223 results on '"Camilo Partezani Helito"'
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2. Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament: Triple-Strand Braided Hamstring Graft for the Anterior Cruciate Ligament and Gracilis Strand for the Anterolateral Ligament With a Single Femoral Tunnel
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Diego Ariel de Lima, M.D., Ph.D., Camilo Partezani Helito, M.D., Ph.D., and Sergio Marinho de Gusmão Canuto, M.D.
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Orthopedic surgery ,RD701-811 - Abstract
This article presents a surgical technique for combined reconstruction of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL) of the knee using hamstring tendon graft. This approach involves creating a single femoral tunnel and using a triple-strand braided hamstring graft for the ACL and a strand of the gracilis tendon for the ALL. This technique aims to increase strength and improve knee stability, potentially reducing the risk of reinjury. The described method provides anatomic reconstruction of the ACL and ALL and allows for combined reconstruction with just 1 graft donor site. Another advantage is that the triple braided graft takes on a tape-like shape, mimicking the native form of the ACL and theoretically increasing biomechanical strength. Combined reconstruction of the ALL and ACL has shown excellent results in specific patient groups, reducing graft failure and improving outcomes in patients with a high risk of rupture. Thus, we describe a promising option for ligament reconstruction in cases of combined ACL and ALL injuries. This method may be a valuable alternative for orthopaedic surgeons, combining anatomic reconstruction with the use of a single donor site.
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- 2024
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3. Efficacy of Autologous Micrografting Technology in Managing Osteoarthritis Pain: A Pilot Study
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Camilo Partezani Helito, Valeria Pessei, Cecilia Zaniboni, and Ilie Muntean
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osteoarthritis (OA) ,intra-articular injection ,knee osteoarthritis ,micrograft ,pain management ,regenerative medicine ,Technology ,Biology (General) ,QH301-705.5 - Abstract
Osteoarthritis (OA) is one of the most common joint diseases worldwide, predominantly present in elderly people. Being a major source of pain for patients, it is debilitating and leads inevitably to a reduction in quality of life. The management of OA needs a personalized and multidimensional approach, resulting in the emergence of new regenerative and non-invasive methods, such as the use of micrografts. In this pilot study, Rigenera® Technology was employed to obtain micrografts of cartilage tissue to be injected into the knees of 10 patients with osteoarthritic pain. To assess the efficacy of the treatment concerning pain reduction at this site, patients were asked to complete KOOS and WOMAC questionnaire and a VAS test before and after the procedure. The results presented in this article show how Rigenera® treatment can potentially improve OA symptoms, alleviating pain in patients.
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- 2024
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4. Tempo de exposição à radiação nas osteossínteses com hastes intramedulares nos membros inferiores
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Jonatas Brito de Alencar Neto, Camilo Partezani Helito, Jônatas Ponte Vasconcelos, Diego Freitas Félix, Luiz Holanda Pinto Neto, and Diego Ariel de Lima
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fluoroscopia ,duração da cirurgia ,fixação intramedular de fraturas ,fraturas do fêmur ,fraturas da tíbia ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objetivo: Avaliar o tempo de fluoroscopia intraoperatória em osteossínteses com haste intramedular das fraturas diafisárias do fêmur e/ou tíbia. Métodos: Estudo observacional, descritivo e retrospectivo, através de estudo dos prontuários de pacientes admitidos com fraturas na região diafisária da tíbia e/ou do fêmur e submetidos a tratamento cirúrgico com haste intramedular. Resultados: O tempo médio de fluoroscopia por procedimento foi de 239 ± 157 segundos. A comparação do tempo de fluoroscopia entre tipos de cirurgia indicou a haste retrógrada de fêmur como menor necessidade de imagens fluoroscópicas (p
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- 2023
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5. Risk Factors for Symptomatic Cyclops Lesion Formation after Anterior Cruciate Ligament Reconstruction
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Camilo Partezani Helito, Andre Giardino Moreira da Silva, Pedro Nogueira Giglio, Vitor Barion Castro de Pádua, José Ricardo Pécora, and Riccardo Gomes Gobbi
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anterior cruciate ligament ,cyclops ,knee joint ,ligaments, articular ,range of motion, articular ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Objective To evaluate the incidence of symptomatic cyclops lesions requiring surgical treatment after anterior cruciate ligament (ACL) reconstruction and to establish possible intraoperative risk factors related to it. Methods Three hundred and eighty-nine patients aged between 18 and 50 years who underwent primary ACL reconstruction were retrospectively evaluated. Patients were divided into groups according to the presence or absence of symptomatic cyclops lesions, and their characteristics were compared. Patients with associated lesions that required additional surgical procedures (except anterolateral extra-articular procedures) were not included. The rate of symptomatic cyclops lesions was recorded and the following parameters were evaluated: age, gender, time from injury to surgery, graft type and diameter, femoral tunnel perforation technique, fixation type, presence of knee hyperextension, preservation of the ACL remnant, associated anterolateral extra-articular procedure, associated meniscal injury and participation in sports. Results 389 patients were evaluated and 26 (6.7%) patients developed cyclops. The patients with and without cyclops lesions did not differ in age, time from injury to surgery, graft type or diameter, surgical technique, femoral fixation method, presence of knee hyperextension, remnant preservation and associated meniscal injury. The group with cyclops lesion had a higher proportion of females (10 (38.4%) vs 68 (18.7%); OR = 2.7; p= 0.015), higher proportion of extra-articular reconstruction (18 (11.8%) vs 8 (3.4%); OR = 3.8; p= 0.001) and higher proportion of sports practice (23 (8.6%) vs 3 (2.5%); OR = 3.6; p= 0.026). Conclusion In our series, 6.7% of the patients required arthroscopic removal of cyclops lesions. Female gender, associated extra-articular reconstruction and sports practice were factors related to this lesion. Remnant preservation had no relationship with cyclops lesion formation.
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- 2023
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6. Analysis of the Mechanical Behavior of Porcine Graft Fixation in a Polyurethane Block Using a 3D-printed PLA Interference Screw
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Juliana Pereira de Oliveira, André Luigui Bezerra Santos, Camilo Partezani Helito, Rodrigo Nogueira de Codes, Lana Lacerda de Lima, and Diego Ariel de Lima
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bone screws ,lactic acid ,printing, three-dimensional ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Objective The interest in using 3D printing in the healthcare field has grown over the years, given its advantages and potential in the rapid manufacturing of personalized devices and implants with complex geometries. Thus, the aim of the present study was to compare the mechanical fixation behavior of a 3D-printed interference screw, produced by fused deposition modeling of polylactic acid (PLA) filament, with that of a titanium interference screw. Methods Eight deep flexor porcine tendons, approximately 8 mm wide and 9 cm long, were used as graft and fixed to a 40 pounds-per-cubic-foot (PCF) polyurethane block at each of its extremities. One group was fixed only with titanium interference screws (group 1) and the other only with 3D-printed PLA screws (BR 20 2021 018283-6 U2) (group 2). The tests were conducted using an EMIC DL 10000 electromechanical universal testing machine in axial traction mode. Results Group 1 (titanium) obtained peak force of 200 ± 7 N, with mean graft deformation of 8 ± 2 mm, and group 2 (PLA) obtained peak force of 300 ± 30 N, and mean graft deformation of 7 ± 3 mm. Both the titanium and PLA screws provided good graft fixation in the polyurethane block, with no slippage or apparent deformation. In all the samples, the test culminated in graft rupture, with around 20 mm of deformation in relation to the initial length. Conclusion The 3D-printed PLA screw provided good fixation, similar to that of its titanium counterpart, producing satisfactory and promising results.
