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ResumoO tecido muscular esquelético possui a maior massa do corpo humano, correspondendo a 45% do peso total. As lesões musculares podem ser causadas por contusões, estiramentos ou lacerações. A atual classificação separa as lesões entre leves, moderadas e graves. Os sinais e sintomas das lesões grau I são edema e desconforto; grau II, perda de função, gap e equimose eventual; grau III, rotura completa, dor intensa e hematoma extenso. O diagnóstico pode ser confirmado por ultrassom (dinâmico e barato, porém examinador-dependente); e ressonância magnética (RM) (maior definição anatômica). A fase inicial do tratamento se resume à proteção, ao repouso, ao uso otimizado do membro afetado e crioterapia. Anti-inflamatórios não hormonais (AINHs), ultrassom terapêutico, fortalecimento e alongamento após a fase inicial e amplitudes de movimento sem dor são utilizados no tratamento clínico. Já o cirúrgico possui indicações precisas: drenagem do hematoma, reinserção e reforço musculotendíneos.

Introduction: Recent studies have shown that the likelihood of semitendinosus-gracilis graft rupture is inversely correlated to its diameter. A graft can be prepared in a five-strand or four-strand fashion to increase its diameter. However, the biomechanical superiority of five-strand semitendinosus-gracilis grafts is still under debate. Objective: This study aimed to evaluate the biomechanical characteristics of matched four-strand and five-strand human semitendinosus-gracilis grafts. Methods: We evaluated semitendinosus-gracilis tendons harvested from ten fresh human male and female cadavers, aged 18-60 years. Four-strand or five-strand grafts were prepared with the tendons and fixed to wooden tunnels with interference screws. Each graft was submitted to axial traction at 20 mm/min until rupture; the tests were donor matched. Data were recorded in real time and included the analysis of the area, diameter, force, maximum deformation and stiffness of the grafts. Results: The diameter, area and tunnel size were significantly greater in the five-strand grafts than in the four-strand grafts. There were no significant differences in biomechanical properties. The area and diameter of the graft were positively correlated to stiffness, and inversely correlated to elasticity. There was no significant correlation between graft size and maximum force at failure, maximum deformation or maximum tension. Conclusion: Five-strand hamstring grafts have greater area, diameter and tunnel size than four-strand grafts. There were no significant differences in biomechanical properties. In this model using interference screw fixation, the increases in area and diameter were correlated with an increase in stiffness and a decrease in elasticity. Level of evidence V; biomechanical study. RESUMEN Introducción: Estudios recientes demostraron que la probabilidad de ruptura de los injertos semitendinoso y gracilis (STG) durante el pos operatorio de reconstrucción de ligamento cruzado anterior (LCA) está inversamente correlacionada a su diámetro. Un injerto puede ser preparado para obtener cuatro o cinco hebras para aumentar su diámetro, pero la superioridad biomecanica de los injertos STG de cinco hebras aún se mantiene en discusión. Objetivo: Evaluar las características biomecánicas de los injertos STG de humanos de cuatro o cinco hebras por pares. Métodos: Fueron evaluados tendones STG de diez cadaveres masculinos y diez cadaveres femeninos frescos, entre los 18 y 60 años. Los injertos de cuatro y cinco hebras fueron fijados en túneles de madera con tornillos de interferencia. Cada injerto fue sometido a una tracción axial de 200mm/min hasta su ruptura; estos tendones fueron separados por pares de acuerdo con sus donadores. Los datos fueron registrados en tiempo real y incluyeron el análisis del área del injerto, diámetro, fuerza, deformación máxima y rigidez. Resultados: Los resultados sobre el diámetro, el área y el tamaño del túnel fueron significativamente mayores en los injertos de cinco hebras que en los de cuatro. No existieron diferencias significativas en las propiedades biomecánicas. El área y el diámetro del injerto fueron correlacionados positivamente con la rigidez e inversamente con la elasticidad. No existió correlación significativa entre el tamaño del injerto y la fuerza máxima al momento de la falla, Máxima deformación o máxima tensión. Conclusión: Los injertos de isquiotibiales de cinco hebras tienen una área, diámetro y tamaño de túnel más grande que los injertos de cuatro hebras. No hubieron diferencias biomecánicas significativas. Los aumentos de área y diámetro en este modelo con la fijación de tornillo de interferencia fueron correlacionados con aumento de en la rigidez y una disminución en la elasticidad. Nivel de evidencia V; estudio biomecánico. RESUMO Introdução: Estudos recentes demonstraram que a probabilidade de ruptura do enxerto dos tendões do semitendíneo e do grácil (STG) é correlacionada inversamente com seu diâmetro. Um enxerto pode ser preparado de forma quádrupla ou quíntupla para se aumentar o diâmetro. No entanto, a superioridade biomecânica dos enxertos STG quíntuplos ainda está em debate. Objetivo: Este estudo teve como objetivo avaliar as características biomecânicas dos enxertos STG humanos quádruplos ou quíntuplos pareados. Métodos: Foram avaliados tendões STG retirados de dez cadáveres masculinos e femininos frescos, com idades entre 18 e 60 anos. Os enxertos quádruplos ou quíntuplos foram preparados com os tendões e fixados em túneis de madeira com parafusos de interferência. Cada enxerto foi submetido à tração axial a 20 mm/min. até a ruptura; os testes foram pareados de acordo com os doadores. Os dados foram registrados em tempo real e incluíram a análise de área, diâmetro, força, deformação máxima e rigidez dos enxertos. Resultados: O diâmetro, a área e o tamanho do túnel foram significativamente maiores nos enxertos quíntuplos do que nos enxertos quádruplos. Não houve diferenças significativas nas propriedades biomecânicas. A área e o diâmetro do enxerto foram correlacionados positivamente com a rigidez e inversamente com a elasticidade. Não houve correlação significativa entre o tamanho do enxerto e a força máxima na falha, deformação máxima ou tensão máxima. Conclusão: Os enxertos quíntuplos dos músculos isquiotibiais têm maior área, diâmetro e tamanho do túnel do que os enxertos quádruplos. Não houve diferenças significativas nas propriedades biomecânicas. Neste modelo de fixação com parafuso de interferência, aumentos da área e do diâmetro foram correlacionados com o aumento da rigidez e a diminuição na elasticidade. Nível de evidência V; Estudo Biomecânico.

