Pedro Augusto Pontin

INTRODUCTION: Managing partial Achilles’ tendon tears in elite soccer players during a competitive season requires a balance between structural healing and performance maintenance. Transcranial direct current stimulation (tDCS) has emerged as a potential neuromodulatory adjunct to manage pain and optimize motor efficiency through top-down regulation. OBJECTIVES: This case report evaluates the effects of a 17-session dual-site tDCS protocol on pain modulation, competitive performance, and structural tendon repair in a professional top-level soccer player. MATERIALS AND METHODS: The intervention consisted of 17 tDCS sessions (2mA) using a dual-target montage: anodal stimulation over the left primary motor cortex (M1) and left dorsolateral prefrontal cortex (DLPFC), with cathodal electrodes over the supraorbital and contralateral frontal midline areas. Assessments included the Visual Analog Scale (VAS) for pain and the Rating of Perceived Exertion (RPE) for recovery training and competitive matches. Structural evolution was monitored via serial ultrasonography (US) and confirmed by multi-sequence magnetic resonance imaging (MRI). RESULTS: The athlete exhibited a positive pain-exertion dissociation: a consistent progressive reduction in VAS pain scores occurred simultaneously with an increasing trend in match-play RPE, indicating a higher capacity for physical exertion despite the injury. Training RPE remained stable and low (1–3), reflecting controlled recovery workloads. Serial axial US initially identified a partial tear in the lateral and deep fibers with laminar fluid. A 30-day follow-up US and MRI (T1, T2-weighted with fat saturation) confirmed successful tissue repair, with intermediate-signal intensity tissue filling the defect, indicating organized scar formation without transfixing lesions. Serial axial ultrasonography initially identified a partial tear within the lateral and deep fibers of the tendon midbody, accompanied by localized laminar fluid. A 30-day follow-up, utilizing US and multi-sequence MRI (T1; T2-weighted with fat saturation), confirmed structural restoration. The previous defect was replaced by tissue of intermediate-signal intensity, consistent with organized fibroblastic repair and scar formation, in the absence of residual transfixing lesions. CONCLUSION: The dual-site tDCS intervention was associated with significant pain modulation and improved motor efficiency, allowing the athlete to increase competitive output during the structural healing phase. The correlation between reduced pain (VAS), increased match effort (RPE), and confirmed biological repair suggests that tDCS facilitated an optimal environment for recovery. This suggests that tDCS is a promising adjunct for maintaining elite performance during injury rehabilitation, though further controlled research is needed to elucidate the specific mechanisms of tDCS-mediated tissue repair.

Objective: This study aimed to evaluate the clinical and radiographic outcomes of conservative treatment in patients with isolated Weber B fractures of the lateral malleolus. Methods: Medical charts of 30 patients with isolated and stable Weber B fractures of the lateral malleolus, exhibiting less than 2mm of displacement, were retrospectively evaluated. All patients underwent early weightbearing and joint mobilization, with treatment involving the use of a cam-walker boot (CWB) for a period of 6 to 8 weeks. Clinically, qualitative variables such as the presence of residual pain, tibiotalar joint motion, and total return to physical activities were evaluated. Radiographic parameters included bone healing time, healing rate and fracture displacement. Results: Among the 30 patients, 6 (20%) experienced residual pain, while 25 (83%) successfully resumed their previous physical activities within an average period of 3.4 months. Limited joint mobility was observed in 6 (20%) patients. Radiographically, 22 (73.3%) had fracture deviation of 1 mm, 6 (20%) of 2 mm, and 2 (6.7%) showed no deviation. The average time for bone healing was 7 weeks. Three (10%) patients developed pseudarthrosis. Return to physical activities was correlated with time and rate for fracture healing. Residual pain was associated with pseudarthrosis, dyslipidemia, and hypothyroidism. Bone healing did not correlate with age, displacement or comorbidities. Conclusion: The present study demonstrated that the proposed conservative treatment yielded satisfactory clinical and radiographic results, with a high rate of bone healing and successful return to previous physical activities. Level of Evidence IV; Retrospective case series.

Case: A 36-year-old male professional soccer player sustained an acute left hip injury during a tournament game while defending the goal. Magnetic resonance imaging demonstrated a complete avulsion of the iliopsoas tendon from the left trochanter. The patient was treated nonoperatively, and after 10 weeks, he was able to return to full activity. After 1 year of follow-up, the patient was completely asymptomatic, and was still playing professional soccer without flexion strength deficit. Conclusion: In this professional soccer athlete, nonoperative treatment of complete psoas avulsion resulted in a good functional outcome and successful return to play.

Posterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive effect on the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-α) gene with PPT dysfunction. A total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER-α gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism. The analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER-α gene showed significant differences in the frequency of genotypes between control and test groups (p = 0.01; OR 95% 1.14 (0.55–2.33). The XbaI SNP in the ERα gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy.

OBJETIVO: Este artigo faz a avaliação retrospectiva clínica e radiológica das fraturas do odontóide de 20 pacientes atendidos no IOT-HCFMUSP, durante o período de 2004-2010. MÉTODOS: Foi realizado a estratificação destas fraturas segundo sua classificação (AO/Anderson e D'Alonzo), perfil epidemiológico, tipo de tratamento, tempo de consolidação e complicações. RESULTADOS: Observou-se maior número de casos da fratura do odontóide em pacientes do sexo masculino (4:1), com idade entre 3ª e 4ª década de vida (60%), vítimas de quedas de altura (60%) e acidentes automobilísticos (25%) como principais mecanismos de trauma, e 15% dos casos apresentaram-se com déficit neurológico. A fraturas do odontóide de maior prevalência foram as do tipo II (55%), seguidas pelas fraturas do tipo III (40%). Os tratamentos mais empregados nas fraturas do tipo II e III foram, respectivamente, o cirúrgico (73%) e conservador (87,5%). A consolidação ocorreu em até 16 semanas para 87,5% dos casos de tratamento cirúrgico e para 54,5% dos tratados conservadoramente. Não houve casos de pseudoartrose. CONCLUSÃO: O tratamento cirúrgico das fraturas do odontóide do tipo II apresentou resultados satisfatórios em relação ao tempo consolidação e baixa incidência de complicações, bem como o tratamento conservador destinado às fraturas do tipo III.Nivel de Evidência IV, série de casos.