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Physical examination in the presence of a multiligament knee injury can be complex and challenging. Hence, stress radiography is a useful and inexpensive tool that is widely used in the assessment of this type of injury. It guarantees an objective analysis of the magnitude of knee instability, which may reduce the observer's interpretation bias in relation to the physical examination. However, for the radiographic analysis to be reproducible, it is necessary to standardize the technique to evaluate each of the main knee ligaments. This article aims to describe in detail how to perform stress radiography to assess the sufficiency of the posterior cruciate ligament and collateral ligaments in the context of a multiligament injury.

Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions.

Patellar fractures, which constitute approximately 1% of bone lesions, may lead to severe impairment of the extensor mechanism. When conservative or surgical treatment fails, the patella may develop pseudoarthrosis. Neglect or delayed treatment of this type of injury may lead to significant diastasis between the patellar fragments. There is no consensus regarding the best treatment for such cases. This study is aimed at describing a rare case of patellar pseudoarthrosis in a patient who underwent two-step surgical treatment comprising transskeletal patellar traction followed by osteosynthesis with a tension band. A 17-year-old male patient presented with a left patellar fracture that resulted from a fall from a standing height 8 years ago. He did not undergo any type of surgical treatment during that time, but the fracture was immobilized for only 2 weeks. The two-step surgical treatment with transskeletal patellar traction and patellar osteosynthesis was performed and provided satisfactory functional clinical results in this patient. This two-step surgical treatment can be performed in cases similar to ours with satisfactory results.

ABSTRACT OBJECTIVE: The methods most used for patellar height measurement were compared with the plateau-patella angle method. METHODS: A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall-Salvati (IS), Blackburne-Peel (BP) and Caton-Deschamps (CD). These were compared with the plateau-patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. RESULTS: The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau-patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau-patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau-patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau-patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau-patella angle. In relation to the cases of low patella, the plateau-patella angle was capable of identifying more cases than were the other three methods. CONCLUSIONS: The plateau-patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied.

ABSTRACT Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.

resumo Objetivos: Avaliar o efeito do uso da radioscopia intraoperatória em artroplastias primárias de joelho sobre o alinhamento final do componente tibial. Métodos: Foram incluídos no estudo os pacientes submetidos à artroplastia total do joelho (ATJ) entre 13/04/2013 e 20/04/2013. Os pacientes foram avaliados retrospectivamente e dois grupos foram identificados, um com uso de radioscopia intraoperatória para avaliação do posicionamento do componente tibial durante a cirurgia e o segundo sem uso desse recurso. Resultados: A média do ângulo de alinhamento do componente tibial em relacão à diáfise da tíbia foi superior no grupo sem uso de radioscopia intraoperatória (90,82) em comparacão com o grupo com radioscopia (90,63), com resultado estatisticamente significativo (p < 0,05). Conclusão: O uso de radioscopia no intraoperatório de ATJ produz melhor média de ângulo de alinhamento entre o componente tibial em relacão à diáfise da tíbia quando comparado ao não uso.

OBJECTIVE: To make a comparative inter and intraobserver analysis on measurements of the anatomical axis between panoramic radiographs of the lower limbs in anteroposterior (AP) view with bipedal weight-bearing, on short film.METHODS: An accuracy study comparing radiographic measurements on 47 knees of patients attending the knee surgery outpatient clinic due to osteoarthritis. The radiographic evaluation used was as standardized for the total knee arthroplasty program, including panoramic AP views of the lower limbs and short radiographs of the knees in AP and lateral views, all with bipedal weight-bearing. Following this, the anatomical axis of the lower limbs or the femorotibial angle was measured by five independent examiners on the panoramic and short AP radiographs; three of the examiners were considered to be more experienced and two, less experienced. All the measurements were made again by the same examiners after an interval of not less than 15 days. The statistical analysis was performed using the intraclass correlation coefficient, in order to evaluate the inter and intraobserver concordance of the anatomical axis measurements.RESULTS: From the statistical analysis, it was observed that there was strongly significant concordance between the anatomical axis measurements on the panoramic and short radiographs, for all the five examiners and for both measurements.CONCLUSIONS: Under the conditions studied, short radiographs were equivalent to panoramic radiographs for evaluating the anatomical axis of the lower limbs in patients with advanced osteoarthritis. The measurements used also showed high rates of inter and intraobserver concordance and reproducibility.

