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Total knee arthroplasty is used to treat end-stage knee osteoarthritis with great results. Tourniquet use has become popular over the years because of its various benefits, but the literature regarding functional outcomes, pain and rehabilitation and comparison between tourniquet use and improvement cement penetration and overall improve fixation is limited. The authors proposed a hypothesis that cementation quality, and clinical outcomes can be influenced by tourniquet technique. Fifty patients were allocated randomly in two groups: (1) tourniquet was inflated throughout all the procedure and (2) only during skin incision and cementation. Radiolucent lines were analyzed by two and independent examiners, using the The Knee Society Roentgenographic Evaluation and Scoring System. The functional scores used were the Oxford knee score and improvement in visual pain scale (VAS). After a mean follow-up period of 2.4 ± 0.2 years, no difference was observed regarding partial use of tourniquet in the cementation quality (p value > 0.05). There was no difference between groups regarding gender, age, knee side, Visual VAS, Oxford Score, total range-of-motion (ROM), knee extension and knee flexion (p value > 0.05). No difference was attained regarding functional outcomes and cementation quality regarding two different tourniquet protocols.

The aim of this study is to provide an updated meta-analysis comparing the benefits and clinical outcomes between high flexion (HF)-TKA and standard (S)-TKA. A detailed database analysis was carried out using Web of Science, PubMed, EMBASE, Cochrane Library, MEDLINE and Clinicaltrial.gov, to identify eligible studies. The meta-analysis and sensitivity analysis were performed using Review Manager 5.3 software and STATA 12.0. Twenty-two randomized control trials (RCTs), including 2841 patients and 4268 knees, were eligible for the meta-analysis. The pooled results of subgroup analysis reveal that there was significant difference between HF-TKA and S-TKA in each subgroup in terms of postoperative ROM, with a higher degree of knee flexion for HF-TKA than S-TKA. However, no statistical difference was identified between HF-TKA and S-TKA in other clinical outcomes including various functional scores and complications. On the basis of this meta-analysis, we can recommended HF-TKA as an alternative choice to S-TKA for patients requiring higher knee flexion in their daily activities.

Background In developing countries, the illiteracy index is high in public hospitals. We describe a method in which patients are instructed before total knee arthroplasty (TKA) in a differentiated way without the necessity of reading any self-orientation. Methods To improve patient education before TKA we developed a multidisciplinary method in which an orthopedic surgeon, a nurse and a physiotherapist give the patients a differentiated orientation with specific lectures regarding the pre, intra and post-operative issues in a prospective case-control study of 79 consecutive patients undergoing primary TKA. Twenty-nine patients received the standard verbal education (control group) and 38 patients received the differentiated education (intervention group). The patients were evaluated during at least six months. Results After a 6-month follow-up period, SF-36 and WOMAC forms, VAS and range of motion improved significantly in both groups. ROM was better in the intervention group (mean and SD − 106.9 ± 5.7 versus 92.5 ± 12.1 degrees, p = 0.02). Moreover, walk ability (more than 400 meters) was improved in the intervention group compared with control group (97.4% versus 72.4%, p = 0.003). In the intervention and control groups, respectively, 10.5% and 31% of patients reported the need of some walking device (p = 0.03). Conclusions A differentiated educational program with a multidisciplinary team had a positive impact on functional outcomes, improving ROM and walk ability of patients undergoing TKA in a short-term evaluation.

Resumo A fratura‐avulsao da tuberosidade anterior da tibia e uma lesao incomum que ocorre no jovem atleta, resultado de uma contracao excentrica do mecanismo extensor do joelho com o membro inferior fixo ao solo. Lesoes concomitantes ao tendao patelar sao muito raras, com poucos casos relatados na literatura. Os autores apresentam o caso de um atleta de basquete de 15 anos que sofreu uma fratura‐avulsao da tuberosidade anterior da tibia associada a ruptura completa distal do tendao patelar durante movimento de arremesso no treino esportivo. O paciente foi tratado com reducao aberta da fratura e reparo do tendao patelar com miniâncoras e parafuso poste com reforco tendinoso com enxerto autologo de semitendineo. O paciente apresentou otimos resultados e retornou ao esporte apos 12 meses de acompanhamento.

An osteochondral fracture of the posterolateral tibial plateau associated with an anterior cruciate ligament (ACL) injury in a 24-year-old boy is reported. Anterior cruciate ligament rupture is accompanied by bone contusions resulting from the impact of the posterolateral tibial plateau on the anterior part of the lateral femoral condyle. The osteochondral fracture of the posterolateral tibial plateau matched the site where the bone bruise is observed. Keywords: Osteochondral fracture, Anterior cruciate ligament injury, Posterolateral tibial plateau, Fibular head osteotomy

Background During medial patellofemoral ligament (MPFL) reconstruction, achieving anatomical positioning of the femoral and patellar origins is important for restoration of patellofemoral biomechanics. Although visual and manual detection can also be used to determine the femoral point of the MPFL, minimal research exists regarding accuracy of this method. Our aim was to evaluate the accuracy of free-hand method in determining the femoral point of the MPFL during surgery. Methods A prospective analysis was completed with 19 patients (20 knees), age ranging 15 to 39 years, in whom, three orthopedic surgeons with experience in knee procedures performed surgical reconstruction of the MPFL. MPFL femoral origin was accessed in a free-hand technique and a strict lateral view of the knee was then obtained. If the selected point was not considered appropriate, a better position was identified following the criteria set forth by Schottle. Results In a mean clinical follow-up of 2.3±1.3 years, anatomical point was achieved using the free-hand palpation method in seven knees (28.5%). Among the thirteen knees for whom the anatomical point was not attained without fluoroscopy, the mean error pattern found was 27.5%±8.6% for proximal (P-D axis) and 24%±6.3% for anterior in the posterior-anterior axis. The average error (difference between the marked point and the anatomical point) was 20.6%±5.9% (P=0.98) for the distal-proximal axis and 15.9%±6.1% (P=0.77) for the posterior-anterior axis. Conclusions The anatomical palpation technique showed low accuracy, even when performed by experienced surgeons. The most common error pattern observed was proximal and anterior.

Objective: The aim of this study was to prospectively evaluate the evolution and postoperative complication patterns relating to the use of suction drains, in comparison with not using these devices in total knee arthroplasty (TKA) procedures. Methods: Forty-two patients at a knee surgery referral clinic were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of motion, hematological indices, knee circumference and complication rate. The observation period was for six months after the surgical procedure. Results: There were no statistically significant differences between the groups regarding knee circumference, hemoglobin, hematocrit, transfusion rate or infection index. Regarding range of motion, there was no statistically significant difference between the groups with and without drains preoperatively (p = 0.126), during the first postoperative day (p = 0.583), on the fifth to seventh postoperative day (p = 0.076) or at the six-month follow-up (p = 0.848). There was a statistically significant difference between the groups in the evaluation performed between the 14th and 28th postoperative days (p = 0.025). Conclusion: From this study, it was concluded that there was no benefit from using closed suction drains in TKA cases beyond six months after the operation. However, the range of movement at the end of the first month was greater in the patients that received suction drainage.

