Francisco Forriol

Background: This pilot study assessed whether a modified Pavlik harness (mPH) could safely and feasibly influence trochlear morphology in newborns with developmental trochlear dysplasia (DTD). Methods: Seven consecutive newborns (14 knees) with breech presentation and ultrasound-confirmed DTD (sulcus angle ≥150 degrees) were prospectively enrolled in this proof-of-concept study. Bilateral knee ultrasound measured sulcus angle before and after 8-week continuous mPH treatment. Pre- and post-treatment measurements were compared using paired t tests, with P P =0.001) when combining bilateral measurements. Six of 7 newborns with DTD (85.70%) showed improvements ≥4 degrees. All newborns demonstrated high compliance with mPH, with no complications or adverse events reported. Conclusion: This preliminary study clearly demonstrates that early mPH treatment can safely influence trochlear morphology in newborns with DTD. These encouraging anatomic changes establish a strong foundation; however, this proof-of-concept study must be validated in larger, controlled trials with long-term follow-up to determine the clinical significance and facilitate its potential integration into screening protocols. Level of Evidence: Level IV—therapeutic case series.

Background Patellofemoral joint instability is the most common knee pathology observed in childhood and adolescence. One significant contributing factor to this condition is trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain, recurrent instability, and premature wear of the patellofemoral joint. Amongst the identified risk factors, breech presentation (BP) at birth has been highlighted as a potential contributor to the development of trochlear dysplasia. This study explores the association between breech presentation and the femoral trochlea’s increased sulcus angle (SA), further emphasising its role in patellofemoral joint pathology. Methods A prospective cohort study was conducted with 85 newborns (170 knees), including healthy infants born in breech presentation (BP) between weeks 31 and 42 and those born in cephalic presentation (CP) between weeks 35 and 41. Sulcus angle (SA) values were measured using ultrasound, and a physical examination was performed for each group. Results We observed significant differences in the SA measurements between the two groups (p < 0.05): 149.92º (95% CI 148.81–151.04; SD = 5.56), compared to the CP group, which had a mean SA of 142.52º (95% CI 141.83–143.21; SD = 2.94). The BP group also had shorter gestation periods (267 days, SD = 11 vs 274 days, SD = 8) and lower birth weights (3091.71 g, SD = 500.94 vs. 3380.74 g, SD = 424.72, p < 0.05). Additionally, the rate of caesarean-section deliveries was higher in the BP group (44.8%) compared to the CP group (17.14%) (p < 0.05). Conclusion Newborns with breech presentation exhibit significantly higher SA values, suggesting a flatter trochlear groove and a potential predisposition to patellofemoral joint instability.

Background: Injury surveillance is fundamental for understanding and managing risks in elite football. The simultaneous organisation of Union of European Football Associations (UEFA) EURO 2024 and Confederación Sudamericana de Fútbol (CONMEBOL) Copa America 2024 created a unique chance to use a standardised method across two major men’s tournaments, providing descriptive insights into injury rates and patterns in various competitive settings. Objective: To analyse the incidence, severity and burden of time-loss injuries across both tournaments. Methods: A prospective injury surveillance study was conducted using standardised methodologies from UEFA’s Elite Club Injury Study and International Olympic Committee reporting guidelines. Injury incidence rates (IRs) were calculated per 1000 hours of exposure, and injury burden was measured in tournament days lost per 1000 hours. Results: A total of 85 injuries were recorded, resulting in an overall IR of 4.0 per 1000 hours (95% CI: 3.1 to 4.8). Match injury rates (16.3 per 1000 hours; 95% CI: 11.9 to 20.7) were significantly higher than training rates (1.8 per 1000 hours; 95% CI: 1.2 to 2.4). Injury rates were comparable between UEFA EURO (3.9 per 1000 hours; 95% CI: 2.9 to 4.9) and CONMEBOL Copa America (4.2 per 1000 hours; 95% CI: 2.6 to 5.7). The injury burden was higher in UEFA EURO (30.0 vs 18.3 days lost per 1000 hours). Muscle injuries (58%) and lower extremity injuries (86%) were the most common. Conclusions: Injury patterns were broadly similar across tournaments, with lower extremity injuries, particularly muscle injuries, being the most common. The study highlights the presence and impact of pre-existing injuries on player availability and underscores the practical value of harmonised injury surveillance, even in small sample contexts, to enhance international data comparability and support future multi-tournament analyses.