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.

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

A mask is a simple device yet it provides high levels of protection. As the virus affects mainly the respiratory tract – the nose, mouth, and lungs - it is highly contagious when people sneeze or cough, or exchange respiratory droplets with other people. This exchange is also promoted when a person is performing physical exercise. Although a mask provides some protection, it does not eliminate the need for social distancing. Around 25% of people infected with the new coronavirus may show no symptoms, yet still transmit the virus. One of the main problems with wearing a mask is that it hinders breathing, with the mask gradually becoming damp, increasing its resistance to air intake. Wearing a mask while performing physical activity requires a period of adaptation, as the flow of air to the lungs is reduced, requiring a reduction in the normal rhythm until the wearer has managed to adapt to it. Vigorous and intense exercise can cause inflammatory activity to increase, and should be minimized in order to protect the immune system. Secretory immunoglobulin A (IgA) is an antibody protein used by the immune system to neutralize pathogens, including viruses, and decreases with intense exercise. Exercise is considered intense when it is necessary to breathe through the mouth to eliminate the higher concentrations of CO2, but mouth breathing is associated with infections of the upper respiratory tract. Preference should be given to light to moderate exercise, around three times a week. Wearing a mask, and training in nasal breathing are the best and safest ways to reduce the entry of particles, and should be encouraged during this COVID-19 pandemic. Level of evidence V; Opinion of the specialist.

