Revista de Medicina Desportiva (English) May 2018 - Page 27

meniscus , the tibiofemoral contact area is 3 cm 2 , so the pressure is 70 / 80 kg / cm 2 , making it 3-4 times greater after meniscectomy by the fact that the surface contact area is reduced to 1 / 3 . Thus , in 1948 , T . J . Fairbank describes for the first time the serious degenerative changes associated with meniscectomy , praising since then the relevance of this structure for joint functionality . The increase in sport activity by children and adolescents has changed the paradigm of sports injuries in this age group , including complex meniscus and ACL injuries , with future catastrophic consequences on those cases of inadequate diagnosis and treatment . The options about the treatment will always be : conservative , meniscectomy or meniscus repair , depending on multiple factors , being the location of the injury the most fundamental . The injuries in the red zone of the meniscus ( vascularized ) or in the redwhite zone are always worth of reparation . On children , some authors ( Accadbled F , Cassard X et al , 2007 ) also suggest meniscus repair in the white-white zone . The notion that former injuries predisposes the
athlete to arthrosis in the course of his / her life makes sense on a biomechanical perspective , particularly if we accept that the current surgical techniques , despite the constant research of improvement , have not yet achieved perfection with regard to instability , alignment , regeneration and substitution , but also in a biochemical perspective , emphasizing the role of articulate aggression played by metalloproteinases and cytokines . The meniscus collagen implants , customized implants with different materials and matrices , combined with biological therapies , can be very important to minimize the absence of the meniscus , stalling or avoiding evolution to arthrosis .
Bibliography
1 . Fairbank , T . J . Knee joint changes after meniscectomy . J Bone Joint Surg Br . 1948 ; 30B : 664-670 .
2 . Accadbled F , Cassard X , Sales de Gauzy J , Cahuzac JP . Meniscal tears in children and adolescents : results of operative treatment . J Pediatr Orthop B . 2007 ; 16 ( 1 ): 56-60 .
Dr . Raul Maia e Silva . Medicina Física e Reabilitação ; Medicina Desportiva , Porto
The osteochondrosis . What can be done ?
About 15 % of all sports injuries in youth are disorders of ossification in epiphyses or apophisitis . 1 These disturbances of normal bone growth which primarily involve the physis and / or ossification centers are generically called osteochondrosis . In general , it is a heterogeneous a group of aseptic diseases , not related to one another , but they share some common characteristics : they involve the immature skeleton , involvement of epiphyses or apophisitis , fragmentation on X-ray , collapse , sclerosis , reossification . 2 The pathogenesis of the osteochondrosis is not completely clarified , but they behave like as necrosis of a previously normal epiphysis . It ’ s not exactly avascular necrosis because , despite the ischemia , there are still
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meniscus, the tibiofemoral contact area is 3 cm 2 , so the pressure is 70/80 kg/cm 2 , making it 3-4 times greater after meniscectomy by the fact that the surface contact area is reduced to 1/3. Thus, in 1948, T.J. Fairbank describes for the first time the serious degenerative changes associated with meniscectomy, praising since then the relevance of this structure for joint functionality. The increase in sport activity by chil- dren and adolescents has changed the paradigm of sports injuries in this age group, including complex meniscus and ACL injuries, with future catastrophic consequences on those cases of inadequate diagnosis and treatment. The options about the treatment will always be: con- servative, meniscectomy or menis- cus repair, depending on multiple factors, being the location of the injury the most fundamental. The injuries in the red zone of the menis- cus (vascularized) or in the red- white zone are always worth of repa- ration. On children, some authors (Accadbled F, Cassard X et al, 2007) also suggest meniscus repair in the white-white zone. The notion that former injuries predisposes the athlete to arthrosis in the course of his/her life makes sense on a biome- chanical perspective, particularly if we accept that the current surgical techniques, despite the constant research of improvement, have not yet achieved perfection with regard to instability, alignment, regenera- tion and substitution, but also in a biochemical perspective, emphasiz- ing the role of articulate aggression played by metalloproteinases and cytokines. The meniscus collagen implants, customized implants with different materials and matrices, combined with biological therapies, can be very important to minimize the absence of the meniscus, stalling or avoiding evolution to arthrosis. Bibliography 1. Fairbank, T. J. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948; 30B:664-670. 2. Accadbled F, Cassard X, Sales de Gauzy J, Cahuzac JP. Meniscal tears in children and adolescents: results of operative treatment. J Pediatr Orthop B. 2007; 16(1):56-60. Dr. Raul Maia e Silva. Medicina Física e Reabilitação; Medicina Desportiva, Porto The osteochondrosis. What can be done? About 15% of all sports injurie 0WF&RF6&FW'2b76f6ЧFW6W2"6F2FW6RF7GW&&6W2b&&Pw&wFv6&&ǒffRFP62B"76f6F6VFW'0&RvVW&6ǒ6VB7FV6ЦG&62vVW&B2WFW&vRЦVW2w&Wb6WF2F6V6W2B&VFVBFRFW"'WBFW6&R6R66&7FW&7F73FWffRFRGW&R6VЦWFffVVBbW6W2 6F2g&vVFF&66R66W&62&V76f6F FRFvVW62bFR7FV6ЦG&622B6WFVǒ6&fVB'WBFW&VfRƖR2V7&62b&WfW6ǒ&W62N( 2@W7Fǒf67V"V7&62&V6W6RFW7FRFR66V֖FW&R&R7FDT4tDPDD8|84DdDU4tĔtT$RD45$UDDD8|84L94Ԕ4DU4tU$t94Ԕ44TԔF'6FV6*wwrFW&'F