Background/Objectives: Total knee arthroplasty (TKA) is a frequent procedure in orthopedic surgery. Advances in TKA include the development of robotic-assisted systems. Training in raTKA entails a learning curve to achieve proficiency comparable to conventional manual TKA (maTKA). Methods: We conducted a prospective study of the learning curve in raTKA using the Robotic Surgical Assistant (ROSA) Knee System. The study included 180 patients (90 raTKAs; 90 maTKAs) and three surgeons (one with >15 years of experience in maTKA). The cumulative sum control chart method (CUSUM) was used to define the transition from the learning phase to the mastered phase in raTKA. Results: The learning curves were 43 cases (experienced surgeons) and 61 cases (all surgeons). Mean operative times for both phases in raTKA were longer than in maTKA (p < 0.001). In raTKA, operative times in the learning phase were longer compared to those in the mastered phase (p < 0.001). Operative times in the learning and mastered phases for all surgeons in raTKA were significantly longer compared to those in maTKA (p < 0.001); however, operative times of the experienced surgeon in the mastered phase of raTKA and in maTKA showed no differences. Conclusions: The learning curve in raTKA is dependent upon the surgeon’s previous experience in maTKA.

A shallow sulcus characterizes trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain or instability of the patellofemoral joint. Breech presentation at birth has been identified as a risk factor for developing this condition, which an ultrasound can identify early. Early treatment could be considered at this stage, given the potential for remodelling in these skeletally immature patients. Newborns with breech presentation at birth who meet the inclusion criteria will be enrolled and randomised in equal proportions between treatment with the Pavlik harness and observation. The primary objective is to determine the difference in the means of the sulcus angle between the two treatment arms at two months. Ours is the first study protocol to evaluate an early non-invasive treatment for TD in the newborn with breech presentation at birth using a Pavlik harness. We hypothesised that trochlear dysplasia could be reverted when identified and treated early in life with a simple harness, as it is done with developmental dysplasia of the hip.

Bone is a heterogeneous, hierarchical biocomposite material made of an organic matrix filled with a mineral component, which plays an important role in bone strength. Although the effect of the mineral/matrix ratio on the mechanical properties of bone during aging has been intensively investigated, the relationship between the mechanical properties and the chemical composition of bone with age requires additional research in juvenile individuals. In this study, bone coupons from bovine and ovine animal species were machined from cortical areas of long bones to quantify whether the variation in mechanical properties at different stages of development is related to the change in the composition of bone tissue. An energy-dispersive X-ray detector (EDX) attached to a scanning electron microscope (SEM) was used to perform a compositional analysis of the tissue. In addition, nanoindentation analyses were carried out to address how the elastic modulus changed with age. Nonparametric statistical analyses found significant differences (p < 0.05) in Ca content and elastic modulus between species, but no differences were found within each species with development. A multiple linear regression model found that the elastic modulus was significantly related to the decrease in P and C in the samples, to the animal species (larger in bovine), and development, although not linearly. This model also found an interaction between Ca and development that could explain the lack of significance of the relationship between the elastic modulus and development in the univariate models.

Objetivo Analisar as dimensões do ligamento cruzado posterior (LCP), do ligamento cruzado anterior (LCA), a presença de ligamentos meniscofemorais (LMFs) em joelhos humanos e a correlação com as dimensões do esqueleto do joelho. Métodos Estudo anatômico em 29 espécimes de joelhos humanos nos quais medimos o comprimento e a largura dos ligamentos cruzado e meniscofemoral e as dimensões dos côndilos femorais e tibiais e do entalhe femoral. O comprimento do LCA foi calculado com diferentes graus de flexão do joelho. Analisou-se a relação entre os ligamentos e as dimensões ósseas. Resultados O comprimento do LCA e do LCP foram semelhantes, LMF posterior foi mais frequente e mais longo do que o LMF anterior. Foram encontradas LMF posterior em 72,41% dos joelhos e LMF anterior em 20,69%. O LCA apresentou 30% de seu comprimento máximo até 60°, aproximadamente metade de seu comprimento entre 90° e 120°, atingindo seu comprimento máximo com flexão de 170°. Encontramos uma forte correlação entre o comprimento do LCA e do LCP (p = 0,001). No entanto, os comprimentos do LCA e do LCP não estavam relacionados com as dimensões ósseas. Conclusão Não encontramos correlações entre os ligamentos cruzado e meniscofemoral e as dimensões anatômicas do entalhe intercondilar e da tíbia proximal e do fêmur distal. A presença do LMF posterior foi mais frequente e maior que a do ligamento anterior. Não houve apoio financeiro de fontes públicas, comerciais ou sem fins lucrativos. ^* Estudo realizado na Faculdade de Medicina da Universidade CEU-San Pablo, Madri, Espanha. Received: 22 November 2021 Accepted: 28 April 2022 Article published online: 24 March 2023 © 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil