ObjectiveThe aim of this study was to analyze the anatomic variations of the bicipital aponeurosis (BA) (lacertus fibrosus) and its implications for the compression of the median nerve, which is positioned medially to the brachial artery, passing under the bicipital aponeurosis.MethodsSixty upper limbs of 30 cadavers were dissected, 26 of which were male and four, female; of the total, 15 had been previously preserved in formalin and glycerine and 15 were dissected fresh in the Laboratory of Anatomy.ResultsIn 55 limbs, short and long heads of the biceps muscle contributed to the formation of the BA, and the most significant contribution was always from the short head. In three limbs, only the short head contributed to the formation of the BA. In two limbs, the BA was absent. The length of the bicipital aponeurosis from its origin to its insertion ranged from 4.5 to 6.2 cm and its width, from 0.5 to 2.6 cm. In 42 limbs, the BA was thickened; of these, in 27 it was resting directly on the median nerve, and in 17 a high insertion of the humeral head of the pronator teres muscle was found, and the muscle was interposed between the BA and the median nerve.ConclusionThese results suggest that a thickened BA may be a potential factor for nerve compression, by narrowing the space through which the median nerve passes.

Purpose Magnetic resonance imaging (MRI) is the gold standard image examination for anterior cruciate ligament (ACL) lesion diagnosis. Our hypothesis was that measuring the posterior cruciate ligament inclination angle (PCLIA) using MRI images may be an auxiliary tool to aid the recognition of ACL insufficiency. The purpose of this study was to compare the PCLIA measurement in MRIs of individuals with and without ACL injury. Methods The PCLIA was measured by two radiologists in 65 knee MRIs of patients with intact ACL (control group) and in 65 knee MRIs of people with ACL injury (study group). In both groups, the posterior cruciate ligament was intact. The control group was included 35 men (53.8%) and 30 women (46.1%). The patients' average age was 38.7 years (range 15-75; SD ± 14.8 years). In this group, 31 (47.6%) MRIs were from right knees and 34 (52.3%) were from left knees. The study group consisted of 45 men (69.2%) and 20 women (30.7%). The patients' average age was 36.8 years (range 14-55; SD ± 10.3 years). In this group, 33 (50.7%) were right knees and 32 (49.2%) were left knees. PCLIA was formed by the intersection of two lines drawn in MRI sagittal images. The first passed tangentially to the articular surface of the tibial condyle and the second was drawn over the fraction of the ligament that originated where the first crossed the PCL, outlined proximally. ResultsThe average PCLIA was 44.2 ± 3.8° in the control group and 78.9 ± 8.6° in the study group. Statistical analyses showed that the PCLIA was higher in the group with ACL injury (p < 0.05). ConclusionThe PCLIA was significantly higher in individuals with ACL injuries. The measurement of this angle using MRI images may allow for detection of ACL insufficiency and thus assist in an individualized and precise approach to the treatment of injuries to the ACL. Clinical relevance PCLIA may be a way to detect ACL insufficiency and thus help surgeons to decide which patient might need ACL reconstruction. Level of evidence III.

Objective: The objective of our study was to evaluate if functional training with the Functional Movement Screen (FMS) can reduce the risk of a new injury for patients that underwent an anterior cruciate ligament reconstruction (ACLR). Our hypothesis was that the functional training might reduce the risk of a new injury. Methods: Our training protocol consisted of six phases, each one lasting six weeks. It began two months after surgery. The study group was composed of 10 individuals that completed our protocol after ACLR. The control group consisted of 10 people that completed a regular ACLR rehabilitation protocol. The FMS was used to compare the study and control group performance. Patients with a score of 14 or less on the FMS were considered more likely to suffer an injury than those with a score higher than 14. Results: The study group average FMS score was 16.6 compared to the control group at 12.3. Functional training for ACLR rehabilitation added a statistically significant benefit (p < 0.0002) to reduce the risk of a new injury compared to regular protocol. Conclusion: Functional training may be considered an alternative to the regular ACLR rehabilitation to reduce the risk of a new injury before returning to sports. Level of Evidence III, Case control study.

Anterior cruciate ligament intra-articular reconstruction may require extra-articular reinforcement in certain situations. As knee lateral region anatomical and biomechanical knowledge has increased with new research, it has been reported that the iliotibial band is important in the anterolateral stabilization of the knee. Possible indications for a "more anatomical" extra-articular tenodesis focusing on capsulo-osseous layer tensioning and distal Kaplan fibers reconstruction are reported, surgical approach details are described, and scientific data that gives support for this procedure are discussed.

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Objetivo: O objetivo do nosso estudo foi avaliar se o treinamento funcional pode reduzir o risco de nova lesão para pacientes que tiveram reconstrução do ligamento cruzado anterior (RLCA) por meio do Sistema de Pontuação do Functional Movement Screen (FMS). A hipótese testada foi de que nosso algoritmo de treinamento funcional pode diminuir o risco de nova lesão. Métodos: Nosso protocolo de treinamento consistiu em seis fases, cada uma com duração de seis semanas. Começou dois meses após a reconstrução do ligamento. O grupo de estudo foi composto por 10 indivíduos que completaram nosso protocolo proposto, após a RLCA. O grupo controle consistiu em 10 pessoas que tiveram permissão para retornar às atividades esportivas após concluir um protocolo regular de reabilitação da RLCA. O FMS foi utilizado para comparar o desempenho dos grupos controle e estudo. Pacientes com pontuação igual ou inferior a 14 no FMS foram considerados mais propensos a sofrer uma nova lesão do que aqueles com pontuação maior que quatorze. Resultados: A pontuação média, segundo o FMS, do grupo estudo foi de 16,6 e a do grupo controle, 12,3. O treinamento funcional para a reabilitação da RLCA adicionou um benefício estatisticamente significativo (p <0,0002) para diminuir o risco de nova lesão, em comparação com o protocolo regular de reabilitação. Conclusão: O treinamento funcional pode ser considerado mais uma estratégia a ser incluida na reabilitação regular da RLCA, com o objetivo de diminuir o risco de uma nova lesão, antes de retornar ao esporte. Nível de Evidência: II (Estudo terapêutico - Investigação dos resultados do tratamento)