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Background There are several studies comparing techniques and different materials, yet the results are not unanimous. We compared three methods of skin closure in total knee arthroplasty (TKA), including suture with single stitches and unabsorbable MonoNylon®, as well as continuous subcuticular suture with Monocryl® or barbed Stratafix® absorbable suture. Methods A prospective, randomized study was conducted with 63 patients undergoing TKA between March 2016 and December 2016. Patients were divided into three groups: traditional suture MonoNylon® (n 22), subcuticular continuous suture with Monocryl® (n 20), and another barbed with Stratafix® (n 21). The closure time, length of wire used, pain intensity, possible complications, and cosmeses were evaluated. Results Subcuticular continuous suture using Monocryl® was superior to traditional suture using MonoNylon® as less thread was used (p 0.01) and a better cosmetic effect was achieved (p Stratafix® aspects analyzed (p > 0.05). Complications were observed mostly in patients who used Stratafix®. Conclusions This study concluded that the subcuticular suture with absorbable monofilament Monocryl® proved to be advantageous compared to the others because it presented results equal to the barbed Stratafix®, however with fewer complications. Furthermore, Monocryl® was shown to be equal or superior to traditional MonoNylon® suture regarding in relation pain intensity, aesthetic result, and effective cost. Trial registration WHO ICTRP identifier RBR78dh5d. Retrospectively registered: 07/29/2020.

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.

This case report presents a 15-year-old football player who was diagnosed with a pubis stress fracture and underwent conservative treatment with satisfactory results. After a review of the literature, the clinical picture, diagnosis and treatment are described. The importance of this paper comes from the rarity of finding reports about this kind of injury in the literature.

Objective: Eighty-three soccer players aged between 14 and 19 years, in the basic category of a professional soccer club in the city of Belo Horizonte, were followed up during the 2009 season. Methods: A prospective observational cohort study was conducted, in which these soccer players were divided randomly into two groups. The first consisted of individuals with joint hypermobility syndrome (JHS), totaling 22 players, and the second was a control group with 61 players without this syndrome, determined through a physical examinati. Results: Both groups were studied with regard to incidence of ankle sprains. At the end of this period, the data were compiled and statistical analysis was performed. A total of 43 cases of ankle injury due to sprains were recorded, of which nine episodes were in players with JHS, thus making p = 0.106. The significance level was 5%. Conclusion: We were able to conclude that in our study there was insufficient evidence to assert that there is an association with increased incidence of ankle sprains among patients with JHS.

Objective: To assess the reproducibility of the Outerbridge and the French Society of Arthroscopy classifications between different observers, and to establish a comparison between them. Method: Thirty videos on randomly selected knee arthroscopy procedures demonstrating chondral lesions were used. These were classified by six observers: two third-year orthopedics residents and four orthopedic surgeons, of whom two were knee surgery specialists. The intraobserver and interobserver reliability was evaluated by means of the kappa index. Results: The result from the complete evaluation on the Outerbridge classification with all the observers gave a kappa index of 0.434411. For the classification proposed by the French Society of Arthroscopy, the kappa index was 0.45166. Conclusion: The Outerbridge and French Society of Arthroscopy classifications for chondral lesions are moderately reproducible between observers. Comparing the two classifications, the proposal from the French Society of Arthroscopy was shown to be more reproducible, and the authors suggest that this classification should be used preferentially in clinical practice for evaluations on chondral lesions of the knee.

OBJETIVO: Avaliar a reprodutibilidade da classificação de Outerbridge e da Sociedade Francesa de Artroscopia entre diferentes observadores e estabelecer uma comparação entre elas. MÉTODO: Foram utilizados 30 vídeos de artroscopia de joelho selecionados aleatoriamente demonstrando lesões condrais que foram classificadas por seis observadores, dois residentes em ortopedia do terceiro ano e quatro ortopedistas, entre os quais dois especialistas em cirurgia de joelho. A avaliação da reprodutibilidade intra e interobservador foi feita através do índice estatístico de Kappa. RESULTADOS: Como resultado da avaliação completa da classificação de Outerbridge com a totalidade dos observadores, encontramos um índice Kappa de 0,434411. Quanto à classificação proposta pela Sociedade Francesa de Artroscopia, encontramos um índice Kappa de 0,45166. CONCLUSÃO: A classificação de Outerbridge e da Sociedade Francesa de Artroscopia para lesões condrais é moderadamente reprodutível entre observadores. Comparando as duas classificações, a proposta pela Sociedade Francesa de Artroscopia se mostrou mais reprodutível, e os autores sugerem o uso dessa classificação como de escolha para a prática clínica da avaliação das lesões condrais do joelho. OBJECTIVE: To assess the reproducibility of the Outerbridge and the French Society of Arthroscopy classifications between different observers, and to establish a comparison between them. METHOD: Thirty videos on randomly selected knee arthroscopy procedures demonstrating chondral lesions were used. These were classified by six observers: two third-year orthopedics residents and four orthopedic surgeons, of whom two were knee surgery specialists. The intraobserver and interobserver reliability was evaluated by means of the kappa index. RESULTS: The result from the complete evaluation on the Outerbridge classification with all the observers gave a kappa index of 0.434411. For the classification proposed by the French Society of Arthroscopy, the kappa index was 0.45166. CONCLUSION: The Outerbridge and French Society of Arthroscopy classifications for chondral lesions are moderately reproducible between observers. Comparing the two classifications, the proposal from the French Society of Arthroscopy was shown to be more reproducible, and the authors suggest that this classification should be used preferentially in clinical practice for evaluations on chondral lesions of the knee.

