RESUMO Objetivo: Avaliar a altura labral e a resistência ao arrancamento do reparo da lesão de Bankart em articulação glenoumeral de suínos, com âncoras duplamente carregadas com duas configurações de sutura: simples e tipo Mason-Allen. Métodos: Foram usados dez ombros suínos, nos quais foram criadas as lesões de Bankart. Para cada espécime foi feita a sutura da lesão com suturas tipo Mason-Allen e simples de forma aleatória. A altura labral foi mensurada previamente à confecção da lesão e após o reparo labral. Os espécimes foram submetidos ao ensaio de tração para avaliação biomecânica. Resultados: Nos espécimes submetidos a sutura simples (n = 5), observou-se altura média previamente à confecção da lesão de 3,86 mm e após a sutura, de 3,33 mm. Nos espécimes submetidos a sutura Mason-Allen (n = 5), observou-se que a altura média previamente à confecção da lesão era de 3,92 mm e após a sutura, de 3,48 mm. Ao comparar a altura labral após a sutura simples e Mason-Allen, não foram observadas diferenças significantes. A força de arrancamento no fim do ensaio de tração nos espécimes com sutura simples foi de 130 N e nos espécimes com sutura Mason-Allen, 128,6 N. Não houve diferença estatisticamente significante entre os ombros com suturas simples e Mason-Allen, p = 0,885. Conclusões: O reparo das lesões de Bankart com sutura Mason-Allen proporciona aumento da altura do labrum, mas não eleva a força de resistência ao arrancamento.

ABSTRACT Objective: To evaluate the labral height and pullout resistance after the repair of Bankart lesions in the glenohumeral joint of swine models, using double-loaded anchors with two suture configurations: simple and Mason-Allen. Methods: Ten swine shoulders were used, in which Bankart lesions were created. For each specimen, the lesion was sutured randomly with Mason-Allen sutures or simple sutures. The labral height was measured before the lesion was created and after the labral repair. The specimens were submitted to a tensile test for biomechanical evaluation. Results: In specimens submitted to simple suture (n = 5), the mean labral height observed before the lesion was 3.86 mm, and after suturing, 3.33 mm. In specimens submitted to Mason-Allen suture (n = 5), it was observed that the mean labral height before the lesion was 3.92 mm, and after suturing, 3.48 mm. When comparing the labral height after simple suture and Mason-Allen suture, no significant difference was observed. The pullout force at the end of the tensile test on specimens with single suture was 130 N, and in specimens with Mason-Allen suture, 128.6 N. No statistically significant differences were observed between the shoulders treated with single suture and Mason-Allen suture; p = 0.885. Conclusions: Repair of Bankart lesions with Mason-Allen suture provides increased labrum height; however, it does not increase the pullout strength.

RESUMO Objetivo: Avaliar a eficácia da aspirina como profilaxia da trombose venosa profunda (TVP) em pacientes submetidos à artroplastia total de quadril (ATQ) e analisar a incidência de possíveis sangramentos no pós-operatório. Método: Este estudo prospectivo realizado em 2017 foi constituído por 37 pacientes, com indicação de ATQ, com alto risco de TVP. No pós-operatório imediato foram iniciadas administração de aspirina, uso de meias de compressão elástica e deambulação precoce. Realizou-se um ultrassom com dopplerfluxometria no 6º dia e na 6ª semana de pós-operatório para excluir tromboembolismo venoso. Para detectar sangramentos, foram usadas variáveis hematimétricas e critérios clínicos. Resultados: No 6o dia após o procedimento, a incidência de TEV (tromboembolismo venoso) foi 21,6% e na 6ª semana houve uma redução para 8,1% (p = 0,102). Apenas 2,7% foram diagnosticados com TVP tanto no 6o dia como na 6ª semana. No pós-operatório imediato houve uma redução da hemoglobina (p < 0,001), contrastando com a sexta semana de pós-operatório, quando esses níveis se elevaram para os níveis basais. Conclusões: A aspirina mostrou-se eficaz como profilaxia química da trombose venosa em pacientes de alto risco submetidos à ATQ. Não houve registro clínico de sangramento pós-operatório e os níveis hematimétricos sugeriram não ter havido sangramento crônico. Nível de Evidência II; Estudo prospectivo.

ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.