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- 2023
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7. Magnetic resonance imaging of the knee anteromedial quadrant
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Pedro Baches Jorge, Rafael Baches Jorge, Diego Escudeiro de Oliveira, Camilo Partezani Helito, Lucas Nakazone Matos da Silva, Fernanda Tami Sato, Deivis Silva Brito, and Igor Possebom
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Anterior oblique ligament ,Anteromedial quadrant ,Posteromedial corner ,Anteromedial rotatory instability ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Objective This study aims to evaluate the possibility of characterizing an extra-articular thickening in the knee anteromedial quadrant in routine MRI scans. Materials and methods Firstly, in a pilot study, for a better understanding of this extra-articular thickening trajectory in MRI, polytetrafluoroethylene (PTFE) tubes were attached to the ligament structure topography in two dissected pieces. Afterward, 100 knee MRI studies were randomly selected from our database, and 97 met the inclusion criteria. Two musculoskeletal radiologists interpreted the exams separately. Both had previously studied the ligament in the cadaveric knee MRI with the PTFE tube. Results The intraobserver and interobserver agreement for the ligament identification was calculated using Cohen’s Kappa coefficient. The first radiologist identified the structure in 41 of the 97 scans (42.2%), and the second radiologist in 38 scans (39.2%). The interobserver agreement was substantial, with a Kappa of 0.68 and an agreement of 84.5%. The results suggest that this extra-articular thickening, recently called Anterior Oblique Ligament (AOL) in the literature, is a structure that can be frequently visualized on MRI scans with a high level of interobserver agreement in a relatively large number of exams. Conclusion Therefore, this study indicates that MRI is a promising method for evaluating this anteromedial thickening, and it may be used for future studies of the Anterior Oblique Ligament.
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- 2023
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8. Combined ACL and Anterolateral Ligament Reconstruction Using an Adjustable-Loop Fixation Device: Surgical Technique
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German Alejandro Jaramillo Quiceno MD, Paula Andrea Sarmiento Riveros MD, Camilo Partezani Helito MD, PhD, Ruben Dario Arias Perez MD, BS, and Andre Giardino Moreira da Silva MD
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Sports medicine ,RC1200-1245 ,Orthopedic surgery ,RD701-811 - Abstract
Background: There are several techniques for the combined reconstruction of the anterior cruciate ligament (ACL) and the anterolateral ligament (ALL), but none have shown superiority. This study aims to present a surgical technique that theoretically reduces some of the risks reported in these procedures. Indications: The main indications for the ALL reconstruction include chronic ACL injuries, revision ACL reconstruction, acute ACL injuries in patients with high-grade pivot-shift (grades 2 or 3), patients involved in pivoting sports, and generalized ligament hyperlaxity or knee hyperextension. Technique Description: Hamstring tendon autografts are used for the ACL and ALL reconstruction; a common femoral ACL and ALL tunnel is made outside-in, making a short socket. A continuous looped hamstring tendon autograft attached to one button is used. The ACL is fixed with an adjustable-loop button. Through small incisions, the tibial fixation of both grafts is performed with bioabsorbable screws. Results: We present a 19-year-old professional soccer player with an acute ACL tear, with no associated meniscal or chondral lesions. Owing to his young age and high-risk sports practice, a combined ACL and ALL reconstruction was performed. The combined ACL and ALL reconstruction with a single femoral tunnel using the hamstrings tendons graft is a well-established procedure for ACL augmentation, reducing failure rates for certain risk groups, with excellent outcomes reported. The use of an adjustable-loop button on the femur is a viable option for this kind of reconstruction with postoperative stability comparable to the interference screw, classically used for this kind of reconstruction. Discussion/Conclusion: This technique has some advantages, such as the use of a short outside-in femoral socket, thus theoretically improving healing. In addition, this lowers the risk of lateral collateral ligament injury, and since the ileotibial band graft is not used, the risk of injuring the lateral inferior genicular vessels and the peroneal nerve is theoretically reduced. Besides, using an adjustable-loop cortical button in the femur can theoretically reduce potential complications such as screw migration, soft-tissue impingement, femoral-site pain, and implant removal. Finally, the reconstruction is done with small incisions, improving the aesthetic result and postoperative pain. Considering all the aforementioned factors, this technique theoretically offers some benefits. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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- 2024
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9. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Single Peroneus Longus Tendon Graft
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Andre Giardino Moreira da Silva, M.D., Rodrigo Sousa Macedo, M.D., Michel Oliveira Souza, M.D., Pedro Nogueira Giglio, M.D., Ph.D., Livia Dau Videira, M.D., Riccardo Gomes Gobbi, M.D., Ph.D., Alexandre Leme Godoy dos Santos, M.D., Ph.D., and Camilo Partezani Helito, M.D., Ph.D.
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Orthopedic surgery ,RD701-811 - Abstract
The peroneus longus tendon seems a viable graft option for knee ligament reconstructions, with adequate biomechanical properties and low morbidity after harvesting. The objective of this article is to describe a combined anterior cruciate ligament and anterolateral ligament reconstruction technique using a single peroneus longus tendon graft harvested from the infra malleolar region to ensure sufficient length.
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- 2024
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10. Reconstruction of the Posterior Cruciate Ligament and Medial Collateral Ligament With a Single Combined Femoral Tunnel
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Andre Giardino Moreira da Silva MD, Riccardo Gomes Gobbi MD, PhD, Marcelo Batista Bonadio MD, PhD, Fabio Janson Angelini MD, PhD, José Ricardo Pécora MD, PhD, and Camilo Partezani Helito MD, PhD
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Sports medicine ,RC1200-1245 ,Orthopedic surgery ,RD701-811 - Abstract
Background: Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries and, when they occur in isolation, they often progress with satisfactory outcomes using conservative treatment. However, MCL lesions associated with anterior cruciate ligament or posterior cruciate ligament (PCL) injuries in knee dislocations should be reconstructed to prevent failure of the central pivot. In knees with combined injuries involving the PCL and the MCL, the confluence of tunnels in the medial femoral condyle can be a potential problem during reconstruction surgery. Indications: The indication of this technique is the combined injury of the PCL and the MCL. Technique Description: The technique consists in the reconstruction of the PCL and the MCL with an Achilles tendon allograft. The bone plug of the graft is fixed on the tibial bed with the inlay technique. The graft passes through a single femoral tunnel drilled in the medial femoral condyle, with entrance point on the footprint of the PCL on the inner wall of the condyle and exit on the origin of the native MCL, near to the medial epicondyle. The graft is fixed in the femoral tunnel with an interference screw and continues to the isometric point of the anatomic insertion of the MCL in the tibia, where an interference screw is used to fix it. Results: Results from our group using this technique have shown good clinical outcomes, with complications and failure rates similar to other series in the literature. Discussion/Conclusion: This technique is an excellent option for surgeons, when an Achilles tendon allograft is available, to avoid confluence of tunnels in the medial femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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- 2023
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11. Reconstruction of the Anterior Cruciate Ligament and the Posterolateral Corner With a Single Combined Femoral Tunnel
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Andre Giardino Moreira da Silva MD, Riccardo Gomes Gobbi MD, PhD, Marcelo Batista Bonadio MD, PhD, Fabio Janson Angelini MD, PhD, José Ricardo Pécora MD, PhD, and Camilo Partezani Helito MD, PhD
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Sports medicine ,RC1200-1245 ,Orthopedic surgery ,RD701-811 - Abstract
Background: Posterolateral knee injuries can occur in 16% of patients with acute ligament injuries, and up to 70% have a combined anterior cruciate ligament (ACL) tear. Studies have shown that, in different populations, the distance between the insertion of the popliteus tendon and the lateral collateral ligament (LCL) may be smaller than the 18.5 mm previously reported in the literature. When we have an associated injury of the ACL and the posterolateral corner (PLC), the confluence of tunnels in the lateral femoral condyle can be a potential problem during reconstruction surgery. Indications: The indication of this technique is the combined injury of the ACL and the PLC. Technique Description: The reconstruction is performed with 2 semitendinosus tendons and 1 gracilis tendon. The technique consists of making a tunnel in the lateral wall of the femur, from the outside-in, at the isometric point between the origin of the LCL and insertion of the popliteus tendon, and emerging in the inner wall of the lateral femoral condyle at the anatomic point of the ACL. The graft is passed from the tibia to the femur with the doubled gracilis tendon and the 2 simple semitendinosus tendons for the ACL graft. The remaining portions of the semitendinosus tendons are left for reconstruction of the PLC structures, with one of them going straight to the posterolateral tibial tunnel (reconstructing the popliteus tendon), and the other passing through the fibular head tunnel (reconstructing the LCL) and continuing from the fibular head to the posterolateral tibial tunnel (reconstructing the popliteofibular ligament). Results: Patients undergoing this technique achieved good functional outcomes and a failure rate similar to that reported in the literature for combined ACL and PLC reconstruction. Discussion/Conclusion: This technique is an excellent option for patients with the combined injury of the ACL and the PLC, avoiding the confluence of tunnels in the lateral femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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- 2023
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12. Iliotibial band reconstruction with allograft fasciae latae tissue: Imaging aspects of a novel surgical technique
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Renata Vidal Leão, MD, Thais Rossana Cruz De Souza, MD, Paulo Victor Partezani Helito, PhD, Marcos Felippe de Paula Correa, MD, and Camilo Partezani Helito, PhD
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Knee ,Iliotibial band ,Surgery ,Allograft ,Reconstruction ,Magnetic resonance ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
We describe a unique case of 43-year-old male who presented with a persistent lateral knee pain caused by impingement between a femoral surgical screw and the iliotibial band, which was treated with surgical resection of the screw debris. The patient had reincidence of the symptoms and a magnetic resonance showed a wide and unrepairable tear of the iliotibial band, which was treated with interposition of a folded fasciae latae allograf. After the procedure, the patient had excellent clinical results and imaging evaluation showed progressive allograft integration. This case highlights the imaging findings and surgical aspects of an iliotibial band reconstruction, a novel surgical procedure that could be considered in patients with an unrepairable iliotibial band injury.
