99 results on '"Eduardo Branco de Sousa"'
Search Results
2. Update of clinical aspects of knee osteoarthritis: data mining from NMR-based metabolomics of synovial fluid
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Mario Correa Netto Pacheco Junior, Ramon Pinheiro Aguiar, Diego Pinheiro Aguiar, Gilson Costa dos Santos Junior, and Eduardo Branco de Sousa
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metabolomics ,metabolic syndrome ,osteoarthritis ,synovial fluid ,Medicine - Abstract
Introduction: Knee osteoarthritis (OA) is a prevalent disease which leads to progressive disability. There is increasing evidence of the association between OA with metabolic syndrome. Metabolomics emerges as a promising tool for investigation of this connection. The goal of this study was to correlate the metabolic profile of synovial fluid of patients with and without knee osteoarthritis with clinical factors related to the development of metabolic syndrome (MetS) based on the reanalysis of a patient’s database from our previous study. Methods: Patients were divided in two groups: without osteoarthritis (OA), who underwent knee arthroscopy (n = 8; K-L Grade 0) and with knee OA (KOA), who underwent total knee arthroplasty surgery (n = 26, K-L Grades 3 and 4). From a database of synovial fluid metabolomic analysis by nuclear magnetic resonance, clinical data were collected from medical records, including age, sex, height and weight, and fasting blood glucose levels. Then, multivariate analysis was performed to identify the possibility of distinguishing different subgroups of patients based on clinical factors potentially associated with osteoarthritis and MetS. Results: Metabolic analysis was able to differentiate patients without osteoarthritis from those with osteoarthritis, based on metabolic profile, with glycerol being the increased metabolite in the group of patients with osteoarthritis. However, metabolomics was not able to classify patients into subgroups according to blood glucose ranges, body mass index and by age. Conclusion: In a population with osteoarthritis, metabolic analysis evidences a slightly different profile in the analysis by age and BMI, or age and glycaemia. Keywords: Metabolomics; Metabolic syndrome; Osteoarthritis; Synovial fluid.
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- 2024
3. Perfil epidemiológico dos pacientes atendidos em programa de acompanhamento e tratamento da osteoartrite do joelho: estudo observacional e transversal
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Pedro Felipe Araújo de Paula Santos, Vitor Pereira da Silva, Phelippe Augusto Valente Maia, Alan de Paula Mozella, Marcia Cristina Chagas Macedo Pinheiro, Sandra Tie Minamoto, and Eduardo Branco de Sousa
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epidemiologia ,joelho ,osteoartrite ,tratamento conservador ,Medicine - Abstract
Introdução: A osteoartrite (OA) é principal causa de diminuição da função articular, com impacto nas atividades da vida diária. O objetivo do estudo foi avaliar o perfil epidemiológico dos pacientes atendidos em um ambulatório de tratamento conservador da osteoartrite do joelho em uma instituição de nível terciário do Sistema Único de Saúde. Métodos: Foi realizado um estudo observacional e transversal avaliando 577 pacientes com osteoartrite do joelho submetidos a tratamento farmacológico, no período de setembro de 2014 a abril de 2019. Foram coletados os seguintes dados epidemiológicos: sexo; data de nascimento; peso e altura; lateralidade; gravidade da OA, pela classificação de Ahlback, modificada por Keyes e Goodfellow; presença de crepitação articular e desvio do eixo dos membros inferiores. Resultados: Não foi observada diferença entre os grupos em relação a gravidade da OA (p = 0,75), sexo (p=0,90), presença de crepitação articular (p=0,57), lateralidade (p=0,89), desvio do eixo dos membros inferiores (p=0,75), nem histórico de tratamentos prévios (p=0,46). Conclusão: O perfil da população de pacientes com osteoartrite do joelho submetidos ao tratamento conservador, em sua maioria, é do sexo feminino, com obesidade e idade superior a 60 anos. Os graus II e III de Ahlback são preponderantes.
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- 2024
4. Treatment of Chondral Lesions in the Knee
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José Paulo Aramburu Gabbi Filho and Eduardo Branco de Sousa
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cell transplantation ,cartilage, articular ,knee injuries ,microfracture ,chondrocytes ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Articular cartilage injuries are common and lead to early joint deterioration and osteoarthritis. Articular cartilage repair techniques aim at forming a cartilaginous neo-tissue to support the articular load and prevent progressive degeneration. Several techniques are available for this purpose, such as microfracture and chondrocyte transplantation. However, the procedural outcome is often fibrocartilage, which does not have the same mechanical resistance as cartilaginous tissue. Procedures with autologous osteochondral graft have a morbidity risk, and tissue availability limits their use. As such, larger lesions undergo osteochondral transplantation using fresh or frozen grafts. New techniques using minced or particulate cartilage fragments or mesenchymal stem cells are promising. This paper aims to update the procedures for treating chondral lesions of the knee.
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- 2023
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5. Evaluation of multiple doses of tranexamic acid on blood loss in total knee arthroplasty
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Victor Elias Titonelli, Douglas Mello Pavão, Pedro Purita Paes Leme, Renan Teixeira Lobo Teixeira Lobo, Rodrigo Sattamini Pires e Albuquerque, and Eduardo Branco de Sousa
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Blood loss, surgical ,Arthroplasty, replacement, knee ,Osteoarthritis, knee ,Tranexamic acid. ,Medicine - Abstract
Objective: To evaluate the efficacy of multiple doses of tranexamic acid (TXA) in blood loss in patients undergoing total knee arthroplasty (TKA). Methods: Seven patients of both genders over 50 years old undergoingTKA, who received 15 mg/kg intravenous (IV) TXA 30 minutes before the surgical incision and another 3 doses thereafter were included in this report. Blood loss analysis included blood loss at the drain, hemoglobin loss, and estimated blood loss. Statistical analysis was performed. Results: There was a significant hemoglobin drop after 48 hours, compared to preoperative. Mean blood loss assessed by drain was 20.0 ± 25.17 mL after 24 h. Estimated blood loss was higher after 48 hours compared to 24 hours. No complications were reported in this sample, and no patient received transfusions. Conclusion: The use of TXA in multiple doses did not prevent the drop in postoperative hemoglobin levels and did not correlate with increased complications.
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- 2023
6. Neuropathic-like symptoms and central sensitization related signs and symptoms negatively affect the functional performance of patients with knee osteoarthritis – a cross-sectional study
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Enrico Seixas Goldoni, Juliana Valentim Bittencourt, Lanucia Ranhol do Espirito Santo, Eduardo Branco de Sousa, José Leonardo Rocha de Faria, Dângelo José de Andrade Alexandre, and Leandro Alberto Calazans Nogueira
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Osteoarthritis ,Knee ,Neuropathic pain ,Central sensitization ,Functionality ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Objective: This study aimed to compare the functional performance among participants with a neuropathic-like symptoms (NS) and central sensitization related signs and symptoms (CS), and their knee osteoarthritis (OA) counterparts. Methods: A cross-sectional observational study was conducted with 125 participants with knee OA (94 females, mean age 63.1 ± 7.4 years). Participants completed a self-reported questionnaire with personal and clinical features and musculoskeletal pain characteristics, including NS (PainDETECT), CS (Central Sensitization Inventory, CSI), and conditioned pain modulation. Self-reported functional disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and functional mobility (Timed Up and Go, TUG) were compared among patients with NS, CS, and their knee OA counterparts using the one-way analysis of variance (ANOVA). Results: Thirty-three (26.4%) participants had NS and CS, eighteen (14.4%) had NS, twenty-seven (21.6%) participants had CS, and 47 (37.6%) had knee OA with no NS or CS. A one-way ANOVA revealed greater functional limitation in the group with NS and CS (mean = 67.5 ± 12.0) or NS (mean = 56.7 ± 17.5) than the group without these symptoms (mean = 32.0 ± 20.7) with a statistical significance difference [F(3, 121) = 29.434, p
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- 2023
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7. Influence of type I collagen polymorphisms and risk of anterior cruciate ligament rupture in athletes: a case-control study
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Jamila Alessandra Perini, Lucas Rafael Lopes, João Antonio Matheus Guimarães, Rodrigo Araújo Goes, Luiz Fernando Alves Pereira, Camili Gomes Pereira, Marcelo Mandarino, Alfredo Marques Villardi, Eduardo Branco de Sousa, and Victor Rodrigues Amaral Cossich
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Collagen ,ACL rupture ,Polymorphisms ,Athletes ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Anterior cruciate ligament (ACL) rupture is a common and severe knee injury in sports and occurs mostly due to noncontact injuries. There is an increasing amount of evidence associating ACL rupture to single nucleotide polymorphisms (SNPs), and SNPs in the collagen type I genes can change its expression and tissue mechanical features. This study aimed to investigate the association between SNPs in COL1A1 and COL1A2 with sports-related ACL tears. Methods A total of 338 athletes from multiple sports modalities were analyzed: 146 were diagnosed with ACL rupture or underwent an ACL reconstruction surgery and 192 have no musculoskeletal injuries. SNPs were genotyped using validated TaqMan assays. The association of the polymorphisms with ACL rupture was evaluated by a multivariable logistic regression model, using odds ratios (OR) and 95% confidence intervals (CI). Results The age, sport modality, and training location were associated with an increased risk of a non-contact ACL tear. COL1A2 SNPs (rs42524 CC and rs2621215 GG) were associated with an increased risk of non-contact ACL injury (6 and 4-fold, respectively). However, no significant differences were detected in the distribution of COL1A1 rs1107946 and COL1A2 rs412777 SNPs between cases and controls. There was a protective association with ACL rupture (OR = 0.25; 95% CI = 0.07–0.96) between COL1A1 rs1107946 (GT or TT) and the wildtype genotypes of the three COL1A2 (rs412777, rs42524, rs2621215). COL1A2 rs42524 and rs2621215 SNPs were associated with non-contact ACL risk. Conclusion The combined analysis of COL1A1-COL1A2 genotypes suggests a gene-gene interaction in ACL rupture susceptibility.
