Introduction: the anterior cruciate ligament (ACL) along with the posterior cruciate ligament are the central stabilizers of the knee. Rupture of the ACL usually occurs in active and young people. For a correct diagnosis it is necessary a good clinical history, examination and a complementary study. The literature recommends surgical treatment in athletes and young people. Objective: to detail current information related to anterior cruciate ligament injury, embryology, anatomy, biomechanics, incidence, risk factors, diagnosis, management, approach and treatment of the disease. Methodology: a total of 72 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 46 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar, SciELO and Cochrane; the terms used to search for information in Spanish, Portuguese, German and English were: ACL, anterior cruciate ligament, anterior cruciate ligament, Vordere Kreuzband. Results: ACL deficiency not only causes instability episodes but also changes in joint mechanics that may lead to degenerative changes. Meniscal lesions are linked to 50% of these injuries. The Lachman test is the most accurate clinical diagnostic test, with a reported combined sensitivity of 85% and specificity of 94%. The anterior drawer test has high sensitivity and specificity for chronic ACL tears (92% sensitivity and 91% specificity), but lower accuracy for acute cases. In MRI, the following statistics were found in patients with acute ACL injuries in several studies: specificity 98-100% and sensitivity 94%. Conclusions: The ACL is a specialized band of connective tissue located in the knee joint that joins the tibia and femur. It consists primarily of collagen fibers, making up 70% of its dry weight.Variation in the anatomy of the intercondylar groove of the distal femur is a factor that appears to be related to an increased risk of ACL injury. ACL injuries are rarely diagnosed with an MRI, but in some circumstances, such as a meniscal tear or bone contusion, this test may be useful. The decision on the course of treatment for a patient with an ACL injury depends on a number of variables. Surgical reconstruction in anterior cruciate ligament (ACL) tears has proven to be a very effective technique that usually provides satisfactory results. Patients with ACL insufficiency may receive conservative treatment, which may involve activity modification, rehabilitation, and sometimes bracing. Proprioception and strength deficits should be taken into account when designing rehabilitation programs for knees with ACL insufficiency. KEY WORDS: ligament, anterior cruciate, ACL, rupture.

Introduction: Avascular necrosis of the lunate bone was described in 1910 by the Austrian radiologist Robert Kienböck, which is named after him. A mixture of different factors such as mechanical, vascular and genetic predisposition may be related to the pathogenesis of this disease. As for the natural evolution of the disease, failure in early diagnosis and early treatment may lead to a gradual evolution from stage I to stage IV, causing discomfort to the patient. Objective: to detail the current information related to avascular necrosis of the lunate, description, etiology, classification, imaging presentation and management of Kienböck's disease. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Kienböck, avascular necrosis of the lunate and lunatomalacia. Results: it is the second most frequent cause of avascular necrosis of the carpal bones and generally affects males between 20 and 40 years of age. Nuclear magnetic resonance has a greater contribution due to greater sensitivity and detection of radiographically occult cases, computed tomography also has a good specificity at the time of diagnosis. Radiography at the beginning of the disease does not present evident changes and nuclear scintigraphy presents non-specific findings. In the first stage, the treatment is based on immobilization with a plaster cast or splints. When incomplete necrosis is evidenced in the second stage, conservative treatment can be performed, however with complete necrosis or in the third and fourth stage, it requires "joint leveling" surgery and probably vascular bone grafting or transfer of branches of adjacent arteries. Stage IIIA usually merits lunate restoration, in stage IIIB and Lichtman IV wrist arthrodesis can be used. Conclusions: Kienböck's disease presents with unilateral pain over the dorsal aspect of the wrist, weakness and limited wrist motion, in addition to functional impotence, decreased grip strength, wrist edema, sensory disturbances in the median nerve territory and synovitis, depending on the stage. It is related to the following variables such as ulnar minus or ulnar negative variation, vascular contribution of the lunate bone, morphology of the lunate, radial inclination angle. The diagnosis is clinical and imaging where Lichtman's classification is useful. Treatment will depend on the cause and also on the stage of the disease.