The importance of tendinopathies in the clinical scenario has increased recently. It may be attributed to the increase of sport activities, life expectancy, and other factors such as environment, diet, systemic diseases, and some drug therapies (e.g., fluoroquinolones). In fact, not only athletes but also the general population suffer from inflammatory or degenerative tendon conditions which may be attributed to the quality of tendon tissue and mechanical overuse (Fusini et al. 2016).

Background Anterior cruciate ligament (ACL) reconstruction using a single-bundle transtibial technique can achieve good or excellent results in more than 90% of patients, but anatomical and biomechanical studies have questioned its ability to restore knee function. The purpose of this study was to evaluate clinical and tomographic results (patient satisfaction, knee function, and tunnel location) of patients who underwent transportal or transtibial single-bundle ACL reconstruction. Methods Seventy-one patients with ACL tears were included. Forty-one patients were treated by the single-bundle transportal technique and 30 patients were treated by the single-bundle transtibial technique. Clinical and tomographic data were analyzed in both groups. Results After a minimum of 2-year period, the transportal group showed more patients with normal clinical tests than the transtibial group (Lachman [ p =0.037], pivot shift [0.00], anterior drawer [0.002]; and arthrometer [0.002] tests). Regarding CT evaluation, transportal and transtibial groups obtained the following femoral central tunnel location (mean [SD]), as percentage: 30 (6.5) and 4.2 (6.4) in high–low axis; and 30.9 (5.9) and 33.2 (4.6) in the deep–shallow axis. Values in the tibial side were, respectively: 38 (6.5) and 46.0 (6.8) in the anterior–posterior axis; and 47.2 (2.5) and 46.9 (2.1) in the medial–lateral axis. Conclusion CT findings showed that the transportal single-bundle technique positions the ACL tunnel closer to the native ACL footprint in both femur and tibia compared with the transtibial single-bundle technique. Moreover, mild asymptomatic instability and extension deficit were observed more often in the transtibial group.

Metatarsal (MTT) fractures are common injuries in the outpatient orthopedic setting. Lesser MTT fractures, although often technically simple, can lead to an inordinate number of unsatisfied patients. The objective of our study was to evaluate the results obtained using an anterograde percutaneous technique for lesser MTT fractures. To our knowledge, there are no previous publications about this technique. We performed a prospective study with 14 patients from 2003 to 2008, in which we evaluated the fracture location, mechanism of trauma, associated comorbidities, and American Orthopaedic Foot and Ankle Society’s functional score for postoperative clinical assessments. The most common fracture location was the MTT neck (79%). Involvement of multiple MTTs (53%) was more common than isolated fractures (47%), and low-energy trauma (79%) was more frequent than highenergy trauma (21%). Female patients with diabetes had the worst functional postoperative results. There were no postoperative complications related to our chosen technique. The surgical technique proposed was effective for treating lesser MTT fractures and had lower complication rates compared with other established techniques.

Femoral and tibial footprint coordinates have been well studied in double-bundle anterior cruciate ligament (ACL) reconstruction. However, in a single-bundle reconstruction approach, the central coordinate of femoral and tibial footprints have not been determined. The purpose of this study was to describe the central point locations of the ACL footprints visualized by three-dimensional computed tomography (3D CT) images and analysed by the quadrant method.Eight cadaveric knees were dissected, and the central points of ACL femoral and tibial footprints were marked and analysed using 3D CT images.In the present study, the means (and standard deviation) of ACL femoral footprint dimensions were in the ventral-dorsal plane and in the cranial-caudal plane 9.4 ± 0.8 and 15.6 ± 0.9 mm, respectively. In the tibial side, the means of ACL footprint dimensions were in the anterior-posterior and in the medial-lateral 18.5 ± 1.9 and 15.5 ± 1.0 mm, respectively. In the tomographic analyses, the means of femoral central location coordinates in the ventral-dorsal (y) and in the cranial-caudal (x) axes were 35.3 ± 4.5 and 30.0 ± 1.6 %, respectively. The means of tibial central location coordinates were in the anterior-posterior (y) and in the medial-lateral (x) axes, respectively: 40.5 ± 5.3 and 50.2 ± 1.3 %, respectively.These computed tomographic coordinates might help future studies as a reference on ACL single-bundle anatomic reconstruction, with respect to the management of ACL revision surgery or in symptomatic patients after ACL reconstruction. Improvements in three-dimensional image acquisition could facilitate its intraoperative applicability in the coming years.

Knee arthroplasty improve function and symptoms in osteoarthritic patients. In the last years, implant and technical innovations increased clinical success rates. Better pain and bleeding control made it safer than few decades ago. Moreover, surgeon knowledge and skills have evolved continually over time.

Objective: To describe functional outcomes following surgical treatment of patients with patellofemoral instability submitted to patellar realignment. Methods: This was a retrospective study evaluating 34 operated knees for patellofemoral instability between 1989 and 2004. The patients were evaluated in the late postoperative period when a functional questionnaire was applied. Results: After a mean follow-up time of 6 years and 5 months, the mean score was 82.94 in the surgical group (p=0.00037). The results of this investigation showed pain relief in 97.05% and low rate of recurrent dislocation (5.88%), although lower scores were seen in intense articular activities (squatting, running and jumping). No patient developed osteoarthritis while being followed up. Conclusion: The procedure for joint described in this paper was shown to be effective for treating patients with recurrent patellofemoral instability.

OBJETIVO: Descrever e comparar clínica e radiograficamente pacientes submetidos a artroplastia total do joelho (ATJ) com implantes tibiais tipo all-polyethylene (ALP) e metal-backed (MTB). MÉTODOS: Pacientes submetidos a ATJ realizadas entre janeiro de 1998 e dezembro de 2004 foram agrupados de acordo com o tipo de implante recebido: all-polyethylene ou metal-backed. Sessenta pacientes compareceram para a avaliação, totalizando 82 joelhos operados. Destes, 22 pacientes haviam sido submetidos a ATJ apenas com ALP (12 unilaterais e 10 bilaterais), 33 pacientes apenas com MTB (26 unilaterais e sete bilaterais) e cinco pacientes foram submetidos a ATJ com ALP em um joelho e MTB em outro joelho, assim divididos: Grupo 1-37 joelhos com ALP e Grupo 2 - 45 joelhos com MTB. RESULTADOS: Não houve diferença na avaliação clínica e funcional entre os grupos. A média de radioluscência no fêmur foi de 0,838mm para os pacientes do grupo 1 e 0,356mm para os pacientes do grupo 2 (p = 0,049). Para a tíbia, na incidência AP, houve um valor médio de 2,703mm para o grupo 1 e de 0,733mm para o grupo 2 (p = 0,000). Na incidência em perfil, o valor médio de osteólise foi de 0,405mm para o grupo 1 e de 0,200mm para o grupo 2 (p = 0,074). CONCLUSÕES: Não houve diferença entre os grupos na avaliação clínica e funcional. Houve aumento da radioluscência nas artroplastias com ALP, tanto no fêmur na incidência em perfil quanto na tíbia na incidência em AP. Nível de evidência IV - Estudo tipo série de caso. OBJECTIVE: To evaluate and clinically and roentgenographically compare two populations who had undergone total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial components. METHODS: Two groups of 40 patients underwent TKA between January 1988 and December 2004. Sixty patients showed up for evaluation, totaling 82 operated knees. From these, 22 patients had undergone TKA with only ALP (12 unilateral and 10 bilateral), 33 patients with only MTB (26 unilateral and 7 bilateral) and 5 patients had undergone both implants. The 82 operated knees were divided into two groups according to the type of tibial implant: Group 1 - 37 knees with ALP and Group 2 - 45 knees with MTB. RESULTS: There was no clinical or functional difference in outcome between the studied groups. The measurement of radioluscent line in the femoral component averaged 0.838 mm in Group 1 and 0.356 mm in Group 2 (p=0.049). For the tibial component, in the AP view radioluscent line measurement averaged 2.703 mm in Group 1 and 0.733 mm in Group 2 (p=0.000); and in the lateral view, the average values were 0.405 mm in Group 1 and 0.200 mm in Group 2 (p=0.074). CONCLUSIONS: There was no difference in the functional or clinical outcomes between the groups. However, radioluscent line was observed more frequently in the ALP arthroplasty group, in the lateral view in the femoral component as well as the AP view of the tibial component. Level of evidence IV - case series study.

Objective: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. Methods: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. Results: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). Conclusions: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV – case series study.

Objective: To assess the early complications in the orthopedic treatment of metastatic bone lesions and the factors associated with these complications. Method: There were assessed, retrospectively, 64 patients that underwent surgical treatment for bone metastases, analyzing the complications that occurred in the pre-operative and early post- operative period and associating them with the tumor origin, type of procedure done, the need of blood reposition before the surgery, the need of new surgical procedures and the mortality due to the complications. Results: Early complications in the treatment were observed in 17 (26.6%) patients, of which six (35.2%) ended up dying due to these complications. Regarding the type, 15 (23.8%) cases were due to surgical complications, four (6.3%) clinical and three (4.7%) patients showed clinical and surgical complications. There was no significant difference in the frequency of complications or mortality when assessed the type of reconstruction or affected region. The tumors with a renal origin needed more blood reposition and showed a bigger frequency of complications. Conclusion: The complications occurred in 26.6%. The complications are not related to the kind of treatment performed or to the region affected. The renal origin tumors showed a higher risk of hemorrhage.

OBJETIVO: Descrever os resultados funcionais do tratamento cirúrgico de pacientes portadores de instabilidade fêmoro-patelar submetidos a realinhamento do aparelho extensor. Métodos: Trata-se de estudo retrospectivo de 34 joelhos operados devido à instabilidade fêmoro-patelar no período de 1989 a 2004. Os pacientes foram avaliados no pós-operatório remoto, sendo aplicado questionário funcional. RESULTADOS: Em um seguimento médio de seis anos e cinco meses, o valor médio de pontuação foi de 82,94 pontos no grupo operado (p = 0,00037). Melhora do quadro de dor (97,05% de excelentes e bons resultados) e baixa taxa de recorrência dos episódios de luxação (5,88%) foram observadas no grupo, embora pontuações mais baixas tenham sido obtidas em atividades de maior demanda articular (agachamento, prática de corridas e execução de saltos). Nenhum dos pacientes avaliados desenvolveu artrose no tempo de seguimento. CONCLUSÃO: O procedimento de realinhamento articular descrito neste artigo mostrou-se eficaz no tratamento dos pacientes com instabilidade fêmoro-patelar recidivante. OBJECTIVE: To describe functional outcomes following surgical treatment of patients with patellofemoral instability submitted to patellar realignment. METHODS: This was a retrospective study evaluating 34 operated knees for patellofemoral instability between 1989 and 2004. The patients were evaluated in the late postoperative period when a functional questionnaire was applied. RESULTS: After a mean follow-up time of 6 years and 5 months, the mean score was 82.94 in the surgical group (p=0.00037). The results of this investigation showed pain relief in 97.05% and low rate of recurrent dislocation (5.88%), although lower scores were seen in intense articular activities (squatting, running and jumping). No patient deve-loped osteoarthritis while being followed up. CONCLUSION: The procedure for joint described in this paper was shown to be effective for treating patients with recurrent patellofemoral instability.

Objective: Assess the long-term results of distal femoral varusing osteotomy and try to establish predictive criteria that could help on selecting patients to be submitted to this technique. Methods: Fifteen patients with lateral compartment osteoarthritis and valgus deformity of the knee were submitted to distal femoral “V” varusing osteotomy fixated with lateral plate, pursuing knee alignment at 0° on the anatomical axis. The mean follow-up period was 81.4 months, ranging from 43 to 132 months. The Knee Society Rating System protocol was employed. Additional assessed variables were the following: patient age, follow-up time, and postoperative anatomical angle. Results: 11 results were regarded as excellent or good (73%) and four as fair or poor (27%). Conclusion: Distal femoral “V” varusing osteotomy constitutes a good treatment alternative for patients with lateral compartment osteoarthritis and valgus knee. The following variables have not been confirmed: patient age at the time of surgery, follow-up time, and postoperative anatomical angle as predictive factors for the results.