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- 2022
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8. Impacto orçamentário da Diacereína no tratamento da osteoartrite de joelho
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Cristiane Rocha de Oliveira, Ivan Ricardo Zimmermann, Eduardo Branco de Sousa, and Roberto Carlos Lyra da Silva
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Análise de impacto orçamentário ,Farmacoeconomia ,Osteoartrite do joelho ,Custos da doença ,Ortopedia. ,Pharmacy and materia medica ,RS1-441 ,Pharmaceutical industry ,HD9665-9675 - Abstract
Objetivos: conhecer os custos e estimar o impacto orçamentário do Instituto Nacional de Traumatologia e Ortopedia sobre o uso da diacereína no tratamento medicamentoso oferecido aos pacientes ambulatoriais com osteoartrite do joelho. Método: foram desenvolvidas etapas para a análise de impacto orçamentário incremental, descrevendo o cenário de linha de base e o conjunto de medicamentos já utilizados na instituição; descrevendo o cenário alternativo com inserção de diacereína e estimando o custo direto da introdução deste medicamento para a fração de pacientes elegíveis. As estimativas serão convertidas em dólares e euros, utilizando a taxa de câmbio do dia 29 de dezembro de 2017, segundo banco central. Dados públicos foram consultados a partir do cadastro de compras governamentais e do sistema informatizado do Instituto. Análise de sensibilidade determinística e probabilística foi aplicada para verificar o impacto de incertezas e pressupostos. O horizonte temporal de cinco anos foi considerado na comparação dos cenários. A análise foi feita sob a perspectiva dos gestores da instituição. Resultados: um perfil dos pacientes ambulatoriais com osteoartrites que recebem tratamento no Instituto; medicamentos mais prescritos neste Instituto e seus custos diretos de aquisição. O impacto orçamentário da diacereína como terapia adjuvante foi estimado para este cenário. Houve um aumento de 6% nos custos institucionais de compra de medicamentos. Conclusões: a análise do impacto orçamentário da diacereína no tratamento da osteoartrite de joelho permite aos gestores da instituição o planejamento de recursos e implementação de estratégias para tal tratamento, assim como, elaboração de um protocolo clínico e diretrizes terapêuticas para esta população específica.
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- 2022
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9. HIGHER RISK OF COMPLICATIONS AFTER TOTAL KNEE ARTHROPLASTY IN OCTOGENARIANS
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Gabriel Garcez de Araujo Souza, Raphael Soejima Correia Ramalho, Rodrigo Sattamini Pires e Albuquerque, João Maurício Barretto, Rafael Souza Mançãno Chaves, and Eduardo Branco de Sousa
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Arthroplasty. Knee. Postoperative Complications. Aged ,80 and over ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: To evaluate the complication rate of total knee arthroplasty (TKA) in octogenarian patients and identify predictive factors. Methods: The study comprised 70 octogenarians and 70 non-octogenarian patients as control group, all submitted to TKA. We analyzed the medical records of these patients, seeking for complications during the first postoperative year. Regarding the risk factors, we evaluated: age, sex, race, American Society of Anesthesiologists score, body mass index, smoking, hypertension and diabetes mellitus. Results: In the control group, the incidence of complications was 7.1%. Whereas in the octogenarian group it was significantly higher, reaching 34.3% (OR 6.8; 95% CI 2.4-19.1). We found no association to sex, skin color, and comorbidities. Age is an independent risk factor for postoperative complications. Our data may help patients to acknowledge the risks of undergoing primary TKA and physicians to assess and adjust perioperative risk. Conclusion: The incidence of postoperative complications is significantly higher in octogenarians. Level of Evidence III, Case-control study.
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- 2020
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10. Insatisfação e complicações pós-cirúrgicas caracterizam erro médico?
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Douglas Mello Pavão, Fernando Carneiro Werneck, José Leonardo Rocha de Faria, Victor Elias Titonelli, Rodrigo Sattamini Pires e Albuquerque, and Eduardo Branco de Sousa
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Erros Médicos ,Complicações Intraoperatórias ,Public aspects of medicine ,RA1-1270 - Abstract
Nota-se atualmente um crescente número de processos judiciais a médicos, com base em uma suposta quebra de contrato ao direito do consumidor, onde se exige do profissional médico resultados, enquanto este, pelo código de ética médica e bom senso, tem obrigação de meios. O objetivo deste estudo foi discutir os resultados, satisfação e complicações de três das principais cirurgias ortopédicas à nível do joelho (área de atuação dos autores) com o fim de estabelecer diferenças entre erro e insucesso, próprio do ato médico. Concluímos que a imperfeição faz parte da natureza humana e que, por diversos motivos, as cirurgias ortopédicas complicam, falham e pacientes ficam insatisfeitos, independente do grau de recursos que o profissional disponha, o que não caracteriza erro médico.
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- 2021
11. Posterior Root Repair of Medial Meniscus Combined With Valgus Opening Wedge Tibial Osteotomy
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José Leonardo Rocha de Faria, M.D., M.Sc., Douglas Mello Pavão, M.D., M.Sc., Marcos de Castro Moreirão, M.D., Victor Elias Titonelli, M.D., M.Sc., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., Sandra Tie Nishibe Minamoto, M.D., M.Sc., Marcelo Mandarino, M.D., M.Sc., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5° for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear.
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- 2021
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12. BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI)
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Gustavo Constantino de Campos, Eduardo Branco de Sousa, Paulo César Hamdan, Cyro Scala de Almeida Júnior, Antonio Martins Tieppo, Marcia Uchôa de Rezende, Adrieni Antunes do Amaral Alchaar, Carlos Bruno Pinheiro, Eduardo de Melo Carvalho Rocha, Fabiano Gonçalves Cunha, Ivan Pacheco, Mário Sérgio Rossi Vieira, Sílvio Figueira Antonio, and Zartur José Barcelos Menegassi
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Osteoarthritis ,Knee ,Viscosupplementation ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. Conclusion: This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.
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- 2019
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13. Bodyweight distribution between limbs, muscle strength, and proprioception in traumatic transtibial amputees: a cross-sectional study
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Carlos Henrique da Silva Fontes Filho, Conrado Torres Laett, Ubiratã Faleiro Gavilão, José Carlos de Campos Jr, Dângelo José de Andrade Alexandre, Victor R.A. Cossich, and Eduardo Branco de Sousa
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Body Weight ,Amputation ,Muscle Strength ,Proprioception ,Position Sense ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: To evaluate how transtibial amputation (TT) affects bodyweight distribution, voluntary knee joint position sense (JPS), and quadriceps (QUA) and hamstrings (HAM) strength in prosthetized patients. METHODS: Only TT patients who had been prosthetized for more than one year were included, and an age-paired able-bodied group was used as control. The participants stood on force plates with their eyes open to measure bodyweight distribution between the limbs. Knee voluntary JPS was assessed by actively reproducing a set of given arbitrary joint angles using a video analysis approach, and QUA and HAM strength were assessed isometrically with a hand-held dynamometer. RESULTS: Sixteen TT subjects (age: 39.4±4.8 years) and sixteen age-paired control subjects (age: 38.4±4.3 years) participated in the study. The amputees supported their bodyweight majorly on the sound limb (54.8±8.3%, p
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- 2021
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14. Stress Radiography for Multiligament Knee Injuries: A Standardized, Step-by-Step Technique
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José Leonardo Rocha de Faria, M.D., Igor Stefano Menescal Pedrinha, M.D., Douglas Mello Pavão, M.D., M.Sc., Rodrigo Pires e Albuquerque, M.D., M.Sc., Ph.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., Marcelo Mandarino, M.D., M.Sc., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
Physical examination in the presence of a multiligament knee injury can be complex and challenging. Hence, stress radiography is a useful and inexpensive tool that is widely used in the assessment of this type of injury. It guarantees an objective analysis of the magnitude of knee instability, which may reduce the observer's interpretation bias in relation to the physical examination. However, for the radiographic analysis to be reproducible, it is necessary to standardize the technique to evaluate each of the main knee ligaments. This article aims to describe in detail how to perform stress radiography to assess the sufficiency of the posterior cruciate ligament and collateral ligaments in the context of a multiligament injury.