The main goal of this study was to identify the performance parameters and blood profile found among female soccer players. The second aim was to examine if there were any systematic differences between players assigned to different playing positions. Thirty-six players (age: 23.7 ± 3.5 y; weight: 61.9 ± 5.7 kg; height: 165.7± 6.2 cm) underwent a set of laboratory tests (cardiopulmonary exercise test, skinfold measurements, Wingate test, sit-and-reach test, and blood biochemical tests). The following results were verified: maximal oxygen uptake (53±3.9 mL . kg -1. min -1 ), second ventilatory threshold (11.5 ± 0.8 km . h -1 ), body fat (14.1 ± 2.9%), Wingate anaerobic test (peak power: 9.5 ± 0.8 w . kg -1 ; mean power: 7.3 ± 0.4 w . kg -1 and fatigue index: 55.5 ± 4.9%), flexibility test [sit-and-reach] (18.1 ± 2.9 cm) and biochemical parameters of blood (Hb:13.9 ± 0.3 g . dL -1 ; iron: 85.2 ± 12.6 µ . dL -1 ; calcium: 9.2±0.5 mg . dL -1 ; total cholesterol: 204.7 ± 34.7 mg . dL -1 ; HDL-c: 50.7± 3.6 mg . dL -1 ; LDL-c: 125.8± 23.3 mg . dL -1 ; triglycerides: 96.8±18.5 mg . dL -1 ). In conclusion, the current results indicate that present elite players' physiological characteristics are similar to those previously shown, despite the rapid changes of the female soccer game worldwide. However, data showed that different playing positions had different physiological and anthropometrics differences.

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 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.

Objective: To evaluate the nature and rate of sports injuries in medical students, as well as the risk factors at these events. Methods: All student-athletes (218) from a Medical School, integrated in at least one of the six team sport modalities (soccer, rugby, indoor soccer, handball, basketball, and volleyball) in 2017, were included. Injuries affecting their performance, regardless of time loss, were included. Athlete-exposure (A-E) was defined as one student-athlete participating in one practice or game. Results: Injury rates were significantly higher in junior medical students (1st - 3rd year) (7.58 per 1000 A-E, 95%CI = 6.11-9.06) than in senior medical students (4th - 6th year) (4.49 per 1000 A-E, 95%CI = 3.26-5.73) (p < 0.001). Multi-sports athletes had higher injury rates (10.69 per 1000 A-E, 95%CI = 8.22-13.17) than single-sport athletes (4.49 per 1000 A-E, 95%CI = 3.51-5.47) (p = 0.002). More than 60% of reported injuries occurred in the lower limbs and the mechanism that accounted for most injuries in games was player contact (51%); whereas in practice, it was non-contact (53%). Conclusion: Junior medical students present a higher injury rate than seniors. Medical students practicing more than one modality had a higher injury rate than those involved in just one sport modality. Level of Evidence IV, Cross-Sectional Study. RESUMO Objetivo: Avaliar a incidência e as características das lesões esportivas em alunos de medicina, assim como os fatores de risco envolvidos. Métodos: Todos os alunos (218) da Faculdade de Medicina da Universidade de São Paulo que integravam seis modalidades esportivas (futebol, rugby, futsal, handebol, basquete e vôlei) em 2017 foram incluídos. Foram incluídas as lesões que afetaram a performance, independente do tempo de afastamento. Uma exposição-atleta (E-A) foi definida como a participação de um aluno em um jogo ou treino. Resultados: A taxa de lesão foi maior em alunos do 1º ao 3º ano (7,58 por 1000 E-As 95% IC = 6,11-9,06) do que em alunos do 4º ao 6º ano (4,49 por 1000 E-As 95% IC = 3,26-5,73) (p < 0.001). Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão (10,69 por 1000 E-As, 95% IC 8,22-13,17) do que alunos praticantes de apenas uma modalidade (4.49 por 1000 E-As, 95% IC 3,51-5,47) (p = 0.002). Mais de 60% das lesões ocorreram nos membros inferiores e o principal mecanismo em jogos foi contato com outro jogador (51%), e em treinos foi lesão sem contato (53%). Conclusão: Alunos do 1 ˚ ao 3 ˚ ano apresentaram maior taxa de lesão do que alunos do 4º ao 6º ano. Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão do que alunos praticantes de apenas uma modalidade. Nível de Evidência IV, Estudo Transversal.