OBJETIVO: Avaliar as complicações precoces do tratamento ortopédico de lesões ósseas metastáticas e os fatores associados a essas complicações. MÉTODOS: Foram avaliados retrospectivamente 64 pacientes submetidos a tratamento cirúrgico de metástases ósseas, analisando as complicações ocorridas no peroperatório e pós-operatório precoce e associando-as com a origem do tumor, o tipo de procedimento realizado, a necessidade de reposição de sangue no peroperatório, necessidade de novos procedimentos cirúrgicos e a mortalidade em decorrência das complicações. RESULTADOS: Complicações precoces do tratamento foram observadas em 17 (26,6%); seis (35,2%) evoluíram para óbito em decorrência dessa complicação. De acordo com o tipo, em 15 (23,8%) casos foram complicações cirúrgicas, em quatro (6,3%), clínicas e três (4,7%) pacientes apresentaram tanto complicações clínicas quanto cirúrgicas. Não houve diferença significativa na frequência das complicações ou mortalidade quando avaliados o tipo de reconstrução ou o local acometido. Os tumores de origem renal necessitaram de maior reposição sanguínea e tiveram maior frequência de complicações (p = 0,0001). CONCLUSÃO: As complicações ocorreram em 26,6%. As complicações não estão associadas ao tipo de tratamento realizado, nem ao local acometido. Os tumores de origem renal apresentaram risco aumentado de hemorragia. OBJECTIVE: To assess the early complications in the orthopedic treatment of metastatic bone lesions and the factors associated with these complications. METHOD: There were assessed, retrospectively, 64 patients that underwent surgical treatment for bone metastases, analyzing the complications that occurred in the pre-operative and early post- operative period and associating them with the tumor origin, type of procedure done, the need of blood reposition before the surgery, the need of new surgical procedures and the mortality due to the complications. RESULTS: Early complications in the treatment were observed in 17 (26.6%) patients, of which six (35.2%) ended up dying due to these complications. Regarding the type, 15 (23.8%) cases were due to surgical complications, four (6.3%) clinical and three (4.7%) patients showed clinical and surgical complications. There was no significant difference in the frequency of complications or mortality when assessed the type of reconstruction or affected region. The tumors with a renal origin needed more blood reposition and showed a bigger frequency of complications. CONCLUSION: The complications occurred in 26.6%. The complications are not related to the kind of treatment performed or to the region affected. The renal origin tumors showed a higher risk of hemorrhage.

INTRODUÇÃO: a cirurgia de reconstrução do ligamento cruzado anterior do joelho objetiva restabelecer a estabilidade e melhorar a função articular. Para isso, é fundamental conhecer a sua anatomia e o ponto anatômico que corresponda ao centro das suas inserções femoral e tibial para o correto posicionamento dos túneis durante a reconstrução cirúrgica. OBJETIVOS: descrever em peças anatômicas as coordenadas de localização que correspondam ao centro da origem ligamentar femoral e tibial do ligamento cruzado anterior; verificar qual das duas técnicas de reconstrução do ligamento cruzado anterior, transportal ou transtibial, que mais se aproxima desse marco anatômico. MÉTODOS: oito joelhos de cadáveres humanos foram dissecados e o centro da origem femoral e tibial identificados, marcados e analisados após reconstrução tridimensional por tomografia computadorizada. Em um segundo momento, 23 pacientes submetidos à reconstrução do ligamento cruzado anterior, sendo 14 pacientes operados por meio da técnica transportal e nove por meio da técnica transtibial, foram analisados por imagens tomográficas tridimensionalmente reconstruídas. RESULTADOS: no estudo anatômico, as dimensões médias da origem femoral foram de 9,4 ± 0,8 mm no eixo ventral-dorsal e de 15,6 ± 0,9 mm no eixo cranial-caudal. Na origem tibial, as dimensões médias encontradas foram de 18,5 ± 1,9 mm no eixo anterior-posterior e de 15,5 ± 1,0 mm no eixo medial-lateral. As coordenadas tomográficas que representam o ponto médio central da origem femoral foram de 35,3% ± 4,5% no eixo ventral-dorsal e de 30,0% ± 1,6% no eixo cranialcaudal. Na origem tibial foram encontradas coordenadas médias de 40,5% ± 5,3% no eixo anterior-posterior e 50,2% ± 1,3% no eixo medial-lateral. Nos grupos transportal e transtibial, as coordenadas do centro do túnel femoral obtidas foram, respectivamente, 30% ± 6,5% e 4,2% ± 6,4% no eixo ventral-dorsal, e de 30,9 ± 5,9% e 33,2 ± 4,6% no eixo cranial-caudal. As coordenadas tibiais dos grupos transportal e transtibial foram, respectivamente, 38 ± 6,5% e 46,0% ± 6,8 no eixo anterior-posterior e 47,2% ± 2,5% e de 46,9% ± 2,1% no eixo medial-lateral. CONCLUSÃO: no estudo anatômico pôde-se identificar o ponto central único da origem femoral e tibial do ligamento cruzado anterior. No estudo clínico, verificou-se que as coordenadas tomográficas dos pacientes no grupo transportal se aproximaram mais desse ponto anatômico em comparação aos pacientes no grupo transtibial. INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction surgery aims to reestablish joint stability and improve knee function. Knowledge about ACL insertion-sites and ACL anatomy is crucial while positioning femoral and tibial tunnels. An anatomical landmark that represents a central position of femoral and tibial footprints has been studied. OBJECTIVES: Describe tomographic coordinates that represent a central position of femoral and tibial ACL footprints. Indeed, compare two ACL reconstruction techniques and their ability in achieving this central point in both sides (femur and tibia). METHODS: Eight cadaveric knees were dissected, and the central point of ACL femoral and tibial footprints were marked and analyzed using three-dimensional computed tomography. Moreover, 23 patients who presented with a reconstructed ACL 14 patients with transportal technique and 9 patients with transtibial technique were evaluated by the same method. RESULTS: In the cadaveric study, the means (and standard deviation) of ACL femoral footprint dimensions were in the ventraldorsal axis and in the cranialcaudal axis 9.4 ± 0.8 and 15.6 ± 0.9 mm, respectively. In the tibial side, the means of ACL footprint dimensions were in the anteriorposterior and in the mediallateral axis 18.5% ± 1.9% and 15.5% ± 1.0% mm, respectively. In the tomographic analyses, the means of femoral central location coordinates in the ventraldorsal and in the cranialcaudal axes were 35.3% ± 4.5% and 30.0% ± 1.6%, respectively. The means of tibial central location coordinates were in the anterior posterior and in the mediallateral axes, respectively: 40.5% ± 5.3% and 50.2% ± 1.3%, respectively. Regarding evaluation of transportal and transtibial groups, the following femoral central tunnel location (as mean) were found: 30.9% ± 5.9% and 33.2% ± 4.6% in the cranial-caudal axis, and 30% ± 6.5% and 4.2% ± 6.4% in the ventral-dorsal axis. Values in the tibial side were, respectively: 38% ± 6.5% and 46.0% ± 6.8% in anterior-posterior axis; and 47.2% ± 2.5% and 46.9% ± 2.1% in the medial-lateral axis. CONCLUSION: In the anatomical study, coordinates that represent the central location of femoral and tibial ACL footprints were defined, moreover, in the clinical study, transportal group attained coordinates that better resembled that location.