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- 2020
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15. Outside-in Continuous Meniscal Suture Technique of the Knee
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José Leonardo Rocha de Faria, M.D., M.Sc., Douglas Mello Pavão, M.D., M.Sc., Vitor Barion Castro de Padua, M.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., João Matheus Guimarães, M.D., M.Sc., Ph.D., Berliet Assad Gomes, M.D., M.Sc., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the “Meniscus 4-All suture device.” The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique.
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- 2020
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16. Vertical Continuous Meniscal Suture Technique
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José Leonardo Rocha de Faria, M.D., Douglas Mello Pavão, M.D., M.Sc., Raphael Serra Cruz, M.D., M.Sc., Eduardo Branco de Sousa, M.D., Ph.D., João Matheus Guimarães, M.D., Ph.D., Marcelo Costa de Oliveira Campos, M.D., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device.
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- 2020
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17. Posterior Meniscal Root Repair Using a Meniscal Suture Device
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José Leonardo Rocha de Faria, M.D., Douglas Mello Pavão, M.D., M.Sc., Igor Stefano Menescal Pedrinha, M.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., João Matheus Guimarães, M.D., M.Sc., Ph.D., Berliet Assad Gomes, M.D., M.Sc., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
A greater understanding of the deleterious consequences that a meniscal root tear brings to the knee joint and how its surgical repair can be advantageous over the previously used treatment strategies brings the need for the development of surgical techniques that make the procedure less complex and more reproducible. When meniscal root rupture occurs, a mechanical overload occurs in the affected compartment similar to a total meniscectomy. Several authors have concluded that meniscal root reinsertion significantly improves postoperative outcomes and patient satisfaction, regardless of age or laterality of the meniscal injury. The Meniscus 4 A-II device (Rio de Janeiro, Brazil) allows stitching at the root of the medial and lateral menisci. In this article, we describe the surgical repair technique for posterior-medial and -lateral meniscal root tears using this meniscal suture device. This technique is fast and effective.
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- 2020
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18. Continuous Meniscal Suture Technique of the Knee
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José Leonardo Rocha de Faria, M.D., Douglas Mello Pavão, M.D., M.Sc., Alfredo Marques Villardi, M.D., M.Sc., Ph.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., João Matheus Guimarães, M.D., M.Sc., Ph.D., José Maurício de Morais Carmo, M.D., M.Sc., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
The menisci are fibroelastic structures interposed between the articular surfaces of the femur and tibia. They absorb impact and transmit load. Meniscal injury may compromise function and cause rapid joint degeneration, leading to the development of secondary osteoarthritis. Surgical treatment of meniscal injury is usually performed by arthroscopy, and meniscectomy or meniscal suture may be associated with such treatment. Meniscal suture should be considered when the injury compromises the proper functioning of the meniscus to recover its anatomy and function. Different meniscal suture techniques exist; the most widely used are the inside-out, outside-in, and all-inside techniques. The gold-standard repair technique is the inside-out technique. A drawback of this technique is the need to alternate between intra- and extra-articular structures for every stitch, which makes it even more laborious. We describe the continuous meniscal suture technique, also called “meniscal stitching,” for a medial meniscal bucket-handle injury. This technique is performed from the inside out and allows the surgeon to perform multiple stitches with the same thread quickly and effectively. This surgical technique is performed using a single meniscal suture device that was developed by our group, called the “Meniscus 4 A-II” device.
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- 2020
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19. How to Perform a Giant Parameniscal Cyst Exeresis: Step by Step Technique
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José Leonardo Rocha de Faria, M.D., Douglas Mello Pavão, M.D., M.Sc., Marcos de Castro Moreirão, M.D., Hugo Alexandre de Barros Cobra, M.D., M.Sc., Rodrigo Pires e Albuquerque, M.D., M.Sc. , Ph.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions.
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- 2020
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20. Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages
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José Leonardo Rocha de Faria, M.D., Matheus de Barros Carvalho, M.D., André Cavalcante Marques, M.D., Naasson Trindade Cavanellas, M.D., M.Sc., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., João Mauricio Barretto, M.D., M.Sc., Ph.D., and Alan de Paula Mozella, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
Patellar tendon rupture is an uncommon but disabling lesion. It usually occurs in men younger than 40 years, through direct or indirect trauma. Obtaining satisfactory results with treatment of chronic injuries and re-ruptures in which the patella retracts owing to quadriceps contraction is a challenge. This is of major concern especially in cases in which the patella cannot be positioned in its anatomic position when distal traction is performed. In these cases, V-Y stretching of the quadriceps can be performed in an attempt to perform reconstruction in 1 stage. Instead, a 2-stage procedure can be chosen, in which the first stage relies on patellar trans-skeletal traction to achieve distalization of the patella. In 1981, a technique for the treatment of chronic injuries of the patellar tendon in 2 stages was described. In that procedure, the first stage consisted of transpatellar traction and the second stage was tendon-tendon suturing with fascia lata reinforcement. We describe a surgical technique performed in 2 stages; in the first stage, trans-skeletal traction is performed, and in the second stage, the technique of Kelikian et al. with our modification is performed. This technique is used in patients with chronic rupture of the patellar tendon associated with a high patella with nonreducible quadriceps shortening.
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- 2020
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21. Positioning Technique of the Fixed Knee in Hyperflexion for the Transportal Femoral Tunnel During Reconstruction of the Anterior Cruciate Ligament
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José Leonardo Rocha de Faria, M.D., Douglas Melo Pavão, M.D., M.Sc., Fernando Carneiro Werneck, M.D., Marcos de Castro Moreirão, M.D., Pedro José Labronici, M.D., M.Sc., Ph.D., Alan de Paula Mozella, M.D., M.Sc., and Eduardo Branco de Sousa, M.D., M.Sc., Ph.D.
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Orthopedic surgery ,RD701-811 - Abstract
During reconstruction surgery of the anterior cruciate ligament, the evolution of the femoral tunnel from the transtibial to the transportal path provides greater accuracy in reaching the desired anatomic point. However, there are also some new challenges, such as correct execution, reproducibility, and minimizing the risk of iatrogenic injury from its use. In an effort to overcome these challenges, we have proposed the use of a positioner, which was developed by our group and allows the leg to stay in the desired position, without variations in the operation or aid from a medical assistant. This manuscript presents our femoral tunnel preparation technique and its application in clinical practice.
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- 2020
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22. Intraoperative morphometric study of distal femur in Brazilian patients undergoing total knee arthroplasty.
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Fabrício Bolpato Loures, Rogério Franco de Araújo Góes, Eduardo Branco de Sousa, Naasson Cavanellas, João Maurício Barretto, Marcel Jun Sugawara Tamaoki, Rodrigo Sattaminni Pires E Albuquerque, and Pedro José Labronici
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Medicine ,Science - Abstract
BACKGROUND:Total knee arthroplasty (TKA) is the treatment option for patients with severe osteoarthritis (OA) of the knee whose symptoms are refractory to conservative management. Unfortunately, the level of patient dissatisfaction is high, reaching up to 25%. The reasons for this dissatisfaction are multifactorial, but bone-implant mismatch significantly increases the chance of pain and functional limitation. Sex-specific prosthesis designs have been developed to overcome this issue, but their use is still controversial. The primary objective of this study was to evaluate possible sex differences in the shape of the distal femur in patients with osteoarthritis. Secondary objectives were to investigate interpersonal variability of the distal femur and to determine the number of femoral implant sizes required to meet shape variations. METHODS AND FINDINGS:A cross-sectional observational study prospectively compared 294 knees of 293 patients with osteoarthritis according to sex (201 female/93 male). Six intraoperative measurements were performed on the distal femur (height and width of both lateral and medial condyles, total medial-lateral width of the femur, and intercondylar distance). Sex differences and interpersonal variability were analyzed by multiple linear regressions. Measurements were also correlated with patient height. An optimization analysis was used to estimate the number of femoral implant sizes required. There were significant sex differences in the distal femur, where men had higher values than women in all measurements. Great interpersonal variability was found. The height of the lateral condyle was correlated with patient height, but the correlation was not strong. Twenty-five femoral implant sizes were required to meet the shape variations in our sample. CONCLUSIONS:The shape of the distal femur in patients with osteoarthritis shows great interpersonal variability, with men showing significantly higher values than women. A total of 25 different implant sizes would be necessary to adequately meet the variations observed in our study population.
