Marco Demange | Universidade de São Paulo (original) (raw)

Papers by Marco Demange

Revista Brasileira de Ortopedia (English Edition), 2013

Objective:Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of or... more Objective:Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. Methods: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. Results: The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed. Conclusion: The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

Os autores declaram inexistência de conflito de interesses na realização deste trabalho / The aut... more Os autores declaram inexistência de conflito de interesses na realização deste trabalho / The authors declare that there was no conflict of interest in conducting this work Este artigo está disponível online nas versões Português e Inglês nos sites: www.rbo.org.br e www.scielo.br/rbort This article is available online in Portuguese and English at the websites: www.rbo.org.br and www.scielo.br/rbort

Revista Brasileira de Ortopedia, 2014

Current Reviews in Musculoskeletal Medicine, 2012

Large symptomatic osteochondral defects in a young active population represent a therapeutic chal... more Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.

The American journal of sports medicine, 2015

The American journal of sports medicine, 2014

Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendi... more Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendinosus grafts in children with open physes has been described as a successful surgical technique in short-term follow-up clinical reports. To evaluate the clinical outcomes of nonanatomic ACLR in children with open physes and a minimum of 15 years' follow-up. Case series; Level of evidence, 4. Twelve patients with an average age of 10.7 years (range, 8.3-12.4 years) underwent ACLR between 1991 and 1998. All patients were classified as Tanner development stage 2 or lower. The surgical technique involved transphyseal tibial tunnel drilling and over-the-top (OTT) femoral fixation using a double-stranded graft for all patients. Clinical outcomes were evaluated in terms of the manual Lachman test, pivot-shift test, return to sports activity, and International Knee Documentation Committee (IKDC) score at the end of growth and at a minimum 15-year follow-up (range, 15-22 years). No clinicall...

Acta ortopedica brasileira, 2014

Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperat... more Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis.

Clinics, 2014

Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of th... more Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.

Clinics (São Paulo, Brazil), 2015

To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (M... more To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). Provenance from a health service-rel...

Acta Ortopédica Brasileira, 2014

Citation: Rosa BB, Asperti AM, Helito CP, Demange MK, Fernandes TL, Hernandez AJ. Epidemiology of... more Citation: Rosa BB, Asperti AM, Helito CP, Demange MK, Fernandes TL, Hernandez AJ. Epidemiology of sports injuries on collegiate athletes at a single center. Acta Ortop Bras.

Case reports in orthopedics, 2014

Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedu... more Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedures. In this paper, we present a case of an intraosseous metallic foreign body situated in the medial femoral condyle for one year, causing pain, which was removed with complete resolution of the symptoms.

Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not ... more Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking. To evaluate the quality of life and walking ability among patients who underwent amputation and among those who refused to undergo amputation following infection of a total knee arthroplasty. Retrospective case series. Patients who received an indication for amputation following an infection of a total knee arthroplasty were evaluated retrospectively. The patients were divided between those who accepted the amputation procedure and those who refused amputation (four amputee vs four non-amputees). Walking ability and quality of life were evaluated using the Short Form-36 questionnaire. The average physical health was 27.4 for the amputees and 31.3 for the non-amputees. The average mental health was 49.9 for the amputees and 47.1 for the non-amputees. In relation to walking ability, only one (25%) of the amputees was able to walk, as opposed to 100% in the non-amputee groups. Twenty-five percent of the amputee patients continued to be able to walk. The functional outcome of non-amputee patients was better, with 100% being able to walk, though with limitations. This is the first study evaluating patients who refused the amputation procedure and remained with the spacer. Despite the fact that this option is not recommended by the medical community, we believe that these data are useful when discussing, with a patient, quality of life after amputation.