Purpose This article discusses current evidence in nutraceuticals and viscosupplementation uses in osteoarthritis (OA) treatment. Methods A search was carried out to identify systematic reviews, randomized controlled trials, review articles, and original articles (PubMed and Cochrane Database) about nutraceuticals and viscosupplementation. The keywords used were nutraceuticals, glucosamine, chondroitin, diacerein, avocado, soybean unsaponifiables, nutraceuticals, and viscosupplementation, independently or combined with the terms "review" and "randomized." Results Glucosamine hydrochloride has no effect on pain management, although the sulfate formulation has a moderate effect. Diacerein leads to pain relief, with a superior carryover effect when compared with placebo. Avocado and soybean unsaponifiables may have positive effects on knee and hip OA, but long-term results could not be confirmed. Despite the American Academy of Orthopaedic Surgeons' recommendation against the use of hyaluronic acid in OA, some systematic reviews found some benefits in the knee. Conclusions There is no evidence that nutraceuticals or viscosupplementation influences OA's natural progression. However, some of these agents seem to reduce pain and improve function. Level of Evidence Level IV, systematic review of studies with Level I through Level IV evidence.

INTRODUÇÃO: a cirurgia de reconstrução do ligamento cruzado anterior do joelho objetiva restabelecer a estabilidade e melhorar a função articular. A técnica transtibial foi considerada padrão-ouro no tratamento por vários anos, entretanto, estudos biomecânicos e anatômicos geraram questionamentos sobre a sua eficácia em restaurar a homeostase articular. A proposição da reconstrução anatômica por meio da técnica transportal do ligamento cruzado anterior foi desenvolvido no intuito de melhorar os resultados cirúrgicos. OBJETIVOS: comparar os resultados clínicos entre as técnicas transportal e transtibial, avaliando os pacientes operados no intervalo entre 2007 e 2010. MÉTODOS: foram avaliados 71 joelhos em 61 pacientes submetidos à cirurgia de reconstrução ligamentar. Foram avaliados 41 joelhos operados pela técnica transportal e 30 joelhos operados pela técnica transtibial. Os pacientes foram acompanhados por parâmetros clínicos de satisfação pós-operatória (IKDC e Lysholm), pela estabilidade (ressalto, gaveta anterior, teste de Lachman e KT- 1000-MEDmetrics®) e pela função articular global (amplitude de movimento final, perimetria da coxa, desempenho ao hop test monopodálico). RESULTADOS: os joelhos operados pela técnica transportal e pela técnica transtibial apresentaram, respectivamente, os seguintes resultados: ressalto positivo 14,6% versus 60% (p=0,00); gaveta positiva 17,1% versus 53,3% (p=0,002); teste de Lachman positivo 2,4% versus 20% (p=0,037); diferença lado-lado pelo artrômetro (KT- 1000-MEDmetrics®) 0,5 mm versus 2 mm (p =0,002). O déficit de extensão foi maior no grupo transtibial (2,5 graus versus 0,98 graus, p=0,013). CONCLUSÃO: a técnica transportal apresentou melhores resultados em termos de estabilidade e menos perda de extensão articular quando comparada à técnica transtibial. Não houve diferença entre as técnicas pela avaliação funcional. INTRODUCTION: The goals of anterior cruciate ligament surgery are to restore stability and improve function. The transtibial arthroscopic technique had made this procedure as the gold standard treatment in the last decades. However, biomechanics and anatomic studies have brought into question its ability to restore knees homeostasis. The concept of anatomic reconstruction has been developed, as well as the transportal procedure. OBJECTIVES: The objective of this study is to evaluate the clinical results of the anterior cruciate ligament reconstruction through transportal or transtibial technique. METHODS: Sixty-one patients (seventy-one knees) in whom an anterior cruciate reconstruction was made (41knees through a transportal technique and 30 knees through a transtibial technique) were evaluated, considering the functional scores (IKDC and Lysholm), stability (pivot-shift, anterior drawer test, Lachman test and KT-1000- MEDmetrics®) and global articular function (extension and flexion deficit, thigh circumference and monopodalic hop test performance). RESULTS: Transportal technique showed better results in terms of stability than transtibial technique (transportal versus transtibial results, respectively positive pivot-shift: 14.6% versus 60%, p 0.00; positive anterior drawer test: 17.1% versus 53.3%, p 0.002; positive Lachman test: 2.4% versus 20%, p 0.037; arthrometer side-to-side difference (KT-1000-MEDmetrics®) 0.5 mm versus 2 mm, p 0.002). Extension deficit was more evident in the transtibial group (2.5 degrees versus 0.98 degrees, p 0.013). CONCLUSION: in this study, transportal technique gave better results than the transtibial technique regarding articular stability function and articular mobility.

OBJETIVO: O objetivo deste trabalho é avaliar prospectivamente o padrão de evolução e complicações pós-operatórias relacionadas ao uso de drenos de sucção quando comparado à não utilização destes dispositivos na ATJ. MÉTODOS: Foram incluídos 42 pacientes de um serviço de referência em cirurgia do joelho. Quinze pacientes não receberam e 27 receberam dreno de sucção no pós-operatório. Os parâmetros avaliados foram: amplitude de movimento (ADM), índices hematimétricos, circunferência do joelho e taxa de complicações. O período de observação estendeu-se até o sexto mês de pós-operatório. RESULTADOS: Não foi observada diferença estatisticamente significativa entre os grupos quanto à circunferência do joelho, hemoglobina, hematócrito, taxa de transfusão e índice de infecção. Com relação à amplitude de movimentos, não houve diferença estatística entre os grupos com e sem dreno no pré-operatório (p = 0,126), primeiro DPO (p = 0,583), quinto ao sétimo DPO (p = 0,076) e seis meses de pós-operatório (p = 0,848). Foi identificada diferença estatisticamente significante entre os grupos na avaliação entre o 14º e 28º DPO (p = 0,025). CONCLUSÃO: Este estudo conclui que não existe benefício no uso de dreno de sucção fechado na ATJ além de seis meses de pós-operatório. No entanto, a ADM ao final do primeiro mês é melhor no grupo que utilizou o dreno de sucção. OBJECTIVE: Our aim is to prospectively evaluate the standard evolution and post-operative complications related to the use of suction drainage devices when compared to not using these devices in TKA. METHODS: Forty-two patients from a clinic referred to knee surgery were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of movement, hematometric indices, knee circumference, and complications for each group. Patients were observed for six months after the surgical procedure. RESULTS: There were no statistically significant differences in knee circumference, hemoglobin, hematocrit, transfusion rate, and infection index. The analysis of the range of movement did not reveal statistically significant differences between the groups preoperatively (p=0.126), during the first postoperative day (p=0.583), fifth to seventh postoperative day (p=0.076) and at six months follow-up (p=0.848). There was a statistically significant difference between groups in the comparison during the 14th and 28th postoperative days (p=0.025). CONCLUSION: In conclusion, there is no benefit to using closed suction drains beyond six months after TKA. However, the range of movement at the end of the first month is superior in patients that received suction drainage.