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.

The COVID-19 pandemic has created many challenges to ensure a safe environment for competitive sport. While modern medicine has already developed effective protocols for the treatment and prevention of the disease, there are serious concerns about hosting a sporting event of the scale of the Olympic Games, where more than 11 000 athletes from over 200 nations are expected to participate. Accordingly, there have been many calls to cancel the Tokyo Olympic Games, also known as Tokyo 2020, in both the international press and the scientific literature. A recent perspective published in the New England Journal of Medicine (NEJM)1 highlights the complexity and risks of convening the Tokyo Olympic Games during the COVID-19 pandemic. Despite the many uncertainties,1 much has been learnt over the past 18 months and many policies trialled and tested to protect athletes during sports participation. To develop a rapid understanding of the perspectives from the international sports and exercise medicine community, an informal survey of the International Federation of Sports Medicine (FIMS) Executive Committee, Commissions, and Collaborating Centres of Sports Medicine agreed that the Tokyo Olympic Games could go ahead safely based on the plans addressing the pandemic developed by the IOC (figure 1). This international network of 26 research laboratories and clinics has a mission to promote best practice …

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 these 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 magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

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 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 identify the incidence of injuries, their main characteristics, and the way they were managed throughout 2016 in two major series of a professional soccer championship in São Paulo, Brazil. Methods: This prospective study used an electronic questionnaire previously developed by the Medical Committee of the Paulista Soccer Federation which was sent to the team doctors after each match. Results: Two hundred and fifty-nine injuries occurred during 361 matches, and the incidence of injury per 1000 hours of game play was 21.32. Strikers were the most affected by injury; the most frequent diagnosis was muscle injury and the legs were predominantly affected. Most of the injuries occurred in the last 15 minutes of the first half and only 7.7% required surgical treatment. Conclusions: Muscle injuries were the most frequent, with most occurring in forwards and in the legs. Approximately half of the injuries occurred after contact and the vast majority was treated without surgery. MRI was the most requested exam and most injuries were classified as moderate (8 to 28 lost play days). Level of Evidence III, Study of Non Consecutive Patients; Without Consistently Applied Reference “Gold” Standard. RESUMO Objetivo: Identificar a incidência de lesões, suas principais características e a maneira como foram conduzidas durante todo o ano de 2016 nas duas principais séries (A1 e A2) do Campeonato Paulista. Métodos: Realizou-se um estudo prospectivo por meio de questionário eletrônico previamente desenvolvido pelo Comitê Médico da Federação Paulista de Futebol, que foi enviado aos médicos dos times das séries A1 e A2 do Campeonato Paulista de Futebol após cada rodada. Resultados: Houve 259 lesões durante 361 jogos, com incidência de 21,32 lesões por 1.000 horas de jogo ao se agrupar as duas séries do Campeonato Paulista. Os atacantes foram os mais envolvidos, sendo as lesões musculares as mais frequentes e os membros inferiores os mais afetados. A maioria das lesões ocorreu nos últimos 15 minutos do primeiro tempo e somente 7,7% das lesões precisaram de tratamento cirúrgico. Conclusões: As lesões musculares são as mais frequentes, sendo que a maioria ocorreu em atacantes e nos membros inferiores. Cerca de metade das lesões ocorreu após contato e a maioria absoluta das lesões foi tratada de forma não cirúrgica. A ressonância magnética foi o exame mais solicitado e a maior parte das lesões foi classificada como de gravidade moderada (8 a 28 dias de afastamento). Nível de Evidência III, Estudo de Pacientes Não - Consecutivos; Sem Padrão de Referência “Ouro” Aplicado Uniformente.

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.

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.