Objectives:To review radiographs of patients who suffered tendon tears of the knee extensor apparatus and observe alterations that might be factors predisposing toward this type of injury.Methods:We retrospectively analyzed 60 cases of injury to the knee extensor mechanism that were treated surgically at the Miguel Couto Municipal Hospital between March 2004 and March 2011. Four patients were excluded due to poor quality of the examination.Results:Of the 56 patients evaluated, 23 were considered to be normal and 33 presented radiographic alterations. Among these, eight (24.3%) presented suprapatellar osteophytes alone; seven (21.2%), infrapatellar calcification; seven (21.2%), suprapatellar calcification; six (18.2%), supra- and infrapatellar osteophytes; and five (15.1%), infrapatellar osteophytes alone.Conclusion:Radiographic alterations were frequently observed in patients with extensor mechanism tears.

Fixation of an osteochondral fracture after acute patellar dislocation is an infrequent form of treatment. Likewise, the location of this fragment in the lateral region of the lateral femoral condyle, functioning as a free body, is uncommon. The aim of this study was to present a case of osteochondral fracture of the patella at an unusual site, along with the therapy used and the clinical follow-up.

OBJECTIVE: A comparative analysis by applying the criteria of the original classification Ahlbäck in the anteroposterior (AP) bipedal knee in extension and anteroposterior (AP) monopodal knee in symptomatic knee arthrosis. With this analysis we intend to observe the agreement, any advantage or difference between the incidence and degree of joint involvement between the orthopedic surgeons and radiologists with the referring physician. METHODS: From January 2012 to March 2012, was a prospective study of 60 symptomatic arthrosis knees (60 patients), clinically selected group of outpatient knee and radiographic proposals submitted to the search. Of the 60 patients, 39 were female and 21 male, mean age 64 years (ranging from 50 to 84 years). Of the 60 knees studied, 37 corresponded to the right side and 23 on the left side. Statistical analysis was performed by Kappa statistics, which evaluates the interobserver agreement for qualitative data. RESULTS: According to the scale of Ahlbäck, there was a significant agreement (p < 0.0001) intra-observer in the classification of knee osteoarthritis among the five evaluators. There was a significant agreement (p < 0.0001) with inter-observer referring physician in the incidence of AP monopodal and AP bipedal for the four raters. CONCLUSION: The study found no difference between the incidence in the AP monopodal versus AP bipedal in osteoarthritis of the knee.

OBJETIVOS: Revisar aspectos epidemiológicos das fraturas do planalto tibial em hospital de nível I. MÉTODOS: Analisamos, retrospectivamente, 239 fraturas do planalto tibial tratadas cirurgicamente. Levamos em consideração idade, sexo, mecanismo de trauma, classificações das lesões, lado acometido e lesões associadas. RESULTADOS: Dos pacientes estudados, 168 são do sexo masculino, a quinta década foi a mais acometida, quanto ao mecanismo de trauma o acidente de trânsito foi o principal fator causal, 128 casos foram do lado esquerdo e 22,6% tiveram lesões associadas. CONCLUSÕES: A maioria dos pacientes foi do sexo masculino, na quinta década de vida, e vítima de acidente de trânsito, sendo as fraturas por depressão e cisalhamento do planalto tibial as lesões mais comuns. Lesões associadas foram pouco frequentes em nossa casuística. Nível de Evidência II, Estudos Prognósticos. Investigação do Efeito de Característica de Um Paciente Sobre o Desfecho da Doença.OBJECTIVES: To review the epidemiological aspects of fractures of the tibial plateau in a level I trauma center. METHODS: We retrospectively analyzed 239 tibial plateau fractures treated surgically. We took into account age, sex, trauma mechanism, classification of the injury, associated injuries and affected side. RESULTS: Of the patients, 168 were male, most in the fifth decade of life; regarding the mechanism of trauma, the primary causal factor was car accident; 128 cases occurred on the left side and 22,6% had associated injuries. CONCLUSIONS: The majority of patients were male, in the fifth decade of life, and victim of traffic accidents; the depressed and shear fractures of the tibial plateau were the most frequent. Associated lesions were infrequent in our study. Evidence Level II, Prognostic Studies. Investigation of the Effect of a Patient Characteristics on the Outcome of the Disease.