Recent anatomic studies have confirmed the presence of a true ligament structure, the anterolater... more Recent anatomic studies have confirmed the presence of a true ligament structure, the anterolateral ligament (ALL), in the anterolateral region of the knee. This structure is involved in the rotatory instability of the knee and might explain why some isolated reconstructions of the anterior cruciate ligament result in a residual pivot shift. Therefore, when considering the least invasive method for reconstruction of this structure, it is important to identify the corresponding bony landmarks on radiographic images. To establish radiographic femoral and tibial landmarks for the ALL in frontal and lateral views. Descriptive laboratory study. Ten unpaired cadaver knees were dissected. The attachments of the ALL were isolated and its anatomic parameters were quantified. Its origin and insertion were marked with a 2-mm-diameter metallic sphere, and radiographs were taken from frontal and lateral views. The obtained images were analyzed and the ALL parameters established. The origin of the ALL in the lateral view was found at a point an average ± SD of 47.5% ± 4.3% from the anterior edge of the femoral condyle and about 3.7 ± 1.1 mm below the Blumensaat line. In the frontal view, the origin was about 15.8 ± 1.9 mm from the distal condyle line. The ALL insertion was an average of 53.2% ± 5.8% from the anterior edge of the lateral tibial plateau in the lateral view and 7.0 ± 0.5 mm below the lateral tibial plateau in the frontal view. In anatomic dissections, the origin of the ALL was 1.9 ± 1.4 mm anterior and 4.1 ± 1.1 mm distal to the lateral collateral ligament, and the insertion was 4.4 ± 0.8 mm below the lateral tibial plateau cartilage. The ALL origin on an absolute lateral radiograph of the knee is approximately 47% of the anterior-posterior size of the condyle and 3.7 mm caudal to the Blumensaat line. In a frontal radiograph, the ALL is 15.8 mm from the posterior bicondyle line. The ALL insertion is approximately 53.2% of the anterior-posterior size of the plateau in the lateral view and 7.0 mm below the articular line in the frontal view. Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.

Revista Brasileira de Ortopedia (English Edition), 2014

Pages 8 r e v b r a s o r t o p . 2 0 1 4;x x x(x x):xxx-xxx w w w . r b o . o r g . b r Ankle Os... more Pages 8 r e v b r a s o r t o p . 2 0 1 4;x x x(x x):xxx-xxx w w w . r b o . o r g . b r Ankle Osteotomy Arthroplasty Arthrodesis a b s t r a c t The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease. Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento Palavras-chave: Osteoartrite Tornozelo Osteotomia Artroplastia Artrodese r e s u m o A principal etiologia da osteoartrose (OA) do tornozelo é pós-traumática e sua maior prevalência está entre indivíduos jovens; assim, essa doença apresenta grande impacto socioeconômico e significativo prejuízo na qualidade de vida dos pacientes. O objetivo do tratamento é eliminar a dor e manter os pacientes ativos. Dessa forma, o tratamento deve ser estagiado de acordo com o grau de evolução da degeneração, a etiologia, a localização articular, a condição sistêmica, a qualidade óssea, o alinhamento do membro inferior, a estabilidade ligamentar e a idade. O algoritmo de tratamento é dividido nas modalidades RBOE-842; No. of Pages 8 2 r e v b r a s o r t o p . 2 0 1 4;x x x(x x):xxx-xxx de terapia não cirúrgicas e nas opç ões de tratamento cirúrgico. As cirurgias de preservação articular, as cirurgias de substituição articular e as artrodeses apresentam indicaç ões precisas. O presente artigo apresenta uma revisão sobre o tema e uma proposta de algoritmo de tratamento para essa doença.

Revista Brasileira de Ortopedia, 2014

r e v b r a s o r t o p . 2 0 1 4;4 9(6):565-572 w w w . r b o . o r g . b r Artigo de Revisão Le... more r e v b r a s o r t o p . 2 0 1 4;4 9(6):565-572 w w w . r b o . o r g . b r Artigo de Revisão Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento ଝ informações sobre o artigo Histórico do artigo: Recebido em 21 de outubro de 2013 Aceito em 21 de outubro de 2013 On-line em 28 de outubro de 2014 Palavras-chave: Osteoartrite Tornozelo Osteotomia Artroplastia Artrodese r e s u m o A principal etiologia da osteoartrose (OA) do tornozelo é pós-traumática e sua maior prevalência está entre indivíduos jovens; assim, essa doença apresenta grande impacto socioeconômico e significativo prejuízo na qualidade de vida dos pacientes. O objetivo do tratamento é eliminar a dor e manter os pacientes ativos. Dessa forma, o tratamento deve ser estagiado de acordo com o grau de evolução da degeneração, a etiologia, a localização articular, a condição sistêmica, a qualidade óssea, o alinhamento do membro inferior, a estabilidade ligamentar e a idade. O algoritmo de tratamento é dividido nas modalidades de terapia não cirúrgicas e nas opç ões de tratamento cirúrgico. As cirurgias de preservação articular, as cirurgias de substituição articular e as artrodeses apresentam indicaç ões precisas. O presente artigo apresenta uma revisão sobre o tema e uma proposta de algoritmo de tratamento para essa doença. Ankle Osteotomy Arthroplasty Arthrodesis a b s t r a c t

