Lesão do ligamento cruzado anterior (LCA) do joelho em população indígena do estado do Amazonas, Brasil

Abstract

SUMMARYIn August 2003, 151 Ticuna Indians (88 males and 63 females) living in the surroundings of Tabatinga city in Amazonas state (Brazil) were examined for anterior cruciate ligament ( ACL) injury using the International Knee Documentation Committee -IKDC2000 method. About 14% of males presented ACL injury, against 3% of female, and 88% of the population studied presented varus knee alignment.The authors believe that the expressive rate of ACL injury in male Brazilian Indians was determined by cultural issues, probably because of soccer playing, with the isolation of the Ticuna village being critical for the lack of diagnosis and treatment.Keywords: Knee; Anterior cruciate ligament; Indigenous population; Physical examination. INTRODUCTIONAnterior cruciate ligament (ACL) is the major anterior stabilizer of the knee (1) and its rupture is mainly associated to an indirect mechanism of trauma followed by hemarthrosis (2) . The natural progression of this ligament injury remains unclear, but it is believed that the anterior instability may evolve to meniscal and chondral degenerative injuries (3)(4)(5) and the natural evolution is reflected on the performance of these individuals in their physical activities (6) . In the USA, the annual incidence is estimated as 0.35 ACL injury/ general population resident, resulting in approximately 75,000 injuries each year (7) . About 70% of the injuries occur during sports practice, especially during soccer playing, with most of these injuries occurring in individuals aged 16 -45 years (8) . It was found that sportswomen showed an increased incidence of ACL injury when compared to men, but there is no convincing explanation for that (9) . In Brazil, there is still a lack of epidemiological data about knee ligament injuries in the overall population, or in the indigenous populations. The Amazon region accounts for almost half of the entire Brazilian territory, with Amazonas being the biggest state of the federation, with such big dimensions that some geographical regions are overcome by it. The peculiar characteristics of the region make internal travels difficult, being usually made by river and by plane, a fact that makes access to health services difficult. As a large portion of the orthopaedic doctors live in the capital city of that state, patients must travel by boat to seek orthopaedic care. Among indigenous populations, healthcare challenges are even more impressive, as a result of the geographical isolation, the indigenous culture itself, as well as of the different languages turning medical care difficult to be provided. The objective of this study is to determine the incidence of ACL injury in an indigenous population village of the state of Amazonas, upon a physical examination protocol based on the "International Knee Documentation Committee" -IKDC 2000 (10) . In addition, this study is intended to: a) compare the differences found between genders, b) check for the association of ACL injuries with other ligament injuries, and c) check for the alignment of lower lim...

Protocolos De Tratamento Fisioterápico Nas Lesões De Ligamento Cruzado Anterior Após Ligamentoplastia – Uma Revisão

“…Essa lesão promove instabilidade articular, levando a uma limitação das atividades; o individuo pode referir dor, edema e perda da função do membro. A maioria tentará compensar o membro devido à estabilidade, fazendo-se necessário o uso da musculatura periarticular [12][13][14][15][16][17] . Ela acomete principalmente em homens, em que o mecanismo de lesão acontece por um estresse no ligamento suficiente para causar uma ruptura.…”