OBJETIVOS: O propósito do presente estudo é revisar aspectos epidemiológicos das rupturas tendinosas do aparelho extensor do joelho em hospital de nível I. MÉTODOS: Analisamos, retrospectivamente, 76 lesões do mecanismo extensor do joelho, tratadas cirurgicamente no Hospital Municipal Miguel Couto, no período de março de 2004 a março de 2011. Levamos em consideração idade, sexo, mecanismo de trauma, classificação anatômica da lesão, lado acometido, comorbidades e lesões associadas. RESULTADOS: Dos pacientes estudados, 68 eram do sexo masculino, com idade média de 36 anos. Quanto ao mecanismo de trauma, 62 foram por trauma direto, 21 casos foram do lado direito, oito apresentavam comorbidades e quatro tiveram lesões associadas. CONCLUSÕES: A maioria dos pacientes foi do sexo masculino, na faixa etária economicamente ativa (jovens), e vítima de trauma direto, sendo as rupturas do ligamento patelar as lesões mais comuns. Lesões associadas são raras, e as comorbidades foram pouco frequentes em nossa casuística.OBJECTIVES: The purpose of the present study was to review the epidemiological aspects of tendon ruptures of the knee extensor apparatus at a level 1 hospital. METHODS: We retrospectively ana lyzed 76 lesions of the knee extensor apparatus that were treated surgically at the Miguel Couto Municipal Hospital between March 2004 and March 2011. We took into consideration age, sex, trauma mechanism, anatomical classification of the lesion, affected side, comorbidities and associated lesions. RESULTS: Among the patients studied, 68 were male and the mean age was 36 years. Regarding the trauma mechanism, 62 lesions occurred due to direct trauma; the right side was affected in 21 cases; eight presented comor bidities and four presented associated lesions. CONCLUSION: The majority of the patients were male, at an economically active age (young people), and were victims of direct trauma. Ruptures of the patellar ligament were the most frequent lesions. Associated lesions were rare and comorbidities were infrequent in our sample.

OBJETIVO: A pesquisa analisa 47 pacientes submetidos à artroplastia total de joelho (ATJ) com implante de fabricação nacional com seguimento médio de cinco anos. MÉTODOS: No período compreendido entre janeiro de 1993 a dezembro de 2002 foi realizado um estudo retrospectivo no Hospital da Santa Casa de Misericórdia do Rio de Janeiro. A casuística foi de 47 pacientes totalizando 58 joelhos submetidos à ATJ, sendo 44 do sexo feminino e três do sexo masculino. A idade dos pacientes variou de 46 a 83 anos. O diagnóstico de osteoartrose ou doença reumática foi confirmado em todos os pacientes. RESULTADOS: Na pesquisa todos os casos foram submetidos à ATJ cimentada e com preservação do ligamento cruzado posterior. O tempo de seguimento dos pacientes variou de 5 a 17 anos. O critério de avaliação funcional usado foi o do Hospital for Special Surgery (HSS) e obtivemos a média de 87 pontos no pós-operatório. Na avaliação radiográfica utilizamos os critérios da Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System e obtivemos três casos com uma linha radioluscente sem soltura do implante e assintomáticos do ponto de vista clínico. CONCLUSÃO: A artroplastia total do joelho com implante de fabricação nacional realizado por equipe treinada e experiente, até o presente momento, demonstrou um resultado satisfatório no seguimento clínico em pacientes com osteoartrose do joelho ou artrite reumatóide.OBJECTIVE: This study assessed 47 patients who underwent total knee arthroplasty (TKA) with implants manufactured in Brazil, with a mean follow-up of five years. METHODS: This was a retrospective study at Santa Casa de Misericordia Hospital in Rio de Janeiro, from January 1993 to December 2002. The sample comprised 47 patients (44 females and three males) who underwent TKA, totaling 58 knees. The patients' ages ranged from 46 to 83 years. A diagnosis of osteoarthritis or rheumatic disease was confirmed in all the patients. RESULTS: In this investigation, all the patients underwent cemented TKA with preservation of the posterior cruciate ligament. The length of follow-up ranged from 5 to 17 years. The functional assessment criterion used was the one of the Hospital for Special Surgery (HSS), and this yielded an average of 87 points after the operation. The radiographic criterion used was the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. We had three cases with a radiolucent line without implant loosening, which were asymptomatic from a clinical standpoint. CONCLUSION: The total knee arthroplasty procedures using an implant made in Brazil were performed by a trained and experienced team. To date, over the clinical follow-up on these patients with knee osteoarthritis or rheumatoid arthritis, the results have been seen to be satisfactory.