INTRODUÇÃO: A artroplastia total do joelho (ATJ) é um procedimento que resulta em índices de satisfação excelentes, por restaurar, mesmo que parcialmente, a função articular de maneira pouco dolorosa. Contudo, os resultados insatisfatórios impactam negativamente na vida dos pacientes, sendo que grande causa de insucesso está relacionada a queixas da articulação femoropatelar. Apesar disso, poucos são os estudos com boa evidência que avaliam a influência da gordura retropatelar sobre os resultados desse procedimento cirúrgico. OBJETIVOS: comparar o resultado clínico-funcional, o tempo cirúrgico e o posicionamento do componente tibial na ATJ com a manutenção ou a ressecção da gordura retropatelar. MÉTODOS: o presente estudo prospectivo, randomizado, duplo-cego contou com a participação de 40 pacientes, sendo que 22 foram submetidos à manutenção da gordura retropatelar (MG) e 18 à sua ressecção (RG). Foram feitas avaliações do grau máximo de flexão, medição da dor pela escala visual analógica da dor (EVA), mensuração do Knee Society Score (KSS) do joelho e função, altura da patela pelo índice de Insall-Salvatti no pré-operatório e no primeiro, sexto e décimo segundo mês pós-operatório, sendo também analisados duração da cirurgia e posicionamento radiográfico do componente tibial. RESULTADOS: os valores médios para o tempo cirúrgico foi de 98,32 minutos no grupo MG e 96,78 minutos no grupo RG (p=0,892). As médias foram de 103,2° vs. 100° (p= 0,466) para grau máximo de flexão; para a altura da patela foi de 1,10 vs. 1,07 (p= 0,20), KSS do joelho com 83,41 vs. 83,06 (p=0,46), KSS funcional com 73,95 vs. 78,06 (p=0,39), intensidade da dor pela EVA com 2,41 vs. 1,56 (p=0,19) e posicionamento do componente tibial no AP com 91,18° vs. 91,17° e no perfil 94,86° vs. 94,56°. Em nenhuma das variáveis foi evidenciada diferença estatística entre os grupos. CONCLUSÃO: não houve diferença entre os aspectos avaliados na comparação entre os pacientes submetidos à manutenção ou à ressecção da gordura retropatelar durante a artroplastia total do joelho. INTRODUCTION: Total knee arthroplasty (TKA) is a procedure that results in excellent satisfaction ratings to restore, even partially, painless joint function. However, the unsatisfactory results negatively impact the lives of patients, and major cause of failure is related to complaints of the patellofemoral joint. Nevertheless, there are few studies with good evidence that evaluate the influence of fat pad on the results of this surgical procedure. OBJECTIVES: compare the clinical and functional outcome, surgical time and the placement of the tibial component in TKA with maintaining or resection of retropatellar fat pad. METHODS: The present prospective, randomized, double blind, with the participation of 40 patients, 22 underwent maintenance of retropatellar fat pad (MG) and 18 to resection (RG). Evaluations were made of the maximum degree of flexion, measuring the pain by visual analog pain scale (VAS), measurement of the Knee Society Score (KSS) and function of the knee, patellar height by Insall-Salvatti index preoperatively, first, sixth and twelfth postoperative month and also analyzed the duration of surgery and radiographic positioning of the tibial component. RESULTS: The mean values for the surgical time was 98.32 min. MG group and 96.78 min. the RG group (p = 0.892). The averages were 103.2 ° vs. 100 ° (p = 0.466) to the maximum degree of flexion, the patella to the height was 1.10 vs. 1.07 (p = 0.20), with knee KSS vs. 83.41 83.06 (p = 0.46), with functional KSS vs. 73.95 78.06 (p = 0.39), pain intensity by VAS with 2.41 vs. 1.56 (p = 0.19) and positioning the tibial component with the AP vs. 91.18 ° 91.17 ° and 94.86 ° vs. profile 94.56 °. None of the variables was observed statistical difference between the groups. CONCLUSION: there is no difference between the aspects evaluated when comparing patients undergoing maintenance or resection fat pad during total knee arthroplasty.