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- 2023
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13. THE USE OF ADHESIVE RADIOPAQUE GRIDS IN GENICULAR NERVE BLOCK BY RADIOSCOPY
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DANIEL PEIXOTO LEAL, MATHEUS GARCIA LOPES MERINO, MUHAMAD MUSTAFA ATIEH, VITOR HENRIQUE CAMPOY GUEDES, JOSE RICARDO PECORA, and CAMILO PARTEZANI HELITO
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Nerve Block ,Orthopedic Surgeons ,Peripheral Nerves ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT The performance of genicular nerve block requires an imaging method to guide the procedure. Radioscopy has the disadvantage of being radiation dependent. Objective: To assess whether the use of adhesive radiopaque grids reduce radiation exposure in these cases. Methods: This is a cross-sectional study conducted with 23 orthopedists in which needles were positioned in a model with and without the use of adhesive radiopaque grids. The number of fluoroscopy shots necessary for proper positioning in three points (superior lateral, superior medial, and inferior medial) were registered. Results: A statistical difference was observed in the three blocking points studied. The number of radioscopies required for these three points were 12.1 ± 2.5 in the group without grid and 5.0 ± 1.8 in the group with grid. The superior medial point presented the greatest numerical difference and the inferior medial point the smallest. Conclusion: The use of adhesive radiopaque grids led to a statistically significant reduction in the number of radioscopies/fluoroscopies required to perform the genicular block. The use of this device increases the safety of the physician and patient by reducing radiation exposure in this procedure. Level of Evidence III, Level of Evidence II, Random Clinical Trial.
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- 2023
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14. Combined All-Inside Anterior Cruciate Ligament Reconstruction With Semitendinosus Plus Anterolateral Ligament Reconstruction With Intact Gracilis Tibial Insertion and Transtibial Passage
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Daniel Almeida Neto e Santos, M.D., José Leonardo Rocha de Faria, M.D., M.Sc., Tiago Carminatti, M.D., M.Sc., Rafael Erthal de Paula, M.D., M.Sc., Vitor Barion Castro de Pádua, M.D., Ph.D., Douglas Melo Pavão, M.D., Ph.D., Robert F. LaPrade, M.D., Ph.D., and Camilo Partezani Helito, M.D., Ph.D.
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Orthopedic surgery ,RD701-811 - Abstract
The indications for combining anterior cruciate ligament reconstruction with anterolateral ligament reconstruction have increased considerably in recent years since several anatomical, clinical, and biomechanical studies have proven the importance of the anterolateral periphery in knee rotational stability. Much is still being discussed on how to combine these techniques in terms of which grafts and fixation options to use, as well as avoiding tunnel convergence. This study aims to describe anterior cruciate ligament reconstruction with a triple-bundle semitendinosus tendon graft all-inside technique combined with an anterolateral ligament reconstruction maintaining the gracilis tendon insertion on the tibia, using independent anatomical tunnels. With this, we were able to reconstruct both using only hamstring autografts, reducing morbidity in other possible donor areas, in addition to allowing stable fixation of both grafts without tunnel convergence.
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- 2023
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15. Anterior Cruciate and Anterior Oblique Ligament Reconstruction Using Hamstrings and Peroneus Longus’ Anterior Half Grafts
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Pedro Baches Jorge, M.D., M.sC., Melanie Mayumi Horita, M.D., Marconde de Oliveira e Silva, M.D., Sérgio Marinho de Gusmão Canuto, M.D., Camilo Partezani Helito, M.D., Ph.D., and Diego Escudeiro de Oliveira, M.D., M.sC.
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Orthopedic surgery ,RD701-811 - Abstract
Anterior cruciate ligament injuries are common in high school and college with an estimated 120,000 cases per year in the United States. Most sports injuries occur without direct contact, and knee valgus with external rotation of the foot is the most common movement. This movement may be related to the injury of the anterior oblique ligament located in the anteromedial quadrant of the knee. This technical note presents anterior cruciate ligament reconstruction with extraarticular anteromedial reinforcement using hamstring and the anterior half of the peroneus longus grafts.
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- 2023
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16. Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction
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Camilo Partezani Helito, Andre Giardino Moreira da Silva, Tales Mollica Guimarães, Marcel Faraco Sobrado, José Ricardo Pécora, and Gilberto Luis Camanho
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Revision ACL reconstruction ,Enlarged ACL tibial tunnel ,Anterolateral ligament ,ACL ,ALL ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Background Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction. Methods Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales. Results Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery. Conclusion The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.
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- 2022
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17. Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis
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Diego Ariel de Lima, Lana Lacerda de Lima, Nayara Gomes Reis de Souza, Rodrigo Amorim de Moraes Perez, Marcel Faraco Sobrado, Tales Mollica Guimarães, and Camilo Partezani Helito
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Anterolateral ligament ,Anterior cruciate ligament ,Combined reconstruction ,Isolated reconstruction ,Clinical outcomes ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Objectives To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. Methods A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were “anterior cruciate ligament” OR “acl” AND “anterolateral ligament” AND “reconstruction.” Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use “anatomical” techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p
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- 2021
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18. ANATOMICAL STUDY OF THE POSTEROLATERAL LIGAMENT COMPLEX OF THE KNEE: LCL AND POPLITEUS TENDON
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MARCEL FARACO SOBRADO, CAMILO PARTEZANI HELITO, LUCAS DA PONTE MELO, ANDRE MARANGONI ASPERTI, RICCARDO GOMES GOBBI, and FABIO JANSON ANGELINI
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Knee ,Knee Dislocation ,Tendons ,Knee Injuries ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To analyse the distances between the femoral insertions of the popliteus tendon (PT) and the lateral collateral ligament (LCL) through dissections of cadaveric specimens in a mixed population. Methods: Fresh cadavers were dissected, and the anthropometric data of all specimens were recorded. The distances from the origin of the PT to the LCL in the femoral region and the diameter of each structure were measured using a digital calliper. Results: In total, 11 unpaired knees were dissected, eight men and three women, with an average age of 71.5 ± 15.2 years, weight of 57.2 ± 15.6 kg, and a mean height of 170.5 ± 8.2 cm. The distance from the center of the femoral footprint of the LCL to the PT was 10.0 ± 2.4 mm. The distances between the edges closest to each other and those more distant from each other were 3.1 ± 1.1 mm and 16.3 ± 2.4 mm, respectively. Conclusion: The distance between the midpoints of the PT and the LCL in our mixed population is smaller than the distances often reported in the literature. PLC reconstruction with separate tunnels for the LCL and PT may not be technically possible for individuals of any population. Level of Evidence III, Diagnostic studies.
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- 2021
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19. THREE-DIMENSIONAL PRINTING IN ORTHOPEDICS: WHERE WE STAND AND WHERE WE ARE HEADING
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LEANDRO EJNISMAN, CAMILO PARTEZANI HELITO, ANDRÉ FERRARI DE FRANÇA CAMARGO, BRUNO ARAGÃO ROCHA, ANDRÉ MATHIAS BAPTISTA, and OLAVO PIRES DE CAMARGO
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Orthopedics ,Printing ,Three-Dimensional ,Models ,Anatomic ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Three-dimensional printing is a technology in expansion in the medical field. It also presents many applications in orthopedics. Our review article aims to describe 3D printing, types of 3D printers, and its use in the orthopedic field. 3D models can be created using tomography scans. Those models can then be manipulated, even simulating surgeries. It is possible to print biomodels, which will help us understand deformities and plan surgeries. Orthopedic surgeons must be updated in these disruptive technologies that may help their daily practice. Level of Evidence V, Expert opinion.