Medical Imaging 2014: Computer-Aided Diagnosis, 2014

ABSTRACT The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral... more ABSTRACT The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral instability is one condition that generates pain, functional impairment and often requires surgery as part of orthopedic treatment. The analysis of the patellofemoral dynamics has been performed by several medical image modalities. The clinical parameters assessed are mainly based on 2D measurements, such as the patellar tilt angle and the lateral shift among others. Besides, the acquisition protocols are mostly performed with the leg laid static at fixed angles. The use of helical multi slice CT scanner can allow the capture and display of the joint´s movement performed actively by the patient. However, the orthopedic applications of this scanner have not yet been standardized or widespread. In this work we present a method to evaluate the biomechanics of the patellofemoral joint during active contraction using multi slice CT images. This approach can greatly improve the analysis of patellar instability by displaying the physiology during muscle contraction. The movement was evaluated by computing its 3D displacements and rotations from different knee angles. The first processing step registered the images in both angles based on the femur´s position. The transformation matrix of the patella from the images was then calculated, which provided the rotations and translations performed by the patella from its position in the first image to its position in the second image. Analysis of these parameters for all frames provided real 3D information about the patellar displacement.

Current Frontiers in Cryopreservation, 2012

The Journal of arthroplasty, 2014

Prosthetics and Orthotics International, 2013

Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of ov... more Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of overload on the implant, it is apparently more subject to failure than in the non-amputated population. The aim of this case report is to show a failure of primary total knee arthroplasty contralateral to transfemoral amputation that required revision involving a tissue bank because of severely compromised knee bone. Surgical strategies, rehabilitation, and postoperative care for the operated limb and the contralateral prosthesis were demonstrated. A 60-year-old patient with early failure of total knee arthroplasty contralateral to transfemoral amputation underwent arthroplasty revision in which a graft from a tissue bank was used. After the revision, prosthesis length adjustment and exercise therapy were fundamental to the rehabilitation. The patient progressed well after the revision of the arthroplasty, with increases on the Knee Society Score and 36-Item Short Form Health Survey scales. Knee arthroplasty in amputees should be planned differently to that of the general population. For the procedure to be successful, there should be greater attention to implant stability, equalization of leg length, and a postoperative regimen including muscle strengthening and range of motion exercises to achieve the required knee flexion. This case report is important because it presents a challenging case of a unilateral transfemoral amputee with failed arthroplasty over the years in the contralateral limb. To our knowledge, such a case has not been described in the scientific literature. It would be helpful for surgeons and rehabilitation professionals to chart out a treatment protocol and also to prevent premature failure of the joint.

The Knee, 2014

Many reconstruction techniques have already been developed for treating posterolateral corner (PL... more Many reconstruction techniques have already been developed for treating posterolateral corner (PLC) injuries, with still no consensus regarding what would be the best option. Some techniques use non-bone tunnel fixation, attaching the graft to the femur using a cortical screw with toothed washer. The main objective of the present study is to evaluate complications related to fixation performed by a screw and toothed washer technique. A prospective study with surgical reconstruction of the PLC structures of the knee between January 2008 and December 2009 was performed. PLC reconstruction included reconstruction of the lateral collateral ligament, popliteofibular ligament and popliteal muscle tendon. Fixation of the grafts in the femur was achieved by means of a 4.5mm screw with a toothed washer. The assessments were done using the following methods: objective IKDC, subjective IKDC, Lysholm and Tegner. Radiographic evaluations were performed immediately after the operation, at 3, 6 and 12months after surgery, and yearly thereafter. Complications were documented. The mean subjective IKDC score after the operation was 69.2; Lysholm scale was 80.7. Two patients presented failure of reconstructions of the PLC. In the radiographic evaluations, signs of loosening of the screw with toothed washer in the femur were observed in eight cases (66.6%). Six patients (50%) complained of lateral pain after the operation. The technique of femoral fixation was shown to be efficient in restoration of stability. However there was a high rate of complications secondary to implant, such as loosening of the screws and iliotibial tract friction. Case series, leve IV.