OBJETIVO: Apresentar os resultados do tratamento cirúrgico de 15 pacientes com fratura da escápula. MÉTODOS: Avaliação retrospectiva dos resultados clinicos e radiográficos do tratamento cirurgico de fraturas da escápula, em um periodo de dez anos. A avaliação clínica baseou-se tanto no escore de Schofer et al. quanto no Constant-Murley. Na avaliação radiográfica, pesquisou-se a existência de perda da redução, pseudartrose ou alterações póstraumáticas. A análise estatística foi puramente descritiva, por meio de cálculo percentual dos achados. RESULTADOS: Todas as fraturas consolidaram em um período médio de 90 dias, confor- me documentação radiográfica. Na última consulta ambulatorial, o tempo médio de seguimento foi de 45,6 meses (variando de 14 a 109,2 meses). Nenhum paciente referiu dor constante e incapacitante no ombro operado. O escore médio de Constant- Murley foi de 84 pontos (variando de 76 a 90 pontos). Dos 15 pacientes, 13 (86,7%) retornaram ao nível funcional prévio sem restrição (atividades profissional e recreacionais). Não forma detectados sinais de perda de redução, pseudartrose ou osteo- artrose pós-traumática. Não ocorreram penetração ou impacto articular pela presença do material de osteossíntese. CONCLUSÃO: Em pacientes com fraturas da escápula, que se enquadrem nos critérios para tratamento cirúrgico, os resultados são bons desde que sejam respeitados os tecidos moles periarticulares e realizado o devido planejamento da via de acesso e do protocolo de reabilitação.OBJECTIVE: To evaluate the clinical and radiographic outcomes on 15 unstable scapula fractures treated by open reduction and internal fixation. METHODS: A retrospective study to evaluate the results of scapula fracture fixation in 15 patients, managed at our Institution during a 10-year period. Shoulder function was recorded in both upper extremities with both the Schofer et al. and the Constant-Murley score. Radiographic analysis was done in terms of loss of reduction, nonunion, and post-traumatic degenerative changes. Statistical analysis was purely descriptive with calculation of percentage. RESULTS: All fractures healed in a mean of 90 days, as documented by simple radiographs. At the last consultation, the mean follow-up was 45.6 months (ranging from 14 to 109,2 months). No patient had constant pain or referred incapacity. The mean Constant- Murley score for the 15 patients was 84 points (ranging from 76 to 90 points). Of the 15 patients, 13 (86.7%) had returned to their previous employment and recreational activities with- out restrictions. No signs of loss of reduction, nonunion, or post-traumatic degenerative changes were seen. In addition, no ardware impingement or articular penetration was observed in any case. CONCLUSION: The respect to the soft tissue is the cornerstone of proper treatment of this scapular fractures. In our series good results were obtained when appropriate preoperative planning and post-operative rehabilitation has been performed.

Os autores relatam a rara ocorrência de um caso de pseudoartrose de fratura de Hoffa em um paciente alcoólatra com geno valgo associado à insuficiência venosa que foi submetido a artroplastia total do joelho. Fazem uma revisão da literatura e discutem os principais fatores de indicação cirúrgica de artroplastia total do joelho após fratura do joelho. A artroplastia total do joelho foi uma opção viável em um paciente de 60 anos com pseudoartrose de fratura de Hoffa e comorbidades.A rare occurrence of a case of Hoffa fracture pseudarthrosis in an alcoholic patient with genu valgum associated with venous insufficiency who underwent total knee arthroplasty is reported. The literature is reviewed and the main factors for surgical indication of total knee arthroplasty after a fracture of the knee are discussed. Total knee arthroplasty was a viable option in a 60-year-old patient with Hoffa fracture pseudarthrosis and comorbidities.