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- 2021
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20. LEVER SIGN TEST FOR CHRONIC ACL INJURY: A COMPARISON WITH LACHMAN AND ANTERIOR DRAWER TESTS
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MARCEL FARACO SOBRADO, MARCELO BATISTA BONADIO, GABRIEL FERNANDES RIBEIRO, PEDRO NOGUEIRA GIGLIO, CAMILO PARTEZANI HELITO, and MARCO KAWAMURA DEMANGE
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Anterior Cruciate Ligament ,Anterior Cruciate Ligament Injuries ,Knee Joint ,Joint Instability ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: This study aims to evaluate the sensitivity and specificity of the lever sign test in patients with and without chronic Anterior Cruciate Ligament (ACL) injuries in an outpatient setting and the inter-examiner agreement of surgeons with different levels of experience. Methods: 72 consecutive patients with a history of previous knee sprains were included. The Lachman, anterior drawer, and Lever Sign tests were performed for all subjects in a randomized order by three blinded raters with different levels of experience. Sensitivity, specificity, positive predictive value, negative predictive value, and inter-rater agreement were estimated for all tests. Results: Among the 72 patients, the prevalence of ACL injuries was 54%. The lever test showed sensitivity of 64.1% (95% CI 0.47-0.78) and specificity of 100% (95% CI 0.87-1.00) for the senior examiner. For the less experienced examiner the sensitivity was 51.8% and the specificity was 93.7%. Positive predictive values (PPV) and negative predictive values (NPV) were 100% and 70.2%, respectively. Conclusion: Lever Sign test shows to be a maneuver of easy execution, with 100% specificity and 100% PPV. Moderate agreement between experienced examiners and low agreement among experienced and inexperienced examiners was found. This test may play a role as an auxiliary maneuver. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.
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- 2021
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21. HOW TO PERFORM A META-ANALYSIS: A PRACTICAL STEP-BY-STEP GUIDE USING R SOFTWARE AND RSTUDIO
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Diego Ariel de Lima, Camilo Partezani Helito, Lana Lacerda de Lima, Renata Clazzer, Romeu Krause Gonçalves, and Olavo Pires de Camargo
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Meta-Analysis ,Guideline ,Software ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Meta-analysis is an adequate statistical technique to combine results from different studies, and its use has been growing in the medical field. Thus, not only knowing how to interpret meta-analysis, but also knowing how to perform one, is fundamental today. Therefore, the objective of this article is to present the basic concepts and serve as a guide for conducting a meta-analysis using R and RStudio software. For this, the reader has access to the basic commands in the R and RStudio software, necessary for conducting a meta-analysis. The advantage of R is that it is a free software. For a better understanding of the commands, two examples were presented in a practical way, in addition to revising some basic concepts of this statistical technique. It is assumed that the data necessary for the meta-analysis has already been collected, that is, the description of methodologies for systematic review is not a discussed subject. Finally, it is worth remembering that there are many other techniques used in meta-analyses that were not addressed in this work. However, with the two examples used, the article already enables the reader to proceed with good and robust meta-analyses. Level of Evidence V, Expert Opinion.
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- 2022
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22. Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention
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Bruno Alves Rudelli, Pedro Nogueira Giglio, Vladimir Cordeiro de Carvalho, José Ricardo Pécora, Henrique Melo Campos Gurgel, Ricardo Gomes Gobbi, José Riccardo Negreiros Vicente, Ana Lucia Lei Munhoz Lima, and Camilo Partezani Helito
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Periprosthetic joint infection ,Total hip arthroplasty ,Total knee arthroplasty ,Multidrug resistant bacteria ,Complications ,Acute post-operative infection ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. Methods All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. Results Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p
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- 2020
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23. The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention
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Camilo Partezani Helito, Marcel Faraco Sobrado, Pedro Nogueira Giglio, Marcelo Batista Bonadio, José Ricardo Pécora, Marco Kawamura Demange, and Riccardo Gomes Gobbi
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Negative-pressure wound ,Wound dehiscence ,Knee arthroplasty ,Wound complication ,Periprosthetic joint infection ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Wound healing complications are causal factors of prosthesis infection and poor postoperative evolution of patients after total knee arthroplasty (TKA). Negative-pressure wound therapy (NPWT) can be an option to minimize these complications. The aim of this study is to compare the complications of patients undergoing TKA who used a portable NPWT device in the immediate postoperative period with those of a control group. Methods A total of 296 patients were evaluated. Patients were divided into two groups: those who used NPWT for seven days in the postoperative period (Group 1 – prospective evaluated) and those who used conventional dressings (Group 2 – historical control group). Epidemiological data, comorbidities, local parameters related to the surgical wound and complications were evaluated. Results The groups did not differ in regard to sex, age and clinical comorbidities. Overall, 153 (51.7%) patients had at least one risk factor for wound complications. Patients who used NPWT had a lower rate of complications (28.5% vs. 45.7%, p = 0.001) and a lower rate of reintervention in the operating room (2% vs. 8.5%, p = 0.001). Patients in group 1 had a lower incidence of hyperaemia (14.7% vs. 40.2%, p = 0.01), skin necrosis (2.1% vs. 8.5%, p = 0.04) and wound dehiscence (3.1% vs 10.1%, p = 0.03). The use of NPWT was a protective factor for the presence of complications, with an odds ratio of 0.36 (95% CI 0.206–0.629). Conclusion The number of complications related to the wound after TKA is high; however, most of them are minor and have no impact on the treatment and clinical evolution of patients. The use of NPWT decreased the number of surgical wound complications, especially hyperaemia, dehiscence and necrosis, and reduced the need for reintervention.
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- 2020
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24. REVIEW OF TOTAL KNEE ARTHROPLASTY AND THE BRAZILIAN UNIFIED HEALTH SYSTEM: A NATIONAL PROBLEM
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Lucas da Ponte Melo, Guilherme Augusto Losso, Guilherme Henrique Ricardo da Costa, José Ricardo Pécora, Marco Kawamura Demange, and Camilo Partezani Helito
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Reviews ,Arthroplasty ,Knee ,Public Health ,Osteoarthritis ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objectives: To analyze, through DATASUS data, the historical trend of revision of total knee arthroplasty (TKA) in the period between 2008-2016 and to relate them to demographic, regional and national aspects. Methods: Elaboration of a historical series between the period 2008-2016, using the database of DATASUS, in the area of Health Information (TABNET). In order to calculate the incidence, the total number of TKA revisions and as denominator the total national, regional or state population for the period studied was used as numerator. Results: The national rate of procedures per 100,000 inhabitants varied between 0.41 and 0.48 in the analyzed period (mean of 0.44). The Southeast region, with 69% of the SBCJ accredited services and 61% of the SBCJ members, was responsible for 60% of the absolute number of procedures performed in Brazil. Conclusions: In absolute numbers, the Southeast region has the highest volume of procedures. However, the highest rate is found in the South region. The North, Northeast and Central-West regions presented unsatisfactory results, well below the others. Level of evidence IV, Economic and decision analysis - development of economic model or decision.
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- 2019
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25. EXTRA-ARTICULAR RECONSTRUCTION ASSOCIATED WITH THE ANTERIOR CRUCIATE LIGAMENT IN BRAZIL
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Camilo Partezani Helito, Carlos do Amaral Junior, Danilo Bordini Camargo, Marcelo Batista Bonadio, Jose Ricardo Pecora, and Marco Kawamura Demange
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Anterior cruciate ligament ,Anterolateral ligament ,Knee joint ,Joint instability ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To assess the knowledge and technical preferences of Brazilian knee surgeons in relation to the treatment of Anterior Cruciate Ligament (ACL) injuries using intra-articular reconstruction in combination with extra-articular reconstruction. Methods: A questionnaire consisting of 16 questions about intra-articular ACL reconstruction in combination with extra-articular procedures and about the Anterolateral Ligament (ALL) was applied at the 48th Brazilian Congress of Orthopedics. Results: One hundred thirty-seven surgeons answered the questionnaire. Most surgeons perform 10-30 ACL reconstructions per year, with the transtibial technique appearing as the most common. Most surgeons find some percentage of residual pivot-shift after reconstructions, but the minority performs extra-articular procedures on a routine basis. The main indications for extra-articular reconstruction are revision and profuse pivot-shift cases. Most surgeons consider the ALL a true ligament, but 46.7% with less biomechanical importance and 32.3% with greater importance in knee stability. However, 91.4% had a positive perception of the reconstruction of this structure. Conclusion: Although the preferred technique is still the transtibial procedure, combined anatomical reconstructions already make up more than 50% of cases. Extra-articular reconstructions associated with the ACL are still performed by the minority of Brazilian surgeons, but 91.4% of them report having had a positive perception with their reconstruction. Level of Evidence III, Descriptive Study.