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- 2020
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23. Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial
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Phelippe Augusto Valente Maia, Victor Rodrigues Amaral Cossich, José Inacio Salles-Neto, Diego Pinheiro Aguiar, and Eduardo Branco de Sousa
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Dexamethasone ,Hyaluronic Acid ,Osteoarthritis ,Viscosupplementation ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: This study aimed to evaluate the clinical outcomes of intra-articular infiltration with hyaluronic acid and dexamethasone alone and in combination in the treatment of knee osteoarthritis (OA). METHOD: This prospective randomized trial evaluated 44 patients undergoing treatment for OA. Patients were selected through clinical and radiological analysis using the American College of Rheumatology criteria. We included patients aged between 50 and 70 years who presented with K-L stage ≤2 knee OA and normal limb alignment. Patients with a previous history of knee injury (ligamentous, meniscal or traumatic), infection, patellofemoral OA or chondroprotective drug use in the previous year were excluded. Participants were randomized into 3 groups and underwent treatment with viscosupplementation (VS, n=16), viscosupplementation plus dexamethasone (VD, n=16) or dexamethasone (DX, n=12). All patients were evaluated before and 6 weeks, 3 months and 6 months after infiltration. Analysis included a physical examination, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire (total score and domain subscores) and an evaluation of knee extensor and flexor strength and proprioception using an isokinetic dynamometer. RESULTS: VS significantly improved the WOMAC total score and subscores for pain, stiffness and function for up to 6 months after infiltration. It also improved knee extensor and flexor strength during the same period. Proprioception was not affected by any of the treatments. CONCLUSIONS: VS alone improved pain, stiffness and function according to the WOMAC total score and subscores and improved knee extensor and flexor strength, but not proprioception, for up to six months after infiltration. These findings suggest that VS has a positive effect on quadriceps arthrogenic inhibition.
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- 2019
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24. Surgical Treatment of Chronic Rupture of the Quadriceps Using a Modified Pulvertaft Weave Technique
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José Leonardo Rocha de Faria, M.D., Murilo Barroso de Matos, M.D., Hugo Alexandre de Araújo Barros Cobra, M.D., M.Sc., Naasson Cavanellas, M.D., M.Sc., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., João Mauricio Barretto, M.D., M.Sc., Ph.D., and João Matheus Guimarães, M.D., M.Sc., Ph.D.
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Orthopedic surgery ,RD701-811 - Abstract
The extensor mechanism provides active knee joint extension and stability of the patellofemoral joint. Rupture of the quadriceps tendon, although uncommon, is therefore associated with impairment in knee joint stability and, thus, requires surgical repair. Although various techniques provide excellent clinical outcomes for acute rupture, treatment of chronic rupture remains clinically challenging. We describe our modified technique for quadriceps tendon repair using a semitendinosus tendon autograft, with suturing of the quadriceps tendon stump to the patella via transosseous sutures, wherein the use of allograft and anchors is avoided. Our modified Pulvertaft weave technique is simple and reproducible.
- Published
- 2019
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25. Lateral Tenodesis Associated With an Intra-articular Anterior Cruciate Ligament Reconstruction Without Proximal Disinsertion of Iliotibial Band
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Helder Rocha da Silva Araújo, M.D., José Leonardo Rocha de Faria, M.D., Renan Simões Heyn, M.D., Ulbiramar Correia da Silva Filho, M.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., Alan de Paula Mozella, M.D., M.Sc., and Douglas Mello Pavão, M.D., M.Sc.
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Orthopedic surgery ,RD701-811 - Abstract
The persistence of rotational instability after anterior cruciate ligament (ACL) reconstruction has been studied by several authors in the past 10 years. Although ACL lesions are currently treated arthroscopically, in the recent past, they were treated with isolated extra-articular tenodesis alone. Understanding the role and importance of anterolateral structures in the pathophysiology of rotational knee instability has increased since the rediscovery of the anterolateral ligament, and combined intra- and extra-articular reconstructions have been increasingly investigated. We sought to describe an option of lateral tenodesis associated with the ACL reconstruction through an iliotibial band tenodesis, without the need for large incisions or extra fixation devices, in a simple, fast, and reproducible manner.
- Published
- 2019
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26. Modified Lemaire Lateral Tenodesis Associated With an Intra-articular Reconstruction Technique With Bone-Tendon-Bone Graft Using an Adjustable Fixation Mechanism
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Douglas Mello Pavão, M.D., M.Sc., Raphael Serra Cruz, M.D., José Leonardo Rocha de Faria, M.D., Eduardo Branco de Sousa, M.D., M.Sc., Ph.D., and João Mauricio Barretto, M.D., M.Sc., Ph.D.
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Orthopedic surgery ,RD701-811 - Abstract
The goal of this study was to report a surgical technique used in a revision anterior cruciate ligament (ACL) reconstruction case, consisting of an adaptation of the anterolateral iliotibial band tenodesis technique (modified Lemaire technique) combined with ACL reconstruction using an adjustable fixation mechanism. Rotational overload was one of the most likely hypotheses for failure of primary surgery, despite correct positioning and secure fixation. We performed a review of the most pertinent factors related to ACL reconstruction failure, as well as surgical strategies for its treatment. After this, we described, step by step, a combination of the 2 forms of surgical intervention that were already presented isolated with good clinical results, correcting the common anterior and rotational instabilities found in these cases. Knowing new techniques for intra- and extra-articular ligament reconstruction is imperative in the present day, when more patients are seeking a full return to their preinjury recreational, labor, and sports activities. We believe that the combination of these surgical techniques is able to achieve these goals effectively and reproducibly.
- Published
- 2019
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27. Patellar Transskeletal Traction for the Treatment of Chronic Patellar Pseudoarthrosis
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José Leonardo Rocha de Faria, Dieno Mol Souza Portella, Victor Elias Titonelli, Naasson Trindade Cavanellas, Rodrigo Pires e Albuquerque, Eduardo Branco de Sousa, and João Maurício Barretto
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Orthopedic surgery ,RD701-811 - Abstract
Patellar fractures, which constitute approximately 1% of bone lesions, may lead to severe impairment of the extensor mechanism. When conservative or surgical treatment fails, the patella may develop pseudoarthrosis. Neglect or delayed treatment of this type of injury may lead to significant diastasis between the patellar fragments. There is no consensus regarding the best treatment for such cases. This study is aimed at describing a rare case of patellar pseudoarthrosis in a patient who underwent two-step surgical treatment comprising transskeletal patellar traction followed by osteosynthesis with a tension band. A 17-year-old male patient presented with a left patellar fracture that resulted from a fall from a standing height 8 years ago. He did not undergo any type of surgical treatment during that time, but the fracture was immobilized for only 2 weeks. The two-step surgical treatment with transskeletal patellar traction and patellar osteosynthesis was performed and provided satisfactory functional clinical results in this patient. This two-step surgical treatment can be performed in cases similar to ours with satisfactory results.
- Published
- 2019
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28. Osteoarthritic Synovial Fluid Modulates Cell Phenotype and Metabolic Behavior In Vitro
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Eduardo Branco de Sousa, Gilson Costa dos Santos Junior, Ramon Pinheiro Aguiar, Rafaela da Costa Sartore, Ana Carolina Leal de Oliveira, Fabio Ceneviva Lacerda Almeida, Vivaldo Moura Neto, and Diego Pinheiro Aguiar
- Subjects
Internal medicine ,RC31-1245 - Abstract
Synovial fluid holds a population of mesenchymal stem cells (MSC) that could be used for clinical treatment. Our goal was to characterize the inflammatory and metabolomic profile of the synovial fluid from osteoarthritic patients and to identify its modulatory effect on synovial fluid cells. Synovial fluid was collected from non-OA and OA patients, which was centrifuged to isolate cells. Cells were cultured for 21 days, characterized with specific markers for MSC, and exposed to a specific cocktail to induce chondrogenic, osteogenic, and adipogenic differentiation. Then, we performed a MTT assay exposing SF cells from non-OA and OA patients to a medium containing non-OA and OA synovial fluid. Synovial fluid from non-OA and OA patients was submitted to ELISA to evaluate BMP-2, BMP-4, IL-6, IL-10, TNF-α, and TGF-β1 concentrations and to a metabolomic evaluation using 1H-NMR. Synovial fluid cells presented spindle-shaped morphology in vitro. Samples from OA patients formed a higher number of colonies than the ones from non-OA patients. After 21 days, the colony-forming cells from OA patients differentiated into the three mesenchymal cell lineages, under the appropriated induction protocols. Synovial fluid cells increased its metabolic activity after being exposed to the OA synovial fluid. ELISA assay showed that OA synovial fluid samples presented higher concentration of IL-10 and TGF-β1 than the non-OA, while the NMR showed that OA synovial fluid presents higher concentrations of glucose and glycerol. In conclusion, SFC activity is modulated by OA synovial fluid, which presents higher concentration of IL-10, TGF-β, glycerol, and glucose.
- Published
- 2019
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29. Comparative evaluation of patellar height methods in the Brazilian population
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Christian Behrendt, Alexandre Zaluski, Rodrigo Pires e Albuquerque, Eduardo Branco de Sousa, and Naasson Cavanellas
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Patela ,Radiologia ,Joelho ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT OBJECTIVE: The methods most used for patellar height measurement were compared with the plateau-patella angle method. METHODS: A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall-Salvati (IS), Blackburne-Peel (BP) and Caton-Deschamps (CD). These were compared with the plateau-patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. RESULTS: The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau-patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau-patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau-patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau-patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau-patella angle. In relation to the cases of low patella, the plateau-patella angle was capable of identifying more cases than were the other three methods. CONCLUSIONS: The plateau-patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied.