OBJETIVO: Descrever os achados clínicos, eletrofisiológicos e de imagem na síndrome de Parsonage-Turner e avaliar os resultados do tratamento conservador.MÉTODOS: Foram estudados oito casos entre fevereiro de 2010 e fevereiro de 2012, com seguimento mínimo de um ano (média de 14 meses). Todos os pacientes foram submetidos ao questionário clínico e avaliados funcionalmente com o escore de Constant e Murley. Após a suspeita clínica o exame de eletroneuromiografia foi feito para confirmação diagnóstica.RESULTADOS: Oito pacientes (média de 29 anos) foram avaliados. O lado direito foi acometido em 70% dos casos e era o dominante em 80%. Todos os pacientes relataram um início súbito de dor no ombro, com duração de um a cinco dias em seis casos e de até 15 dias em dois casos. Em três casos foi observada atrofia severa do músculo deltoide. Hipotrofia dos músculos supraespinhal e infraespinhal foi observada em três casos. Escápula alada foi observada em dois casos restantes. A eletromiografia demonstrou envolvimento do nervo torácico longo nesses dois últimos casos e confirmou o envolvimento dos nervos axilar e supraescapular nos seis casos restantes. A pontuação média na escala de Constant e Murley foi de 96 no fim do tratamento conservador com medicamentos anti-inflamatórios não esteroides e fisioterapia. Seis dos oito pacientes apresentaram boa recuperação da força muscular.CONCLUSÃO: Na maioria dos casos a recuperação funcional foi boa, embora a força muscular não tenha sido completamente restaurada em alguns deles.

OBJECTIVE: To describe the clinical, electrophysiological and imaging findings from Parsonage-Turner syndrome and evaluate the results from conservative treatment.METHODS: Eight cases were studied between February 2010 and February 2012, with a minimum follow-up of one year (mean of 14 months). All the patients answered a clinical questionnaire and underwent functional evaluation using the Constant and Murley score. After clinical suspicion was raised, an electromyography examination was performed to confirm the diagnosis.RESULTS: Eight patients (mean age of 29 years) were evaluated. The right side was affected in 70% of the cases, and the dominant side in 80% of the cases. All the patients reported that their shoulder pain had started suddenly, lasting from one to five days in six cases and up to 15 days in two cases. In three cases, severe atrophy of the deltoid muscle was observed. Hypotrophy of the supraspinatus and infraspinatus muscles was observed in three cases. A winged scapula was observed in the two remaining cases. Electromyography demonstrated involvement of the long thoracic nerve in these last two cases and confirmed the involvement of the axillary and suprascapular nerves in the remaining six cases. The mean score on the Constant and Murley scale was 96 at the end of the conservative treatment with non-steroidal anti-inflammatory drugs and physiotherapy. Six of the eight patients presented good recovery of muscle strength.CONCLUSIONS: In the majority of the cases, the functional recovery was good, although muscle strength was not completely restored in some of them.

OBJECTIVE: To evaluate the function of the subscapularis muscle by means of isometric strength, clinical examination and analysis of fatty infiltration in patients with recurrent anterior dislocation of the shoulder undergoing Latarjet-Patte surgery. METHODS: 38 patients operated from March 2011 to March 2012, with minimum follow-up of two years were evaluated, being 26 males and 12 females, with a mean age of 28.7 years old. Isometric strength was measured using a portable dynamometer and measuring the distance from the back of the hand during the lift-off test. We used the Rowe and Walch-Duplay scores for clinical evaluation. The degree of fatty infiltration of the subscapularis belly was assessed by computed tomography. RESULTS: The mean scores in the Walch-Duplay and Rowe were 84.7 and 89.4, respectively. The mean distance to the back of the hand was 7.34 cm on the operated side and 8.72 cm on the opposite side (p <0.0001). The mean strength measured in the lift-off test was 0.38 kg lower than on the contralateral side (p = 0.001). There was no fatty infiltration of the subscapularis in 16 patients (42.1%). Sixteen patients (42.1%) were classified as Goutallier grade 1 and six (15.8%) as grade 2. We found that the measured isometric strength decreases with increasing the degree of fatty infiltration (p <0.0001). CONCLUSIONS: The decrease in subscapularis strength, albeit of low magnitude (0.38 kg), was directly related to the degree of fatty infiltration and worse clinical outcomes. Level of Evidence III, Therapeutic Study - Investigating the Results of Treatment.

PURPOSE:To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS:Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS: The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS:The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.

OBJETIVO: Mensurar as áreas cicatrizadas dos defeitos osteocondrais produzidos em côndilos femorais de coelhos preenchidos com gel de biopolímero da cana-de-açúcar e comparar com o grupo controle nos períodos de 90, 120 e 180 dias. MÉTODOS: Foram estudados, 16 coelhos da raça Nova Zelândia com seis a sete meses de idade, entre 2,0 e 2,5 kg de peso. Foram feitos, com trefina, defeitos de 3,2 x 4 mm nos côndilos femorais dos joelhos direito e esquerdo. Como grupo de estudo foram utilizados os defeitos dos côndilos medial e lateral dos joelhos direito que foram preenchidos com gel de biopolímero da cana-de-açucar. Como grupo controle foram utilizados os defeitos dos côndilos medial e lateral dos joelhos esquerdos que foram deixados abertos para cicatrização natural. Os defeitos foram analisados nos períodos de 90, 120 e 180 dias após a cirurgia. Após a eutanásia, os joelhos foram retirados e fixados em solução de Bouin para posterior documentação fotográfica com maquina digital Nikon Coopix® 5400. As áreas cicatrizadas foram mensuradas nos grupos estudo e controle, através das imagens obtidas com o programa Image-J®. A análise estatística foi feita aplicando-se o teste não paramétrico Mann-Whitney. RESULTADOS: Não houve diferenças significantes entre as médias das áreas cicatrizadas nos grupos estudo e controle nos períodos de 90, 120 e 180 dias após a cirurgia. CONCLUSÃO: A dimensão das áreas cicatrizadas dos defeitos tratados com o gel do biopolímero da cana-de-açúcar, grupo de estudo foi semelhante as do grupo controle, cicatrizadas naturalmente.