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- 2019
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26. Anterolateral ligament of the knee: a step-by-step dissection
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Diego Ariel de Lima, Camilo Partezani Helito, Matthew Daggett, Francisco Magalhães Monteiro Neto, Lana Lacerda de Lima, José Alberto Dias Leite, and Maria Luzete Costa Cavalcante
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Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background The number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL. Methods Twenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL. Results A transverse incision is performed in the iliotibial band (ITB), around 10 cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy’s tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60° flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy’s tubercle and the fibula (4.0 mm to 7.0 mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.0 ± 0.4 cm and mean width of 5.5 ± 0.8 mm. Conclusions The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study.
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- 2019
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27. PROTOCOL FOR TREATING ACUTE INFECTIONS IN CASES OF TOTAL KNEE ARTHROPLASTY
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Jose Ricardo Pecora, Ana Lucia Munhoz Lima, Camilo Partezani Helito, Riccardo Gomes Gobbi, Marco Kawamura Demange, and Gilberto Luis Camanho
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Arthroplasty, replacement, knee/methods ,Arthroplasty, replacement, knee/adverse effects ,Infection ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To retrospectively evaluate the results after applying a protocol for treating acute infections in cases of total knee arthroplasty and to establish factors predictive of success or failure. Methods: Thirty-two patients who were diagnosed with acute infection of the knee following total arthroplasty between 2004 and 2009 were retrospectively evaluated. Infections following arthroplasty were treated in accordance with the protocol for acute infections following arthroscopy recommended at our institution. Results: With application of a treatment protocol for acute infections following total knee arthroplasty, 26 patients (81.2%) had good results and 6 (18.8%) had unsatisfactory results. Statistical analysis showed that the variables correlated with a worse prognosis were age (p = 0.038) and number of surgical debridement procedures performed (p = 0.038). Conclusion: Our treatment routine was effective for infection. Prosthesis revision was performed in 2 cases when the initial surgical debridement failed to control the infection. Nível de Evidência IV, Série de casos.
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- 2019
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28. The role of viscosupplementation in patellar chondropathy
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Sergio Ricardo da Costa, Roberto Freire da Mota e Albuquerque, Camilo Partezani Helito, and Gilberto Luis Camanho
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Diseases of the musculoskeletal system ,RC925-935 - Abstract
Patellar chondropathy has a high incidence in the general population, being more common in patients younger than 50 years, female and recreational athletes, and overweight and obese patients. The most common complaints are pain, limited mobility, crepitus, difficulty climbing and descending stairs, and joint instability, usually showing unsatisfactory results with anti-inflammatory, physiotherapy, rehabilitation, and many other conservative treatment methods. The presumed hyaluronic acid (HA) disease-modifying activity may include effects on cartilage degradation, endogenous HA synthesis, synoviocyte and chondrocyte function, and other cellular inflammatory processes. Currently, HA is widely used as a safe and effective conservative treatment for osteoarthritis in the knee and other joints. HA improves the physiological environment in an osteoarthritic joint and the shock absorption and lubrication properties of the osteoarthritic synovial fluid, thus restoring the protective viscoelasticity of the synovial HA, reducing the pain, and improving the mobility. The complete mechanism of HA in the joint is not fully understood, but a wide range of actions in the joint is recognized. Its anti-inflammatory, analgesic, and chondroprotective action is related to the modulation of the intra- and extracellular inflammation cascade. HA has been shown to be safe and effective in the treatment of pain related to patellar chondropathy.
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- 2021
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29. Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel
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Camilo Partezani Helito MD, PhD, Tales Mollica Guimarães MD, and Marcel Faraco Sobrado MD
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Sports medicine ,RC1200-1245 ,Orthopedic surgery ,RD701-811 - Abstract
Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.
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- 2021
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30. Alternative Techniques for Lateral and Medial Posterior Root Meniscus Repair Without Special Instruments
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Camilo Partezani Helito, M.D., Ph.D., Lucas da Ponte Melo, M.D., Tales Mollica Guimarães, M.D., Marcel Faraco Sobrado, M.D., Paulo Victor Partezani Helito, M.D., José Ricardo Pécora, M.D., Ph.D., and Riccardo Gomes Gobbi, M.D., Ph.D.
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Orthopedic surgery ,RD701-811 - Abstract
Improved understanding and treatment of posterior medial and lateral meniscus root tears have attracted increasing interest. These lesions significantly compromise meniscal function, which can result in an outcome resembling total meniscectomy, and are also a potential cause of knee instability. Despite facilitating repair procedures and reducing the operative time for these lesions, all-inside meniscal repair devices are not available in all circumstances or registered for use in all countries worldwide. Furthermore, all-inside arthroscopic devices can be expensive. Therefore, low-cost alternatives for the treatment of these lesions must be identified. We present 2 efficient and safe techniques: an outside-in technique for repairing medial meniscus root tears and a technique using a simple needle inserted through the transtibial tunnel for lateral meniscal root repairs, neither of which requires the use of specific instruments, thus enabling appropriate treatment of posterior medial and lateral meniscus root tears.
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- 2020
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31. INCISIONAL NEGATIVE-PRESSURE WOUND THERAPY IN REVISION TOTAL HIP ARTHROPLASTY DUE TO INFECTION
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Helder de Souza Miyahara, Felipe Ribeiro Serzedello, Leandro Ejnisman, Ana Lúcia Lei Munhoz Lima, José Ricardo Negreiros Vicente, and Camilo Partezani Helito
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Negative-pressure wound therapy ,Arthroplasty, replacement, hip ,Surgical wound dehiscence ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To present our institution's experience with negative-pressure wound therapy (NPWT) as an adjuvant in wound healing of patients who have undergone revision total hip arthroplasty (THA) due to septic loosening in the presence of active fistula. Methods: We prospectively assessed patients presenting with THA infection, associated with the presence of fistula, treated with a PICO® device for NPWT, in combination with the standard treatment for prosthesis infection in our institution. Resolution of the infectious process and healing of the surgical wound without complications were considered an initial favorable outcome. Results: We assessed 10 patients who used PICO® in our department. No complications were identified in association with the use of the NPWT device. The mean follow-up of the patients after use of the device was 12.7 months. Only one patient progressed with fistula reactivation and recurrence of infection. Conclusion: NPWT can be used in wound complications and infection following THA procedures safely and with promising results. Randomized prospective studies should be conducted to confirm its effectiveness. Level of Evidence IV, Case Series.
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- 2018
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32. NEGATIVE-PRESSURE WOUND THERAPY IN THE TREATMENT OF COMPLEX INJURIES AFTER TOTAL KNEE ARTHROPLASTY
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Camilo Partezani Helito, Daniel Kamura Bueno, Pedro Nogueira Giglio, Marcelo Batista Bonadio, José Ricardo Pécora, and Marco Kawamura Demange
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Negative-pressure wound therapy ,Arthroplasty, replacement, knee ,Surgical wound dehiscence ,Infection ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To present an experience with negative-pressure wound therapy (NPWT) in the treatment of surgical wounds in patients treated for infections after total knee arthroplasty (TKA) with or without dehiscence and prophylaxis in wounds considered at risk of healing problems. Methods: We prospectively evaluated patients with TKA infection with or without surgical wound dehiscence and patients with risk factors for infection or surgical wound complications treated with Pico(r) device for NPWT in addition to standard treatment of infection or dehiscence in our institution. We considered as an initial favorable outcome the resolution of the infectious process and the closure of the surgical wound dehiscences in the treated cases and the good progression of the wound without complicating events in the prophylactic cases. Results: We evaluated 10 patients who used Pico(r) in our service. All patients had a favorable outcome according to established criteria. No complications were identified regarding the use of the NPWT device. The mean follow-up of the patients after the use of the device was 10.5 months. Conclusion: The NPWT can be safely used in wound infections and complications following TKA with promising results. Long-term randomized prospective studies should be conducted to prove its effectiveness. Level of Evidence IV, Case Series.
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- 2017
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33. Comparison of Floseal® and Tranexamic Acid for Bleeding Control after Total Knee Arthroplasty: a Prospective Randomized Study
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Camilo Partezani Helito, Marcelo Batista Bonadio, Marcel Faraco Sobrado, Pedro Nogueira Giglio, José Ricardo Pécora, Gilberto Luis Camanho, and Marco Kawamura Demange
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Total Knee Arthroplasty ,Bleeding Control ,Tranexamic Acid ,Hemostatic ,Transfusion Rate ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseal® have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal® and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseal® (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseal® and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseal® group. Both TXA and Floseal® had significantly less output than the control group, and Floseal® had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseal® was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal® showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal® group.
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- 2019
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34. PLATEAU-PATELLA ANGLE: AN OPTION FOR ASSESSING PATELLAR HEIGHT ON PROXIMAL TIBIA OSTEOTOMY
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MARCELO BATISTA BONADIO, JÚLIO AUGUSTO DO PRADO TORRES, VICENTE MAZZARO FILHO, CAMILO PARTEZANI HELITO, RICCARDO GOMES GOBBI, and MARCO KAWAMURA DEMANGE
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Patellar ligament ,Osteotomy ,Knee. ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To compare the plateau-patella angle method to the methods already established for patellar height measurement in patients undergoing high tibial osteotomy. Methods: This is a retrospective study of 13 patients undergoing medial opening tibial osteotomy. The patellar height was measured in pre and post-operative radiographs by the methods from Insall-Salvati, Caton-Deschamps, Blackburne-Peel and patella-plateau angle, as well as the tibial slope and length of the patellar tendon. Measurements were performed by two knee surgeons at two different times. Results: The mean age was 41.33 ± 01.09 years old. The average rates of Caton-Deschamps, Blackburne-Peel, Insall-Salvati and plateau-patella angle were, respectively, 1.00; 0.89; 1.10; and 23.15° preoperatively, and 0.89; 0.78; 1.11; and 20.46°, postoperatively. The correlation of Caton-Deschamps, Blackburne-Pell, and Insall-Salvati indexes and plateau-patellar angle interobserver was 0.72 (p
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- 2016
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35. KNEE ARTHROPLASTY REVISION WITH A CONSTRAINED IMPLANT USING HINGE AND ROTATING TIBIAL BASIS
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Fabio Jansen Angelini, Camilo Partezani Helito, Bruno Azevedo Veronesi, Tales Mollica Guimarães, José Ricardo Pécora, and Marco Kawamura Demange
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Arthroplasty, replacement, knee ,Prostheses and Implants ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To evaluate the results of total knee arthoplasty revisions performed in high complexity cases, with large bone defects or serious ligament deficiencies using a constrained implant hinge associated to a rotating tibial basis. Methods: We evaluated 11 patients in which we used the constrained implant hinge associated to rotating tibial basis, with minimum follow-up of two years. The indications for the procedure included instability, septic loosening, late postoperative infection without loosening and periprosthetic fracture. We evaluated the knee range of movement and functional outcomes by the Knee Society Score (KSS) e Knee Injury and Osteoarthritis Outcome Score (KOOS), besides the presence of complications. Results: All patients achieved 5o to 85o minimum range of motion at 1 year postoperatively and, in the present evaluation, KSS ranged from 67 to 95. Three patients had no complications until the last evaluation and two patients required implant revision. Conclusion: Despite the complications rate observed, the functional result were acceptable for most patients, and it proved being a viable alternative, especially for patients with low functional demand. Level of Evidence IV, Case Series.
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- 2016
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36. Advances in treating exposed fractures
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Pedro Nogueira Giglio, Alexandre Fogaça Cristante, José Ricardo Pécora, Camilo Partezani Helito, Ana Lucia Lei Munhoz Lima, and Jorge dos Santos Silva
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Fraturas expostas ,Ferimentos e lesões ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.
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- 2015
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37. Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination
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Camilo Partezani Helito, Marco Kawamura Demange, Paulo Victor Partezani Helito, Hugo Pereira Costa, Marcelo Batista Bonadio, Jose Ricardo Pecora, Marcelo Bordalo Rodrigues, and Gilberto Luis Camanho
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Joelho ,Instabilidade articular ,Imagem por ressonância magnética ,Anatomia ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJECTIVE: To evaluate the presence of the anterolateral ligament (ALL) of the knee in magnetic resonance imaging (MRI) examinations.METHODS: Thirty-three MRI examinations on patients' knees that were done because of indications unrelated to ligament instability or trauma were evaluated. T1-weighted images in the sagittal plane and T2-weighted images with fat saturation in the axial, sagittal and coronal planes were obtained. The images were evaluated by two radiologists with experience of musculoskeletal pathological conditions. In assessing ligament visibility, we divided the analysis into three portions of the ligament: from its origin in the femur to its point of bifurcation; from the bifurcation to the meniscal insertion; and from the bifurcation to the tibial insertion. The capacity to view the ligament in each of its portions and overall was taken to be a dichotomous categorical variable (yes or no).RESULTS: The ALL was viewed with signal characteristics similar to those of the other ligament structures of the knee, with T2 hyposignal with fat saturation. The main plane in which the ligament was viewed was the coronal plane. Some portion of the ligament was viewed clearly in 27 knees (81.8%). The meniscal portion was evident in 25 knees (75.7%), the femoral portion in 23 (69.6%) and the tibial portion in 13 (39.3%). The three portions were viewed together in 11 knees (33.3%).CONCLUSION: The anterolateral ligament of the knee is best viewed in sequences in the coronal plane. The ligament was completely characterized in 33.3% of the cases. The meniscal portion was the part most easily identified and the tibial portion was the part least encountered.
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- 2015
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38. Clinical and epidemiological differences between septic arthritis of the knee and hip caused by oxacillin-sensitive and -resistant s. aureus
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Camilo Partezani Helito, Bruno Bonganha Zanon, Helder de Souza Miyahara, Jose Ricardo Pecora, Ana Lucia Munhoz Lima, Priscila Rosalba de Oliveira, Jose Ricardo Negreiros de Vicente, Marco Kawamura Demange, and Gilberto Luis Camanho
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Knee Infection ,Hip Infection ,Septic Arthritis ,MRSA ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE: To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. METHODS: All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). RESULTS: S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). CONCLUSION: Provenance from a health service-related environment was associated with a higher incidence of MRSA-related septic arthritis, suggesting that this agent should be considered in the initial choice of antibiotic treatment. Previous surgeries of the knee or affected limb and the absence of leukocytes might also be related to infection with this agent.
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- 2015
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39. Epidemiology of sports injuries on collegiate athletes at a single center
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Bruno Berbert Rosa, André Marangoni Asperti, Camilo Partezani Helito, Marco Kawamura Demange, Tiago Lazzaretti Fernandes, and Arnaldo José Hernandez
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Athletic injuries ,Knee ,Ankle ,Epidemiology ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJECTIVE: To evaluate the incidence of sports injuries in college athletes from the same institution from 1993 to 2013. METHODS: Athletes from 13 modalities were interviewed about the presence and type of injury, type of treatment and time of withdrawal, based on the questionnaire "Injury Surveillance System" (ISS). Data were analyzed with graphs and tables of injury prevalence by gender, age, site of injury and modality. We also analyzed the average time of withdrawal of athletes, returning to sports practice and new lesions. RESULTS: It was observed that 49.91% of the athletes showed some type of injury, with similar incidence between genders; the most frequent injuries were the anterior cruciate ligament (ACL) and the ankle sprain; the average withdrawal time was 11 weeks. ACL was the injury with greater impact on college sports career, especially given the time of withdrawal. CONCLUSION: The most frequent injury, ACL, occurred most frequently in indoor sports such as handball and volleyball and had the highest number of cases treated with surgery and a longer average withdrawal time. More studies are needed to create a larger database in order to schedule preventive measures for amateur athletes. Level IV of Evidence, Epidemiological Study.