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- 2016
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30. Avaliação da radioscopia intraoperatória no alinhamento coronal do componente tibial em artroplastias primárias de joelho
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Hugo Cobra, Marcio Bruno Hadid, Daniel Torres Jácome, Eduardo Branco de Sousa, Alan de Paula Mozella, and Rodrigo Pires e Albuquerque
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Artroplastia ,Radiologia ,Joelho ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
resumo Objetivos: Avaliar o efeito do uso da radioscopia intraoperatória em artroplastias primárias de joelho sobre o alinhamento final do componente tibial. Métodos: Foram incluídos no estudo os pacientes submetidos à artroplastia total do joelho (ATJ) entre 13/04/2013 e 20/04/2013. Os pacientes foram avaliados retrospectivamente e dois grupos foram identificados, um com uso de radioscopia intraoperatória para avaliação do posicionamento do componente tibial durante a cirurgia e o segundo sem uso desse recurso. Resultados: A média do ângulo de alinhamento do componente tibial em relacão à diáfise da tíbia foi superior no grupo sem uso de radioscopia intraoperatória (90,82) em comparacão com o grupo com radioscopia (90,63), com resultado estatisticamente significativo (p < 0,05). Conclusão: O uso de radioscopia no intraoperatório de ATJ produz melhor média de ângulo de alinhamento entre o componente tibial em relacão à diáfise da tíbia quando comparado ao não uso.
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- 2015
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31. Proprioceptive deficit in individuals with unilateral tearing of the anterior cruciate ligament after active evaluation of the sense of joint position
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Victor Cossich, Frédéric Mallrich, Victor Titonelli, Eduardo Branco de Sousa, Bruna Velasques, and José Inácio Salles
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LCA ,Sistema somatossensorial ,Joelho ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Objective:To ascertain whether the proprioceptive deficit in the sense of joint position continues to be present when patients with a limb presenting a deficient anterior cruciate ligament (ACL) are assessed by testing their active reproduction of joint position, in comparison with the contralateral limb.Methods:Twenty patients with unilateral ACL tearing participated in the study. Their active reproduction of joint position in the limb with the deficient ACL and in the healthy contralateral limb was tested. Meta-positions of 20% and 50% of the maximum joint range of motion were used. Proprioceptive performance was determined through the values of the absolute error, variable error and constant error.Results:Significant differences in absolute error were found at both of the positions evaluated, and in constant error at 50% of the maximum joint range of motion.Conclusion:When evaluated in terms of absolute error, the proprioceptive deficit continues to be present even when an active evaluation of the sense of joint position is made. Consequently, this sense involves activity of both intramuscular and tendon receptors.
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- 2014
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32. Proprioceptive deficit in patients with complete tearing of the anterior cruciate ligament
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Pedro Godinho, Eduardo Nicoliche, Victor Cossich, Eduardo Branco de Sousa, Bruna Velasques, and José Inácio Salles
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Ligamento cruzado anterior ,Propriocepção ,Joelho ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Objective:To investigate the existence of proprioceptive deficits between the injured limb and the uninjured (i.e. contralateral normal) limb, in individuals who suffered complete tearing of the anterior cruciate ligament (ACL), using a strength reproduction test.Methods:Sixteen patients with complete tearing of the ACL participated in the study. A voluntary maximum isometric strength test was performed, with reproduction of the muscle strength in the limb with complete tearing of the ACL and the healthy contralateral limb, with the knee flexed at 60°. The meta-intensity was used for the procedure of 20% of the voluntary maximum isometric strength. The proprioceptive performance was determined by means of absolute error, variable error and constant error values.Results:Significant differences were found between the control group and ACL group for the variables of absolute error (p = 0.05) and constant error (p = 0.01). No difference was found in relation to variable error (p = 0.83).Conclusion:Our data corroborate the hypothesis that there is a proprioceptive deficit in subjects with complete tearing of the ACL in an injured limb, in comparison with the uninjured limb, during evaluation of the sense of strength. This deficit can be explained in terms of partial or total loss of the mechanoreceptors of the ACL.
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- 2014
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33. Estresse Mental e Sistema Cardiovascular
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Débora Lopes Loures, Isis Sant'Anna, Clarissa Seródio da Rocha Baldotto, Eduardo Branco de Sousa, and Antonio Claudio Lucas da Nóbrega
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2002
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34. Protocol for Harvest, Transport and Storage of Human Osteochondral Tissue
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Thiago Alberto Vivacqua, Rafael Dantas Prinz, Naasson Cavanellas, João Maurício Barretto, Eduardo Branco de Sousa, and Diego Pinheiro Aguiar
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cartilage, articular ,allografts ,bone transplantation ,tissue and organ harvesting ,osteochondral lesion ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Objective To elaborate a protocol for the harvest, transport, and preservation of human osteochondral tissue for use in tissue banks (TBs). Methods Osteochondral fragments measuring 2 cm3 of 5 corpse donors aged between 15 and 45 years old were analyzed. The samples were stored in cell preservation medium containing: human albumin, Iscove's and vancomycin preserved at 4ºC. The concentration of proteoglycans in the extracellular medium was quantified by the use of Safranin-O, while tissue structural analysis was assessed by histological study with hematoxylin-eosin stained slides. The images obtained were analyzed according to the histological scores of Mankin and the score proposed by the OsteoArthritis Research Society International. The samples were analyzed with 0, 15, 30 and 45 days of preservation. Results The osteochondral fragments studied showed a progressive decrease in proteoglycan concentration with increased preservation time. After 30 days of preservation, structural changes were identified with discontinuity of the cartilage surface layer. According to the results obtained by the Mankin score, there was a statistically significant difference between 15 and 30 days of tissue preservation. Conclusion The protocol described defined knee transport immersed in Lactated Ringer at a controlled temperature of 10º C until its arrival at the TB. After processing, the preservation solution was composed of Iscove's serum-free cell culture medium supplemented with 10% human albumin and 100 µg/ml vancomycin. The tissue was preserved at a temperature of 4ºC until the moment of transplantation characterizing the fresh preservation.
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35. Prospective Study on the Impact of the Use of Human Fibrin Sealant free of Clot-Stabilizing Agents in Total Knee Arthroplasty
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Douglas Mello Pavão, Guilherme Mathias Palhares, Rodrigo Satamini Pires e Albuquerque, Eduardo Branco de Sousa, and João Maurício Barretto
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artroplastia de joelho ,osteoartrite ,perda sanguínea ,selante de fibrina ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Objective The present study aimed to evaluate the results of the intraoperative topical use of a human fibrin sealant free of clot-stabilizing agents in total knee arthroplasties (TKAs), looking for differences between groups regarding blood loss, transfusion requirement, length of hospital stay, pain perception, range of motion (ROM), and incidence of complications. Methods We have analyzed prospectively an intervention group with 32 patients (Sealant) and a control group with 31 patients (Control) with symptomatic knee osteoarthritis who underwent TKA. Results The results were similar between the groups regarding visible blood loss in the drain in 24 hours (Control, 276.5 mL ± 46.24 versus Sealant, 365.9 mL ± 45.73), total blood loss in 24 hours (Control, 930 mL ± 78 versus Sealant, 890 mL ± 67) and in 60 hours after surgery (Control, 1,250 mL ± 120 versus Sealant, 1,190 mL ± 96), blood transfusion requirement (which occurred only in 1 control patient), length of hospital days stay (Control, 5.61 ± 0.50 versus Sealant, 4.81 ± 0.36), postoperative pain, and ROM. Sealant use was not related to wound healing complications, to infection, or to deep venous thrombosis. Conclusion We have concluded that the hemostatic agent composed of human fibrin was not effective in reducing bleeding volume and blood transfusion requirement, nor it interfered with hospital length of stay, pain perception, and ROM. Its use was not related to any complications.
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36. Comparative analysis of quadriceps and hamstrings strength in knee osteoarthritis before and after total knee arthroplasty: a cross-sectional study
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Naasson Trindade Cavanellas, Victor Rodrigues Amaral Cossich, Eduardo Becker Nicoliche, Marilena Bezerra Martins, Eduardo Branco de Sousa, and José Inácio Salles
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Muscle strength ,Arthroplasty, replacement, knee ,Osteoarthritis ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
ABSTRACT Objective: Compare the maximal isokinetic muscle strength of knee extensor and flexor muscles between patients with knee osteoarthritis and patients submitted to total knee arthroplasty. Methods: Volunteers were divided into five groups (n = 20): Control; Ahlbäck I and II; Ahlbäck IV; six months after total knee arthroplasty; 12 months after total knee arthroplasty. An isokinetic knee strength evaluation was conducted for the quadriceps and hamstrings at 60°/s. Results: Significant differences in the peak torque of the quadriceps and hamstrings were found among the groups (p < 0.001). The Ahlbäck IV, six-month, and 12-month postoperative groups demonstrated lower values when compared to the Control and Ahlbäck I and II groups. When percentage values were compared to the Control group, mean differences ranged from 7% to 41%. Conclusion: Patients with healthy knees or early stage osteoarthritis have higher quadriceps and hamstrings strengths than those with a more advanced stage of the disease, even after knee replacement. These findings suggest that the traditional rehabilitation programs do not recover strength to levels observed in individuals without knee osteoarthritis.
