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Arthrofibrosis is a challenging complication associated with knee injuries in both children and adults. While much is known about managing arthrofibrosis in adults, it is necessary to understand its unique aspects and management strategies in the pediatric population. This paper provides an overview of arthrofibrosis in pediatric orthopedic surgery, focusing on its causes, implications, classifications, and management. This paper is a comprehensive review of the literature and existing research on arthrofibrosis in pediatric patients. Arthrofibrosis is characterized by excessive collagen production and adhesions, leading to restricted joint motion and pain. It is associated with an immune response and fibrosis within and around the joint. Arthrofibrosis can result from various knee injuries in pediatric patients, including tibial spine fractures, ACL and PCL injuries, and extra-articular procedures. Technical factors at the time of surgery play a role in the development of motion loss and should be addressed to minimize complications. Preventing arthrofibrosis through early physical therapy is recommended. Non-operative management, including dynamic splinting and serial casting, has shown some benefits. New pharmacologic approaches to lysis of adhesions have shown promise. Surgical interventions, consisting of arthroscopic lysis of adhesions (LOA) and manipulation under anesthesia (MUA), can significantly improve motion and functional outcomes. Arthrofibrosis poses unique challenges in pediatric patients, demanding a nuanced approach that includes prevention, early intervention with non-operative means, and improvements in surgical techniques. Modern pharmacological interventions offer promise for the future. Customized interventions and research focused on pediatric patients are critical for optimal outcomes.

La artrofibrosis es una complicación difícil asociada con lesiones de rodilla tanto en niños como en adultos. Si bien se sabe mucho sobre el manejo de la artrofibrosis en adultos, es necesario comprender sus aspectos únicos y estrategias de manejo en la población pediátrica. Este documento proporciona una visión general de la artrofibrosis en la cirugía ortopédica pediátrica, centrándose en sus causas, implicaciones, clasificaciones y manejo. Este documento es una revisión completa de la literatura y la investigación existente sobre artrofibrosis en pacientes pediátricos. La artrofibrosis se caracteriza por una producción excesiva de colágeno y adherencias, lo que conduce a un movimiento articular restringido y dolor. Se asocia con una inmunorrespuesta y fibrosis dentro y alrededor de la articulación. La artrofibrosis puede ser el resultado de varias lesiones de rodilla en pacientes pediátricos, incluyendo fracturas de columna tibial, lesiones de LCA y LCP, y procedimientos extraarticulares. Los factores técnicos en el momento de la cirugía desempeñan un papel en el desarrollo de la pérdida de movimiento y deben abordarse para minimizar las complicaciones. Se recomienda prevenir la artrofibrosis a través de la fisioterapia temprana. La gestión no operativa, incluyendo el empalme dinámico y la fundición en serie, ha mostrado algunos beneficios. Los nuevos enfoques farmacológicos a la lisis de adherencias han demostrado ser prometedores. Las intervenciones quirúrgicas, consistentes en lisis artroscópica de adherencias (LOA) y manipulación bajo anestesia (MUA), pueden mejorar significativamente el movimiento y los resultados funcionales. La artrofibrosis plantea desafíos únicos en los pacientes pediátricos, exigiendo un enfoque matizado que incluye prevención, intervención temprana con medios no operatorios y mejoras en las técnicas quirúrgicas. Las intervenciones farmacológicas modernas ofrecen una promesa para el futuro. Las intervenciones e investigaciones personalizadas centradas en pacientes pediátricos son fundamentales para obtener resultados óptimos.

