Benno Ejnisman

Resumo: Identificar e sintetizar os critérios de retorno ao esporte relatados após o procedimento de Bristow-Latarjet para instabilidade glenoumeral anterior em atletas, e avaliar o tempo associado e a taxa de retorno ao esporte e a recorrência de instabilidade, com o objetivo de informar uma combinação baseada em evidências de critérios de retorno ao esporte que possa otimizar o retorno antecipado, para minimizar a recorrência. Este protocolo segue as diretrizes da declaração Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) e está registrado no International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). Incluiremos estudos comparativos randomizados e não randomizados, estudos de coorte e de caso-controle, e séries de casos que relatem critérios explícitos de retorno ao esporte após Bristow-Latarjet em atletas, com seguimento mínimo de 12 meses. As buscas serão realizadas nas bases de dados PubMed, Web of Science, Embase, SciELO, CENTRAL e SPORTDiscus, além do Google Acadêmico para a literatura cinzenta, sem restrições de data, geografia ou idioma. Dois revisores farão a triagem e a extração de dados de forma independente, usando o programa Covidence (Veritas Health Innovation Ltd). Os resultados primários são o tempo até o retorno ao esporte, a taxa de retorno ao esporte e a recorrência (usando o ponto de tempo mais próximo de 12 meses, quando várias avaliações estão disponíveis). O risco de viés será avaliado utilizando a ferramenta Risk of Bias 2 (RoB 2; the Cochrane Collaboration) para ensaios clínicos randomizados (ECRs), a Newcastle-Ottawa Scale (NOS) para estudos comparativos não randomizados, e a Lista de Verificação de Avaliação Crítica para Séries de Casos do Joanna Briggs Institute (JBI) para séries de casos, e a certeza da evidência será classificada por meio da abordagem Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Quando apropriado, metanálise de efeitos aleatórios e metarregressão exploratória serão realizadas; análises de subgrupo e de sensibilidade estão planejadas. Esta revisão sistemática fornecerá uma síntese centrada nos critérios das definições de retorno ao esporte e das estratégias de liberação após Bristow-Latarjet, relacionando cada critério a desfechos clinicamente relevantes (tempo até o retorno ao esporte, taxa de retorno ao esporte e recorrência). Espera-se que os resultados apoiem a tomada de decisão de retorno ao esporte de forma mais consistente e baseada em evidências, e orientem a futura validação prospectiva de combinações otimizadas de critérios de retorno ao esporte.

To identify and synthesize return-to-sport (RTS) criteria reported after the Bristow–Latarjet procedure for anterior glenohumeral instability in athletes, and to evaluate the associated time to RTS, RTS rate, and instability recurrence, with the aim of informing an evidence-based combination of RTS criteria that may optimize earlier RTS while minimizing recurrence. This protocol follows the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P) statement and it has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024563618). We will include randomized and non-randomized comparative studies, cohort and case-control studies, and case series reporting explicit RTS criteria after Bristow–Latarjet in athletes, with a minimum follow-up of 12 months. Searches will be conducted in the PubMed, Web of Science, Embase, SciELO, CENTRAL and SPORTDiscus databases, as well as Google Scholar for grey literature, without restrictions on date, geography, or language. Two reviewers will independently screen and extract data using the Covidence (Veritas Health Innovation Ltd) software. The primary outcomes are time to RTS, RTS rate, and recurrence (using the time point closest to 12 months, when multiple assessments are available). The risk of bias will be assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration) for randomized clinical trials (RCTs), the Newcastle-Ottawa Scale (NOS) for non-randomized comparative studies, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series, and the certainty of the evidence will be rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. When appropriate, random-effects meta-analysis and exploratory meta-regression will be performed; subgroup and sensitivity analyses are planned. The systematic review will provide a criterion-centered synthesis of RTS definitions and clearance strategies after Bristow–Latarjet, linking each criterion to clinically-relevant outcomes (time to RTS, RTS rate, and recurrence). The findings are expected to support more consistent, evidence-informed RTS decision-making and guide future prospective validation of optimized RTS criteria combinations.

Purpose: To map the scientific literature on the use of dynamic ultrasound in the assessment of medial knee instability. Methods: Primary (clinical or experimental) and secondary studies that used dynamic ultrasound to assess medial knee opening were included. There were no restrictions on language or date. Sources of information: The searches were conducted in the PubMed/MEDLINE, Scopus, Web of Science, Embase and CINAHL databases. Data selection and extraction: The process of data selection and extraction was conducted by two independent reviewers. The information was organised into thematic tables and a conceptual matrix was developed based on the components of population, concept, and context. Results: Ten studies were included: two biomechanical, six clinical, and two reviews. Ultrasound demonstrated good reliability in measuring medial opening and distinguishing between injured and normal knees. Heterogeneity was observed in the stress protocols, evaluation angles, units of measurement, and anatomical points. Conclusions: Dynamic ultrasound presents consolidated clinical potential in the assessment of medial knee instability. Standardisation of methods and additional clinical validation are necessary. Level of Evidence: Not applicable.

