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Adult acquired flatfoot deformity (AAFD) is a pathology with a wide range of treatment options. Physicians decide the best treatment based on their experience, so the process is entirely subjective. A better understanding of soft tissue stress and its contribution in supporting the plantar arch could help to guide the clinical decision. Traditional experimental trials cannot consistently evaluate the contribution of each tissue. Therefore, in this research a 3-Dimensional FE foot model was reconstructed from a normal patient in order to measure the stress of the passive stabilizers of the arch, and its variation in different scenarios related with intermediate stages of AAFD development. All bones, the plantar fascia (PF), cartilages, plantar ligaments and the spring ligament (SL) were included, respecting their anatomical distribution and biomechanical characteristics. An AAFD evaluation scenario was simulated. The relative contribution of each tissue was obtained comparing each result with a normal case. The results show that PF is the main tissue that prevents the arch elongation, while SL mainly reduces the foot pronation. Long and short plantar ligaments play a secondary role in this process. The stress increment on both PF and SL when one of two fails suggests that these tissues complement each other. These findings support the theory that regards the tibialis posterior tendon as a secondary actor in the arch maintenance, compared with the PF and the SL, because this tendon is overstretched by the hindfoot pronation around the talonavicular joint. This approach could help to improve the understanding of AAFD.

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Las lesiones del complejo posteroexterno (CPE) comprenden una porción significativa de las lesiones ligamentarias de la rodilla. Se necesita un alto índice de sospecha durante la evaluación de la rodilla lesionada, un examen físico completo y una revisión exhaustiva de los estudios radiográficos para poder identificar estas lesiones. En este sentido, las radiografías con estrés pueden ayudar a determinar objetivamente el alcance de estas lesiones. Las opciones de tratamiento quirúrgico o no, se encuentran en función de la gravedad de la lesión. Las lesiones completas del CPE rara vez se curan con tratamiento no quirúrgico, por lo que son tratados con mayor frecuencia quirúrgicamente. El propósito de este artículo fue revisar la anatomía y biomecánica clínicamente relevantes, los algoritmos de diagnóstico, los protocolos de tratamiento y rehabilitación para las lesiones del CPE.

Injuries to the posterolateral corner (PLC) comprise a significant portion of knee ligament injuries. A high index of suspicion is necessary when evaluating the injured knee to detect these sometimes-occult injuries. Moreover, a thorough physical examination and a comprehensive review of radiographic studies are necessary to identify these injuries. In this sense, stress radiographs can help to objectively determine the extent of these lesions. Non-operative and operative treatment options have been reported depending on the extent of the injury. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. The purpose of this article was to review the anatomy and clinically relevant biomechanics, diagnosis algorithms, treatment and rehabilitation protocols for PLC injuries.

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Given the frequency and burden of ankle sprains, the pathologic features identified on magnetic resonance imaging (MRI) scans are widely known in the symptomatic population. Ankle MRI pathologic features in the asymptomatic population, however, are poorly understood. Such examinations are rarely undertaken unless an ankle has been injured or is painful. We report the systematic MRI findings from the reports of 108 consecutive asymptomatic lateral ankles (104 patients). Our purpose was to (1) report the prevalence of osteochondral lesions of the talus (OLTs) and pathologic features of the medial and lateral ligaments, peroneal tendons, and superior peroneal retinaculum (SPR); (2) correlate the presence of OLTs with the pathologic features of the medial and lateral ligaments, peroneal tendons, and SPR; and (3) correlate ligamentous discontinuity with the peroneal pathologic features, OLTs, and SPR pathologic features. A total of 16 OLTs (14.81%) were present (13 medial and 3 lateral). Of the 16 patients with OLTs, 8 (50.00%) had concomitant peroneal pathologic findings. Healthy medial and lateral ligaments were noted in 41 patients (37.96%), and ligamentous discontinuity was grade I in 25 (23.15%), II in 32 (29.63%), III in 5 (4.63%), and grade IV in 5 patients (4.63%). A weak positive correlation was found between attenuation or tears of the superficial deltoid and medial OLTs (phi coefficient = 0.23, p = .0191) and a moderate positive correlation between tears of the posterior talofibular ligament and lateral OLTs (phi coefficient = 0.30, p = .0017). Additionally, a moderate positive correlation between ligamentous discontinuity and tendinopathy of the peroneus brevis was noted [Spearman's coefficient(106) = 0.29, p = .0024]. These findings add to the evidence of concomitant pathologic features in the asymptomatic population. To definitively assess causation and evaluate the clinical evolution of radiologic findings, future, prospective, longitudinal cohort studies are necessary.

