Ricardo Bastos Filho - Academia.edu (original) (raw)
Papers by Ricardo Bastos Filho
Arthroscopy techniques, 2017
Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism ... more Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone. First, the patellar tendon is repaired with an end-to-end technique and the semitendinous tendon is harvested. A transosseous tunnel at the tibial tubercle is drilled and 2 rents are made, both medial and lateral to the retinaculum at the level of the intermedial segment of the patella close to the patellar margin. The graft is passed through...
Arthroscopy techniques, 2017
Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, ... more Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osse...
Stem Cells International, 2016
There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue r... more There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue repair. However, the variability in the methodology for its obtaining may cause different and opposing findings in the literature. Particularly, the choice of the anticoagulant is the first definition to be made. In this work, blood was collected with sodium citrate (SC), ethylenediaminetetraacetic acid (EDTA), or anticoagulant citrate dextrose (ACD) solution A, as anticoagulants, prior to PRP obtaining. Hematological analysis and growth factors release quantification were performed, and the effects on mesenchymal stromal cell (MSC) culture, such as cytotoxicity and cell proliferation (evaluated by MTT method) and gene expression, were evaluated. The use of EDTA resulted in higher platelet yield in whole blood; however, it induced an increase in the mean platelet volume (MPV) following the blood centrifugation steps for PRP obtaining. The use of SC and ACD resulted in higher induction of ...
Motricidade, 2018
INTRODUÇÃO A excelência competitiva requer uma abordagem multidisciplinar na carreira do nadador,... more INTRODUÇÃO A excelência competitiva requer uma abordagem multidisciplinar na carreira do nadador, onde o papel do treinador permanece fulcral. No entanto, o papel de outros intervenientes, como é o caso do médico sensibilizado para a patologia do nadador, tem sido relegado para papeis secundários, sendo este normalmente restringido ao exame médico desportivo no início de época e à intervenção no momento de lesão. Por este motivo, é da maior importância a interação entre corpo clínico e a restante equipa técnica no sentido de se otimizarem estratégias ao nível da prevenção, correto diagnóstico e tratamento de lesões no nadador. Neste sentido, os autores consideram de extrema importância a divulgação e promoção do trabalho dos prestadores de saúde no atleta nadador.
Knee Surgery, Sports Traumatology, Arthroscopy, 2019
Purpose To compare the clinical and laboratory outcomes of intra-articular injections of culture-... more Purpose To compare the clinical and laboratory outcomes of intra-articular injections of culture-expanded bone-derived mesenchymal stem cells (MSCs) with or without platelet-rich plasma (PRP) to intra-articular corticosteroid injections for the treatment of knee osteoarthritis (OA). Methods Forty-seven patients with radiographic and symptomatic knee OA were randomized into three groups for intraarticular injections: autologous bone marrow-derived culture-expanded MSCs (n = 16); autologous bone marrow-derived culture-expanded MSCs + PRP (n = 14); and corticosteroid (n = 17). The outcomes were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) and range of motion (ROM) at baseline, 1, 2, 3, 6, 9 and 12 months and intra-articular cytokines analysis at baseline, 6 and 12 months postoperatively. Results The three groups showed significant improvement in most KOOS domains and global score at 1st month and all domains and global score at 12-month follow-up (p < 0.05). At the 1st month, only the MSCs group showed significant differences in KOOS symptoms domain (p = 0.003). The MSCs and MSCs + PRP groups showed the highest percentage of improvement in most KOOS domains and global score compared to the corticosteroid group. All three groups showed a significant reduction in intra-articular levels of human interleukin-10 cytokine, from baseline to 12 months (p < 0.05). Conclusion An intra-articular injection of bone marrow-derived culture-expanded MSCs with or without the addiction of PRP is effective in improving the function and decreasing symptoms caused by knee OA at 12-month follow-up. Level of evidence II.
Arthroscopy Techniques
The authors report the following potential conflicts of interest or sources of funding: The exper... more The authors report the following potential conflicts of interest or sources of funding: The experimental work (arthroscopy laboratory) and surgical equipment were financially supported by Arthrex. Video 1 was edited by Arthrex. J.E-M. received support for travel-related expenses and laboratory equipment from Arthrex for this study. R.B. received support for travel-related expenses and laboratory equipment from Arthrex for this study. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Return to Play in Football
Football (soccer) is the most played sport worldwide, practiced by more than 300 million people [... more Football (soccer) is the most played sport worldwide, practiced by more than 300 million people [1]. It is a high-impact contact sport, and with the increasing competitive level, it often results in sports-related damage of the knee structures, including articular cartilage injuries [2-4]. These articular cartilage injuries can also be caused by forceful and repetitive mechanical stresses on the
Articular cartilage lesions are serious injuries, particularly in the football player, once these... more Articular cartilage lesions are serious injuries, particularly in the football player, once these may endanger the athlete’s competitive career. Returning to competition at the preinjury sports activity level as fast and as safe as possible is the ultimate goal to be achieved. Although there is no consensus on the best surgical technique, clinical algorithms have been proposed to manage the different articular cartilage defects. Herein, we summarize the available clinical treatment possibilities for addressing focal cartilage defects and osteochondral lesions. We also overview the three rehabilitation phases and the progression of the patient within these plans shall follow objective criteria. The considerations to return to play are also briefly discussed herein.
Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the hand... more Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the handball player competitive career. Returning to competition at the pre-injury sports activity level as early and as safe as possible is the ultimate goal to be achieved. There is no consensus on the best surgical technique, and clinical algorithms have been proposed to manage the different articular cartilage defects. The chapter will also overview and summarize the available conservative and surgical management options and stepwise criteria-based rehabilitation strategy and return to play considerations in handball players with focal cartilage defects and osteochondral lesions.
Football is a sport characterized by physical contact, which explains the high rate of musculoske... more Football is a sport characterized by physical contact, which explains the high rate of musculoskeletal injuries in players described in the literature. The most common injuries are lower limb injuries. Herein, we discuss the main injuries involving the elbow and wrist encountered in football players.
Complex Knee Ligament Injuries
Multiligament knee injuries have low incidence, however are very devastating and require special ... more Multiligament knee injuries have low incidence, however are very devastating and require special attention. New approaches in the diagnosis are vital to allows a better assessement of associated lesions, more careful treatment planning and objective follow-up. The Porto-Knee Testing Device (PKTD) shows very promising results in the assessment of knee instability. The goal of the PKTD is to provide both anatomical and functional evaluation of the knee. It is able to carefully assess the knee sagittal and rotational stability. In multiligament injuries, the use of a arthrometric device concomitantly with imaging procedures can provide valuable information for surgical planning and stability restoration procedures. It is also possible in the postoperative follow-up to evaluate residual instability. Herein, we discuss the recent developments related to PKTD in diagnosis of knee ligament lesions and instability assessment.
Return to Play in Football
The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligamen... more The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligament (ACL) lesion has an essential role in the knee stability assessment. These measurements can further be evaluated through magnetic resonance imaging (MRI), which in combination with instrumented assessment and physical examination can correlate both the “anatomy” and “function” of the ligament. The Porto-Knee Testing Device (PKTD) is a knee laxity testing device compatible with MRI that is capable of measuring the posterior-anterior tibial translation and tibial internal and external rotation. In this sense, the PKTD is a useful tool for the assessment of knee sagittal and rotatory laxity in the follow-up of football players that underwent ACL reconstruction. Hence, this tool may allow to identify individuals presenting residual knee laxity with increased risk of sustaining secondary ACL injuries and assist in the planning of secondary prevention programs.
Revista de Medicina Desportiva informa
Revista de Medicina Desportiva Informa
Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine
ObjectiveInvestigate the patellar force-displacement profile (ligament stiffness) of patellofemor... more ObjectiveInvestigate the patellar force-displacement profile (ligament stiffness) of patellofemoral disorders.MethodsFifty-two knees from 34 consecutive patients (mean 31.6 years and 53% male) were analysed including 24 knees with patellofemoral pain (PFP), 19 with potential patellofemoral instability (PPI) and 9 with objective patellofemoral instability (OPI). Physical examination, patient-reported outcome measures (Kujala and Lysholm Scores), standard radiography and MRI or CT were performed in all patients. Instrumented stress testing (Porto Patella testing device) concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness.ResultsThe force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that of the PFP group. Patients with PPI showed higher ligament stiffness (a higher force was required to displace the patella) than the patients in the OPI group. Patients with OPI had a statistically significant sha...
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Arthroscopy Techniques
Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both... more Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both conservative and surgical options available. Several surgical techniques of the combined or isolated reconstruction of the medial patellofemoral ligament are described in the literature using different grafts, locations, and types of fixations, providing different advantages and disadvantages. New recent developments in cadaveric dissection studies have unveiled the importance of structures that were neglected until recently, such as the medial quadriceps tendonefemoral ligament, which provides a connection between the medial femur and the quadriceps tendon component of the knee extensor mechanism. Hence, we present a surgical technique with combined reconstruction of the medial patellofemoral ligament and medial quadriceps tendonefemoral ligament without the use of hardware and with no need for patellar or femoral drilling (no physis compromise or risk of patellar fracture), which can be used concomitantly with other bony procedures.