Revista Brasileira de Ortopedia (English Edition), 2013

Objective:Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of or... more Objective:Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. Methods: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. Results: The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed. Conclusion: The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

Os autores declaram inexistência de conflito de interesses na realização deste trabalho / The aut... more Os autores declaram inexistência de conflito de interesses na realização deste trabalho / The authors declare that there was no conflict of interest in conducting this work Este artigo está disponível online nas versões Português e Inglês nos sites: www.rbo.org.br e www.scielo.br/rbort This article is available online in Portuguese and English at the websites: www.rbo.org.br and www.scielo.br/rbort

Revista Brasileira de Ortopedia, 2014

Current Reviews in Musculoskeletal Medicine, 2012

Large symptomatic osteochondral defects in a young active population represent a therapeutic chal... more Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.

The American journal of sports medicine, 2015

The American journal of sports medicine, 2014

Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendi... more Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendinosus grafts in children with open physes has been described as a successful surgical technique in short-term follow-up clinical reports. To evaluate the clinical outcomes of nonanatomic ACLR in children with open physes and a minimum of 15 years' follow-up. Case series; Level of evidence, 4. Twelve patients with an average age of 10.7 years (range, 8.3-12.4 years) underwent ACLR between 1991 and 1998. All patients were classified as Tanner development stage 2 or lower. The surgical technique involved transphyseal tibial tunnel drilling and over-the-top (OTT) femoral fixation using a double-stranded graft for all patients. Clinical outcomes were evaluated in terms of the manual Lachman test, pivot-shift test, return to sports activity, and International Knee Documentation Committee (IKDC) score at the end of growth and at a minimum 15-year follow-up (range, 15-22 years). No clinicall...

Acta ortopedica brasileira, 2014

Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperat... more Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis.

Clinics, 2014

Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of th... more Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.

Clinics (São Paulo, Brazil), 2015

To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (M... more To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). Provenance from a health service-rel...

Acta Ortopédica Brasileira, 2014

Citation: Rosa BB, Asperti AM, Helito CP, Demange MK, Fernandes TL, Hernandez AJ. Epidemiology of... more Citation: Rosa BB, Asperti AM, Helito CP, Demange MK, Fernandes TL, Hernandez AJ. Epidemiology of sports injuries on collegiate athletes at a single center. Acta Ortop Bras.

Case reports in orthopedics, 2014

Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedu... more Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedures. In this paper, we present a case of an intraosseous metallic foreign body situated in the medial femoral condyle for one year, causing pain, which was removed with complete resolution of the symptoms.

Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not ... more Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking. To evaluate the quality of life and walking ability among patients who underwent amputation and among those who refused to undergo amputation following infection of a total knee arthroplasty. Retrospective case series. Patients who received an indication for amputation following an infection of a total knee arthroplasty were evaluated retrospectively. The patients were divided between those who accepted the amputation procedure and those who refused amputation (four amputee vs four non-amputees). Walking ability and quality of life were evaluated using the Short Form-36 questionnaire. The average physical health was 27.4 for the amputees and 31.3 for the non-amputees. The average mental health was 49.9 for the amputees and 47.1 for the non-amputees. In relation to walking ability, only one (25%) of the amputees was able to walk, as opposed to 100% in the non-amputee groups. Twenty-five percent of the amputee patients continued to be able to walk. The functional outcome of non-amputee patients was better, with 100% being able to walk, though with limitations. This is the first study evaluating patients who refused the amputation procedure and remained with the spacer. Despite the fact that this option is not recommended by the medical community, we believe that these data are useful when discussing, with a patient, quality of life after amputation.