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- 2014
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40. Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty
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Camilo Partezani Helito, Jader Joel Machado Junqueira, Ricardo Gomes Gobbi, Fábio Janson Angelini, Marcia Uchoa Rezende, Luis Eduardo Passarelli Tírico, Marco Kawamura Demange, Roberto Freire da Mota e Albuquerque, José Ricardo Pécora, and Gilberto Luis Camanho
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Arthroplasty ,Knee Prosthesis ,Wound Infection ,Oxygen Inhalation Therapy ,Postoperative Complications ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. METHOD: A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. RESULTS: There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. CONCLUSION: Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.
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- 2014
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41. Clinical and epidemiological characteristics of septic arthritis of the hip, 2006 to 2012, a seven-year review
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Helder de Souza Miyahara, Camilo Partezani Helito, Guilherme Batista Oliva, Paulo César Aita, Alberto Tesconi Croci, and José Ricardo Negreiros Vicente
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Hip ,Infection ,Arthritis ,Infectious ,Epidemiologic Studies ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE:To epidemiologically characterize the population treated at our orthopedic clinic with a diagnosis of septic arthritic of the hip between 2006 and 2012.METHODS:Fifteen patients diagnosed with septic arthritis of the hip between 2006 and 2012 were retrospectively evaluated. The patients' clinical and epidemiological characteristics were surveyed; a sensitivity profile relating to the microorganisms that caused the infections and the complications relating to the patients' treatment and evolution were identified.RESULTS:Septic arthritis was more common among males. Most diagnoses were made through positive synovial fluid cultures, after joint drainage was performed using the Smith-Petersen route. Among the comorbidities found, the most prevalent were systemic arterial hypertension, diabetes mellitus, and human immunodeficiency virus. The pathological joint conditions diagnosed prior to joint infection were osteoarthrosis and developmental dysplasia of the hip. The infectious agent most frequently isolated was Staphylococcus aureus. From the clinical and laboratory data investigated, 53.33% of the cases presented with fever, and all except one patient presented with increased measures in inflammation tests. Gram staining was positive in only 26.66% of the synovial fluid samples analyzed. Six patients presented with joint complications after treatment was administered.CONCLUSION:S. aureus is the most common pathogen in acute infections of the hip in our setting. Factors such as clinical comorbidities are associated with septic arthritis of the hip. Because of the relatively small number of patients, given that this is a condition of low prevalence, there was no statistically significant correlation in relation to worse prognosis for the disease.
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- 2014
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42. Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo
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Camilo Partezani Helito, Guilherme Guelfi Noffs, Jose Ricardo Pecora, Riccardo Gomes Gobbi, Luis Eduardo Passarelli Tirico, Ana Lucia Munhoz Lima, Priscila Rosalba de Oliveira, and Gilberto Luis Camanho
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Infectious and parasitic diseases ,RC109-216 ,Microbiology ,QR1-502 - Abstract
Background: Septic arthritis is an infrequent disease although very important due to the possibility of disastrous outcomes if treatment is not adequately established. Adequate information concerning the epidemiology of septic arthritis is still lacking due to the uncommon nature of the disease as well as the struggle to establish a correct case-definition. Objective: To epidemiologically characterize the population seen at Hospital das Clínicas, University of São Paulo with a diagnosis of septic arthritis between 2006 and 2011. Methods: Sixty-one patients diagnosed with septic arthritis of the knee between 2006 and 2011 were retrospectively evaluated. The patients’ clinical and epidemiological characteristics, the microorganisms that caused the infection and the patients’ treatment and evolution were analyzed. Results: Septic arthritis of the knee was more common among men, with distribution across a variety of age ranges. Most diagnoses were made through positive synovial fluid cultures. The most prevalent clinical comorbidities were systemic arterial hypertension and diabetes mellitus, and the most commonly reported joint disease was osteoarthritis. Staphylococcus aureus was the prevailing pathogen. Fever was present in 36% of the cases. All patients presented elevation in inflammatory tests. Gram staining was positive in only 50.8% of the synovial fluid samples analyzed. Six patients presented complications and unfavorable evolution of their condition. Conclusion: S. aureus is still the most common pathogen in acute knee infections in our environment. Gram staining, absence of fever and normal leukocyte count cannot be used to rule out septic arthritis. Keywords: Knee, Infection, Septic arthritis, Epidemiology
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- 2014
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43. Complications after total knee arthroplasty: periprosthetic fracture after extensor mechanism transplantation
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Camilo Partezani Helito, Leonardo Pozzobon, Riccardo Gomes Gobbi, Jose Ricardo Pecora, and Gilberto Luis Camanho
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Artroplastia do joelho ,Complicacoes pos-operatorias ,Infeccao ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
With the increase in total knee replacements in Brazil there is also an increase in the number of complications. The authors report a case in which 3 serious complications happened after a total knee replacement and the treatment was based on the literature, but individualized to the patient in some important points. The outcome was considered very good.
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- 2013
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44. Retalhos de rotação para cobertura após artroplastia total de joelho
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Leonardo Rafael Pozzobon, Camilo Partezani Helito, Tales Mollica Guimarães, Riccardo Gomes Gobbi, José Ricardo Pécora, and Gilberto Luis Camanho
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Artroplastia ,Infecção ,Retalhos cirúrgicos ,Joelho ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJETIVO: Avaliar os resultados obtidos com o uso de retalhos miocutâneos de rotação local nos casos de deiscência da ferida operatória após artroplastia total de joelho. MÉTODOS: Os pacientes submetidos a esse procedimentos cirúrgicos foram selecionados no período de 2000 a 2012. Os nove casos selecionados neste período foram submetido a retalhos de cobertura devido a deiscência de pele associada a infecção. Em oito casos utilizamos retalhos de rotação local do gastrocnêmio medial e um caso de avanço de pele. RESULTADOS: Em 89% destes casos houve sucesso quanto à cobertura da prótese e viabilidade dos retalhos. Em quatro casos foi possível manter ou revisar a prótese. Outros quatro casos evoluíram com necessidade de amputação por falha no tratamento infeccioso e um caso permaneceu sem a prótese. A avaliação funcional mostrou um resultado insatisfatório em 89% desses casos. CONCLUSÃO: Os retalhos de cobertura são uma boa opção para o tratamento dos casos de deiscência com exposição da prótese e que o insucesso funcional esteve associado à falha no controle do quadro infeccioso e aos danos causados por este. Nível de Evidência IV, Série de Casos.
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- 2013
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45. Anatomical study on the anterolateral ligament of the knee
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Camilo Partezani Helito, Helder de Souza Miyahara, Marcelo Batista Bonadio, Luis Eduardo Passareli Tirico, Riccardo Gomes Gobbi, Marco Kawamura Demange, Fabio Janson Angelini, Jose Ricardo Pecora, and Gilberto Luis Camanho
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Cadaver ,Dissecacao ,Joelho ,Ligamento cruzado anterior/anatomia & histologia ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJECTIVE: Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. METHODS: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. RESULTS: The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed. CONCLUSION: The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.
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- 2013
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46. Enxerto homólogo de mecanismo extensor em artroplastia total do joelho
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Camilo Partezani Helito, Riccardo Gomes Gobbi, Mateus Ramos Tozi, Alessandro Monterroso Félix, Fábio Janson Angelini, and José Ricardo Pécora
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Joelho ,Artroplastia ,Transplante homólogo ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJETIVO: Analisar a experiência com transplante homologo do mecanismo extensor nas artroplastias totais do joelho e comparar resultados com experiência internacional. MÉTODOS: Foram avaliados retrospectivamente três casos de transplante homologo do mecanismo extensor após artroplastia total do joelho que foram realizados em nosso serviço com apoio de um dos poucos bancos de tecidos brasileiros e tentamos estabelecer se nossa experiência foi similar à reportada na literatura internacional quanto a indicação do paciente, técnica utilizada e resultados. RESULTADOS: Dois casos evoluíram bem com o procedimento e um caso apresentou resultado insatisfatório evoluindo para amputação. Assim como mostra a literatura, tensão adequada do enxerto, fixação tibial apropriada e principalmente seleção precisa do paciente são os melhores preditores de bom resultado. CONCLUSÃO: O procedimento em questão tem indicação precisa, apesar de incomum, tanto pela raridade da problemática quanto pela baixa demanda de enxertos devido aos poucos bancos de tecidos no Brasil. Nível de Evidência IV, Série de Casos.