Arthroscopy techniques, 2017
Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism ... more Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone. First, the patellar tendon is repaired with an end-to-end technique and the semitendinous tendon is harvested. A transosseous tunnel at the tibial tubercle is drilled and 2 rents are made, both medial and lateral to the retinaculum at the level of the intermedial segment of the patella close to the patellar margin. The graft is passed through...
Arthroscopy techniques, 2017
Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, ... more Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osse...
Stem Cells International, 2016
There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue r... more There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue repair. However, the variability in the methodology for its obtaining may cause different and opposing findings in the literature. Particularly, the choice of the anticoagulant is the first definition to be made. In this work, blood was collected with sodium citrate (SC), ethylenediaminetetraacetic acid (EDTA), or anticoagulant citrate dextrose (ACD) solution A, as anticoagulants, prior to PRP obtaining. Hematological analysis and growth factors release quantification were performed, and the effects on mesenchymal stromal cell (MSC) culture, such as cytotoxicity and cell proliferation (evaluated by MTT method) and gene expression, were evaluated. The use of EDTA resulted in higher platelet yield in whole blood; however, it induced an increase in the mean platelet volume (MPV) following the blood centrifugation steps for PRP obtaining. The use of SC and ACD resulted in higher induction of ...
Motricidade, 2018
INTRODUÇÃO A excelência competitiva requer uma abordagem multidisciplinar na carreira do nadador,... more INTRODUÇÃO A excelência competitiva requer uma abordagem multidisciplinar na carreira do nadador, onde o papel do treinador permanece fulcral. No entanto, o papel de outros intervenientes, como é o caso do médico sensibilizado para a patologia do nadador, tem sido relegado para papeis secundários, sendo este normalmente restringido ao exame médico desportivo no início de época e à intervenção no momento de lesão. Por este motivo, é da maior importância a interação entre corpo clínico e a restante equipa técnica no sentido de se otimizarem estratégias ao nível da prevenção, correto diagnóstico e tratamento de lesões no nadador. Neste sentido, os autores consideram de extrema importância a divulgação e promoção do trabalho dos prestadores de saúde no atleta nadador.
Knee Surgery, Sports Traumatology, Arthroscopy, 2019
Purpose To compare the clinical and laboratory outcomes of intra-articular injections of culture-... more Purpose To compare the clinical and laboratory outcomes of intra-articular injections of culture-expanded bone-derived mesenchymal stem cells (MSCs) with or without platelet-rich plasma (PRP) to intra-articular corticosteroid injections for the treatment of knee osteoarthritis (OA). Methods Forty-seven patients with radiographic and symptomatic knee OA were randomized into three groups for intraarticular injections: autologous bone marrow-derived culture-expanded MSCs (n = 16); autologous bone marrow-derived culture-expanded MSCs + PRP (n = 14); and corticosteroid (n = 17). The outcomes were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) and range of motion (ROM) at baseline, 1, 2, 3, 6, 9 and 12 months and intra-articular cytokines analysis at baseline, 6 and 12 months postoperatively. Results The three groups showed significant improvement in most KOOS domains and global score at 1st month and all domains and global score at 12-month follow-up (p < 0.05). At the 1st month, only the MSCs group showed significant differences in KOOS symptoms domain (p = 0.003). The MSCs and MSCs + PRP groups showed the highest percentage of improvement in most KOOS domains and global score compared to the corticosteroid group. All three groups showed a significant reduction in intra-articular levels of human interleukin-10 cytokine, from baseline to 12 months (p < 0.05). Conclusion An intra-articular injection of bone marrow-derived culture-expanded MSCs with or without the addiction of PRP is effective in improving the function and decreasing symptoms caused by knee OA at 12-month follow-up. Level of evidence II.
Arthroscopy Techniques
The authors report the following potential conflicts of interest or sources of funding: The exper... more The authors report the following potential conflicts of interest or sources of funding: The experimental work (arthroscopy laboratory) and surgical equipment were financially supported by Arthrex. Video 1 was edited by Arthrex. J.E-M. received support for travel-related expenses and laboratory equipment from Arthrex for this study. R.B. received support for travel-related expenses and laboratory equipment from Arthrex for this study. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Return to Play in Football
Football (soccer) is the most played sport worldwide, practiced by more than 300 million people [... more Football (soccer) is the most played sport worldwide, practiced by more than 300 million people [1]. It is a high-impact contact sport, and with the increasing competitive level, it often results in sports-related damage of the knee structures, including articular cartilage injuries [2-4]. These articular cartilage injuries can also be caused by forceful and repetitive mechanical stresses on the
Articular cartilage lesions are serious injuries, particularly in the football player, once these... more Articular cartilage lesions are serious injuries, particularly in the football player, once these may endanger the athlete’s competitive career. Returning to competition at the preinjury sports activity level as fast and as safe as possible is the ultimate goal to be achieved. Although there is no consensus on the best surgical technique, clinical algorithms have been proposed to manage the different articular cartilage defects. Herein, we summarize the available clinical treatment possibilities for addressing focal cartilage defects and osteochondral lesions. We also overview the three rehabilitation phases and the progression of the patient within these plans shall follow objective criteria. The considerations to return to play are also briefly discussed herein.
Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the hand... more Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the handball player competitive career. Returning to competition at the pre-injury sports activity level as early and as safe as possible is the ultimate goal to be achieved. There is no consensus on the best surgical technique, and clinical algorithms have been proposed to manage the different articular cartilage defects. The chapter will also overview and summarize the available conservative and surgical management options and stepwise criteria-based rehabilitation strategy and return to play considerations in handball players with focal cartilage defects and osteochondral lesions.
Football is a sport characterized by physical contact, which explains the high rate of musculoske... more Football is a sport characterized by physical contact, which explains the high rate of musculoskeletal injuries in players described in the literature. The most common injuries are lower limb injuries. Herein, we discuss the main injuries involving the elbow and wrist encountered in football players.
Complex Knee Ligament Injuries
Multiligament knee injuries have low incidence, however are very devastating and require special ... more Multiligament knee injuries have low incidence, however are very devastating and require special attention. New approaches in the diagnosis are vital to allows a better assessement of associated lesions, more careful treatment planning and objective follow-up. The Porto-Knee Testing Device (PKTD) shows very promising results in the assessment of knee instability. The goal of the PKTD is to provide both anatomical and functional evaluation of the knee. It is able to carefully assess the knee sagittal and rotational stability. In multiligament injuries, the use of a arthrometric device concomitantly with imaging procedures can provide valuable information for surgical planning and stability restoration procedures. It is also possible in the postoperative follow-up to evaluate residual instability. Herein, we discuss the recent developments related to PKTD in diagnosis of knee ligament lesions and instability assessment.
Return to Play in Football
The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligamen... more The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligament (ACL) lesion has an essential role in the knee stability assessment. These measurements can further be evaluated through magnetic resonance imaging (MRI), which in combination with instrumented assessment and physical examination can correlate both the “anatomy” and “function” of the ligament. The Porto-Knee Testing Device (PKTD) is a knee laxity testing device compatible with MRI that is capable of measuring the posterior-anterior tibial translation and tibial internal and external rotation. In this sense, the PKTD is a useful tool for the assessment of knee sagittal and rotatory laxity in the follow-up of football players that underwent ACL reconstruction. Hence, this tool may allow to identify individuals presenting residual knee laxity with increased risk of sustaining secondary ACL injuries and assist in the planning of secondary prevention programs.
Revista de Medicina Desportiva informa
Revista de Medicina Desportiva Informa
Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine
ObjectiveInvestigate the patellar force-displacement profile (ligament stiffness) of patellofemor... more ObjectiveInvestigate the patellar force-displacement profile (ligament stiffness) of patellofemoral disorders.MethodsFifty-two knees from 34 consecutive patients (mean 31.6 years and 53% male) were analysed including 24 knees with patellofemoral pain (PFP), 19 with potential patellofemoral instability (PPI) and 9 with objective patellofemoral instability (OPI). Physical examination, patient-reported outcome measures (Kujala and Lysholm Scores), standard radiography and MRI or CT were performed in all patients. Instrumented stress testing (Porto Patella testing device) concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness.ResultsThe force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that of the PFP group. Patients with PPI showed higher ligament stiffness (a higher force was required to displace the patella) than the patients in the OPI group. Patients with OPI had a statistically significant sha...
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Arthroscopy Techniques
Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both... more Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both conservative and surgical options available. Several surgical techniques of the combined or isolated reconstruction of the medial patellofemoral ligament are described in the literature using different grafts, locations, and types of fixations, providing different advantages and disadvantages. New recent developments in cadaveric dissection studies have unveiled the importance of structures that were neglected until recently, such as the medial quadriceps tendonefemoral ligament, which provides a connection between the medial femur and the quadriceps tendon component of the knee extensor mechanism. Hence, we present a surgical technique with combined reconstruction of the medial patellofemoral ligament and medial quadriceps tendonefemoral ligament without the use of hardware and with no need for patellar or femoral drilling (no physis compromise or risk of patellar fracture), which can be used concomitantly with other bony procedures.