Recent anatomic studies have confirmed the presence of a true ligament structure, the anterolater... more Recent anatomic studies have confirmed the presence of a true ligament structure, the anterolateral ligament (ALL), in the anterolateral region of the knee. This structure is involved in the rotatory instability of the knee and might explain why some isolated reconstructions of the anterior cruciate ligament result in a residual pivot shift. Therefore, when considering the least invasive method for reconstruction of this structure, it is important to identify the corresponding bony landmarks on radiographic images. To establish radiographic femoral and tibial landmarks for the ALL in frontal and lateral views. Descriptive laboratory study. Ten unpaired cadaver knees were dissected. The attachments of the ALL were isolated and its anatomic parameters were quantified. Its origin and insertion were marked with a 2-mm-diameter metallic sphere, and radiographs were taken from frontal and lateral views. The obtained images were analyzed and the ALL parameters established. The origin of the ALL in the lateral view was found at a point an average ± SD of 47.5% ± 4.3% from the anterior edge of the femoral condyle and about 3.7 ± 1.1 mm below the Blumensaat line. In the frontal view, the origin was about 15.8 ± 1.9 mm from the distal condyle line. The ALL insertion was an average of 53.2% ± 5.8% from the anterior edge of the lateral tibial plateau in the lateral view and 7.0 ± 0.5 mm below the lateral tibial plateau in the frontal view. In anatomic dissections, the origin of the ALL was 1.9 ± 1.4 mm anterior and 4.1 ± 1.1 mm distal to the lateral collateral ligament, and the insertion was 4.4 ± 0.8 mm below the lateral tibial plateau cartilage. The ALL origin on an absolute lateral radiograph of the knee is approximately 47% of the anterior-posterior size of the condyle and 3.7 mm caudal to the Blumensaat line. In a frontal radiograph, the ALL is 15.8 mm from the posterior bicondyle line. The ALL insertion is approximately 53.2% of the anterior-posterior size of the plateau in the lateral view and 7.0 mm below the articular line in the frontal view. Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.

Revista Brasileira de Ortopedia (English Edition), 2014

Pages 8 r e v b r a s o r t o p . 2 0 1 4;x x x(x x):xxx-xxx w w w . r b o . o r g . b r Ankle Os... more Pages 8 r e v b r a s o r t o p . 2 0 1 4;x x x(x x):xxx-xxx w w w . r b o . o r g . b r Ankle Osteotomy Arthroplasty Arthrodesis a b s t r a c t The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease. Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento Palavras-chave: Osteoartrite Tornozelo Osteotomia Artroplastia Artrodese r e s u m o A principal etiologia da osteoartrose (OA) do tornozelo é pós-traumática e sua maior prevalência está entre indivíduos jovens; assim, essa doença apresenta grande impacto socioeconômico e significativo prejuízo na qualidade de vida dos pacientes. O objetivo do tratamento é eliminar a dor e manter os pacientes ativos. Dessa forma, o tratamento deve ser estagiado de acordo com o grau de evolução da degeneração, a etiologia, a localização articular, a condição sistêmica, a qualidade óssea, o alinhamento do membro inferior, a estabilidade ligamentar e a idade. O algoritmo de tratamento é dividido nas modalidades RBOE-842; No. of Pages 8 2 r e v b r a s o r t o p . 2 0 1 4;x x x(x x):xxx-xxx de terapia não cirúrgicas e nas opç ões de tratamento cirúrgico. As cirurgias de preservação articular, as cirurgias de substituição articular e as artrodeses apresentam indicaç ões precisas. O presente artigo apresenta uma revisão sobre o tema e uma proposta de algoritmo de tratamento para essa doença.

Revista Brasileira de Ortopedia, 2014

r e v b r a s o r t o p . 2 0 1 4;4 9(6):565-572 w w w . r b o . o r g . b r Artigo de Revisão Le... more r e v b r a s o r t o p . 2 0 1 4;4 9(6):565-572 w w w . r b o . o r g . b r Artigo de Revisão Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento ଝ informações sobre o artigo Histórico do artigo: Recebido em 21 de outubro de 2013 Aceito em 21 de outubro de 2013 On-line em 28 de outubro de 2014 Palavras-chave: Osteoartrite Tornozelo Osteotomia Artroplastia Artrodese r e s u m o A principal etiologia da osteoartrose (OA) do tornozelo é pós-traumática e sua maior prevalência está entre indivíduos jovens; assim, essa doença apresenta grande impacto socioeconômico e significativo prejuízo na qualidade de vida dos pacientes. O objetivo do tratamento é eliminar a dor e manter os pacientes ativos. Dessa forma, o tratamento deve ser estagiado de acordo com o grau de evolução da degeneração, a etiologia, a localização articular, a condição sistêmica, a qualidade óssea, o alinhamento do membro inferior, a estabilidade ligamentar e a idade. O algoritmo de tratamento é dividido nas modalidades de terapia não cirúrgicas e nas opç ões de tratamento cirúrgico. As cirurgias de preservação articular, as cirurgias de substituição articular e as artrodeses apresentam indicaç ões precisas. O presente artigo apresenta uma revisão sobre o tema e uma proposta de algoritmo de tratamento para essa doença. Ankle Osteotomy Arthroplasty Arthrodesis a b s t r a c t