OBJETIVO: Avaliar os resultados em longo prazo da osteotomia femoral distal de varização e procurar estabelecer critérios preditivos que possam auxiliar na seleção dos pacientes a serem submetidos a essa técnica. MÉTODOS: Quinze pacientes portadores de osteoartrose do compartimento lateral e deformidade em valgo do joelho foram submetidos à osteotomia femoral distal de varização em "V" e fixação com placa-lâmina lateral, procurando-se alinhar o joelho a 0º no eixo anatômico. O seguimento médio foi de 81,4 meses, variando de 43 a 132 meses. Utilizou-se o protocolo da Knee Society Rating System. Foram consideradas ainda as variáveis: idade do paciente, tempo de seguimento e ângulo anatômico pós-operatórios. RESULTADOS: Foram obtidos 11 resultados excelentes e bons (73%) e quatro regulares e ruins (27%). CONCLUSÃO: A osteotomia femoral distal de varização em "V" constitui boa opção para o tratamento de pacientes com osteoartrose do compartimento lateral e valgismo do joelho. Não se confirmaram as variáveis idade do paciente na data de cirurgia, tempo de seguimento e ângulo anatômico pós-operatórios como fatores preditivos dos resultados. OBJECTIVE: Assess the long-term results of distal femoral varusing osteotomy and try to establish predictive criteria that could help on selecting patients to be submitted to this technique. METHODS: Fifteen patients with lateral compartment osteoarthritis and valgus deformity of the knee were submitted to distal femoral "V" varusing osteotomy fixated with lateral plate, pursuing knee alignment at 0° on the anatomical axis. The mean follow-up period was 81.4 months, ranging from 43 to 132 months. The Knee Society Rating System protocol was employed. Additional assessed variables were the following: patient age, follow-up time, and postoperative anatomical angle. RESULTS: 11 results were regarded as excellent or good (73%) and four as fair or poor (27%). CONCLUSION: Distal femoral "V" varusing osteotomy constitutes a good treatment alternative for patients with lateral compartment osteoarthritis and valgus knee. The following variables have not been confirmed: patient age at the time of surgery, follow-up time, and postoperative anatomical angle as predictive factors for the results.

Background: The traditional transtibial (TT) technique, usually leads to excellent and good results in more than 90% of patients. However, in the last years, biomechanics and anatomic studies had brought into question its ability to restore knee’s homeostasis. The anatomic reconstruction concept was developed, as well the transportal (AMP) approach for femoral tunnel creation, placing the graft in a more anatomic position.

Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.

INTRODUÇÃO: A reconstrução isolada do ligamento cruzado anterior (LCA) não reestabelece a biomecânica normal do joelho, em casos de lesão associada das estruturas anterolaterais, em estudos biomecânicos in vitro. Estudos avaliando o potencial impacto clínico das lesões do ligamento anterolateral (LAL), no tratamento das lesões do LCA, são necessários para validar ou não os achados dos estudos biomecânicos, principalmente considerando o mau potencial de cicatrização dessa estrutura descrito em trabalhos de ressonância magnética. Dessa forma, o objetivo desta tese é avaliar os resultados clínicos e o índice de falha após reconstrução do LCA, diagnosticada em ressonância magnética em pacientes com e sem lesão do LAL não tratada. MÉTODOS: Uma coorte prospectiva de pacientes com lesão aguda do LCA foram classificados em dois grupos, com base na presença ou ausência da lesão do LAL no exame de ressonância magnética (RM) pré-operatória realizada, na fase aguda da lesão (menos de 3 semanas). O Grupo LAL (1) consistiu em pacientes com lesão do LAL e Grupo LCA isolado (2) sem lesão do LAL associada. Os dois grupos foram submetidos à reconstrução anatômica do LCA com tendões de flexores autólogos com banda simples pela técnica de fora para dentro (outside in). Os escores funcionais subjetivos de Lysholm e International Knee Documentation Committee (IKDC), medidas do KT-1000 pré e pós-operatórias, medidas do pivot shift pré e pós-operatório, taxa de falha da reconstrução, incidência de lesão de LCA contralateral, presença de lesão meniscal associada e seu tratamento e a presença de hiperextensão do joelho foram avaliados com um mínimo de 24 meses de seguimento RESULTADOS: Cento e oitenta e dois pacientes foram avaliados. O seguimento médio foi de 33,6 ± 7,1 meses para o grupo LAL (1) e 36,1 ± 8,1 meses para o grupo LCA isolado (2). Não foram encontradas diferenças significativas entre os grupos em relação à idade, sexo, hiperextensão do joelho, tempo de lesão antes da reconstrução ou lesões meniscais associadas. Na avaliação pré-operatória, o pivot-shift foi semelhante e o grupo LAL apresentou pior KT-1000 (7,9 ± 1,2 mm [grupo LAL] vs 7,2 ± 1,1 mm [grupo LCA isolado]; p < 0,001). Na avaliação pós-operatória, os pacientes do grupo LCA isolado apresentaram menor taxa de falha de reconstrução (10,2% [grupo LAL] vs 1,4% [grupo LCA isolado]; p 0,029) e melhores resultados clínicos das escalas funcionais pós-operatórias para o IKDC (85,5 ± 10,7 [grupo LAL] vs 89,1 ± 6,6 [grupo LCA isolado]; p 0,035) e Lysholm (85,9 ± 10,1 [grupo LAL] vs 92,0 ± 6,3 [grupo LCA isolado]; p < 0,001). Não houve diferença pós-operatória no KT-1000 (P = 0,054) ou pivot-shift (p = 0,116). CONCLUSÃO: Pacientes com lesão do LAL associada ao LCA na RM pré-operatória apresentam maior taxa de rerrotura e piores resultados nos escores funcionais de Lysholm e IKDC subjetivo INTRODUCTION: Isolated anterior cruciate ligament (ACL) reconstruction does not restore normal knee biomechanics in cases of associated injury to anterolateral structures in biomechanical studies. Studies evaluating the potential clinical impact of anterolateral ligament (ALL) injuries in the treatment of ACL tears are necessary to validate or not the findings of biomechanical studies, especially considering the poor healing potential of this structure described in magnetic resonance imaging (MRI) studies. Thus, the objective of this study is to evaluate the clinical outcomes and failure rate after ACL reconstruction, in patients with and without ALL injury diagnosed on MRI. METHODS: A prospective cohort of patients with acute ACL injury was classified into 2 groups based on the presence or absence of the ALL injury in the preoperative magnetic resonance imaging (MRI) performed in the acute phase of the injury (less than 3 weeks). The ALL Group (1) consisted of patients with an ALL injury and an isolated ACL Group (2) without an associated ALL injury. Both groups underwent anatomical reconstruction of the ACL with tendons of autologous hamstrings with a simple bundle through an outside in technique. The functional scores of Lysholm and the subjective International knee Documentation Committee (IKDC), pre- and postoperative KT-1000 measurements, pre- and postoperative pivot shift measurements, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury and its treatment, and the presence of knee hyperextension were assessed with a minimum of 24 months of follow-up. RESULTS: One hundred and eighty-two patients were evaluated. The mean follow-up was 33.6 ± 7.1 months for the ALL group (1) and 36.1 ± 8.1 months for the isolated ACL group (2). No significant differences were found between the groups regarding age, sex, knee hyperextension, time of injury before reconstruction or associated meniscal injuries. In the preoperative evaluation, the pivot shift was similar and the ALL group had the worst KT-1000 (7.9 ± 1.2 mm [ALL group] vs 7.2 ± 1.1 mm [isolated ACL group]; p < 0.001). In the postoperative evaluation, patients in the isolated ACL group had a lower rate of reconstruction failure (10.2% [ALL group] vs 1.4% [isolated ACL group]; p 0.029) and better clinical results of the functional scores for IKDC (85.5 ± 10.7 [group 1] vs 89.1 ± 6.6 [group 2]; p 0.035) and Lysholm (85.9 ± 10.1 [ALL group] vs 92, 0 ± 6.3 [isolated ACL group]; p < 0.001). There was no postoperative difference in the KT-1000 (P = 0.054) or pivot-shift (p = 0.116). CONCLUSION: Patients with ACL tears with an associated ALL injury on preoperative MRI showed a higher re-rupture rate and worse outcomes in Lysholm and subjective IKDC functional scores