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37. Predictive and protective factors for allogenic blood transfusion in total knee arthroplasty. A retrospective cohort study
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Douglas Mello Pavão, Erica Maciel Heringer, Giancarlo Jório Almeida, José Leonardo Rocha de Faria, Rodrigo Sattamini Pires e Albuquerque, Eduardo Branco de Sousa, and Pedro José Labronici
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Orthopedics and Sports Medicine - Published
- 2023
38. Análise do impacto orçamentário da viscossuplementação no tratamento não cirúrgico da osteoartrite de joelho
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Grasiela Martins da Silva, Katia Marie Simões e Senna, Eduardo Branco de Sousa, and Bernardo Rangel Tura
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Viscosuplementación ,Osteoertritis ,Rodilla ,Presupuestos ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Resumo: A osteoartrite de joelho afeta cerca de 3,8% da população mundial e se manifesta por dor, edema, rigidez e redução da função articular, impactando na qualidade de vida do paciente. O tratamento consiste na modalidade farmacológica, não farmacológica e cirúrgica. A viscossuplementação (ácido hialurônico intra-articular) se propõe a oferecer alívio dos sintomas e a possibilidade de adiamento da cirurgia. Este estudo estimou o impacto orçamentário entre a associação desse medicamento e o tratamento não cirúrgico (tratamento padrão), sob a perspectiva do Sistema Único de Saúde. Com base no pressuposto de que 5% dos portadores da doença seguem para tratamento e nos custos diretos das modalidades: farmacológica e não farmacológica foram calculados os cenários de referência e alternativos que compararam as diferentes opções de tratamento para um horizonte temporal de três anos. A análise principal estimou um impacto orçamentário incremental de aproximadamente R$ 126 milhões (1 ampola anual) e R$ 252 milhões (2 ampolas anuais). Já a diacereína, um condroprotetor oral, avaliada como uma opção alternativa, mostrou um impacto de R$ 334 milhões no orçamento em relação ao tratamento padrão, o que proporciona um aumento de 24% no custo em relação ao uso de 2 ampolas anuais de ácido hialurônico, tornando-a economicamente menos vantajosa. A viscossuplementação pode proporcionar maior qualidade de vida ao paciente, redução de custos para o sistema e otimização do fluxo de atendimento nas unidades de saúde. As estimativas apresentadas neste estudo podem auxiliar o gestor quanto à melhor utilização dos recursos financeiros e consequente tomada de decisão quanto à incorporação da tecnologia.
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39. Treatment of Distal Patellar Tendon Chronic Rupture: The X-Wave Technique
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Douglas Mello Pavão, Thiago Alberto Vivacqua, Fernando Carneiro Werneck, José Leonardo Rocha de Faria, Marcos de Castro Moreirão, Victor Elias Titonelli, Rodrigo Pires e Albuquerque, and Eduardo Branco de Sousa
- Subjects
Orthopedics and Sports Medicine - Abstract
Injuries to the patellar tendon (PT) are associated with knee function deterioration and loss of the capacity to perform daily and sports activities. Patellar tendon injury is often misdiagnosed at emergency rooms, leading to chronic proximal retraction and a challenging clinical scenario. Proximal PT injuries are more common, while distal ones, which can involve tibial bone avulsion fractures or direct tendon avulsion, are rarer. The low incidence of distal PT rupture and the variety of injury patterns make a personal approach reasonable when based on the intraoperative findings and the surgeon's experience. Our purpose is to describe a surgical technique to restore the knee extensor mechanism after chronic distal PT rupture using two kinds of graft, one as a waveform augmentation of the native tendon and the other as reinforcement in a letter X aspect.
- Published
- 2022
40. Modified Pulvertaft on Weave Technique Restores Full Active Knee Extension in Patients With Large Chronic Quadriceps Tendon Rupture: A Case Series
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José Leonardo Rocha de Faria, Conrado Torres Laett, Ubiratã Faleiro Gavilão, Matheus de Barros Carvalho, Alan de Paula Mozella, Eduardo Branco de Sousa, and Victor Rodrigues Amaral Cossich
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Adult ,Tendons ,Knee Joint ,Torque ,Tendon Injuries ,Isometric Contraction ,Humans ,Knee ,Orthopedics and Sports Medicine ,Muscle Strength ,Middle Aged ,Quadriceps Muscle - Abstract
We aimed to investigate the clinical and functional outcomes, including maximal and explosive strength, after chronic quadriceps tendon rupture repair with Modified Pulvertaft on Weave (MPW) technique METHODS: Knee joint range of motion (ROM), patella height, thigh circumference, and Lysholm and International Knee Documentation Committee (IKDC) scores were assessed preoperatively and postoperatively. The knee extensors maximal (isokinetic peak torque and isometric maximal voluntary contraction (MVC) torque) and explosive strength-rate of torque development (RTD) early [RTDNine patients (mean age: 53 ± 11 years) took part in the study. We observed a significant increase in the knee active ROM and a decreased extension deficit (both, P.001), but not for pain (P = .07), IKDC (P = .07), and Lysholm (P = .21) after the surgery. We did not observe a difference between involved (n = 8) and uninvolved (n = 10) limbs for ROM, thigh circumference, and MT. We observed differences for extensors peak torque, MVC torque, and late RTD (all, P.05). However, we did not observe differences for early RTD and EMGThe MPW reestablished the active knee extension. The same level of quadriceps muscle mass was observed in both limbs, suggesting a lack of hypotrophy due to the injury. Although the involved limb had demonstrated lower knee extensors maximal strength, they demonstrate an equivalent early RTD when compared to the uninvolved limb. The early RTD seems to be better correlated with the patient's functionality than the later RTD and maximal strength.IV, case series.
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- 2022
41. Modified Lemaire lateral tenodesis associated with revision anterior cruciate ligament reconstruction: a case series
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Douglas Mello Pavão, José Leonardo Rocha De Faria, Rodrigo Pires e Albuquerque, Marcos de Castro Moreirão, Thiago Vivaqua, and Eduardo Branco De Sousa
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General Medicine - Abstract
To increase the success and reduce failures related to anterior cruciate ligament reconstruction (ACLR), many techniques of lateral extra-articular tenodesis (LEAT) have been developed, mainly in revision surgeries, where a previous failure has already occurred. This study aims to report a case series of patients with failed ACLR treated with revision techniques combined with LEAT. Seven patients were retrospectively evaluated. At the postoperative analysis, in all patients, after six months of follow-up, there was no range of motion loss, there was an improvement in the functional Lysholm score, a reduction in the instability degree according to the semiological maneuvers of the anterior drawer and in pivot shift tests, compared to preoperative evaluation. No complications were observed. In conclusion, revision ACLR combined with LEAT showed good clinical functional results, without any complications reported.
- Published
- 2022
42. Mesenchymal stem cells for the treatment of articular cartilage defects of the knee: an overview of systematic reviews
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Eduardo Branco de Sousa, Jose Granjeiro, and Leandra Santos Baptista
- Abstract
Review question / Objective: Population: adults (aged between 18 and 50 years) with traumatic knee lesions who underwent treatment with mesenchymal stem cells; Intervention: defined by the treatment with mesenchymal stem cells; The comparison group: treatment with autologous chondrocytes or microfracture treatments; Primary outcome: formation of cartilage neo tissue in the defect area, determined by magnetic resonance imaging (MRI) or by direct visualization in second-look knee arthroscopy.; Secondary outcomes: based on clinical scores such as visual analog scale (VAS) for pain, Western Ontario and McMaster universities score (WOMAC), knee society score (KSS), Tegner and Lysholm.