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El tratamiento de la Discopatía Degenerativa lumbar, mediante dispositivo suave de estabilización dinámica, con el uso de ligamento para reforzamiento interespinoso, altera favorablemente el movimiento y la transmisión de carga de un segmento vertebral, proporcionando estabilidad y previniendo la enfermedad del segmento adyacente. Por lo tanto se realiza un estudio prospectivo, longitudinal con 25 pacientes con edades comprendidas entre 15 y 58 años, con diagnóstico de Discopatia degenerativa lumbar; con estudios de imágenes previos con radiografias en proyección AP, lateral y laterales dinámicas además de Resonancia Magnética, con los cuales se confirmo el diagnóstico, al igual que control radiológico postoperatorio, a los que se les practico semihemilaminectomia mas discectomíamas foraminectomía mas ligamentoplastia interespinosa del segmento afectado y adyacentes. Se obtuvo como resultado mejoría clínica inmediata en la mayoría de los pacientes y con pronto reintegro a sus actividades habituales luego de la cirugía.

The treatment of lumbar degenerative discopaty, by means of a soft dynamic stabilization device, with the use of ligament for interspinous reinforcement, alter favorably the movement and load transmission of a vertebral segment, providing stability and preventing the disease of the adjacent segment. Therefore a prospectivelongitudinal study is carried out on 25 patients with ages ranging from 15 to 58 years, with a lumbar degenerative disease diagnosis; previous radiographicstudies in AP, lateral and dynamic-laterals projectionsand also Magnetic Resonance Imaging confirm the diagnosis, along with postoperative radiological controls. The patients received semi-hemilaminectomy plus discectomy plus foraminectomy plus interspinous ligamentoplasty of affected and adjacent segments. As result, inmediate clinical improvement in most patients was obtained and a soon return to their usual activities after the surgery.

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A desmopatia degenerativa (DD) possui caráter sistêmico e manifesta-se por acúmulos de proteoglicanos (PG) na matriz extracelular (MEC) de tecidos que contenham colágeno. Este estudo teve o objetivo de diagnosticar equinos suspeitos de serem acometidos por DD, em um plantel de animais de raça nacional, segundo o ângulo da articulação metatarsofalangiana (AMF) e a presença de acúmulos de PG em amostras de ligamento da nuca (LN). Analisaram-se 123 equinos clinicamente sadios e somente três (2,7 por cento) deles, segundo o ângulo AMF < 146(0), foram considerados suspeitos. Não houve diferença significativa entre os grupos. Quinze éguas foram submetidas ao exame do ângulo da AMF e à biópsia do LN, das quais sete (47,7 por cento) foram consideradas suspeitas, segundo ângulo da AMF, enquanto seis (40 por cento) apresentaram acúmulos de PG. Foram encontrados acúmulos de PG em três (20 por cento) éguas não suspeitas. Um animal suspeito não apresentou alterações histológicas compatíveis de DD.(AU)

The prevalence of degenerative desmopathy (DD) was studied in equines of national breeds, according to the metatarsophalangeal joint angle (MPA) and the presence of accumulation of proteoglycans (PG) in samples of nucal ligament (NL) from live animals, according to their age. One hundred twenty three clinically healthy horses were used. Only three (2.7 percent), that had their angle rate MPA<146º were considered suspect, with no significant difference between groups. Fifteen mares were subjected to examination of the angle of the MPA and biopsy of NL as well had reduction of the MPA angle, and six (40 percent) showed accumulation of PG. Accumulation of PG was found in three (20 percent) not suspected mares. A suspected animal showed no histological changes compatible to DD.(AU)

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A desmopatia degenerativa (DD) possui caráter sistêmico e manifesta-se por acúmulos de proteoglicanos (PG) na matriz extracelular (MEC) de tecidos que contenham colágeno. Este estudo teve o objetivo de diagnosticar equinos suspeitos de serem acometidos por DD, em um plantel de animais de raça nacional, segundo o ângulo da articulação metatarsofalangiana (AMF) e a presença de acúmulos de PG em amostras de ligamento da nuca (LN). Analisaram-se 123 equinos clinicamente sadios e somente três (2,7 por cento) deles, segundo o ângulo AMF < 146(0), foram considerados suspeitos. Não houve diferença significativa entre os grupos. Quinze éguas foram submetidas ao exame do ângulo da AMF e à biópsia do LN, das quais sete (47,7 por cento) foram consideradas suspeitas, segundo ângulo da AMF, enquanto seis (40 por cento) apresentaram acúmulos de PG. Foram encontrados acúmulos de PG em três (20 por cento) éguas não suspeitas. Um animal suspeito não apresentou alterações histológicas compatíveis de DD.

The prevalence of degenerative desmopathy (DD) was studied in equines of national breeds, according to the metatarsophalangeal joint angle (MPA) and the presence of accumulation of proteoglycans (PG) in samples of nucal ligament (NL) from live animals, according to their age. One hundred twenty three clinically healthy horses were used. Only three (2.7 percent), that had their angle rate MPA<146º were considered suspect, with no significant difference between groups. Fifteen mares were subjected to examination of the angle of the MPA and biopsy of NL as well had reduction of the MPA angle, and six (40 percent) showed accumulation of PG. Accumulation of PG was found in three (20 percent) not suspected mares. A suspected animal showed no histological changes compatible to DD.

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PURPOSE: The purpose of this study was to arthroscopically determine the incidence of the anterior meniscofemoral ligament of Humphry in anterior cruciate ligament (ACL)-deficient knees. METHODS: One hundred forty knees were prospectively evaluated during arthroscopic ACL reconstruction procedures. The mean patient age was 30 years (range, 16 to 45 years), and there were 93 male and 47 female patients. In 69 patients, the right knee was evaluated, and in 71, the left. Inclusion criteria were skeletally mature patients aged under 45 years with isolated ACL injuries. Exclusion criteria were degenerative articular changes, external meniscus injuries, insufficiencies of ligaments other than the ACL, and previous knee surgery. RESULTS: The anterior meniscofemoral ligament of Humphry was present in all of the knees evaluated. CONCLUSIONS: It has been proposed that traumatic and degenerative changes may explain the variation of the reported incidence of the meniscofemoral ligament. In our study in young patients with no degenerative changes, no meniscal injuries or surgery, and no ligament disruption except from the ACL, the anterior meniscofemoral ligament presented as a constant structure. CLINICAL RELEVANCE: Given the high incidence of the appearance of the anterior meniscofemoral ligament, this structure should be preserved during meniscus and ligament surgeries at least until its function and clinical relevance are determined.

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Artroscopia diagnóstica ou terapêutica foi realizada em 51 articulações fêmoro-tíbio-patelar (FTP) de cão. Os animais foram submetidos à anestesia geral e empregou-se solução Ringer lactado para distensão articular após a coleta do líquido sinovial. Endoscopicamente, a FTP foi dividida em cinco compartimentos: o recesso suprapatelar, articulação fêmoropatelar, compartimento medial, área intercondilar e compartimento lateral. Ruptura de ligamento cruzado cranial foi a mais freqüente patologia observada (46 casos) que em três casos estava associada a prolapso de menisco, em três casos observou-se sinovite e em dois osteocondrose dissecante do côndilo lateral. Dificuldades de introdução do artroscópio, de visibilização das estruturas e infiltração excessiva do tecido subcutâneo foram complicações observadas. Verificou-se, ainda, um caso de necrose tecidual grave. Nos casos crônicos, a observação das estruturas foi dificultada pela presença dos elementos celulares. A ampliação das imagens possibilitou o diagnóstico de lesões ainda em fase incipiente e daquelas não conclusivas ao exame radiográfico.(AU)

Diagnostic or therapeutic arthroscopy of stifle joint (SJ) was performed in 51 dogs. Animals were submitted to general anesthesia and ringer lactate solution was injected for articular distention after synovial fluid punction. SJ was divided in five main areas according to endoscopies: suprapatellar pouch, femuropatellar joint, medial compartment, intercondilar notch and lateral compartment. Cranial cruciate ligament rupture was most frequent (46 cases) detected pathology. In three cases it was related to medial meniscus prolapse. Synovitis was observed in three cases and dissecant osteocondrosis of the lateral femure condyle in two animals. Difficulties for arthroscope introduction, visualization of the structures and excessive infiltration of the subcutaneous tissue were complications observed. It was also noted a case of severe tissue necrosis. In chronic cases, the observation of the structures was affected by the presence of cellular elements. Images magnification allowed the diagnosis of the lesions that was not clear by either clinical or radiographic examinations.(AU)

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