Systemic Lupus Erythematosus is an autoimmune multisystem pathology, characterized by being more prevalent in women, especially African women. One of the most frequent pathologies is usually the presence of Lupus Nephritis (1). The prevalence is higher in women in relation to men in a ratio of 9:1, with an age onset between 15 and 44 years of age (2). Objective: to detail the current information related to cardiovascular, neurological, hematological manifestations of systemic erythematosus lupus, analyzing which pathologies are present in this disease. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, resulting in the election of 15 bibliographies due to the relevance of them. The sources of information were PubMed, Google Scholar and UpToDate; the terms used to search for information in English was: Systemic Erythematosus Lupus and its manifestations. Results: The most frequent gastrointestinal manifestations are regurgitation, peptic ulceration, protein-losing enteropathy, pseudo-obstruction and mesenteric vasculitis; neurological manifestations include seizures, stroke, optic neuritis, altered mental status, aseptic meningitis, chorea, psychosis or depression. At the hematologic level, anemia, thrombocytopenia, leukopenia, thrombotic thrombocytopenic purpura is usually manifested, so the patients clinical manifestations should be analyzed and any other etiology of the patient that is not related to systemic lupus erythematosus should be ruled out. Pulmonary manifestations usually include pleuritic pain, lupus pneumonitis, interstitial pulmonary alterations and pulmonary hypertension. Cardiovascular manifestations should be ruled out considering that patients with lupus have an increased risk of cardiovascular disease. Conclusions: This bibliographic review sought to show the symptoms of patients diagnosed with systemic lupus erythematosus, and which are related to the most important organs; in this case, at the neurological, cardiovascular, pulmonary, hematological and gastrointestinal levels. This review shows us that we must consider several pathologies in patients with Lupus; however, we must remember that the diagnosis of these entities is a rule-out diagnosis, which means that if we have a symptomatology of a certain apparatus or system, we must rule it out with the most frequent, and then consider the less frequent pathology, related to lupus. KEYWORDS: Systemic lupus erythematous; Protein-losing enteropathy; Treatment.

Introduction: fractures of the fifth metatarsal have various forms of treatment, depending on the type of injury and the person who suffered it. They have great importance and frequency in athletes. They usually occur due to different trauma mechanisms. They were first described in 1902. They are the most prevalent metatarsal fractures and need to be recognized and treated in a timely and appropriate manner. Objective: to detail the current information related to the fifth metatarsal fracture, classification, description, treatment, recovery time as well as the different surgical techniques. Methodology: a total of 29 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 19 bibliographies were used because the other 10 articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fractura de pie, 5th metatarsal fracture, Jones fracture. Fracture of the fifth metatarsal, fratura do quinto metatarso. Results: the anatomical division system of Lawrence and Bottle is still used. CT and MRI could be considered in the case of delayed healing, stress fracture with normal radiographs or in nonunion. Surgical options include intramedullary screw fixation, bone grafting procedures or a combination of both. Surgical treatment of fractures of the base of the fifth metatarsal in professional athletes offers good clinical results. Conclusions: Regarding the current information related to the fracture of the fifth metatarsal, we note the importance of classification, clinical and social history of the patient, for the appropriate choice of treatment, both conservative and surgical. As for the recovery time in conservative treatment varies depending on the affected area. In delayed union or nonunion, surgical intervention should be performed.

Introduction: postoperative residual neuromuscular blockade is the postoperative muscle paralysis caused by incomplete or null antagonism of neuromuscular blocking agents. Post-surgical residual paralysis (PORP) has a high incidence and may cause adverse effects, increasing postoperative morbidity and mortality. The gold standard for complete reversal of neuromuscular blockade is a T4/T1 ratio of 0.9. Small degrees of paralysis are associated with an increased risk of postoperative pulmonary complications. Recent research indicates that residual neuromuscular blockade is a significant risk factor for patient safety. Objective: to detail the current information related to postoperative residual paralysis, in addition to explaining the use and characteristics of sugammadex in its reversal. Methodology: a total of 45 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 35 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: postoperative residual neuromuscular block, postoperative muscle weakness, sugammadex, anticholinesterase inhibitors. Results: Neuromuscular block occurs due to muscle fragility in the postoperative period due to antagonism, which produces a decrease in the musculature of the upper and lower airways. When this phase is properly managed, extubation delays are reduced, and postoperative pulmonary complications are reduced. Sugammadex is a relaxant that decreases the possibility of persistent neuromuscular paralysis; as neuromuscular blockade increases, contraction decreases. Therefore, when this drug is used, the risk of adverse effects, mostly respiratory, is avoided. This drug inactivates rocuronium, and the adverse effects it presents (although very infrequent) are dysgeusia, cough, grimacing or increased secretion through the endotracheal tube. Conclusions: sugammadex is suggested to be used before neostigmine, although it should be used in patients with high risk of postoperative complications, such as patients over 80 years of age or with post cardiothoracic surgery. However, sugammadex reverses neuromuscular blockade more rapidly, with a decrease in the frequency of residual neuromuscular blockade and postoperative pulmonary complications such as pneumonias. A point to consider is that sugammadex is more expensive and is usually accompanied by higher presentations of adverse effects. KEY WORDS: sugammadex, paralysis, residual, postoperative, antagonism, neuromuscular.