The Federation Internationale de Football Association (FIFA) World Cup is the biggest football event in the world and the most widely viewed sport event all over the globe. The championship has been awarded every 4 years, and in 2014 it was held in Brazil. In 2014, this major event took place in Brazil with 12 host cities, including Sao Paulo with the Itaquera Stadium which hosted 6 games including the opening match and had a capacity of over 63,000 seats at the World Cup. In this chapter, we will discuss the organization of the FIFA Medical Service in Sao Paulo providing the structural, action plans and challenges involved in that mission.

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.

ResumenObjetivoVerificar el mecanismo isocinético concéntrico de los músculos flexores y extensores de las articulaciones de rodillas en las piernas dominantes y no dominantes en jugadores de fútbol antes de iniciar la temporada futbolística.Material y métodosSe evaluaron 30 futbolistas profesionales de alto rendimiento, con edades entre 18 y 33 años, en el 86% la pierna derecha era dominante (chut). Se realizó el examen isocinético con una velocidad angular de 60°/s en el dinamométro, utilizando acción muscular concéntrica.ResultadosEl pico de torsión de los flexores de la pierna dominante fue un 3% superior a la pierna no dominante, sin encontrar una diferencia significativa. La diferencia del pico de torsión de los músculos extensores de la extremidad no dominante fue un 9% superior a la dominante (p=0,06). La relación porcentual de los flexores/extensores para el pico de torsión de la extremidad no dominante fue un 7% inferior a la dominante (p=0,09).ConclusiónEstos resultados indican la necesidad de evaluar previamente los músculos flexores y extensores de la rodilla como conducta de prevención, antes de iniciar el programa de entrenamiento de los futbolistas profesionales.AbstractObjectiveAssessment the concentric isokinetic performance of the flexor and extensor muscles of the joints of the knees legs dominant and not dominant prior to the commencement of a new soccer season.Material and methodsA total of 30 high-performance professional soccer players aged between 18 and 33 years, and 86% had the right leg as dominant (kick) and the remaining 14% left leg. All underwent isokinetic testing in angular velocity of 60°/s in the dynamometer using concentric muscle action.ResultsThe following results were obtained: peak torque in angular velocity of 60°/s of the flexors of the dominant leg (DL) was higher than 3% to the non-dominant leg (NDL), but this difference was not significant. Unlike the torque pique the extensor muscles of the NDL was 9% higher (P = 0.06) than DL. The percentage of flexors/extensors ratio for peak torque NDL was abnormal and below 7% (P = 0.09) than DL.ConclusionThese results indicate the need for prior assessment of the flexor and extensor muscles of the knee as a preventive conduct before starting the training program of high performance soccer players.

Bone block protrusion out of the tibial tunnel due to a relatively long graft is a common complication in anterior cruciate ligament surgical reconstruction with a patellar tendon. One possible solution is to shorten the patellar tendon graft already fixed in the femur by applying external rotation. This study aimed to evaluate the degree of shortening and biomechanical changes in porcine patellar grafts subjected to relatively higher degrees of rotation. Data obtained with rotations of 0°, 540°, 720°, and 900° were compared. Forty patellar porcine ligaments were subjected to biomechanical tests of degree of shortening, modulus of elasticity and maximum tension in the tendon before rupture. Tests were conducted using a universal mechanical testing machine and a computerized system for acquiring strength and deformation data. Progressive shortening of the patellar ligament occurred with rotations of 0°, 540° and 720°. However, the degree of shortening showed no statistically significant difference as rotation increased from 720° to 900°. Decreased modulus of elasticity was observed compared with the graft rotation at 0° in all groups tested, but no statistically significant differences were observed among 540°, 720° and 900°. The maximum tension of the patellar tendon showed no change before rupture, regardless of the degree of rotation. Rotating the patellar tendon is an efficient method for shortening a relatively long graft; however, more biomechanical studies are necessary to recommend this technique in clinical practice owing to the resulting decrease in graft stiffness that could compromise knee stability.

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.