INTRODUÇÃO: A retirada da gordura retropatelar durante a artroplastia total do joelho é procedimento feito pela grande maioria dos cirurgiões a fim de facilitar a exposição da articulação, levando a maior precisão no posicionamento do componente tibial. Contudo, nas últimas décadas, autores concluíram que a manutenção da gordura retropatelar leva a melhores resultados clínicos, funcionais e menos complicações de ferida operatória. OBJETIVOS: Este estudo tem como objetivo avaliar se a manutenção da gordura retropatelar influencia no alinhamento rotacional do componente tibial, assim como no tempo cirúrgico, além de verificar o estado da inserção da gordura retropatelar na tíbia. MÉTODOS: Trata-se de estudo transversal, de intervenção, randomizado e duplo cego, com a participação de 50 pacientes divididos em dois grupos equivalentes, um com a manutenção da gordura retropatelar e outro com sua retirada completa. Foram avaliados o alinhamento rotacional de acordo com o método de Berger, o tempo cirúrgico e o grau de acometimento da inserção da gordura retropatelar na tíbia. RESULTADOS: Foi observado desinserção da gordura retropatelar na tíbia proximal parcialmente em 84% e completa em 16% na qual ela foi preservada, com maior rotação interna do componente tibial nos pacientes com desinserção parcial da gordura retropatelar na tíbia proximal em comparação aos pacientes com desinserção completa (p 0,02). Em joelhos com artrose mais avançada, o tempo cirúrgico foi maior com a manutenção da gordura retropatelar em comparação com sua retirada completa (p 0,002). Também foi identificado maior tempo cirúrgico nos joelhos com artrose mais avançada em comparação com artrose mais leve dentre os pacientes com a manutenção da gordura retropatelar (p 0,013). CONCLUSÃO: Concluiu-se que a manutenção da gordura retropatelar não interferiu no alinhamento rotacional do componente tibial, houve maior tempo cirúrgico nos pacientes com a manutenção da gordura retropatelar associado a artrose avançada e a gordura retropatelar foi desinserida, pelo menos parcialmente em todos os casos. INTRODUCTION: The removal of retropatellar fat pad during total knee arthroplasty is a procedure performed by most of the surgeons in order to facilitate joint exposure, leading to greater precision in the positioning of the tibial component. However, in recent decades, authors have concluded that maintenance of retropatellar fat pad leads to better clinical and functional outcomes and fewer surgical wound complications. OBJECTIVES: This study aims to evaluate whether the maintenance of retropatellar fat pad influences the rotational alignment of the tibial component, the surgical time and to verify the state of insertion of retropatellar fat pad in the tibia after the procedure. METHODS: This is a cross-sectional, randomized, double-blind intervention study involving 50 patients divided into two equivalent groups, one with the maintenance of retropatellar fat pad and the other with its complete removal. Rotational alignment according to the Berger method, surgical time and degree of involvement of the retropatellar fat pad insertion in the tibia were evaluated. RESULTS: Retropatellar fat pad had been partially injured in 84% and completely in 16% of the knees, and the greatest internal rotation positioning of the tibial component occurred in patients with partial injury of the fat pad compared to its complete disinsertion (p 0.02). In knees with more advanced arthrosis, surgical time was longer in patients in whom the retropatellar fat pad was preserved compared to its complete removal (p 0.002). Longer surgical time was also identified in knees with more advanced arthrosis compared with milder arthrosis among patients with maintenance of retropatellar fat pad (p 0.013). CONCLUSION: It was concluded that the maintenance of retropatellar fat pad did not interfere with the rotational alignment of the tibial component, there was a longer surgical time in patients with maintenance of retropatellar fat pad associated with advanced arthrosis and retropatellar fat pad was disinserted, at least partially in all cases.