Medical Imaging 2014: Computer-Aided Diagnosis, 2014

ABSTRACT The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral... more ABSTRACT The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral instability is one condition that generates pain, functional impairment and often requires surgery as part of orthopedic treatment. The analysis of the patellofemoral dynamics has been performed by several medical image modalities. The clinical parameters assessed are mainly based on 2D measurements, such as the patellar tilt angle and the lateral shift among others. Besides, the acquisition protocols are mostly performed with the leg laid static at fixed angles. The use of helical multi slice CT scanner can allow the capture and display of the joint´s movement performed actively by the patient. However, the orthopedic applications of this scanner have not yet been standardized or widespread. In this work we present a method to evaluate the biomechanics of the patellofemoral joint during active contraction using multi slice CT images. This approach can greatly improve the analysis of patellar instability by displaying the physiology during muscle contraction. The movement was evaluated by computing its 3D displacements and rotations from different knee angles. The first processing step registered the images in both angles based on the femur´s position. The transformation matrix of the patella from the images was then calculated, which provided the rotations and translations performed by the patella from its position in the first image to its position in the second image. Analysis of these parameters for all frames provided real 3D information about the patellar displacement.

Current Frontiers in Cryopreservation, 2012

The Journal of arthroplasty, 2014

Prosthetics and Orthotics International, 2013

Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of ov... more Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of overload on the implant, it is apparently more subject to failure than in the non-amputated population. The aim of this case report is to show a failure of primary total knee arthroplasty contralateral to transfemoral amputation that required revision involving a tissue bank because of severely compromised knee bone. Surgical strategies, rehabilitation, and postoperative care for the operated limb and the contralateral prosthesis were demonstrated. A 60-year-old patient with early failure of total knee arthroplasty contralateral to transfemoral amputation underwent arthroplasty revision in which a graft from a tissue bank was used. After the revision, prosthesis length adjustment and exercise therapy were fundamental to the rehabilitation. The patient progressed well after the revision of the arthroplasty, with increases on the Knee Society Score and 36-Item Short Form Health Survey scales. Knee arthroplasty in amputees should be planned differently to that of the general population. For the procedure to be successful, there should be greater attention to implant stability, equalization of leg length, and a postoperative regimen including muscle strengthening and range of motion exercises to achieve the required knee flexion. This case report is important because it presents a challenging case of a unilateral transfemoral amputee with failed arthroplasty over the years in the contralateral limb. To our knowledge, such a case has not been described in the scientific literature. It would be helpful for surgeons and rehabilitation professionals to chart out a treatment protocol and also to prevent premature failure of the joint.

The Knee, 2014

Many reconstruction techniques have already been developed for treating posterolateral corner (PL... more Many reconstruction techniques have already been developed for treating posterolateral corner (PLC) injuries, with still no consensus regarding what would be the best option. Some techniques use non-bone tunnel fixation, attaching the graft to the femur using a cortical screw with toothed washer. The main objective of the present study is to evaluate complications related to fixation performed by a screw and toothed washer technique. A prospective study with surgical reconstruction of the PLC structures of the knee between January 2008 and December 2009 was performed. PLC reconstruction included reconstruction of the lateral collateral ligament, popliteofibular ligament and popliteal muscle tendon. Fixation of the grafts in the femur was achieved by means of a 4.5mm screw with a toothed washer. The assessments were done using the following methods: objective IKDC, subjective IKDC, Lysholm and Tegner. Radiographic evaluations were performed immediately after the operation, at 3, 6 and 12months after surgery, and yearly thereafter. Complications were documented. The mean subjective IKDC score after the operation was 69.2; Lysholm scale was 80.7. Two patients presented failure of reconstructions of the PLC. In the radiographic evaluations, signs of loosening of the screw with toothed washer in the femur were observed in eight cases (66.6%). Six patients (50%) complained of lateral pain after the operation. The technique of femoral fixation was shown to be efficient in restoration of stability. However there was a high rate of complications secondary to implant, such as loosening of the screws and iliotibial tract friction. Case series, leve IV.