Background Football is a high-speed contact sport and the risk of injury is high. The objective of this study was to compare the two main divisions (A1 and A2) of the Sao Paulo Football Championship and to perform a correlation analysis of the variables studied. Methods A prospective study was conducted using an electronic questionnaire previously developed by the Medical Committee of the Sao Paulo Football Federation. The questionnaire was sent to the doctors of the teams playing in the A1 and A2 divisions of the Sao Paulo Football Championship after each round. Setting: 2016 Sao Paulo Football Championship. Results The comparison of divisions A1 and A2 showed few significant differences among the various variables analysed in this study. The only significant differences were for right-side involvement in division A1 (p=0.044) and morning matches in division A2 (p

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: The incidence of hip arthroscopy procedures has recently increased, current trends demonstrating a wide geographical variation and relatively similar functional outcomes among a wide age range. We aimed to evaluate spatio-temporal trends in state variation of hip arthroscopy procedures as well as the rate and determinants of 90-day hospital revisits.Methods: This was a secondary spatiotemporal analysis of data on hip arthroscopy procedures from the Healthcare Cost and Utilization Project databases, including the State Inpatient Database (SID), the State Ambulatory Surgery Database and the State Emergency Department Database (SEDD) for Florida, Kentucky, and Maryland, spanning a total of six years (2009 - 2014). Revisit risk was only evaluated through Florida data.Results: Out of 4,085 patients, the mean age was 40.7 years, 60.5% were female, 81.4% white, 77.7% had private insurance, and 96.5% were located in metropolitan areas. The average Charlson co-morbidity score was 0.11 (± 0.39), the Van Walraven score was 0.17 (± 1.51). Revisit rates progressively decreased during the study period, from 13.3% in 2009 to 6.2% in 2014 (p for trend 42 [OR: 2.13 (1.7, 2.69)] and a Charlson comorbidity score >0 [OR: 2.35 (1.73, 3.16)] were risk factors for a revisit. Paying mechanisms other than Medicare were protective. Most revisits (93.19%) occurred in the first 25 days after the procedure and the 90-day revisit rates for the State of Florida were centered on the major metropolitan areas such as West Palm Beach, Sarasota, Tampa, and Orlando. The incidence of hip arthroscopies increased in most parts of Florida, Kentucky, and Maryland over the study period.Conclusion: Revisit rates may reflect the quality of care and highlight the need for improvement. Future registries should include patient factors like pre-operative function and social determinants of health that might influence outcomes and revisit rates.

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.

