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OBJECTIVE: To evaluate the effect of complete absence of muscle contractions on normal human cartilage in the presence of joint motion. METHODS: Patients with complete acute spinal cord injuries were enrolled. All patients underwent magnetic resonance imaging (MRI) on both knees as soon as their medical condition was stable and at six months after the primary lesion. All patients received rehabilitation treatment that included lower-limb passive motion exercises twice a day. The MRIs were analyzed by two radiologists with expertise in musculoskeletal disorders. A region of interest was established at the patellar facets and trochlea, and T2 relaxation times were calculated. The area under the cartilage T2 relaxation time curve was calculated and standardized. RESULTS: Fourteen patients with complete spinal cord injuries were enrolled, but only eight patients agreed to participate in the study and signed the informed consent statement. Two patients could not undergo knee MRI due to their clinical conditions. Initial knee MRIs were performed on six patients. After six months, only two patients underwent the second bilateral knee MRI. Both patients were neurologically classified as Frankel A. An increase in T2 values on the six-month MRI was observed for both knees, especially in the patellofemoral joint. CONCLUSION: The absence of muscle contractions seems to be deleterious to normal human knee cartilage even in the presence of a normal range of motion. Further studies with a larger number of patients, despite their high logistical complexity, must be performed to confirm this hypothesis. RESUMO OBJETIVO: Avaliar o efeito da completa ausência de contração muscular na cartilagem humana normal na presença de movimento articular. MÉTODOS: Pacientes com lesão completa da medula espinal foram incluídos. Todos os pacientes foram submetidos à ressonância magnética (RM) em ambos os joelhos assim que as condições clínicas foram estabilizadas e depois de seis meses da lesão inicial. Todos os pacientes receberam tratamento de reabilitação que incluía movimentos passivos para exercitar os membros inferiores duas vezes por dia. RMs foram analisadas por dois radiologistas com experiência em doenças musculoesqueléticas. As regiões de interesse consideradas foram as facetas da patela e a tróclea e os tempos de relaxamento T2 foram calculados. A área da cartilagem abaixo dos valores de relaxamento em T2 foi calculada e padronizada. RESULTADOS: Foram incluídos 14 pacientes com lesão medular completa, porém apenas oito concordaram em participar do estudo e assinaram o termo de consentimento informado. Dois pacientes não puderam fazer RM dos joelhos devido às condições clínicas. RM inicial foi feita em seis pacientes. Após seis meses, apenas dois pacientes fizeram a segunda RM de ambos os joelhos. Ambos estavam em condição neurológica classificada como Frankel A. Um aumento dos valores em T2 no sexto mês foi observado em ambos os joelhos, especialmente na articulação patelofemoral. CONCLUSÃO: A ausência de contração muscular parece ser deletéria à cartilagem do joelho humano normal, mesmo na presença de movimentos articulares normais. Mais estudos com um número maior de pacientes devem ser feitos para confirmar essa hipótese.

OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon, was technically safe and presented good objective and subjective clinical results in this case series with a short follow-up. RESUMO OBJETIVO: Descrever técnica cirúrgica de reconstrução anatômica do LPFM com tendão quadricipital combinada com a reconstrução do LPTM com tendão patelar e apresentar os resultados iniciais em uma série de casos. MÉTODO: Foi aplicada a técnica proposta em uma série de casos de pacientes do Grupo de Joelho do HC-IOT diagnosticados com instabilidade patelofemoral e com indicação de tratamento cirúrgico. No pré e pós-operatório foram avaliados: amplitude de movimento (ADM), teste da apreensão, teste da translação lateral, teste da inclinação patelar, sinal do J invertido, subluxação em extensão, dor a compressão da patela e dor a contração do quadríceps. No pós-operatório também foi perguntado aos pacientes se houve novo episódio de luxação, qual o grau de satisfação com a cirurgia (escala de zero a 10) e se passariam pela cirurgia novamente. RESULTADOS: Foram operados sete joelhos em sete pacientes e a média de seguimento foi de 5,46 meses (±2,07). Tivemos quatro pacientes com apreensão no pré-operatório que não tinham apreensão no pós-operatório. O teste de translação lateral foi normalizado em todos os pacientes enquanto o teste da inclinação patelar permaneceu positivo em dois pacientes. Os pacientes com J invertido permaneceram com o sinal positivo. A subluxação em extensão, presente no pré-operatório em cinco pacientes, foi negativa em todos no pós-operatório. Nenhum paciente apresentou novo episódio de luxação da patela. Todos responderam estar satisfeitos. Cinco pacientes referiram satisfação 9 e dois referiram 10. Todas passariam novamente pela cirurgia. Apenas uma paciente apresentou complicação pós-operatória, deiscência de ferida. CONCLUSÃO: A reconstrução combinada do LPFM com tendão quadricipital com a reconstrução do LPTM com tendão patelar é tecnicamente segura e apresentou bons resultados clínicos objetivos e subjetivos nesta série de caso de curto seguimento.