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- 2022
43. Continuous Meniscal Suture in Radial Meniscal Tear: The Hourglass Technique
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Carlos Rodrigo de Mello Roesler, Eduardo Branco de Sousa, Rodrigo Pires e Albuquerque, José Leonardo Rocha de Faria, Rodrigo Salim, Marcelo Mandarino, Alan de Paula Mozella, Douglas Mello Pavão, João Antonio Matheus Guimarães, and Robert F. LaPrade
- Subjects
medicine.medical_specialty ,Mechanical load ,Proprioception ,business.industry ,Joint stability ,Meniscal suture ,Osteoarthritis ,Meniscus (anatomy) ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Joint capsule ,Technical Note ,Medicine ,Tears ,Orthopedics and Sports Medicine ,business - Abstract
The key to preventing early knee osteoarthritis is meniscal preservation. The main functions of the meniscus are impact absorption, mechanical load transmission, lubrication, joint stability, and proprioception. Radial lesions that extend to the joint capsule are called complete radial tears. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and load distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. In the recent past, the treatment of choice for this type of injury was partial meniscectomy. However, several studies have observed progressive joint degeneration after this type of treatment. Recently, different types of meniscal sutures involving radial lesions of the meniscus have been developed. It is believed that such repairs may bring a decrease in future osteoarthritis in this patient profile. The purpose of this article is to describe the steps of continuous meniscal suture for the treatment of radial tears of the medial and lateral menisci., Technique Video Video 1 In the schematic image, we see a complete radial tear of the medial meniscus. The arrows represent the path through which the suture threads will pass through the meniscal injury. The first arrow will cross the lesion obliquely from proximal to distal and from posterior to anterior. The second arrow will cross the meniscus horizontally, from anterior to posterior The third arrow will cross the lesion obliquely from distal to proximal and posterior to anterior, and the last arrow will cross the lesion horizontally again from posterior to anterior, closing the meniscal lesion. We demonstrate the technique of continuous suture, the hourglass technique, in a bovine anatomical model performed at the arthroscopy laboratory of the National Institute of Traumatology and Orthopedics of Brazil. We make a complete radial tear in the medial meniscus body. We prepare the meniscus 4 A-II suture device with an ultra-resistant wire. Tapes are also advised to be used in this type of injury. Initially, we cross the meniscus proximal and posterior of the radial tear; by palpation, we find the exit site of the meniscal suture device. We pull the shortest suture length, which should always be positioned for the anterior side of the suture device. We fix this end with a Kelly clamp. We return with the device to the interior of the joint and position the device by passing with a suture thread obliquely on the anterior and distal surface about 5 mm from the radial tear. We cross the meniscus, easily finding the region of exit of the meniscus 4 AII. We pull the formed loop on the posterior face of the device to gain length of the wire. After this step, we increase the anterior loop of the wire so that the end of the wire passing through the interior of the device is the same as that passing through the arthroscopic portal. We return the device to the inside of the joint again and cross the lesion with a horizontally, penetrating the meniscus in the posterior and distal region of the lesion. We find the device through the extra-articular surgical approach and repeat the steps to increase the loops. We return the device to the inside of the joint and cross the lesion with the suture in an oblique way again. We enter the meniscus with the device and form a new anterior loop in the extra-articular region. After repairing the loop, we return the device to the joint and cross the lesion horizontally from anterior to posterior, penetrating the meniscus about 10 mm posterior to the radial tear. We find the device on the extra-articular surface and pull the suture out of the Meniscus 4 AII. We then remain with 2 ends of the wires and 3 loops formed. We cut each loop and through a light traction and we observe which wire connect with other. And we start the sutures, making 3 to 4 stitches on each thread. We are able to observe the complete closure of the lesion inside the joint, completing the surgical procedure.
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- 2021
44. How to Create an Arthroscopy Training Laboratory Using a Bovine Knee Model
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Ana Carolina Leal, Vitor Almeida Ribeiro de Miranda, Phelippe Augusto Maia Valente, Alan de Paula Mozella, Douglas Mello Pavão, Rodrigo Salim, Eduardo Branco de Sousa, Marcelo Mandarino, João Antonio Matheus Guimarães, Alfredo Marques Villardi, and José Leonardo Rocha de Faria
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Open surgery ,Arthroscopy ,education ,MEDLINE ,Surgery ,Tissue damage ,Surgical skills ,Technical Note ,Medicine ,Orthopedics and Sports Medicine ,Medical physics ,business ,Cadaveric spasm - Abstract
Orthopaedic surgeries by video arthroscopy have become increasingly popular, as they allow joint treatment through small incisions and minimal tissue damage. However, their execution requires specific skills from the surgeon, different from open surgery, which can only be achieved through practical training. These skills would be ideally performed on human cadaveric anatomical pieces which, however, can be difficult to access for different reasons. Animal anatomical models for surgical skills training have been used for years in medicine, and we observed that the bovine knee has anatomical characteristics quite similar to that of the human knee. In this study, we explain, step by step, the installation and creation of an arthroscopy laboratory with a bovine model, in an effort to contribute to several training centers in arthroscopic surgery around the world, assisting and guiding such centers to install arthroscopy laboratories and facilitating the improvement of more surgeons., Technique Video Video 1 To set up an arthroscopy laboratory that is easily reproducible in any region of the world, we use the bovine knee. We obtain such an anatomical piece in conventional commercial establishments selling animal meat, like slaughterhouses and butcher shops. We ask the owner of the establishment to separate the entire bovine lower limb, only with dry skin. The preparation of the piece begins by sectioning the thigh muscles about 25 cm proximal to the knee, and then we repeat the same 25 cm distal to the knee at the tibial level. Due to the large volume of the sural triceps of this animal model, we section the distal one third of the gastrocnemius to decrease the weight of the anatomical piece. We then observe knee flexion, still with the femur and tibia intact. We perform a transversal osteotomy of the tibia and femur in the same location as the soft tissues were resected. The room for installing the laboratory must have plugs with 110 and 220 volts, a tap with running water, and appropriate drains. It also must be at least 20 square meters in size. We use pressure pliers fused to a press to fix the anatomical piece, and this must be fixed to a rigid surface. A large bucket must be purchased to function as a container for the water used to perform the arthroscopy. A water tap must be adapted to be able to couple one way of the 4-way equipment in this tap and supply water in a continuous way to perform the arthroscopy. Such adapters as the ones shown may be necessary. We again highlight the pressure pliers fused to the vise. A vacuum cleaner is also necessary. The arthroscopy table must be assembled with arthroscopic forceps, blades and a shaver handpiece, scalpel, and Metzenbaum scissors. The arthroscopy tower must be equipped with a video monitor, a light source, a camera controller, and a shaver console. The bovine knee is then attached to the pressure pliers and the arthroscopy begins. We perform an extensive cleaning of the synovial tissue located posterior to the patellar tendon. We initially observe the trochlea to the patella, being able to observe the patellar track. We are able to observe the anterior and posterior cruciate ligament. After we observe the medial compartment, to facilitate the visualization of this compartment, we perform pie crusting of the medial collateral ligament, easily observing the medial meniscus. We made a radial tear in the medial meniscus body for subsequent meniscal suture training. Then, your arthroscopy laboratory is up and running.
- Published
- 2021
45. Harvest, Transport, and Storage of Fresh Humeral Head Osteochondral Allograft: Step-by-Step Protocol
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Diego Pinheiro Aguiar, Rafael Dantas Prinz, Rodrigo Ribeiro Pinho Rodarte, Eduardo Branco de Sousa, and Rodrigo Souto Borges Petros
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musculoskeletal diseases ,medicine.medical_specialty ,Allograft transplantation ,business.industry ,medicine.medical_treatment ,Articular cartilage ,Technical note ,Arthroplasty ,Surgery ,medicine ,Shoulder function ,Technical Note ,Orthopedics and Sports Medicine ,In patient ,Recurrent instability ,business ,Surgical treatment - Abstract
Articular cartilage defects are not common in the glenohumeral joint and are mostly found in patients after shoulder trauma, in patients with recurrent instability, or in patients who underwent previous surgical treatment. Articular cartilage defects lead to pain and loss of motion, consequently causing shoulder function impairment and reducing quality of life. In young patients, the use of osteochondral allografts for the treatment of humeral head defects may avoid well-known complications of shoulder arthroplasty. The goal of this Technical Note is to describe a step-by-step protocol for the harvesting, transport, and preservation of fresh humeral head osteochondral tissue for use in allograft transplantation., Technique Video Video 1 Step-by-step protocol for harvesting, transport, and preservation of fresh humeral head osteochondral tissue. The technique for harvesting, transport, and storage of fresh human osteochondral allografts is presented. The steps described include the surgical approach to corpse donor harvesting, transport and tissue processing at the tissue bank, and calculation of the recipient’s defect size.
- Published
- 2021
46. Posterior Root Repair of Medial Meniscus Combined With Valgus Opening Wedge Tibial Osteotomy
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Marcos de Castro Moreirão, Eduardo Branco de Sousa, Marcelo Mandarino, José Leonardo Rocha de Faria, Alan de Paula Mozella, Douglas Mello Pavão, Sandra Tie Nishibe Minamoto, and Victor Elias Titonelli
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Tibial osteotomy ,Knee Joint ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Technical Note ,Orthopedics and Sports Medicine ,Tibia ,Orthopedic surgery ,Varus deformity ,030222 orthopedics ,biology ,business.industry ,Cartilage ,030229 sport sciences ,Opening wedge ,biology.organism_classification ,medicine.disease ,musculoskeletal system ,Surgery ,Valgus ,medicine.anatomical_structure ,business ,Medial meniscus ,RD701-811 - Abstract
The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5° for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear., Technique Video Video 1 The treated patient had undergone anterior cruciate ligament reconstruction approximately 8 years ago. In the panoramic radiographs of the lower limbs, we can see an asymmetric varus of the knee. Magnetic resonance imaging shows a posterior root tear of the medial meniscus. In the sagittal view, we observe the ghost sign. We start the surgical procedure with tibial osteotomy, initially performing the detachment of the superficial MCL, and we perform the osteotomy after the passage of the guidewires about 4 cm distal to the joint interline. In this case, we planned a 10° opening wedge. During the placement of the osteotomy plate, to avoid confluence with the tibial root tunnel, we place the most posterior proximal screw and distal screws in the traditional way and the most anterior proximal screw is placed in a shorter length. We start the arthroscopic time by visualizing a good medial joint space, since the superficial MCL has already been detached. In this way, we identified the posterior tibial root tear of the medial meniscus. We position the MU guide in the anatomical position of the meniscal root foot print, create the tibial tunnel with a 6-mm FlipCutter drill, bend the drill tip inside the joint, and return with it about 10 mm, creating a bone bed for the meniscus to be reinserted. With the aid of a needle guidewire, we introduce a looped ETHIBOND into this tunnel for future transport of the other threads. With the Knee Scorpion device, we pass a FiberWire over the end of the meniscus, and make Mickey's ear stitch into the wire, repeating this step with 2 more FiberWire threads, performing the second stitch on the second FiberWire, completing then 3 stitches. We transport the 3 FiberWires to the tibial tunnel through the ETHIBOND wire. We use the probe as a pulley to make it easier for the 3 FiberWires to “run” correctly when pulled. We then fix the 3 wires to an ABS button, tensioning the root. We visualize the reinserted root and the meniscus returning to its normal tension. This is the postoperative radiography and this is the patient with 3 months of postoperative, undergoing rehabilitation. (MCL, medial collateral ligament.)