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The aim of this scoping review was to assess the extent of the literature on the use of LED therapy to treat synovial joint disorders. The JBI methodology for scoping reviews was followed. The databases used were PUBMED, EMBASE, Scopus, Web of Science, LILACS, PEDro, Cochrane Database, Google Scholar and ProQuest. To be included, studies should have used LED as therapy, and include at least one measure related to the structures of any synovial joint. The search strategy included all keywords and indexed terms identified in the articles. Studies in any language and in any year, whether published or not, were included. The analysis of the studies was carried out by two independent reviewers. Data were extracted from articles using a data extraction tool developed by the reviewers. After carrying out the definitive search and selection, 47 publications were included: 15 clinical trials, 8 clinical protocols, 12 animal studies, 4 in vitro studies and 8 reviews on the topic. Studies have shown great variability from the device and number of diodes used, to the parameters and dosimetry chosen. Some positive effects were observed: on cell proliferation (in vitro); on anti-inflammatory biomarkers (murine models) and on pain scale (clinical trials - TMD). Although, the cause of non-significant results in clinical trials was rarely discussed: depth of penetration, dosimetry, follow-up time? Thus, future studies should focus on answering more elementary aspects about the LED effect when used alone in different synovial joints.

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Abstract Klippel-Trenaunay syndrome (KTS) is a rare vascular malformation characterized by capillary malformation, venous malformations, and soft tissue or bone hypertrophy that affect the extremities in most cases. Knee or hip arthropathy are common associated conditions and cause serious disability. We present the case of a patient with a diagnosis of KTS and severe knee arthropathy. A 34-year-old man with KTS was referred to our hospital with severe knee arthropathy, with the joint fixed in a 90° position. CT Angiography and MRI of the left leg showed important varicose development of the superficial venous system with intraarticular vessels. After discussion of the case by a multidisciplinary committee, the patient was enrolled on a physiotherapy program and had achieved significant improvements in movement and quality of life at 12-month follow-up. Treatment of KTS is primarily conservative and a multidisciplinary approach is necessary.

Resumo A síndrome de Klippel-Trenaunay (SKT) é uma malformação vascular rara caracterizada por malformação capilar, malformações venosas e hipertrofia de tecidos moles ou ósseos que afetam as extremidades na maioria dos casos. A artropatia do joelho ou do quadril é uma condição comumente associada e causa sérias deficiências. Apresentamos o caso de um paciente com diagnóstico de SKT e artropatia grave do joelho. Um homem de 34 anos com SKT foi encaminhado ao nosso hospital com artropatia grave do joelho com articulação fixa na posição de 90 °. A angiotomografia e a ressonância magnética da perna esquerda mostraram importante desenvolvimento varicoso do sistema venoso superficial com vasos intra-articulares. Após o caso ser discutido em um comitê multidisciplinar, o paciente foi incluído em um programa de fisioterapia, obtendo uma melhora significativa nos movimentos e na qualidade de vida após 12 meses de acompanhamento. O tratamento da SKT é principalmente conservador e exige uma abordagem multidisciplinar.

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Se realizó una intervención terapéutica en 118 pacientes con artrosis cervical, atendidos en el Servicio de Rehabilitación Integral del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba, desde julio de 2013 hasta diciembre de 2014, para evaluar la efectividad de la reflexología podal como modalidad de tratamiento. La muestra fue dividida en 2 grupos (de estudio y control), de 54 integrantes cada uno, pareados por edad y sexo. En ambos grupos, el mayor número de afectados superó los 50 años de edad; asimismo, poco más de dos tercios de los individuos seleccionados mejoraron a los 7 días de evolución y en tan solo 3 sesiones de tratamiento, hasta la resolución definitiva a los 21 días (9 sesiones). Se registró una reacción adversa y se concluyó que esta terapia garantiza una mejoría significativa de los síntomas, de ahí su elevada efectividad, sin consumo excesivo de tiempo

A therapeutic intervention in 118 patients with cervical osteoarthritis was carried out. They were assisted in the Comprehensive Rehabilitation Service of Dr Joaquín Castillo Duany Teaching Clinical Surgical Hospital in Santiago de Cuba, from July, 2013 to December, 2014, to evaluate the effectiveness of podal reflexology as a treatment modality. The sample was divided in 2 groups (study group and control group), of 54 members each, paired by age and sex. In both groups, the highest number of affected patients were over 50 years; also, a little more than two thirds of the selected individuals improved at 7 days of the clinical course and with only 3 treatment sessions, until the definitive resolution at 21 days (9 sessions). An adverse effect was registered and it was concluded that this therapy guarantees a significant improvement of symptoms, so its high effectiveness, without excessive consumption of time

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A Alcaptonúria é uma doença autossômica recessiva rara caracterizada pelo acúmulo de ácido homogentísico. Denomina-se também ocronose e manifesta-se por pigmentação azulada de tecidos orgânicos e urina enegrecida, além de artropatia. A seguir, será relatado o caso de irmãos portadores de artropatia ocronótica e a conduta ortopédica (AU)

Alkaptonuria is a rare autosomal recessive disease characterized by the accumulation of homogentisic acid. It is also called ochronosis and is manifested by bluish pigmentation of organic tissues and blackened urine, besides arthropathy. Here the authors report the case of siblings with ochronotic arthropathy and the orthopedic management (AU)

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BACKGROUND: This systematic review aimed to present and critically appraise the available information on the efficacy of platelet rich plasma (PRP) in equine and human orthopedic therapeutics and to verify the influence of study design and methodology on the assumption of PRP's efficacy. We searched Medline, PubMed, Embase, Bireme and Google Scholar without restrictions until July 2013. Randomized trials, human cohort clinical studies or case series with a control group on the use of PRP in tendons, ligaments or articular lesions were included. Equine clinical studies on the same topics were included independently of their design. Experimental studies relevant to the clarification of PRP's effects and mechanisms of action in tissues of interest, conducted in any animal species, were selected. RESULTS: This review included 123 studies. PRP's beneficial effects were observed in 46.7% of the clinical studies, while the absence of positive effects was observed in 43.3%. Among experimental studies, 73% yielded positive results, and 7.9% yielded negative results. The most frequent flaws in the clinical trials' designs were the lack of a true placebo group, poor product characterization, insufficient blinding, small sampling, short follow-up periods, and adoption of poor outcome measures. The methods employed for PRP preparation and administration and the selected outcome measures varied greatly. Poor study design was a common feature of equine clinical trials. From studies in which PRP had beneficial effects, 67.8% had an overall high risk of bias. From the studies in which PRP failed to exhibit beneficial effects, 67.8% had an overall low risk of bias. CONCLUSIONS: Most experimental studies revealed positive effects of PRP. Although the majority of equine clinical studies yielded positive results, the human clinical trials' results failed to corroborate these findings. In both species, beneficial results were more frequently observed in studies with a high risk of bias. The use of PRP in musculoskeletal lesions, although safe and promising, has still not shown strong evidence in clinical scenarios.

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No presente trabalho é descrito o uso do plasma rico em plaquetas (PRP) no tratamento de um caso de osteoartrose naturalmente adquirida em um cão. O PRP foi obtido a partir de sangue venoso autólogo coletado em citrato de sódio. A separação do precipitado celular do sobrenadante foi realizada de forma estéril. Após adição de cloreto de cálcio e liberação dos fatores de crescimento, o PRP foi infiltrado no joelho do animal em estudo. Após o tratamento, os parâmetros de apoio, crepitação e dor articular apresentaram melhora, não havendo intolerância do animal à infiltração. Preliminarmente, pode-se dizer que é esta é uma técnica minimamente invasiva e de alta aplicabilidade. O emprego do PRP para infiltração mostrou ser simples, rápido, barato e seguro para o tratamento da osteoartrose no animal em questão. Estudos com maior número de casos em cães são necessários, a fim de validar este procedimento como prática terapêutica na rotina clínica...

The use of platelet-rich plasma (PRP) in the treatment of a natural case of osteoarthrosis in a dog is reported in the present work. The PRP was obtained through autologous venous blood collected in sodium citrate. The cellular precipitate was separated from the supernatant in a sterile condition. After the addition of calcium chloride and the release of growth factors, the PRP was infiltrated in the knee of the dog under study. After the treatment, weight-bearing, crackle and joint pain parameters presented improvement without intolerance to the infiltration by the animal. Preliminarily, it can be concluded that this is a minimally invasive method with high applicability, as well as being simple, quick, cheap and safe for the treatment of degenerative joint disease to the described animal. The study of a larger number of cases in dogs is necessary in order to validate the procedure for clinical routine...

