in this study have encouraged us to keep using this surgical technique. Unicamp Faculdade de Ciências Médicas UNICAMP HC DOT Unesp-Botucatu Departamento de Bioestatística Unesp-Botucatu Departamento de Bioestatística

One hundred and fifty asymptomatic shoulders in 75 schoolchildren were studied. The shoulders were tested for instability and a hyperextensometer was used to assess joint laxity. Signs of instability were found in 57% of the shoulders in boys and 48% in girls; the commonest sign was a positive posterior drawer test which was found in 63 shoulders. A positive sulcus sign was found in 17 shoulders and 17 subjects had signs of multidirectional instability. General joint laxity was not a feature of subjects whose shoulders had positive instability signs.

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.