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- 2021
47. BMP-4, TGF-β e Smad3 como moduladores da viabilidade das células do líquido sinovial
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Vivaldo Moura Neto, Diego Pinheiro Aguiar, and Eduardo Branco de Sousa
- Subjects
caminho TGF-β ,0301 basic medicine ,mesenchymal stem cells ,osteoartrite ,General Medicine ,Biology ,células-tronco mesenquimais ,osteoarthritis ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,TGF-β pathway ,Orthopedics and Sports Medicine ,Surgery ,células do líquido sinovial ,synovial fluid cells - Abstract
Objective Our goal was to evaluate the modulation of the synovial fluid cells (SFC) from patients with and without osteoarthritis (OA) by bone morphogenetic protein 4 (BMP-4), Smad-3 and transforming growth factor beta (TGF-β). Methods Synovial fluid was collected from patients submitted to knee arthroscopy or replacement and were centrifuged to isolate cells from the fluid. Cells were cultured for 21 days and characterized as mesenchymal stem cells (MSCs) according to the criteria of the International Society of Cell Therapy. Then, we performed an [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay (MTT) assay after exposing cells with and without OA to TGF-β, Smad3 and BMP-4 pathway inhibitors and to different concentrations of BMP4. Results Exposure to the TGF-β, Smad3 and BMP-4 inhibitors modifies the mitochondrial activity of the SFCs. The activity of the SFCs is modified by influences of increasing concentrations of BMP4, but there is no difference in cellular activity between patients with and without OA. Conclusion TGF-β, Smad3 and BMP-4 modulate the activity of SFCs from patients with and without knee OA. Resumo Objetivo Nosso objetivo foi avaliar a modulação das células do líquido sinovial (SFCs, na sigla em inglês) de pacientes com e sem osteoartrite (OA) por proteína morfogenética óssea 4 (BMP-4), Smad3 e transformador do fator de crescimento β (TGF-β). Métodos O do líquido sinovial foi coletado de pacientes submetidos a artroscopia ou artroplastia do joelho, e centrifugados para isolar as células do liquido sinovial. As células foram cultivadas por 21 dias e caracterizadas como células-tronco mesenquimais (MSCs, na sigla em inglês) de acordo com os critérios da International Society of Cell Therapy. Em seguida, realizamos um ensaio de brometo de 3-4,5-dimetil-tiazol-2-il-2,5difeniltetrazólio (MTT) depois de expor células com e sem OA para TGF-β, inibidores de via Smad3 e BMP-4 e para diferentes concentrações de BMP-4. Resultados A exposição aos inibidores TGF-β, Smad3 e BMP-4 modifica a atividade mitocondrial das SFCs. A atividade das SFCs é modificada por influências sobre o aumento das concentrações de BMP-4, mas não há diferença na atividade celular entre pacientes com e sem OA. Conclusão TGF-β, Smad3 e BMP-4 modulam a atividade das SFCs de pacientes com e sem OA do joelho.
- Published
- 2021
48. Stress Radiography for Multiligament Knee Injuries: A Standardized, Step-by-Step Technique
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Eduardo Branco de Sousa, Rodrigo Pires e Albuquerque, José Leonardo Rocha de Faria, Alan de Paula Mozella, Douglas Mello Pavão, Igor Stefano Menescal Pedrinha, and Marcelo Mandarino
- Subjects
medicine.medical_specialty ,Radiography ,Physical examination ,Objective analysis ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Technical Note ,medicine ,Orthopedics and Sports Medicine ,Orthopedic surgery ,Orthodontics ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Stress radiography ,030229 sport sciences ,musculoskeletal system ,Surgery ,medicine.anatomical_structure ,Posterior cruciate ligament ,business ,Knee injuries ,human activities ,RD701-811 ,Knee instability - Abstract
Physical examination in the presence of a multiligament knee injury can be complex and challenging. Hence, stress radiography is a useful and inexpensive tool that is widely used in the assessment of this type of injury. It guarantees an objective analysis of the magnitude of knee instability, which may reduce the observer's interpretation bias in relation to the physical examination. However, for the radiographic analysis to be reproducible, it is necessary to standardize the technique to evaluate each of the main knee ligaments. This article aims to describe in detail how to perform stress radiography to assess the sufficiency of the posterior cruciate ligament and collateral ligaments in the context of a multiligament injury.
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- 2020
49. Vertical Continuous Meniscal Suture Technique
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Eduardo Branco de Sousa, João Matheus Guimarães, Alan de Paula Mozella, Douglas Mello Pavão, Marcelo Costa de Oliveira Campos, Raphael Serra Cruz, and José Leonardo Rocha de Faria
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Orthopedic surgery ,030222 orthopedics ,education.field_of_study ,medicine.medical_specialty ,Functional impairment ,business.industry ,Population ,Meniscal suture ,030229 sport sciences ,Meniscus (anatomy) ,Meniscal repair ,Surgery ,03 medical and health sciences ,Surgical time ,0302 clinical medicine ,medicine.anatomical_structure ,Functional disability ,medicine ,Technical Note ,Orthopedics and Sports Medicine ,education ,business ,RD701-811 - Abstract
Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device.
- Published
- 2020
50. HIGHER RISK OF COMPLICATIONS AFTER TOTAL KNEE ARTHROPLASTY IN OCTOGENARIANS
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Raphael Soejima Correia Ramalho, Eduardo Branco de Sousa, Gabriel Garcez de Araujo Souza, Rodrigo Pires e Albuquerque, João Maurício Barretto, and Rafael Souza Mançãno Chaves
- Subjects
medicine.medical_specialty ,Total knee arthroplasty ,Physical Therapy, Sports Therapy and Rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,80 and over ,Medicine ,Orthopedics and Sports Medicine ,Arthroplasty. Knee. Postoperative Complications. Aged ,Idoso de 80 Anos ou Mais ,Risk factor ,Artroplastia ,Orthopedic surgery ,030222 orthopedics ,business.industry ,Incidence (epidemiology) ,Medical record ,Rehabilitation ,030229 sport sciences ,Perioperative ,Evidence-based medicine ,medicine.disease ,Complicações Pós-Operatórias ,Joelho ,Original Article ,business ,Body mass index ,RD701-811 - Abstract
Objective: To evaluate the complication rate of total knee arthroplasty (TKA) in octogenarian patients and identify predictive factors. Methods: The study comprised 70 octogenarians and 70 non-octogenarian patients as control group, all submitted to TKA. We analyzed the medical records of these patients, seeking for complications during the first postoperative year. Regarding the risk factors, we evaluated: age, sex, race, American Society of Anesthesiologists score, body mass index, smoking, hypertension and diabetes mellitus. Results: In the control group, the incidence of complications was 7.1%. Whereas in the octogenarian group it was significantly higher, reaching 34.3% (OR 6.8; 95% CI 2.4-19.1). We found no association to sex, skin color, and comorbidities. Age is an independent risk factor for postoperative complications. Our data may help patients to acknowledge the risks of undergoing primary TKA and physicians to assess and adjust perioperative risk. Conclusion: The incidence of postoperative complications is significantly higher in octogenarians. Level of Evidence III, Case-control study. RESUMO Objetivo: O objetivo do estudo foi avaliar a taxa de complicações da artroplastia total do joelho (ATJ) em pacientes octogenários e tentar identificar fatores preditivos. Métodos: Foi realizado um estudo envolvendo 140 pacientes, divididos em dois grupos (70 octogenários e 70 com idade abaixo de 80 anos), submetidos a ATJ no período de janeiro de 2014 a agosto de 2016. Os prontuários desses pacientes foram analisados buscando a presença de complicações ocorridas no prazo de um ano após a cirurgia. Em relação aos fatores de risco foram avaliados idade, sexo, raça, American Society of Anesthesiologists, Indice de Massa Corpórea, tabagismo, hipertensão arterial e diabetes. Resultados: No grupo-controle, a incidência de complicações foi de 7,1%. Já no grupo estudado foi significativamente maior, chegando a 34,3%. A razão de chances para complicações é 6,8, com intervalo de confiança ao nível de 95% igual a (2,4;19,1). A idade maior ou igual a 80 constitui, assim, fator de risco aumentado para a incidência de complicações pós-artroplastia total de joelho. Conclusão: A ocorrência de complicações após ATJ é significativamente maior no grupo dos octogenários. Nível de Evidência III, Estudo de caso-controle.
- Published
- 2020
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