O tratamento clínico da osteoartrite/artrose (OA) está sempre indicado e baseia-se no autocuidado feito pelo paciente e orientado pelo médico. O uso de medicamentos é complementar às medidas de emagrecimento, ganho de força, de propriocepção, de flexibilidade e de amplitude de movimento. Entre os medicamentos disponíveis para o tratamento da OA há os que são essencialmente analgésicos e que não interferem no curso da doença; bem como os anti-inflamatórios, controversos por seus efeitos colaterais e pelo seu papel na OA, porém, com propriedades analgésicas e anti-inflamatórias indiscutíveis; e, por fim, as drogas modificadoras de estrutura, que retardam a evolução da OA. As medicações ainda podem ser de uso tópico, intra-articular, oral e injetável (sistêmico). As várias apresentações de ácido hialurônico (AH) mostram o poder analgésico da droga e há indícios de poder modificador de estrutura da cartilagem pela medicação. Há nível de evidência IA, para diacereína e para a glucosamina, de que retardam a evolução da OA. Mais tecnologia para diagnóstico e controle de tratamento da OA, bem como mais estudos multicêntricos são necessários para consolidar o poder do tratamento medicamentoso de outras drogas. Clinical treatment for osteoarthritis (OA) is very important and is based on patient's self care and guided by the physician. Drug therapy is additional to losing weight, improving muscular strength, proprioception, flexibility and range of motion. Between the available drugs for osteoarthritis' treatment, some are basically analgesics and do not interfere on disease's progression; some are anti-inflammatory with good analgesic power but with side effects that compromise their prolonged usage; and the structure modifying drugs that slow down the progression of OA. The medications are presented in topic, oral, intra-muscular, intra-venous and intra-articular forms. The hyaluronic acid has various presentations with good analgesic effect and some evidence of structure modifying property. There is IA evidence level for the use of diacerhein and of glucosamine to slow down the disease. Still, more technology for diagnosis and therapy control of OA is necessary to define the efficacy of other drugs.

Objectives: To evaluate the initial functional results and early complication rate of ceramic-ceramic total hip replacements among patients living with HIV who presented osteonecrosis of the femoral head. Method: Twelve HIV–positive patients with a diagnosis of osteonecrosis of the incongruent femoral head were evaluated using clinical and laboratory criteria and the WOMAC functional scale before and after treatment with joint replacement. Results: We observed that 83.3% of the subjects were taking protease inhibitors, 75% had dyslipidemia and 66.6% had lipodystrophy syndrome. The improvement over the evolution of the WOMAC score was statistically significant at six and twelve months after the operation, in comparison with the preoperative score. We did not observe complications secondary to this procedure. Conclusion: Total hip arthroplasty with a ceramic-ceramic implant for treating avascular necrosis of the hip is an appropriate surgical option for this portion of the population. It provides a significant initial functional improvement and a low early complication rate.

Objective: To present a biomechanical device for evaluating medial patellofemoral ligament (MPFL) reconstruction and its isometricity. Methods: An accessible biomechanical method that allowed application of physiological and non-physiological forces to the knee using a mechanical arm and application of weights and counterweights was developed, so as to enable many different evaluations and have a very accurate measurement system for distances between different structures, for analysis on experiments. This article describes the assembly of this system, and suggests some practical applications. Six cadaver knees were studied. The knees were prepared in a testing machine developed at the Biomechanics Laboratory of IOT–HCFMUSP, which allowed dynamic evaluation of patellar behavior, with quantification of patellar lateralization between 0° and 120°. The differences between the distances found with and without load applied to the patella were grouped according to the graft fixation angle (0°, 30°, 60° or 90°) and knee position (intact, damaged or reconstructed). Results: There was a tendency for smaller lateral displacement to occur at fixation angles greater than 30 degrees of flexion, especially between the angles of 45° and 60° degrees of flexion, after the reconstruction. For the other angles, there was no statistical significance. Conclusion: The method developed is a useful tool for studies on the patellofemoral joint and the MPFL, and has a very accurate measurement system for distances between different structures. It can be used in institutions with fewer resources available.