Objective: To report a case series of distal triceps tendon rupture associated with olecranon osteophyte avulsion, a rare condition with few reports in the literature. Methods: This study analyzed patients who underwent surgical treatment between 2011 and 2022 for distal triceps tendon rupture associated with olecranon osteophyte avulsion. Clinical and radiographic characteristics, pain levels, and functional outcomes were assessed using the Q-DASH and MEPS scores. Results: There was a significant reduction in pain between the 1st and 12th weeks (mean VAS from 5.8 to 0.8; p<0.001). The mean Q-DASH score improved from 1.9 to 0.2 between the 6th and 12th months (p=0.003). The MEPS remained high throughout the follow-up period (final mean: 100). Patients operated on within 7 days from trauma had less residual pain (p=0.02). Smokers had worse functional scores at 6 months (p=0.04). Previous elbow pain was associated with worse pain score in the first week post op (p=0.048), but no difference in final outcomes. Conclusion: Surgery for triceps tendon rupture with olecranon osteophyte avulsion led to significant improvements in pain and function. Factors such as time to treatment, smoking, and age influence recovery. Level of Evidence IV; Case Series.

Bilateral simultaneous distal triceps tendon ruptures are extremely rare, with only a few cases reported. This article presents two traumatic bilateral ruptures in middle‐aged men with a history of long‐term anabolic steroid use, a factor associated with tendon weakening. In both cases, acute trauma led to immediate loss of active elbow extension, and clinical examination plus imaging confirmed complete distal triceps tears bilaterally. Single‐stage bilateral repair was performed using a suture anchor technique, followed by a structured rehabilitation program to restore range of motion and strength. Both patients recovered full, symmetric elbow motion, returned to their preinjury activities without significant complications, and reported good subjective outcomes. These cases support a potential contribution of anabolic steroid use to tendon vulnerability and suggest that single‐stage bilateral repair is a feasible strategy for this rare injury pattern.

Resumo: Objetivo Este estudo mediu o impacto do isolamento social nas atividades físicas e no comportamento sedentário de crianças e adolescentes brasileiros e avaliou a influência de fatores como idade, sexo, dias da semana, tipo de moradia e população da cidade. Métodos O estudo foi aprovado pelo Comitê de Ética Médica e o consentimento dos pais dos participantes foi obtido. Um Google Form (Google LLC, Mountain View, CA, USA) foi enviado aos pais por e-mail e WhatsApp (Meta Platforms Inc., Menlo Park, CA, USA). Os pais responderam às perguntas do Children's Physical Activity Questionnaire em sua versão em português (C-PAQ.PT) duas vezes, um mês antes e durante o isolamento social. Resultados Houve redução estatisticamente significativa na média de atividade física (p < 0,001) e aumento na média de atividades sedentárias (p < 0,001) nos dias úteis e finais de semana durante o isolamento social. Houve maior redução em basquete, handebol e corrida no grupo de 10 a 14 anos, assim como em brincar em parquinhos no grupo de 5 a 9 anos. Houve diminuição estatisticamente significativa na prática de pega-pega e ciclismo, respectivamente, entre meninas e meninos. Não observamos diferenças estatisticamente significativas entre os tipos de moradia e o número de habitantes na cidade. Conclusão O C-PAQ.PT permitiu uma avaliação quantitativa para identificação das variações nas atividades físicas e comportamentos sedentários durante o isolamento social. Observamos que apenas duas atividades físicas foram impactadas pelo sexo dos participantes. As mudanças não foram influenciadas pelo número de habitantes da cidade ou pelo tipo de moradia.

This case report describes the combined use of the Latarjet procedure with distal tibia allograft augmentation to treat anterior shoulder instability in a 35‐year‐old female patient with a seizure disorder. The patient had significant bipolar bone loss and coracoid fracture pseudoarthrosis. The procedure involved using both coracoid autograft and distal tibia allograft to address the glenoid bone defect. Postoperative care included a sling for 3 weeks followed by progressive physiotherapy. At 18 months postsurgery, the patient reported high satisfaction, full recovery, and no recurrence of dislocations. Radiographic evaluations confirmed proper graft positioning and bone integration. This combined technique offers a robust solution for managing complex shoulder instability cases with significant bone loss and insufficient coracoid graft.

Objective: The aim of this study was to evaluate capsulolabral repair in athletes with traumatic anterior glenohumeral instability using magnetic resonance imaging (MRI) and correlate it with clinical and epidemiological data. Method: A prospective therapeutic clinical study was conducted with 36 athletes undergoing surgical treatment. MRI was performed preoperatively and in the third month postoperatively. The morphology, height, angulation, integrity and density of the repaired capsulolabral tissue were evaluated. Linear and logistic regression models were applied. Results: A total of 36 athletes were evaluated (mean age 29.64 ± 9.08 years). For all numerical variables (morphology, integrity, angles and heights) the differences were statistically significant, except for the coronal angle and homogeneity. Longer time to surgery or multiple dislocations reduced the improvement in morphology. There were no new episodes of dislocation. In the 3-month radiological evaluation, the integrity of the labrum was present in 97% of the patients, however, all patients still had a heterogeneous labrum. Conclusion: There are statistically significant differences between the morphology, height and angulation of the labrum between the pre- and postoperative periods of patients operated on for glenohumeral instability. Although the 3-month MRI showed integrity of the labrum in almost all athletes, this tissue still presented altered density even with satisfactory clinical results. Level of Evidence III; Prospective Study.

The distal rupture of the biceps brachii muscle tendon (DBT) accounts for 3% of biceps ruptures. Diagnosis typically relies on high clinical suspicion and complementary imaging studies, with >90% of cases documented in males between the fourth and sixth decades of life. Reports of DBT ruptures in females are scarce, mostly involving partial and degenerative injuries. Here, we present an unprecedented case of a 28-year-old female professional mixed martial arts athlete with a total traumatic DBT rupture. The athlete underwent surgical repair using anchor reattachment technique. No complications were observed, and the athlete showed satisfactory outcomes, being cleared for physiotherapy after 2 weeks and returning to sports after a 3-month postoperative period.