Classificacao Anatomica para Luxacoes Joelho (SCHENCK, 1992; modificada por Wascher, 1997) I – Cruzado único + colateral II – LCA / LCP (colaterais intactos) IIIM – LCA / PCL / LCM (LCL + CPL intactos) IIIL – LCA / PCL / LCL + CPL (MCL intacto) IV – LCA / LP / LCM / LCL + CPL V – Fratura-Luxacao C – Lesao arterial N – Lesao nervosa Schenck RC et al. South Med J 1992; 85(3S): 61.

Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J

Orthop Trauma 1997; 11 (7): 525–529.

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Classificação quanto ao deslocamento tibial

Spontaneous reduction of knee dislocation occurs in 20‐50%

Kennedy classification (JBJS Am 1963;45:889–904 and JBJS Am 1976;58:350)

• Anterior – hyperextension (40%)

• Posterior – AP force (33%)

• Lateral – Valgus (18%)

• Medial – Varus (4%)

• Rotatory (AM,PM,AL,PL) Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963; (45):889-904.

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Classificacao de Iwano et al. (1990), para OA Fêmoro-patelar Estágio I – leve: espaço articular tem pelo mais do que 3mm Estágio II – moderada: espaço articular mede menos do que 3mm, sem contato ósseo Estágio III – severa: contato ósseo é menor que ¼ da superfície articular Estágio VI – muito severa: superfícies articulares se tocam inteiramente

Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res. 1990;(252):190–197.

Classificação de Ahlbäck modificada por Keyes e Goodfellow

Grau I Redução do espaço articular Grau II Obliteração do espaço articular Grau III AP – desgaste do platô tibial < 5mm perfil – parte posterior do platô intacta Grau IV AP – desgaste de 5 a 10mm do platô tibial perfil – extenso desgaste da margem posterior do platô tibial Grau V AP – grave subluxação da tíbia perfil – subluxação anterior da tíbia > 10mm

Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn.

1968;(Suppl 277):7-72.

Keyes GW, Carr AJ, Miller RK, Goodfellow JW. The radiographic classification of medial

gonarthrosis - Correlation with operation methods in 200 knees. Acta Orthop Scand.

1992;63(5):497-501.

______________________________________________________ Classificação de Kellgreen e Lawrence

Grau 0 Normal Grau I Estreitamento do espaço articular duvidoso e possível osteófitos na borda Grau II Possível estreitamento do espaço articular e osteófito definido Grau III Definido estreitamento do espaço articular, múltiplos osteófitos moderados, alguma esclerose subcondral e possível deformidade do contorno ósseo Grau IV Notável estreitamento do espaço articular, severa esclerose subcondral, definida deformidade do contorno ósseo e presença de grandes osteófitos

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis.

1957;16(4):494-502. ______________________________________________________________________________________________

Dejour

Grau I RX normal (pré-artrose) Grau II Artrose inicial > AFTI: # AP – pinçamento parcial # perfil – pinçamento efetivo na parte central do platô tibial > AFTE: # AP – interlinha articular normal, com condensação subcondral e osteófitos # perfil – pinçamento pouco significativo Grau III Artrose com desequilíbrio > AFTI: # AP – pinçamento total da interlinha articular, com báscula do côndilo femoral medial dentro da cúpula interna, sendo a incidência mais eloqüente (varo com rotação interna) > AFTE: # AP – valgo com cúpula externa bem condensada e decoaptação do compartimento medial (valgo com rotação externa da tíbia) Grau IV Artrose grave > AFTI: # AP – grande varo, com côndilo femoral lateral em conflito com as espinhas tibiais # perfil – lesões importantes na patela > AFTE: # AP – grande valgo # perfil – lesões importantes na patela AFTI – Art. Femorotibial Interna; AFTE – Art. Femorotibial Externa.

Dejour H, Carret JP, Walch G, et al. Les Gonarthroses. 7émes Journées Lyonnaises de Chirurgie

de Genou. Lyon: 1991.

Displasia Troclear

Retirado de: Insall and Scott. Surgery of the Knee 5th ed. , pag. 598.

Rémy, F., Gougeon, F., Ala Eddine, T., Migaud, H., Fontaine, C., and Duquennoy,

A.: Reproducibility of the new classification of femoral trochlea dysplasia proposed by dejour:

predictive value for severity of femoropatellar instability in 47 knees. J Bone Joint Surg Br, Vol

84-B(Issue SUPP): 43, 2002.

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Retirado de: Insall and Scott. Surgery of the Knee 5th ed. , pag. 597.

Rémy, F., Gougeon, F., Ala Eddine, T., Migaud, H., Fontaine, C., and Duquennoy,

A.: Reproducibility of the new classification of femoral trochlea dysplasia proposed by dejour:

predictive value for severity of femoropatellar instability in 47 knees. J Bone Joint Surg Br, Vol

84-B(Issue SUPP): 43, 2002.

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Medida radiográfica do tunel femoral na reconstrução do LFPM (Schottle, 2007).

Schottle PB, Hensler D, Imhoff AB, Anatomical Double-Bundle MPFL Reconstruction with an Aperture Fixation,

Knee Surg Sports Traumatol Arthroscopy (epub ahead of print), 2009.

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Classificação de Insall para as patologias da articulação fêmoropatelar.

Insall JN: Disorders of the patella. In Insall JN (ed): Surgery of the knee, New York, 1984, Churchill

Livingstone, p 191.