En este estudio se ha descrito el uso del plasma rico en plaquetas (PRP) en el tratamiento de un caso de osteoartritis, adquirido naturalmente por un perro. El PRP ha sido obtenido a partir de la sangre venosa autóloga recogido en citrato de sodio. La separación del precipitado celular del sobrenadante se ha realizado de forma estéril. Después de la adición de cloruro de calcio y liberación de los factores de crecimiento, el PRP ha sido infiltrado en la rodilla del animal en estudio. Tras el tratamiento, los parámetros de apoyo, crepitación y dolor articular presentaron mejora, no ocurriendo intolerancia del animal a la infiltración. Preliminarmente, se puede decir que esta es una técnica poco invasiva y de alta aplicabilidad. El empleo del PRP para infiltración ha mostrado ser sencillo, rápido, barato y seguro para el tratamiento de osteoartritis en el animal estudiado. Estudios con mayor número de casos en perros son necesarios, para que se pueda validar este procedimiento como práctica terapéutica en la rutina clínica...

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No presente trabalho é descrito o uso do plasma rico em plaquetas (PRP) no tratamento de um caso de osteoartrose naturalmente adquirida em um cão. O PRP foi obtido a partir de sangue venoso autólogo coletado em citrato de sódio. A separação do precipitado celular do sobrenadante foi realizada de forma estéril. Após adição de cloreto de cálcio e liberação dos fatores de crescimento, o PRP foi infiltrado no joelho do animal em estudo. Após o tratamento, os parâmetros de apoio, crepitação e dor articular apresentaram melhora, não havendo intolerância do animal à infiltração. Preliminarmente, pode-se dizer que é esta é uma técnica minimamente invasiva e de alta aplicabilidade. O emprego do PRP para infiltração mostrou ser simples, rápido, barato e seguro para o tratamento da osteoartrose no animal em questão. Estudos com maior número de casos em cães são necessários, a fim de validar este procedimento como prática terapêutica na rotina clínica.(AU)

The use of platelet-rich plasma (PRP) in the treatment of a natural case of osteoarthrosis in a dog is reported in the present work. The PRP was obtained through autologous venous blood collected in sodium citrate. The cellular precipitate was separated from the supernatant in a sterile condition. After the addition of calcium chloride and the release of growth factors, the PRP was infiltrated in the knee of the dog under study. After the treatment, weight-bearing, crackle and joint pain parameters presented improvement without intolerance to the infiltration by the animal. Preliminarily, it can be concluded that this is a minimally invasive method with high applicability, as well as being simple, quick, cheap and safe for the treatment of degenerative joint disease to the described animal. The study of a larger number of cases in dogs is necessary in order to validate the procedure for clinical routine.(AU)

En este estudio se ha descrito el uso del plasma rico en plaquetas (PRP) en el tratamiento de un caso de osteoartritis, adquirido naturalmente por un perro. El PRP ha sido obtenido a partir de la sangre venosa autóloga recogido en citrato de sodio. La separación del precipitado celular del sobrenadante se ha realizado de forma estéril. Después de la adición de cloruro de calcio y liberación de los factores de crecimiento, el PRP ha sido infiltrado en la rodilla del animal en estudio. Tras el tratamiento, los parámetros de apoyo, crepitación y dolor articular presentaron mejora, no ocurriendo intolerancia del animal a la infiltración. Preliminarmente, se puede decir que esta es una técnica poco invasiva y de alta aplicabilidad. El empleo del PRP para infiltración ha mostrado ser sencillo, rápido, barato y seguro para el tratamiento de osteoartritis en el animal estudiado. Estudios con mayor número de casos en perros son necesarios, para que se pueda validar este procedimiento como práctica terapéutica en la rutina clínica.(AU)

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