Este relato de caso apresenta um atleta de futebol de 15 anos de idade diagnosticado com fratura de estresse do púbis e tratado conservadoramente, com resultados satisfatórios. Uma vez realizada revisão da literatura, os autores descreveram quadro clínico, diagnóstico e tratamento. A importância desta publicação reside no fato de a lesão descrita ser raramente encontrada na literatura. This case report presents a 15-year-old football player who was diagnosed with a pubis stress fracture and underwent conservative treatment with satisfactory results. After a review of the literature, the clinical picture, diagnosis and treatment are described. The importance of this paper comes from the rarity of finding reports about this kind of injury in the literature.

ResumoObjetivoAvaliar radiologicamente a posição do túnel femoral na reconstrução do ligamento cruzado anterior pelas técnicas isométrica e anatômica.MétodosFoi feito estudo analítico prospectivo em pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA), por meio da técnica isométrica e anatômica, com o uso de enxerto de tendões flexores do joelho ou de tendão patelar. Foram captados 28 pacientes, em pós‐operatório imediato, no ambulatório de cirurgia do joelho da FCMMG‐HUSJ. Foram feitas radiografias do joelho operado nas incidências em anteroposterior (AP) com apoio bipodálico e perfil em 30° de flexão. Foram traçadas as linhas e medidos os ângulos e as distâncias na radiografia em perfil para avaliar o plano sagital. Foi medida a distância do centro do parafuso à cortical posterior do côndilo lateral e dividido pela linha de Blumensaat. Com relação à altura do parafuso, foi medida a distância do centro dele até a superfície articular do côndilo lateral do joelho. Na radiografia em AP, que avalia o plano coronal, mede‐se a angulação entre o eixo anatômico do fêmur e uma linha traçada no centro do parafuso.ResultadosPelos testes, o p‐valor (0,4213) é maior do que o nível de significância adotado (0,05), a hipótese nula não é rejeitada e pode ser afirmado que não há diferença estatisticamente significativa entre as técnicas anatômica (TAN) e isométrica (TIS) no que diz respeito à Medida P (posteriorização do parafuso de interferência). Como o p‐valor (0,0006) observado é menor do que o nível de significância adotado (0,05), rejeita‐se a hipótese nula e pode ser afirmado que há diferença estatisticamente significativa entre a TAN e a TIS no que diz respeito à Medida H (altura do parafuso em relação à cortical inferior do joelho). Pode‐se concluir que essa diferença ocorre porque a TIS gera valores maiores para a Medida H do que a TAN. Como o p‐valor observado (0,000) é menor do que o nível de significância (5%), rejeitou‐se a hipótese nula e afirmamos com 95% de confiança que há diferença significativa entre a TAN e a TIS no que diz respeito à variável MED (posição do parafuso na radiografia em AP).ConclusõesHouve diferença estatisticamente significativa na avaliação radiológica do túnel femoral, tanto no plano sagital como no coronal, entre as técnicas de reconstrução do LCA.AbstractObjectiveThe aim of this study was to radiologically evaluate the femoral tunnel position in anterior cruciate ligament (ACL) reconstructions using the isometric and anatomical techniques.MethodsA prospective analytical study was conducted on patients undergoing ACL reconstruction by means of the isometric and anatomical techniques, using grafts from the knee flexor tendons or patellar tendon. Twenty‐eight patients were recruited during the immediate postoperative period, at the knee surgery outpatient clinic of FCMMG‐HUSJ. Radiographs of the operated knee were produced in anteroposterior (AP) view with the patient standing on both feet and in lateral view with 30° of flexion. The lines were traced out and the distances and angles were measured on the lateral radiograph to evaluate the sagittal plane. The distance from the center of the screw to the posterior cortical bone of the lateral condyle was measured and divided by the Blumensaat line. In relation to the height of the screw, the distance from the center of the screw to the joint surface of the lateral condyle of the knee was measured. On the AP radiograph, evaluating the coronal plane, the angle between the anatomical axis of the femur and a line traced at the center of the screw was measured.ResultsWith regard to the P measurement (posteriorization of the interference screw), the tests showed that the p‐value (0.4213) was greater than the significance level used (0.05), the null hypothesis was not rejected and it could be stated that there was no statistically significant difference between the anatomical and isometric techniques. With regard to the H measurement (height of the screw in relation to the lower cortical bone of the knee), the p‐value observed (0.0006) was less than the significance level used (0.05), the null hypothesis was rejected and it could be stated that there was a statistically significant difference between the anatomical and isometric techniques. It can be concluded that the latter difference occurred because the isometric technique generated greater values for the H measurement than did the anatomical technique. With regard to the MED variable (position of the screw on the AP radiograph), the observed p‐value (0.000) was less than the significance level (5%), the null hypothesis was rejected and it could be stated with 95% confidence that there was a significant difference between the anatomical and isometric techniques.ConclusionsThere were statistically significant differences in the radiological evaluations of the femoral tunnel, both in the sagittal and in the coronal plane, between the ACL reconstruction techniques.