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- 2013
47. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction
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Bertrand Sonnery-Cottet, M.D., Matt Daggett, D.O., M.B.A., Camilo Partezani Helito, M.D., Jean-Marie Fayard, M.D., and Mathieu Thaunat, M.D.
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Orthopedic surgery ,RD701-811 - Abstract
Despite technologic advances in the surgical technique for anterior cruciate ligament (ACL) reconstruction, some patients continue to have rotational instability postoperatively. Recently, authors have reported the anatomic and functional characteristics of the anterolateral ligament (ALL), a structure that originates near the lateral epicondyle on the femur and inserts on the tibia between the Gerdy tubercle and the fibular head. Recent biomechanical studies have shown the ALL is an important stabilizer against anterolateral tibial rotation, and its reconstruction has shown excellent initial clinical results. Several techniques have been developed to try to anatomically address this structure in the setting of an ACL reconstruction. This article details a simple anatomic technique to reconstruct the ACL and the ALL of the knee using hamstring tendon autograft and maintaining the semitendinosus insertion.
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- 2016
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48. Valor da avaliação radiográfica pré-operatória dos defeitos ósseos no joelho nas revisões de artroplastia Value of preoperative radiographic evaluations on knee bone defects for revision arthroplasty
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Mauricio Masasi Iamaguchi, Camilo Partezani Helito, Riccardo Gomes Gobbi, Marco Kawamura Demange, Luiz Eduardo Passarelli Tirico, Jose Ricardo Pecora, and Gilberto Luis Camanho
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Defeitos Ósseos ,Revisão de Artroplastia Total do Joelho ,Radiografia ,Bone Defects ,Total Knee Arthroplasty Revision ,Radiography ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJETIVO: Avaliar o valor da avaliação radiográfica pré-operatória nas revisões de artroplastias totais do joelho. MÉTODOS: Trinta e um joelhos operados no período de 2006 a 2008 em uma série consecutiva de casos de cirurgia de revisão de artroplastia total de joelho foram analisados retrospectivamente. CRITÉRIOS ANALISADOS: número de cunhas ou enxertos ósseos estruturados utilizados para preenchimento dos defeitos ósseos; localização das cunhas e enxertos ósseos utilizados e espessura média do polietileno utilizada. A classificação AORI era estabelecida previamente através de radiografias pré-operatórias segundo critérios preestabelecidos. Após a análise, os joelhos foram divididos em quatro grupos (I, IIA, IIB e III). RESULTADOS: O número médio de cunhas ou enxertos ósseos utilizados em cada joelho variou de maneira crescente entre os grupos (grupo I: 1,33; grupo IIA: 2; grupo IIB: 4,33; grupo III: 4,83) (P = 0,0012). As localizações mais comuns foram: medial na tíbia e posteromedial no fêmur. Não houve diferença estatisticamente significante na espessura do polietileno utilizado. CONCLUSÃO: A classificação AORI para defeitos ósseos no joelho baseada em radiografias pré-operatórias mostrou correlação crescente com a necessidade de utilização de cunhas e/ou enxertos estruturados na revisão de artroplastia total do joelho. Porém, até 46% dos joelhos dos grupos I e IIA apresentaram falhas ósseas de até 5mm não diagnosticadas através das radiografias pré-operatórias.OBJECTIVE: To evaluate the value of preoperative radiographic evaluations for total knee arthroplasty (TKA) revision. METHODS: Thirty-one knees that were operated between 2006 and 2008, in a consecutive series of cases of TKA revision surgery were analyzed retrospectively. THE FOLLOWING CRITERIA WERE EVALUATED: number of wedges or structured bone grafts used for filling the bone defects; locations of the wedges and bone grafts used; and mean thickness of the polyethylene used. The AORI classification was previously established based on preoperative radiographs, using preestablished criteria. After the analysis, the knees were divided into four groups (I, IIA, IIB and III). RESULTS: The mean number of wedges or grafts used in each knee progressively increased among the groups (group I: 1.33; group IIA: 2; group IIB: 4.33; and group III: 4.83) (P = 0.0012). The commonest locations were medial in the tibia and posteromedial in the femur. There were no statistically significant differences in the thickness of the polyethylene used. CONCLUSION: The AORI classification for bone defects in the knee, based on preoperative radiographs, showed a correlation with increasing need to use wedges and/or structured grafts in TKA revisions. However, up to 46% of the knees in groups I and IIA presented bone defects of up to 5 mm that were not diagnosed by means of preoperative radiographs.
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- 2012
49. Resultados do procedimento artroscópico de 'remplissage' na luxação anterior recidivante do ombro Results from filling 'remplissage' arthroscopic technique for recurrent anterior shoulder dislocation
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Mauro Emilio Conforto Gracitelli, Camilo Partezani Helito, Eduardo Angeli Malavolta, Arnaldo Amado Ferreira Neto, Eduardo Benegas, Flávia de Santis Prada, Augusto Tadeu Barros de Sousa, Jorge Henrique Assunção, and Edwin Eiji Sunada
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Instabilidade Articular ,Luxação do Ombro ,Artroscopia ,Recidiva ,Joint Instability ,Shoulder Dislocation ,Arthroscopy ,Recurrence ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJETIVO: Avaliar o resultado clínico da técnica de "remplissage" associada ao reparo da lesão de Bankart (BK) para o tratamento da luxação anterior recidivante do ombro. MÉTODOS: Nove pacientes (10 ombros), com seguimento médio de 13,7 meses, apresentaram luxação traumática anterior recidivante do ombro. Todos tinham lesão de BK associada à lesão de Hill e Sachs (HS), com sinal do "encaixe". O defeito das lesões de HS foi medido e apresentava em média 17,3% (7,7% a 26,7%) de perda óssea em relação ao diâmetro da cabeça do úmero. Todos foram submetidos ao reparo artroscópico da lesão de BK associado ao preenchimento ("remplissage") da lesão de HS pela tenodese do infraespinal. RESULTADOS: O escore de Rowe variou de 22,5 (10 a 45) no período pré-operatório para 80,5 (5 a 100) no período pós operatório (p < 0,001). O escore da UCLA variou de 18,0 (8 a 29) para 31,1 (21 a 31) (p < 0,001). As medidas das rotações externa e interna, em 90º de abdução no período pós-operatório, foram 63,5º (45º a 90º) e 73º (50º a 92º), respectivamente. Dois pacientes apresentaram recidiva (um com luxação e outro com subluxações). Nenhum paciente apresentou dor na topografia do tendão infraespinal no período pós-operatório. CONCLUSÃO: A técnica de "remplissage" por artroscopia demonstrou, a curto prazo, melhora dos escores funcionais e baixo índice de complicações no tratamento da instabilidade glenoumeral associada às lesões de Hill-Sachs.OBJECTIVE: To evaluate the clinical result from the filling ("remplissage") technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. METHODS: Nine patients (10 shoulders), with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the "engaging" sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3% (7.7% to 26.7%) in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. RESULTS: The Rowe score ranged from 22.5 (10 to 45) before the operation to 80.5 (5 to 100) after the operation (p < 0.001). The UCLA score ranged from 18.0 (8 to 29) to 31.1 (21 to 31) (p < 0.001). The measurements of external and internal rotation at abduction of 90º after the operation were 63.5º (45º to 90º) and 73º (50º to 92º) respectively. Two patients presented recurrence (one with dislocation and the other with subluxation). None of the patients presented pain in the region of the infraspinatus tendon after the operation. CONCLUSION: Over the short term, the filling ("remplissage") arthroscopic technique produced improvements in functional scores and a low complication rate when used for treating glenohumeral instability associated with Hill-Sachs lesions.
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- 2011
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50. Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee
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Marcelo Batista Bonadio, Camilo Partezani Helito, Lucas Archanjo Gury, Marco Kawamura Demange, José Ricardo Pécora, and Fábio Janson Angelini
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Knee ,Magnetic resonance imaging ,Physical examination ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
OBJECTIVE: Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. METHODS: We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. RESULTS: We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). CONCLUSION: Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis. Level of Evidence II. Diagnostic Studies.
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- 2014
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