Os autores relatam a rara ocorrência de dois casos de fratura do componente tibial em artroplastia total do joelho, fazem uma revisão da literatura e discutem os principais fatores que podem causar as falhas dos implantes.The authors report the rare occurrence of two cases of fracture of the tibial component in total knee arthroplasty. They review the literature and discuss the main factors that can cause failure of the implants.

OBJETIVO: Avaliar o protocolo de Lysholm modificado em pacientes com joelhos considerados normais (sem queixas ou doenças prévias nessa região). MÉTODO: No período de janeiro a março de 2010, foi realizado um estudo prospectivo com 300 pacientes que compareceram à emergência de nosso hospital com queixas ortopédicas em outras regiões do corpo. O critério de inclusão dos pacientes foi ausência de queixas ou cirurgia prévia no joelho considerado dominante. O limite de idade foi entre 16 e 40 anos, com média de 28,8 anos. Nossa pesquisa foi composta de 153 pacientes do sexo masculino e 147 pacientes do sexo feminino. No sistema Lysholm a pontuação máxima é de 100 pontos e inclui critérios funcionais e objetivos. Ao todo, 50% do total do escore é baseado nos sintomas de dor e instabilidade. RESULTADOS: A média do protocolo de Lysholm foi de 95 pontos em joelhos considerados normais. O sexo masculino obteve um escore superior quando comparado ao sexo feminino. CONCLUSÃO: Os pacientes com joelho considerado normal não obtiveram a pontuação máxima na avaliação pelo protocolo modificado de Lysholm. O estudo sugere que esta linha de pesquisa sobre o sistema de avaliação funcional do joelho encontra-se aberta para novas avaliações. Assim como também devemos pesquisar a criação e a elaboração de novos formulários de avaliação funcional do joelho para a obtenção de um consenso mundial.OBJECTIVE: To evaluate the modified Lysholm protocol among patients with knees that were considered to be normal (without previous complaints or pathological conditions in this region). METHOD: Between January 2010 and March 2010, a prospective study was conducted on 300 patients with orthopedic complaints in other regions of the body who came to the emergency service of our hospital. The inclusion criterion among these patients was the absence of complaints or previous surgery in the knee that was considered to be dominant. The age range was from 16 to 40 years, with an average of 28.8 years. Our study group consisted of 153 males and 147 females. In the modified Lysholm system, the maximum score is 100 points and this includes functional and objective criteria. Altogether, 50% of the total score is based on symptoms of pain and instability. RESULTS: The average score using the Lysholm protocol was 95 points in the knees that were considered normal. Males had higher scores than females. CONCLUSION: These patients with knees that were considered normal did not achieve the maximum score when evaluated using the modified Lysholm protocol. This study suggests that this line of research on functional evaluation systems for the knee is open for further evaluations. Moreover, creation and development of new forms of functional assessment for the knee should be investigated in order to achieve a worldwide consensus.

OBJETIVO: Avaliar a concordância interobservador de três classificações utilizadas para a fratura do platô tibial: Schatzker, Grupo AO e Hohl. MÉTODO: Nove observadores, subdivididos de acordo com o grau de titulação (seis médicos residentes - MR - e três médicos especialistas - ME), classificaram 50 fraturas do platô tibial. A concordância interobservador foi avaliada pelo coeficiente Kappa. RESULTADOS: Comparando-se os médicos residentes (MR) com os médicos especialistas (ME), observou-se que as três classificações apresentaram concordância de grau fraco e moderado. Entre os MR, as classificações do Grupo AO e de Hohl mostraram relação direta entre aumento no grau de concordância e ano de residência médica, o que foi observado de forma parcial para a classificação de Schatzker. Para a classificação de Hohl, o Kappa variou de 0,344 a 0,577; para a classificação do Grupo AO, variou de 0,36 a 0,499; e para a classificação de Schatzker, variou de 0,278 a 0,465. CONCLUSÃO: Existe concordância significativa, ao nível de 1%, entre as três classificações para todos os pares de observadores. Comparando-se os MR com os ME, as três classificações estudadas apresentam concordância de grau fraco e moderado. A classificação de Hohl apresenta a maior concordância entre os MR.OBJECTIVE: To assess the inter-observer agreement of three tibial plateau fracture classifications: Schatzker, AO Group, and Hohl. METHODS: Nine physicians of different levels of expertise (six Orthopaedic Residents - OR - and three Orthopaedic Attendings - OA) classified 50 tibial plateau fractures. RESULTS: There was a low to moderate agreement between OR and OA on the three classification systems. A straight correlation was found between the year of Residence and an increase on the level of agreement on the AO group and Hohl classifications. This was partially seen on the Schatzker classification. Kappa ranged from 0.344 to 0.577, 0.36 to 0.499, and 0.278 to 0.465 for the Hohl, AO group, and Schatzker systems, respectively. CONCLUSION: With a level of 0.1, there was a significant agreement on the three classifications among the physicians. When comparing ORs to OAs, the three studied classifications show low to moderate consistency, with the Hohl classification showing the highest level of agreement between OR.

