CONTEXT AND OBJECTIVE: Orthopedic surgery implies high costs for both public and private healthca... more CONTEXT AND OBJECTIVE: Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding treatment of a damaged anterior cruciate ligament, which is a common knee injury. DESIGN AND SETTING: Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS: We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS: The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. CONCLUSION: Both in the public and in the private systems in Brazil, because of non-medical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians. CONTEXTO E OBJETIVO: Cirurgias ortopédicas implicam alto custo para a saúde pública e privada. O objetivo deste estudo foi de entender melhor as diferenças entre os sistemas público e privado em relação ao tratamento da lesão do ligamento cruzado anterior, que é uma lesão comum do joelho. TIPO DE ESTUDO E LOCAL: Estudo transversal descritivo, realizado durante Congresso Brasileiro de Ortopedia em Brasília. MÉTODOS: Aplicamos questionários durante o Congresso Brasileiro de Ortopedia de 2010, com a participação de 241 cirurgiões de joelho de 24 estados brasileiros. Posteriormente foi feita análise estatística nos dados obtidos. RESULTADOS: Diferentes condutas e opções de tratamento em diferentes estados brasileiros são realizadas pelos ortopedistas avaliados, quando comparadas em relação à atuação no sistema público e privado. CONCLUSÃO: No Brasil, tanto no sistema público como no privado nem sempre a melhor decisão é tomada por conta de efeitos outros que não a decisão médica, fato que tem sido maléfico para o paciente e para o médico.
To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL)... more To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL) reconstruction would lead to different cardiorespiratory adjustments during dynamic exercise. Method: Eighteen active male subjects were submitted to isokinetic evaluation of knee flexor and extensor muscles four months after ACL surgery. Thigh circumference was also measured and an incremental unilateral cardiopulmonary exercise test was performed separately for both involved and uninvolved lower limbs in order to compare heart rate, oxygen consumption, minute ventilation, and ventilatory pattern (breath rate, tidal volume, inspiratory time, expiratory time, tidal volume/inspiratory time) at three different workloads (moderate, anaerobic threshold, and maximal). Results: There was a significant difference between isokinetic extensor peak torque measured in the involved (116.5±29.1 Nm) and uninvolved (220.8±40.4 Nm) limbs, p=0.000. Isokinetic flexor peak torque was also lower in the involved limb than in the uninvolved limb (107.8±15.4 and 132.5±26.3 Nm, p=0.004, respectively). Lower values were also found in involved thigh circumference as compared with uninvolved limb (46.9±4.3 and 48.5±3.9 cm, p=0.005, respectively). No differences were found between the lower limbs in any of the variables of the incremental cardiopulmonary tests at all exercise intensities. Conclusions: Our findings indicate that, four months after ACL surgery, there is a significant deficit in isokinetic strength in the involved limb, but these differences in muscle strength requirement do not produce differences in the cardiorespiratory adjustments to exercise. Based on the hypotheses from the literature which explain the differences in the physiological responses to exercise for different muscle masses, we can deduce that, after 4 months of a rehabilitation program after an ACL reconstruction, individuals probably do not present differences in muscle oxidative and peripheral perfusion capacities that could elicit higher levels of peripheral cardiorepiratory stimulus during exercise.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
Purpose: To evaluate the posterior septum of the knee and determine the presence of a safe zone t... more Purpose: To evaluate the posterior septum of the knee and determine the presence of a safe zone that could be removed, without significant damage to blood vessels and nerves. Methods: Nineteen fresh unpaired adult human cadaveric knees, with no macroscopic degenerative or traumatic changes, were used in this study. Microscopic evaluation was performed by analysis of H&E, CD-34, and S-100 staining. Results: The posterior septum of the knee is rich in type II and type IV mechanoreceptors and blood vessels. The superior half has a greater number of blood vessels (21.52 Ϯ 6.36 v 12.05 Ϯ 4.1, P Ͻ .001), higher-caliber vessels (2.2 Ϯ 0.89 m v 1.41 Ϯ 0.45 m, P Ͻ .006), and a greater number of mechanoreceptors per field (type II, 1.8 Ϯ 1.8 v 0.42 Ϯ 1, P ϭ .04; type IV, 22.6 Ϯ 14 v 14.5 Ϯ 9.4, P ϭ .04) than the inferior half of the septum. Conclusions: This study has shown that the posterior septum of the knee is highly vascularized and has a great number of type II and IV mechanoreceptors. The presence of these structures is significantly higher in the superior half of the septum. Clinical Relevance: If debridement of the posterior septum is necessary, it should be done at the inferior aspect so that a greater number of blood vessels and mechanoreceptors can be preserved.