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Classificação de Merchant para as Patologias da Articulação Fêmoropatelar

Merchant AC: Classification of patellofemoral disorders. Arthroscopy 4:235, 1988.

Classificação de Outerbridge modificada (apresentada no sistema métrico), comparada

a classificação da sociedade internacional de cartilagem) o ICRS (ICRS, International

Cartilage Repair Society) para as Lesões Condrais

Retirado de: Insall and Scott. Surgery of the Knee 5th ed. pag. 119.

Classificação de Outerbridge do trabalho original (Medida em polegadas pelo Sistema

Inglês)

Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–757.

Quanto ao tratamento das lesões condrais:

Garrick JG, ed: Orthopaedic knowledge update: sports medicine, 3rd ed,

Rosemont, Ill, 2004, American Academy of Orthopaedic Surgeons.

Lesion Size Operative Treatment

≤1 cm Observation

Abrasion chondroplasty

Microfracture

Osteochondral autograft transfer

1 cm-2 cm Abrasion chondroplasty

Microfracture

Osteochondral autograft transfer

2 cm-3.5 cm Fresh osteochondral allograft

Autologous chondrocyte implantation

3.5 cm-10 cm Autologous chondrocyte implantation

Multiple (2 or 3) Autologous chondrocyte implantation

Classificação das Lesões da Cartilagem Articular quanto a severidade da Lesão Retirado de Campbell’s Operative Orthopaedics. 11 ed.

Grade Outerbridge Modified Outerbridge ICRS

0 Normal cartilage Intact cartilage Intact cartilage

I Softening and swelling Chondral softening or

blistering with intact

surface

Superficial (soft indentation or superficial fissures and cracks)

II Fragmentation and fissures in

area less than 0.5 inch in

diameter

Superficial ulceration,

fibrillation, or fissuring less

than 50% of depth of

cartilage

Lesion less than half the thickness of articular cartilage

III Fragmentation and fissures in

area larger than 0.5 inch in

diameter

Deep ulceration, fibrillation,

fissuring, or chondral flap

more than 50% of cartilage

without exposed bone

Lesion more than half the thickness of articular cartilage

IV Exposed subchondral bone Full-thickness wear with

exposed subchondral bone

Lesion extending to subchondral bone

ICRS, International Cartilage Repair Society.

Retirado de Campbell’s Operative Orthopaedics. 11 ed.

ICRS, International Cartilage Repair Society.

Classificação das Instabilidades do Joelho

(melhor utilizada para as instabilidades crônicas)

Demonstration of shift in vertical axis away from center of tibia as tibia shifts excessively and abnormally in relation to femur. Position of femur is

designated by shaded area. (Redrawn from Nicholas JA: The five-one reconstruction for anteromedial instability of the knee. Indications, technique,

and the results in fifty-two patients, J Bone Joint Surg 55A:899, 1973.

Retirado de Campbell’s Operative Orthopaedics. 11 ed.

Classificação proposta pelo Committee on Research and Education of the

American Orthopaedic Society for Sports Medicine.

Retirado de Campbell’s Operative Orthopaedics. 11 ed.

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Sítios mais comuns na Osteocondrite Dissecante (OCD), de acordo com Heffi

et al. (A) e Aichroth (B).

Classification of Osteochondritis Dissecans Based on Bone Scan (Scintigraphy)

Stag

e Bone Scan Finding

0 Normal radiographic and scintigraphic appearance

I Lesion visible on plain radiographs, bone scan normal

II Increased uptake in area of lesion on bone scan

III Increased isotopic uptake in entire femoral condyle

IV Uptake in tibial plateau opposite lesion

Cahill BR: Osteochondritis dissecans of the knee: treatment of juvenile and adult forms, J Am Acad Orthop Surg

3:237, 1995.

Staging Systems for Osteochondritis Dissecans

Stage Arthroscopy MRI Radiographs

I Irregularity and softening of articular cartilage; no definable fragment Thickening of articular cartilage; low signal changes Compression lesion; no

visible fragment

II Articular cartilage breached; definable fragment, not displaceable Articular cartilage breached; low signal rim behind fragment

indicating fibrous attachment

Fragment attached

III Articular cartilage breached; definable fragment, displaceable, but

attached by some overlying cartilage

Articular cartilage breached; high signal changes behind

fragment indicating synovial fluid between fragment

and underlying subchondral bone

Nondisplaced fragment

without attachment

IV Loose body Loose body Displaced fragment

Dipaola JD, Nelson DW, Colville MR: Characterizing osteochondral lesions by magnetic resonance imaging,

Arthroscopy 7:101, 1991.

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Osteonecrose Idiopática do Joelho

Koshino T: The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-

grafting or drilling of the lesion. J Bone Joint Surg Am. 1982;64:47.

Agietti et al., modificaram a classificação de Koshino, conforme tabela 2, apresentada abaixo.

Aglietti P, Insall JN, Buzzi R, et al: Idiopathic osteonecrosis of the knee: aetiology, prognosis and treatment. J Bone Joint

Surg Br. 1983;65:588.

Mont et al. (1997), adaptaram a classificação de Ficat e Arlet (1980), que é uma classificação básica utilizando RX.

Ficat P: [Vascular pathology of femoral head necrosis (author’s transl)]. Orthopade. 1980;9:238.

Mont MA, Tomek IM, Hungerford DS: Core decompression for avascular necrosis of the distal femur: long-term follow-

up. Clin Orthop. 1997;334:124.