OBJETIVO: Avaliar a reprodutibilidade interobservador das classificações de Ahlbäck modificada, Dejour et al e Kellgreen et al, com o propósito de identificar concordância, discordância e vantagens eventuais de uma classificação sobre a outra e as correlacionando de acordo com o grau de experiência do médico. MÉTODOS: Foram estudados 50 pacientes com diagnóstico de osteoartrose de joelho (50 joelhos), sendo 36 do sexo feminino e 14 do masculino, com média de idade de 62 anos (variando de 50 a 82 anos). Os critérios de inclusão foram: idade maior do que 50 anos, presença de dor no joelho e ausência de cirurgia prévia ou doença reumática nesta articulação. Quatro médicos membros da Sociedade Brasileira de Cirurgia do Joelho (SBCJ) e quatro membros titulares da Sociedade Brasileira de Ortopedia e Traumatologia foram convidados para avaliar as imagens, adotando-se como "padrão-ouro" um dos membros da Sociedade Brasileira de Cirurgia do Joelho que possuía o maior grau de titulação. Análise estatística foi realizada pelo método de Kappa, com nível de significância α = 1%. RESULTADOS: O kappa da amostra pesquisada variou de 0,028 a 0,501, com nenhuma combinação obtendo concordância boa (0,61 < kappa < 0,80) ou excelente (kappa > 0,80). A classificação de Dejour apresentou melhor reprodutibilidade interobservador, com um kappa de 0,487 para cada par de observadores e de 0,501 quando comparado com o padrão-ouro, demonstrando grau de concordância moderado (0,41 < kappa < 0,60). CONCLUSÕES: A análise interobservador evidenciou que não houve concordância absoluta dos pesquisadores em relação com nenhuma das classificações estudadas. A classificação de Dejour apresentou maior concordância (moderada) segundo nosso estudo definindo de forma mais adequada e reprodutível a gravidade da doença degenerativa do joelho. Classificações que avaliam a redução do espaço articular, segundo nossa pesquisa, são melhores para analisar a progressão da doença degenerativa do joelho. A reprodutibilidade foi maior entre os médicos especialistas em joelho, demonstrando influência direta da experiência do observador.OBJECTIVE: To assess the interobserver reproducibility of the modified Ahlbäck, Dejour et al, and Kellgreen et al classifications, with the purpose of identifying points of agreement, points of disagreement, and the possible advantages of one of the classifications over the others, and correlating them according to the level of experience of the physician. METHODS: 50 patients were studied who had the diagnosis of osteoarthrosis of the knee (50 knees), 36 female and 14 male, mean age 62 years (ranging from 50 to 82). Inclusion criteria were older than 50, pain in the knee, and no prior surgery or rheumatic disease in the knee joint. Four physicians who are members of the SBCJ - Brazilian Society of Knee Surgery were invited to evaluate the images, the golden standard being one of the members of the SBCJ who had the highest level of titles. Statistical analysis followed the Kappa method, with significance level α = 1%. RESULTS: The kappa for the sample surveyed ranged from 0.028 to 0.501, with none of the combinations achieving a good concordance (0.61 < kappa < 0.80) or an excellent concordance (kappa > 0.80). The Dejour classification presented the best interobserver reproducibility, with a 0.487 kappa for each pair of observers, and a 0.501 kappa when compared to the golden standard, thus showing a moderate degree of concordance (0.41 < kappa < 0.60). CONCLUSIONS: The interobserver assessment showed that there was no absolute concordance of the researchers for any of the classifications studied. The Dejour classification has the highest concordance (moderate) according to our study, as it defines in a more reproducible and adequate manner the severity of the knee degenerative disease. According to our survey, classifications that assess the reduction in joint space are better tools to analyze the progression of the knee degenerative disease. Reproducibility was higher among physicians who are knee specialists, thus showing that observer experience has a direct impact in the results.