Introdução: o uso tópico intra-articular do ácido tranexâmico (ATX) e da povidonaiodo (PVPI) em artroplastias do joelho está crescendo ao longo dos últimos anos devido às evidências da literatura que confirmam reduções na perda sanguínea, necessidade de hemotransfusão e nas taxas de infecção pós-operatória, respectivamente. Entretanto, são necessários mais estudos sobre a toxicidade dessas substâncias para a cartilagem residual em pacientes submetidos à artroplastia unicompartimental do joelho e artroplastia total do joelho, quando não ocorre a substituição da patela. Objetivos: avaliar os efeitos do uso tópico intra-articular do ATX 20mg/kg e/ou PVPI 0,35% na cartilagem articular do joelho em um modelo experimental de coelhos. Material e Método: quarenta e quatro coelhos machos, com menos de seis meses de vida, da raça Nova Zelândia, alocados de modo aleatório em quatro grupos (controle; ATX; PVPI e PVPI + ATX), tiveram a cartilagem articular do joelho exposta ao soro fisiológico SF 0,9% (grupo controle), ao ATX, ao PVPI e ao PVPI seguido do ATX. Decorridos 60 dias do procedimento cirúrgico os animais foram sacrificados sendo obtidos fragmentos osteocondrais do fêmur distal. Cortes histológicos da cartilagem da área de apoio do fêmur distal foram corados com hematoxilina/eosina e azul de toluidina. Os seguintes parâmetros da cartilagem foram avaliados pelo sistema de graduação histológica/histoquímica de Mankin: estrutura, celularidade, conteúdo de glicosaminoglicanos na matriz extracelular e integridade da linha de maré. Resultados: o uso isolado do PVPI causa alterações na estrutura, celularidade e conteúdo de glicosaminoglicanos da cartilagem, enquanto que o uso isolado do ATX altera o conteúdo de glicosaminoglicanos. O uso sequencial do PVPI + ATX provoca alterações mais pronunciadas tanto na matriz extracelular quanto na estrutura e na celularidade. Conclusão: os dados sugerem que o uso tópico intra-articular do ácido tranexâmico 20mg/kg, após o fechamento da cápsula articular e a lavagem intra-operatória, com solução de povidona-iodo 0,35%, durante três minutos, são tóxicos para a cartilagem articular em um estudo experimental in vivo em joelho de coelhos. Demonstrou-se também que o uso sequencial dessas substâncias apresenta maior toxicidade para a cartilagem articular. Introcuction: the topical intra-articular use of tranexamic acid (ATX) and povidoneiodine (PVPI) in knee arthroplasties has been increasing over the past few years due to evidence from the literature confirming reductions in blood loss, need for blood transfusion, and rates of post-operative surgical site infection, respectively. However, further studies are required on the toxicity of these substances to residual cartilage in patients submitted to unicompartmental knee arthroplasty and unresurfaced patella in total knee arthroplasty. Objectives: to evaluate the effects of topical use of ATX 20mg/kg and/or 0.35% PVPI on knee joint cartilage in an experimental model of rabbits. Material and Method: 44 male rabbits less than six months old, New Zealand breed, were randomly assigned to four groups (control, ATX, PVPI and PVPI + ATX) had knee joint cartilage exposed to physiological saline SF 0,9% (control group), ATX, PVPI and PVPI followed by ATX. Sixty days after the surgical procedure, the animals were sacrificed and osteochondral fragments of the distal femur were obtained. Histological sections of cartilage from this area were stained with hematoxylin/eosin and toluidine blue. The following cartilage parameters were evaluated through the Mankin histological/histochemical grading system: structure, cellularity, glycosaminoglycan content in the extracellular matrix and integrity of the tidemark. Results: the isolated use of PVPI causes changes in cartilage structure, cellularity and glycosaminoglycan content, whereas the isolated use of ATX alters the glycosaminoglycan content. The sequential use of PVPI + ATX causes more pronounced alterations in the extracellular matrix, structure and cellularity. Conclusion: the data suggest that topical intra-articular use of tranexamic acid 20mg/kg after closure of the joint capsule and intraoperative lavage with 0.35% povidone-iodine solution for three minutes are toxic to articular cartilage in an experimental in vivo study in rabbit knee. It has also been shown that the sequential use of these substances presents greater toxicity to the articular cartilage.

Introdução: Estudos recentes convergem para a participação das espécies reativas de oxigênio (EROs) e do glutamato (GLU) na modulação da dor. O presente estudo tem como objetivo avaliar os níveis de EROs em células mononucleares do sangue e líquor nas situações de dor crônica, aguda ou ausência de dor. Desejou-se ainda estudar variações dos níveis liquóricos de GLU nas três situações. Por fim, estudou-se a resposta clínica à medicação antioxidante na dor crônica e sua influência na produção de EROs por células mononucleares do sangue. As hipóteses a serem testadas são de que existe um aumento das espécies reativas de oxigênio em pacientes com dor crônica, aumento do glutamato liquórico em pacientes comdor aguda e resposta analgésica em pacientes tratados com medicação antioxidante. Métodos: Quarenta pacientes com doença articular e candidatos ao tratamento cirurgico foram alocados em três grupos: dor crônica (n=15), dor aguda (n=12) e ausência de dor (n=13). A dor foi avaliada pela escala visual analógica (EVA) e índice WOMAC (WesternOntario and McMaster Universities Index of Osteoarthritis). Para determinação das EROs foi utilizado o indicador DCHF-DA. Os níveis de glutamato foram estimados pelo ensaio enzimático em que o glutamato presente no líquor sofre oxidação pela enzima glutamato desidrogenase (GDH). Para análise estatística foi utilizado o software Prism 5 for Windows. Em outro protocolo, a medicação antioxidante (ArtroTabs®) foi oferecida a 14 pacientes portadores de gonartrose por 3 meses. Foram avaliados: EVA, WOMAC e produção de EROs por células mononucleares do sangue antes e após o tratamento. Resultados: Não houve diferença na fluorescência máxima e coeficiente de inclinação da curva obtida pelo DCHF-DA para as amostras de sangue e líquor nos grupos dor crônica, dor aguda e ausência de dor. A comparação da média dos níveis de glutamato liquórico revelou diferença estatisticamente significante entre o grupo de dor aguda e os demais. Os pacientes que receberam a medicação antioxidante por três meses apresentaram melhora da EVA e do índice WOMAC, todavia não houve alteração correspondente nos níveis de EROs. Conclusões: Os níveis liquoricos de GLU são mais elevados em pacientes com dor aguda. Amedicação ArtroTabs® possivelmente reduz a dor em pacientes com dor crônica. Introduction: Investigation of chronic pain mechanisms and analgesia constitute a promising research field. Recent studies attribute to reactive oxygen species (ROS) and glutamate (GLU) a central role in pain modulation. Our study aims to evaluate the relationship amongserum and cerebrospinal fluid (CSF) ROS, CSF GLU, chronic/acute or no pain situations. In addition, we assessed the treatment of chronic pain by an antioxidant medication and influences on serum levels of ROS.Methods: Forty patients were distributed according to pain symptoms: chronic (n = 15), acute (n = 12) and no pain (n = 13). Pain was assessed by visual analogue scale (VAS) and WOMAC index (Western Ontario and McMaster Universities Osteoarthritis Index). ROS was measured by DCHF-DA essay. Statistical analysis employed Prism 5 software for Windows. Fourteen patients with knee osteoarthritis and chronic pain have taken antioxidant medication for three months. VAS, WOMAC and ROS serum levels were registered before and after treatment.Results: Analysis of maximum fluorescence and DCHF-DA curve inclination for peripheral blood and cerebrospinal fluid samples did not reveal difference among chronic, acute and no pain groups. Comparison of glutamate levels in CSF samples showed a statistically significantdifference between acute pain and the other groups. Patients who took an antioxidant medication for three months showed improvement in VAS and WOMAC index, but there was no correspondence in ROS levels. Linear correlation analysis suggested a better response in VAS for patients with long lasting pain complains. Conclusions: Higher cerebrospinal fluid GLU levels were identified in acute pain group. The antioxidant medication reduced pain in chronic group.