Objective: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. Methods: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. Results: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. Conclusion: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores.
Objective: To compare the effect of a brace designed to stabilize the patellofemoral joint to that of a patella-shaped neoprene sleeve with patella cut out in patients with patellofemoral osteoarthritis. Methods: Fifty-seven patients with femoro-patellar osteoarthritis were allocated to two groups: patients with femoro-patellar functional brace and those with a neoprene knee with a patellar orifice. Both groups underwent clinical treatment of osteoarthritis and used medications daily 1 month before and up to 3 months after brace placement. They were evaluated with the WOMAC and Lequesne questionnaires and performed five times sit to stand test, Timed Up and Go test, and six minutes walk test immediately before and 1 and 3 months after brace placement. Results: Both groups had improved pain, stiffness, and function with no difference between groups. Drug use decreased in both groups in the first month but increased in the third month. Naproxen use was progressively higher in the control group. Conclusion: Both knee orthoses improved pain and function and altered drug use only in the first month. Functional knee brace provided analgesia without increased use of naproxen.
Objective: To postoperatively evaluate knee scores, radiological assessment results, deficit correction, patellar height change, bone healing time, and weight bearing time in patients undergoing high tibial osteotomy (HTO) with/without autologous iliac bone grafting. Methods: This retrospective examination of treated controls from a randomized controlled study included 63 knees of 58 patients aged 46-59 years who underwent HTO with locking open wedge osteotomy plates. The patients were divided into two groups: Group A, HTO with autologous iliac bone grafts (n = 31); and Group B, HTO without autologous iliac bone grafts (n = 32). Clinical and radiological data were evaluated prospectively at the preoperative consultation and again at 6, 9, and 12 weeks, 6 months, and 1 year after the surgery (and annually thereafter). Results: There were no significant intergroup differences in the radiological assessment, deficit correction, patellar height change, bone-healing time, and weight-bearing time at any time after surgery. The knee scores changed positively in both groups (p < 0.001). Conclusions: There was no difference in the results of patients undergoing HTO with open wedge osteotomy titanium locking plates with or without autografting, and comorbidities resulting from autografts were eliminated with the use of locking plates.
Objective: Hand-held dynamometry is a quantitative and accessible means of determining the isometric force of muscle groups. Methods: A total of 52 women aged 20-29 years with no complaints of hip pain who were sedentary or sporadically active and had a body mass index of 18.5-24.99 kg/m(2) were included. All participants underwent bilateral assessments using hand-held dynamometry of the flexor, extensor, adductor, and abductor muscles as well as the internal and external rotator hip muscles. All hip movements were measured. All contraction data collected by the dynamometer are expressed in kilograms, normalized according to body weight, and expressed as percentages. Results: The flexor muscles exhibited an isometric muscle force of 38.54% of body weight versus a muscle force of 27.04% for the extensor muscles, 16.89% for the adductors, 16.85% for the abductors, and 17.09% for the external rotators, and 23.82% for the internal rotators. Conclusion: Standardization of isometric strength values according to body weight proved feasible. This result is important for clinical practice since it allows the establishment of patterns of normality and criteria for discharge, return to sports, or assessment of the impact of injuries in terms of loss of muscle strength.
Objective: To evaluate bone mineral density (BMD) and body composition over a six-year period in elderly long-distance runners. Methods: We analyzed the medical records of elderly athletes who were long-distance runners, were participants of the IOT-HCFMUSP Orthogeriatric Group, and had their BMD evaluated between 2001 and 2007; of these athletes, 11 were included in the study. Inclusion criteria: athletes should be long-distance runners, should not stop long-distance running during the six-year period, and should have undergone BMD and body composition evaluations. Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry with a Lunar-DPX device. Results: Over the six-year period, body composition remained stable, but there was a significant increase only in the fat percentage (p = 0.003). Conclusion: Long-distance running may maintain BMD but may lead to an increase in the fat percentage in elderly runners.
Objective: To evaluate the choice of surgical approach among Brazilian orthopedists and whether shoulder surgery specialty training or duration of experience influences the decision-making. Methods: A questionnaire on the preferred approach and complications was administered to orthopedic surgeons with and without shoulder specialization training. The chi-square test or Fisher's exact test was applied. Results: We interviewed 114 orthopedists, 49 (43.0%) traumatologists, 36 (31.5%) specialist surgeons, and 29 (25%) shoulder surgery specialist residents. In cases of fracture without dislocation, specialized training and duration of experience did not influence the approach used (primarily deltopectoral). In cases of fracture/dislocation, 97.2% of the specialists versus 82.1% of the traumatologists opted for the deltopectoral approach (p = 0.034). In cases of fractures/dislocation, 92.5% of surgeons with more than 5 years of experience and 78.7% with less than 5 years of experience opted for the deltopectoral approach (p = 0.032). Conclusion: Specialization in shoulder surgery did not influence surgeons' approaches to manage fractures without dislocation. In cases of fracture/dislocation, shoulder surgery specialization training and duration of experience were associated with selection of the deltopectoral approach.
Objectives: This study aimed to compare the lumbar lordosis (LL) and spinopelvic parameters of patients with stage 1-2 spondylolisthesis to those of the normal population and demonstrate the importance of these parameters in sagittal balance. Methods: The lumbosacral parameters on the lateral radiographs of a total of 125 patients were retrospectively compared. Lumbosacral parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LLA), L5 incidence (L5I), L5 slope (L5S), and sacral table angle (STA) were compared between groups. Results: Comparison of the parameters between groups revealed no sex-based differences (p > 0.05). Conclusions: Abnormal sagittal spinopelvic parameters are commonly examined for their effects on the development of spondylolisthesis and should be used in routine practice. We found that the low SS values in our study, unlike those of other similar studies, may be a compensatory mechanism developed to reduce pain and maintain sagittal balance.
Objective: To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention. Methods: A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA. Results: Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001). Conclusion: Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion.
Objective: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. Methods: Between 2006-2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. Results: Twenty-four patients (mean age, 11 [2-18] years) were treated and followed up for a mean 3.58 (range, 1-9) years. Mean patient age in the curettage group was 12.1 (range, 3-18) years. Mean operation length was 69.5 (range, 60-120) minutes. Mean hospital stay was 1.3 (range, 0-2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2-17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20-90) minutes. Mean hospital stay was 0.3 (range, 0-1) days. Mean follow-up time was 1.76 (range, 1-4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. Conclusions: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach.
Objective: To report the use of two techniques (radiosurgery and en bloc vertebrectomy) on the same patient for the treatment of two metastases in different sites of the spine arising from intracranial hemangiopericytoma. Intracranial hemangiopericytomas are rare, comprising approximately 2.4% of meningeal tumors and <1% of all tumors of the central nervous system. Metastases to the spine are even rarer: The largest case series reported in the literature has 5 and 7 cases. Methods: A 37-year-old man diagnosed with intracranial hemangiopericytoma was referred for a metastatic lesion in T12 and underwent en bloc resection using the Tomita technique. Results: The disease evolved with a metastasis to T2 treated by radiosurgery with 1600 cGy. The patient died 1,706 days after the en bloc resection of T12 and 1324 days after the radiosurgery of T2, and no recurrence occurred in these locations due to progression of the systemic diseases (liver and central nervous system). Conclusion: This is the first case reported in the literature in which two different techniques were used to treat metastatic lesions in the spine from an intracranial hemangiopericytoma and is unique for its use of two treatments in the same patient.