CONTEXT AND OBJECTIVE: Orthopedic surgery implies high costs for both public and private healthca... more CONTEXT AND OBJECTIVE: Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding treatment of a damaged anterior cruciate ligament, which is a common knee injury. DESIGN AND SETTING: Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS: We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS: The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. CONCLUSION: Both in the public and in the private systems in Brazil, because of non-medical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians. CONTEXTO E OBJETIVO: Cirurgias ortopédicas implicam alto custo para a saúde pública e privada. O objetivo deste estudo foi de entender melhor as diferenças entre os sistemas público e privado em relação ao tratamento da lesão do ligamento cruzado anterior, que é uma lesão comum do joelho. TIPO DE ESTUDO E LOCAL: Estudo transversal descritivo, realizado durante Congresso Brasileiro de Ortopedia em Brasília. MÉTODOS: Aplicamos questionários durante o Congresso Brasileiro de Ortopedia de 2010, com a participação de 241 cirurgiões de joelho de 24 estados brasileiros. Posteriormente foi feita análise estatística nos dados obtidos. RESULTADOS: Diferentes condutas e opções de tratamento em diferentes estados brasileiros são realizadas pelos ortopedistas avaliados, quando comparadas em relação à atuação no sistema público e privado. CONCLUSÃO: No Brasil, tanto no sistema público como no privado nem sempre a melhor decisão é tomada por conta de efeitos outros que não a decisão médica, fato que tem sido maléfico para o paciente e para o médico.
To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL)... more To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL) reconstruction would lead to different cardiorespiratory adjustments during dynamic exercise. Method: Eighteen active male subjects were submitted to isokinetic evaluation of knee flexor and extensor muscles four months after ACL surgery. Thigh circumference was also measured and an incremental unilateral cardiopulmonary exercise test was performed separately for both involved and uninvolved lower limbs in order to compare heart rate, oxygen consumption, minute ventilation, and ventilatory pattern (breath rate, tidal volume, inspiratory time, expiratory time, tidal volume/inspiratory time) at three different workloads (moderate, anaerobic threshold, and maximal). Results: There was a significant difference between isokinetic extensor peak torque measured in the involved (116.5±29.1 Nm) and uninvolved (220.8±40.4 Nm) limbs, p=0.000. Isokinetic flexor peak torque was also lower in the involved limb than in the uninvolved limb (107.8±15.4 and 132.5±26.3 Nm, p=0.004, respectively). Lower values were also found in involved thigh circumference as compared with uninvolved limb (46.9±4.3 and 48.5±3.9 cm, p=0.005, respectively). No differences were found between the lower limbs in any of the variables of the incremental cardiopulmonary tests at all exercise intensities. Conclusions: Our findings indicate that, four months after ACL surgery, there is a significant deficit in isokinetic strength in the involved limb, but these differences in muscle strength requirement do not produce differences in the cardiorespiratory adjustments to exercise. Based on the hypotheses from the literature which explain the differences in the physiological responses to exercise for different muscle masses, we can deduce that, after 4 months of a rehabilitation program after an ACL reconstruction, individuals probably do not present differences in muscle oxidative and peripheral perfusion capacities that could elicit higher levels of peripheral cardiorepiratory stimulus during exercise.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
Purpose: To evaluate the posterior septum of the knee and determine the presence of a safe zone t... more Purpose: To evaluate the posterior septum of the knee and determine the presence of a safe zone that could be removed, without significant damage to blood vessels and nerves. Methods: Nineteen fresh unpaired adult human cadaveric knees, with no macroscopic degenerative or traumatic changes, were used in this study. Microscopic evaluation was performed by analysis of H&E, CD-34, and S-100 staining. Results: The posterior septum of the knee is rich in type II and type IV mechanoreceptors and blood vessels. The superior half has a greater number of blood vessels (21.52 Ϯ 6.36 v 12.05 Ϯ 4.1, P Ͻ .001), higher-caliber vessels (2.2 Ϯ 0.89 m v 1.41 Ϯ 0.45 m, P Ͻ .006), and a greater number of mechanoreceptors per field (type II, 1.8 Ϯ 1.8 v 0.42 Ϯ 1, P ϭ .04; type IV, 22.6 Ϯ 14 v 14.5 Ϯ 9.4, P ϭ .04) than the inferior half of the septum. Conclusions: This study has shown that the posterior septum of the knee is highly vascularized and has a great number of type II and IV mechanoreceptors. The presence of these structures is significantly higher in the superior half of the septum. Clinical Relevance: If debridement of the posterior septum is necessary, it should be done at the inferior aspect so that a greater number of blood vessels and mechanoreceptors can be preserved.
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