INTRODUÇÃO: Estenose do canal cervical consiste na diminuição do diâmetro sagital do canal cervical e está associada com maior risco de lesões neurológicas decorrentes de trauma cervical. Nos esportes de colisão, a estenose do canal cervical consiste em um importante parâmetro na decisão de retorno ao esporte após neuropraxia da medula cervical e após determinadas lesões do plexo braquial. Os métodos atualmente disponíveis para avaliação de estenose do canal cervical em atletas são muito caros (ex: por ressonância nuclear magnética) ou pouco precisos (métodos radiográficos). Este estudo avaliou um novo método radiográfico para determinação de estenose do canal cervical, comparando-o com medições realizadas em cadáveres, medida por ressonância nuclear magnética do canal cervical e do espaço disponível para a medula (SAC/SACD) e com o método radiográfico consagrado na literatura para determinação de estenose do canal cervical, o índice de Torg (IT). MÉTODOS: A população do estudo foram 20 homens entre 16 e 35 anos de idade. Os sujeitos realizaram uma ressonância nuclear magnética da coluna cervical para determinação do SAC/SACD e radiografias cervicais em perfil e antero-posterior para determinação do IT e do novo método radiográfico proposto, o diâmetro corrigido do canal cervical (DCCC). Para determinar o DCCC, foi utilizada uma barra de metal de 100 mm, acoplada verticalmente na linha média cervical, utilizando os processos espinhosos das vertebras cervicais como referência. Obtidos o diâmetro sagital da imagem do canal cervical e o comprimento da imagem da barra de metal na radiografia, e conhecendo o tamanho real da barra de metal, o diâmetro real do canal medular pôde ser estimado matematicamente com o uso do teorema de Tales. Os resultados obtidos para o DCCC foram comparados com valores encontrados em estudos com cadáveres, foi avaliada a concordância entre DCCC e o diâmetro médio-sagital do canal cervical aferido por ressonância magnética (DCRM) e os métodos radiográficos (DCCC e IT) foram correlacionados com o SAC/SACD. Os cálculos foram realizados nos níveis C3 a C7, além das médias de C3 a C6 [DCCC (MDCCC), IT (MTorg) e SAC/SACD (MSAC/MSACD)]. RESULTADOS: Os valores obtidos pelo DCCC (média do MDCCC: 15.29 mm) foram compatíveis com os valores descritos em estudos de medida direta. A correlação entre DCCC e SAC/SACD foi superior à correlação entre IT e SAC/SACD, sendo de 0.7025 para MDCCC e MSACD contra 0.5473 para MTorg e MSACD. O teste de concordância entre os valores absolutos para DCCC e DCRM evidenciou valores mais elevados na medida por DCCC, sendo média de 1.84 mm maior para MDCCC em relação a média de C3 a C6 pelo DCRM. CONCLUSÕES: O Diâmetro Corrigido do Canal Cervical apresentou valores semelhantes aos encontrados em estudos com medida direta em cadáveres e apresentou correlação com SAC/SACD superior ao IT INTRODUCTION: Cervical spinal stenosis is the diminution of the anteroposterior diameter of the spinal canal and it is associated with increased risk of neurological injury from cervical trauma. In collision sports, the cervical canal stenosis is an important parameter in the return to play decision after cervical cord neuropraxia and after some brachial plexus injuries. The methods currently available for evaluation of cervical canal stenosis in athletes are expensive (eg, nuclear magnetic resonance) or imprecise (radiographic methods). This study evaluated a new radiographic method for determination of cervical canal stenosis, comparing it to measurements performed on cadavers, measurement by magnetic resonance imaging of the cervical canal and space available for the cord (SAC/SACD) and the consecrated radiographic method for determining cervical spinal stenosis, Torg ratio(TI). METHODS: The study population were 20 men between 16 and 35 years. The subjects underwent a magnetic resonance imaging of the cervical spine to determine the SAC/SACD and cervical radiographs to determine the IT and the proposed new radiographic method, called corrected cervical canal diameter (DCCC). To determine the DCCC, a 100 mm metal bar was used vertically over the cervical midline, using the spinous processes of the cervical vertebrae as reference. Got the radiographic diameter of the medullary canal and the length of the metal bar image on the radiograph , and knowing the actual size of the metal bar , the actual diameter of the spinal canal could be estimated mathematically with the simple use of the theorem of Thales. The results for the DCCC were compared with values found in cadavers studies, the agreement between DCCC and the mid-sagittal diameter of the cervical canal measured by magnetic resonance imaging (DCRM) was calculated and radiographic methods (DCCC and IT) were correlated with SAC/SACD. Calculations were performed individually for C3 to C7 and averages of C3 to C6 [DCCC (MDCCC), IT (MTorg) and SAC/SACD (MSAC/ MSACD)]. RESULTS: The values obtained by DCCC (average MDCCC: 15:29 mm) were consistent with the values described in studies using direct measurement. The correlation between DCCC and SAC/SACD was higher than the correlation between IT and SAC/SACD, being 0.7025 for MDCCC and MSACD and 0.5473 for MTorg and MSACD. The agreement between absolute values for DCCC and DCRM showed higher values for DCCC, which average 1.84 mm greater for MDCCC compared to the average of C3 to C6 for DCRM. CONCLUSIONS: The Fixed Diameter of the Cervical Canal showed similar values to those found in studies with direct measurement from cadavers and correlated with SAC/SACD better than IT