The total rupture of the quadriceps muscle in an adolescent is a rare lesion. We report a case of a 13 year old boy who suffered a direct trauma to the left knee. No predisposing factors have been diagnosed. The lesion was treated with surgical repair and transosseus sutures. The aim of this study was to present a rare case of rupture of the quadriceps muscle in an adolescent and the therapy used.A ruptura total do músculo quadríceps em um adolescente é uma lesão rara. Nós relatamos um caso de um menino de 13 anos que sofreu um trauma direto no joelho esquerdo. Não foram diagnosticados fatores predisponentes. A lesão foi tratada com o reparo cirúrgico e suturas transósseas. O objetivo desta pesquisa foi apresentar um caso raro de ruptura do músculo quadríceps em um adolescente e a terapêutica adotada.

A ruptura do tendão patelar de um lado e um sleeve fracture contralateral em um pré-adolescente são uma lesão rara. Nós relatamos um caso em um pré-adolescente que caiu enquanto saltava durante uma partida de futebol. Não foram diagnosticados fatores predisponentes. As lesões foram tratadas com os reparos cirúrgicos e suturas transósseas. O objetivo desta pesquisa foi apresentar um caso de ruptura concorrente e espontânea do mecanismo extensor do joelho em um pré-adolescente.Unilateral tearing of a patellar tendon and a contralateral sleeve fracture in a pre-adolescent are rare lesions. We report a case in which a pre-adolescent sustained a fall while jumping during a soccer match. No predisposing risk factors were identified. The injuries were treated with surgical repairs and transosseous suturing. The aim of this study was to present a case of spontaneous concurrent tearing of the extensor mechanism of the knee in a pre-adolescent.

OBJETIVO: Investigar a função da suplementação de ácido ascórbico na consolidação de fraturas da tíbia de ratos. MÉTODOS: Trinta ratos Wistar machos foram aleatoriamente divididos nos grupos Vitamina C (Grupo A) e sham (Grupo B), com 15 ratos em cada grupo. Ao grupo A foram administrados 200mg/kg de ácido ascórbico por dia intraperitonialmente e ao grupo B,5ml/kg de soro fisiológico intraperitonialmente uma vez ao dia. Os animais foram separados em duplas e colocados em gaiolas, com água e ração padrão ad libitum. As fraturas foram produzidas manualmente, não foram estabilizadas nem foi usado qualquer tipo de imobilização. Duas, quatro e seis semanas após a fratura, cinco ratos de cada grupo foram anestesiados e sacrificados por deslocamento cervical. O calo foi dissecado, preparado e analisado histologicamente. A análise histomorfológica foi realizada seis semanas após a fratura e o estágio de consolidação determinado a partir de escala de cinco pontos. RESULTADOS: Não houve diferenças histológicas e histomorfológicas entre os animais nos três diferentes estágios usados no experimento. Seis semanas após a fratura, os cinco animais de cada grupo apresentaram completa consolidação óssea. CONCLUSÃO: Nas condições estudadas, a suplementação de Vitamina C não acelerou o processo de consolidação de fraturas da tíbia de ratos. Nível de evidência II, estudo individual com delineamento experimental.OBJECTIVE: To investigate the role of ascorbic acid supplementation on bone healing after rat tibia fracture. METHODS: Thirty male Wistar rats were randomly divided into Vitamin C (Group A) and sham (Group B) groups (15 rats each). Group A received 200 mg intraperitoneally per kg per day of ascorbic acid and Group B was given saline 5 ml per kg per day intraperitoneally once a day. The animals were caged in pairs and allowed free access to tap water and a standard rodent chow ad libitum. Fractures were produced manually, they were not stabilized, and unprotected weight-bearing was allowed. At two, four, and six weeks post-fracture, the rats in both groups were anesthetized and sacrificed by cervical dislocation. Callus tissue was dissected, prepared, and analyzed histologically. Histomorphological analysis was performed at six weeks post-fracture and the extent of fracture healing was determined using a five-point scale. RESULTS: There were no histological and histomorphological differences between drug-treated animals and the shamin the three different stages studied. By six weeks post-fracture, the five animals of each group had a complete bone union. CONCLUSION: Under the studied conditions, intraperitoneal Vitamin C supplementation does not accelerate the fracture healing process after experimental tibia fracture in rats. Level of evidence: Level 2, individual study with experimental design.