PURPOSE: To measure the healed areas of osteochondral defects produced in femoral condyles of rabbits filled with biopolymer sugar cane gel and to compare these with those of the control group at 90, 120 and 180 days. METHODS: A study was made of 16 New Zealand rabbits, 6 and 7 months old, weighing between 2 and 2.5 kg. Defects of 3.2 x 4 mm were made, with trephine, in the femoral condyles of the right and left knees. As to the study group defects of the medial and lateral condyles of the right knee were used which were filled with Biopolymer Sugar Cane Gel; as to the Control Group defects of the medial and lateral condyles of the left t knees were used which were left open for natural healing. The defects were analyzed at 90, 120 and 180 days after surgery. After euthanasia, the knees were removed and fixed in Bouin's solution for later digital photographic documentation with a digital camera. The areas healed were measured in both the study and control groups using the images obtained from an Image-J® program. Statistical analysis was conducted using the non-parametric Mann-Whitney test. RESULTS: There were no significant differences between the means of the healed areas in the study and control groups at 90, 120 and 180 days after surgery. CONCLUSION: The dimension of the healed areas of the defects treated with the biopolymer sugar-cane gel in the study group was similar to those of the control group, which healed naturally.

OBJETIVO: Estudar a superfície, coloração, continuidade, consistência e cicatrização dos defeitos osteocondrais produzidos em côndilos femorais de coelhos preenchidos com o gel de biopolímero da cana-de-açúcar (GBPCA) nos períodos de 90, 120 e 180 dias e comparar com o grupo Controle. MÉTODO: Foram estudados 16 coelhos, adultos entre seis e sete meses, da raça Nova Zelândia, brancos,, com peso variando entre 2 e 2,5kg e sem alterações no aparelho locomotor. Em todos os animais foi feito um defeito com trefina com 3,2mm de diâmetro por 4mm de profundidade nos côndilos femorais dos joelhos direito e esquerdo. Os animais foram divididos em dois grupos: Estudo - joelho direito, côndilos medial e lateral, preenchimento com GBPCA; Controle - joelho esquerdo, côndilos medial e lateral, submetidos à cicatrização natural e analisados nos períodos de 90, 120 e 180 dias após a cirurgia. Após a eutanásia, ressecaram-se as peças anatômicas, que foram imersas em solução de Bouin, para posterior fotografia com câmara Nikon Coolpix 5400® acoplada a lupa estereoscópica Nikon SM2800® para análise da superfície, coloração, consistência, continuidade e cicatrização. RESULTADOS: Foram avaliados pelo teste do Qui-quadrado. Não houve diferenças significantes na avaliação macroscópica da cicatrização entre os grupos Estudo e Controle. CONCLUSÃO: No que se refere à superfície, coloração, consistência, continuidade e cicatrização dos defeitos, a macroscopia do tecido reparado com GBPCA se mostrou semelhante à do grupo Controle.

OBJECTIVE: To study the surface, coloring, consistency, continuity and healing of osteochondral defects produced in the femoral condyles of rabbits and filled with sugar cane biopolymer gel (SCBG), after 90, 120 and 180 days, and in comparison with a control group. METHOD: Sixteen adult New Zealand white rabbits aged 6 to 7 months, weighing between 2 and 2.5 kg and without locomotor system abnormalities were studied. In all the animals, a defect was made in the femoral condyles of the right and left knees, measuring 3.2 mm in diameter and 4 mm in depth, using a trephine. The animals were divided into two groups: study group formed by the right knees, in which the medial and lateral condyles received implants of SCBG; and control group formed by the left knees, in which the medial and lateral condyles were allowed to heal naturally. The knees were assessed 90, 120 and 180 days after the operation. After the animals had been sacrificed, the anatomical specimens were resected and placed in Bouin's solution. They were then photographed with a Nikon Coolpix 5400® coupled to a Nikon SM2800® stereoscopic loupe, to analyze the surface, coloring, consistency, continuity and healing. RESULTS: The results were evaluated using the chi-square test. There were no significant differences in the macroscopic assessments of healing between the study and control groups. CONCLUSION: With regard to the surface, coloring, consistency, continuity and healing of the defects, the macroscopic appearance of the tissue repaired with SCBG was similar to that of the control group.