Abstract Objective: Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in athletes and is often associated with damage to anterolateral structures. This combination of injuries presents itself clinically as a high-grade pivot shift test. The hypothesis of this study is that patients with ACL deficiency and high-grade pivot shift test should have an increased internal knee rotation. Methods: Twenty-two patients were tested. After effective spinal anesthesia, two tests were performed with the patient in supine position. First, the bilateral pivot shift test was performed manually, and its grade was recorded. Then, with the knee flexed to 90 degrees, the examiner drew the projection of the foot in a neutral position and in maximum internal rotation, and the angle of internal rotation was measured from the axes built between the central point of the heel and the hallux. Results: In the ACL-deficient knee, it was observed that there is a statistically significant average internal rotation (IR) delta of 10.5 degrees between the groups when not adjusted for age, and 10.6 degrees when adjusted for age. Conclusions: Knees with ACL deficiency and with pivot shift test grade I do not show increased internal rotation in relation to knees with intact ACL. Knees with ACL deficiency and with pivot shift test grades II and III show increased internal rotation in comparison to healthy knees. Objective (ACL structures highgrade high Methods Twentytwo Twenty tested anesthesia First manually recorded Then 9 hallux Results ACLdeficient deficient IR (IR 105 10 5 10. age 106 6 Conclusions 1

Resumo Objetivo: A ruptura do ligamento cruzado anterior (LCA) é uma das lesões mais comuns em atletas e está frequentemente associada a danos nas estruturas anterolaterais. Esta combinação de lesões apresenta-se clinicamente como um teste de pivot shift de alto grau. A hipótese deste estudo é que pacientes com deficiência de LCA e teste de pivot shift de alto grau tenham aumento da rotação interna (RI) do joelho. Métodos: Vinte e dois pacientes foram testados. Após raquianestesia efetiva, foram realizados dois testes com o paciente em posição supina. Primeiro, o teste de pivot shift bilateral foi realizado manualmente e seu grau foi registrado. Em seguida, com o joelho flexionado a 90 graus, o examinador traçou a projeção do pé em posição neutra e em RI máxima e mediu o ângulo de RI a partir dos eixos construídos entre o ponto central do calcanhar e o hálux. Resultados: Joelhos com deficiência de LCA apresentam delta da RI média estatisticamente significativo de 10,5 graus entre os grupos sem ajuste de idade e de 10,6 graus com ajuste de idade. Conclusões: Joelhos com deficiência do LCA e teste de pivot shift de grau I não apresentam aumento da RI em relação aos joelhos com LCA íntegro. Joelhos com deficiência do LCA e teste de pivot shift de graus II e III apresentam RI em comparação aos joelhos saudáveis. Objetivo (LCA anterolaterais apresentase apresenta se (RI Métodos testados efetiva supina Primeiro registrado seguida 9 hálux Resultados 105 10 5 10, 106 6 Conclusões íntegro saudáveis 1

ABSTRACTFungal arthritis is a rare complication of arthroscopic surgeries, but its possibility should always be considered due its deleterious effects on any joint. Infection caused by the fungus Histoplasma capsulatum is the most common cause of respiratory tract infections by fungi, meanwhile histoplasmosis arthritis is more rare than all other fungal infections. However, their atypical forms of arthritis and the importance of early diagnosis and treatment cannot be over-emphasized. Herein we report a case of knee monoarthritis in an immunocompetent patient with histoplasmosis arthritis following an arthroscopic meniscetomy, diagnosed by synovial biopsy and culture performed during a second arthroscopic procedure. The joint was debrided in this second intervention and the patient received itraconazole initially and fluconazole latter on. The arthritis subsided after 10 months of treatment.

OBJECTIVE: To evaluate the association between the height of the medial longitudinal arch of the foot and non-contact injuries of the anterior cruciate ligament. METHODS: One hundred and five patients were included in this case-control study. The case group consisted of 52 patients with non-contact injury of the anterior cruciate ligament. Fifty-three individuals with no history of symptoms regarding to feet or knees comprised the control group. An anthropometric assessment of the bony arch index was performed, which consisted of measuring the ratio of the height between the navicular bone to the ground and the distance from the most posterior support point of the calcaneus to the first metatarsal-phalangeal joint. Gender, height, weight, body mass index and the frequency of sports practice were also evaluated. RESULTS: Subjects in the case group had significantly higher medial longitudinal arches than individuals in the control group. CONCLUSION: Individuals with rupture of the anterior cruciate ligament had higher arches than the corresponding controls, suggesting an association between a high medial longitudinal arch of the foot and injury of the anterior cruciate ligament. Level of Evidence III, Case-Control Study

O objetivo do presente trabalho é apresentar os resultados iniciais, obtidos com a osteotomia valgizante de adição de tíbia, fixada com placa calço descrita por Puddu. Foram operados 29 joelhos em 27 pacientes para correção de geno-varo, sendo que, em apenas um paciente o procedimento bilateral teve objetivo profilático. O seguimento foi de 3 a 28 meses com média de 14 meses. A osteotomia proximal de tíbia foi feita de forma oblíqua iniciando na inserção distal do ligamento colateral medial em direção ao tubérculo de Gerdy. A osteotomia foi aberta e fixada com uma placa calço de Puddu. O espaço aberto da osteotomia foi preenchido por enxerto autólogo de ilíaco. A carga total era dada com 45 dias de pós-operatório. Os resultados obtidos mostraram que entre 4 a 6 meses os pacientes tiveram uma significativa melhora na sintomatologia indutora do procedimento cirúrgico. A avaliação final mostrou 27 resultados satisfatórios e apenas 2 regulares. Como conclusão essa técnica tornou a osteotomia de tíbia um procedimento reprodutível com resultados previsíveis com excelente manutenção no pós-operatorio da correção obtida no trans-operatório.

The objective of this paper is to present the initial results obtained with the valgus tibial osteotomy, fixed with the wedge plate described by Puddu. This surgery was performed in 29 knees, in 27 patients, for correction of genu-varum, and as a profilatic measure in only one patient. The follow up time was from 3 to 28 months with average of 14 months. The proximal tibial osteotomy was done in an oblique way with start in the distal insertion of the colateral medial ligament and directed to the Gerby tubercle. The osteotomy was opened and fixed with a wedge plate of Puddu. The space opened by the osteotomy was filled with autologous iliac graft. Total weightbearing was allowed 45 days after surgery. The results show that in 4 to 6 months patients had a significant improvement of symptoms which induced to the surgical procedure. The final evaluation shows 27 satisfactory results and only 2 regular. Concluding, this technique made the tibial osteotomy a reproducible procedure with predictable results and excellent mantainance in the post-surgery of the correction obtained during surgery.