A fratura avulsão bilateral e simultânea da tuberosidade tibial em uma adolescente é uma lesão rara. Os autores relatam o primeiro caso da literatura em uma menina adolescente que caiu enquanto saltava durante uma partida de voleibol. Não foram diagnosticados fatores predisponentes. As lesões foram tratadas com a redução cruenta e a fixação interna. O objetivo desta pesquisa foi o de apresentar um caso de fratura avulsão bilateral e simultânea da tuberosidade tibial em uma adolescente e a terapêutica adotada.Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were identified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used.

ABSTRACT Obtaining axillary radiographs of the shoulder in acute trauma is not always feasible. The authors present a new modification of this radiographic view, in order to assess the anatomic relationship between the humeral head and the glenoid cavity. The incidence is performed with the patient sitting on X-ray table, with the affected limb supported thereon. The authors describe the case of a 28-year-old male who suffered an anterior glenohumeral dislocation that was clearly evidenced by this modified radiograph. The concentric relationship between the humeral head and the glenoid cavity was also easily confirmed by obtaining such radiograph after the reduction maneuver.

ABSTRACT Objective: Identify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery. Methods: The study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group. Results: The case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period.There were no complications during surgery in the groups studied, as there were no statistically significant differences between the incidence of local or systemic intercurrences in the analyzed period. Conclusion: This study found low rates of complications in patients undergoing total knee arthroplasties with use of a tourniquet, with or without calcification of the popliteal artery.

ABSTRACT Objective: Evaluate the efficacy of tranexamic acid in reducing bleeding in patients undergoing total knee arthroplasty. Methods: 101 patients were randomized into two groups: the tranexamic acid group (n = 51) and the placebo group (n = 50). Patients were compared regarding the following parameters: reduction of hemoglobin, total estimated blood loss, drain output, and postoperative blood transfusion rate. Results: Comparing the groups, there were statistically significant differences (p < 0.05) in the following parameters: reduction of hemoglobin, decreased hematocrit, estimated blood loss, and drain output. All values were lower in the tranexamic acid group. Only placebo group patients required blood transfusion. Conclusion: The use of intravenous tranexamic acid is effective to reduce bleeding in patients undergoing total knee arthroplasty.

ABSTRACT OBJECTIVE: To assess the inter- and intraobserver reproducibility of the original version and different descriptions of the Kellgren and Lawrence classification used in epidemiological studies for osteoarthritis of the knee. METHODS: The study included 72 patients with osteoarthritis of the knee. Three medical members of the Brazilian Society of Knee Surgery were invited to evaluate the images. An intra- and interobserver analysis was conducted, with an interval of one month. The intraobserver agreement was analyzed using the weighted Cohen's Kappa coefficient. The interobserver agreement was analyzed using the Krippendorff alpha coefficient (a). RESULTS: The intraobserver assessment indicated conflicting results. In the interobserver analysis, the level of agreement was superficial. CONCLUSIONS: The classification of Kellgren and Lawrence and its variants generated a low reproducibility between observers. The intraobserver analysis showed a lack of uniformity in the use of this classification and its variants, even among experienced observers.

ABSTRACT The occurrence of permanent patellar dislocation associated with severe osteoarthritis is considered rare and difficult to treat. Literature: The literature is quite controversial on the subject. The objective of the study is to report two rare cases of severe osteoarthritis with permanent dislocation of the patella that underwent total knee arthroplasty, in addition to a review of the literature on the subject and related surgical technique. Total knee arthroplasty with using the medial parapatellar approach associated with lateral release was a good surgical option in patients with permanent patellar dislocation associated with advanced osteoarthritis.