CAMILO PARTEZANI HELITO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
11 resultados
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- Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator(2015) ANGELINI, F. J.; HELITO, C. P.; BONADIO, M. B.; ALBUQUERQUE, R. F. da Mota e; PECORA, J. R.; CAMANHO, G. L.Introduction: Knee dislocations are defined as ligament injuries involving at least two of the four most important knee ligaments. Results from recent studies have shown a tendency towards improvement of the functional outcomes with use of an articulated external fixator during the postoperative period following multiligament reconstruction. Our hypothesis was that good knee stability and early gain of range of motion could be achieved with the use of the external fixator after ligament reconstructions. Methods: Fourteen patients with knee dislocations were evaluated after multiligament reconstruction in association with use of a lateral monoplanar external fixator for six weeks. Reconstructions were performed using grafts from a tissue bank. Range of motion was measured after one, two, three, six, twelve months and at the final evaluation at a mean time of 49 months. The assessments were made using objective and subjective IKDC, Lysholm and Tegner scales. Results: The mean scores were 71.7 for the subjective IKDC score, 81.5 for the Lysholm score. No patient was able to return to previous Tegner score. Out of the 45 ligament reconstructions performed, only four failed during the follow-up time. The mean range of motion of the knee presented a progressive increase from the first to the twelfth month, from 67.8 degrees. to 115.7 degrees. Two cases of superficial infection on the site of the external fixator pins were observed. Conclusion: The use of an external fixator enabled early rehabilitation with range of motion gains starting from the first postoperative month, a low rate of reconstruction failure and minimal complications. Nevertheless, none of the patients returned to the level of activity prevailing prior to the injury.
- Advances in treating exposed fractures(2015) GIGLIO, Pedro Nogueira; CRISTANTE, Alexandre Fogaça; PÉCORA, José Ricardo; HELITO, Camilo Partezani; LIMA, Ana Lucia Lei Munhoz; SILVA, Jorge dos SantosThe management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.
- Evaluation of quality of life and walking ability among amputated patients and those who refused to undergo amputation following infection of total knee arthroplasty: Small case series(2015) HELITO, Camilo Partezani; BRITO, Andre Thiago Scandiuzzi de; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; TIRICO, Luis Eduardo P.; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisBackground: Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking. Objectives: 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. Study design: Retrospective case series. Methods: 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. Results: 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. Conclusion: 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.
- Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament(2015) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GOBBI, Riccardo Gomes; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraWe present a new technique for the combined intra- and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament.
- Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination(2015) HELITO, Camilo Partezani; DEMANGE, Marco Kawamura; HELITO, Paulo Victor Partezani; COSTA, Hugo Pereira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; RODRIGUES, Marcelo Bordalo; CAMANHO, Gilberto LuisOBJECTIVE: To evaluate the presence of the anterolateral ligament (ALL) of the knee in magnetic resonance imaging (MRI) examinations. METHODS: Thirty-three MRI examinations on patients' knees that were done because of indications unrelated to ligament instability or trauma were evaluated. T1-weighted images in the sagittal plane and T2-weighted images with fat saturation in the axial, sagittal and coronal planes were obtained. The images were evaluated by two radiologists with experience of musculoskeletal pathological conditions. In assessing ligament visibility, we divided the analysis into three portions of the ligament: from its origin in the femur to its point of bifurcation; from the bifurcation to the meniscal insertion; and from the bifurcation to the tibial insertion. The capacity to view the ligament in each of its portions and overall was taken to be a dichotomous categorical variable (yes or no). RESULTS: The ALL was viewed with signal characteristics similar to those of the other ligament structures of the knee, with T2 hyposignal with fat saturation. The main plane in which the ligament was viewed was the coronal plane. Some portion of the ligament was viewed clearly in 27 knees (81.8%). The meniscal portion was evident in 25 knees (75.7%), the femoral portion in 23 (69.6%) and the tibial portion in 13 (39.3%). The three portions were viewed together in 11 knees (33.3%). CONCLUSION: The anterolateral ligament of the knee is best viewed in sequences in the coronal plane. The ligament was completely characterized in 33.3% of the cases. The meniscal portion was the part most easily identified and the tibial portion was the part least encountered.
- Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up(2015) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; DEMANGE, Marco Kawamura; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; ANGELINI, Fabio JansonPurpose A technique for combined reconstruction of the anterior cruciate ligament (ACL) and posterolateral corner (PLC) with a single femoral tunnel was recently described. This technique aims to avoid tunnel confluence in the lateral femoral condyle. Because there have been no studies on the functional outcomes and possible complications of this technique, our goal is to demonstrate a two-yearminimum follow-up of patients who underwent this type of reconstruction. Methods Nine patients were prospectively evaluated. The ACL was reconstructed with an anatomic single bundle, and the PLC structures reconstructed were the lateral collateral ligament, the popliteus tendon, and the popliteofibular ligament. Patients were evaluated using the objective and subjective International Knee Documentation Committee (IKDC) and the Lysholm and Tegner scales before and after the surgical procedure. Results The mean follow-up period of the studied patients was 27.3 months. The mean subjective IKDC score rose from 43.6 to 84.0, and the Lysholm score rose from 62.1 to 90.8. In the final assessment, six patients were classified as IKDC A and three as IKDC B. According to the Tegner scale, five patients were able to return to their level of activity prior to the injury. There were no reconstruction failures. One patient experienced postoperative infection and pain in the lateral scar. Conclusions The results of the reconstruction of ACL injuries associated with PLC with a single femoral tunnel produced a good functional outcome and a low incidence of complications.
- Clinical and epidemiological differences between septic arthritis of the knee and hip caused by oxacillin-sensitive and -resistant s. aureus(2015) HELITO, Camilo Partezani; ZANON, Bruno Bonganha; MIYAHARA, Helder de Souza; PECORA, Jose Ricardo; LIMA, Ana Lucia Munhoz; OLIVEIRA, Priscila Rosalba de; VICENTE, Jose Ricardo Negreiros de; DEMANGE, Marco Kawamura; CAMANHO, Gilberto LuisOBJECTIVE: To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. METHODS: All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). RESULTS: S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). CONCLUSION: Provenance from a health service-related environment was associated with a higher incidence of MRSA-related septic arthritis, suggesting that this agent should be considered in the initial choice of antibiotic treatment. Previous surgeries of the knee or affected limb and the absence of leukocytes might also be related to infection with this agent.
- Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate(2015) TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; BONADIO, Marcelo Batista; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; PECORA, Jose RicardoDistal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy.
- Correlation of Magnetic Resonance Imaging With Knee Anterolateral Ligament Anatomy A Cadaveric Study(2015) HELITO, Camilo Partezani; HELITO, Paulo Victor Partezani; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; BORDALO-RODRIGUES, Marcelo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraBackground: Anatomic and magnetic resonance imaging (MRI) studies have recently characterized the knee anterolateral ligament (ALL). So far, no study has focused on confirming whether the evaluated MRI parameters truly correspond with ALL anatomy. Purpose: To assess the validity of MRI in detecting the ALL using an anatomic evaluation as reference. Study Design: Descriptive laboratory study. Methods: A total of 13 cadaveric knees were subjected to MRI and then to anatomic dissection. Dissection was performed according to previous anatomic study methodology. MRIs were performed with a 0.6-to 1.5-mm slice thickness and prior saline injection. The following variables were analyzed: distance from the origin of the ALL to the origin of the lateral collateral ligament (LCL), distance from the origin of the ALL to its bifurcation point, maximum length of the ALL, distance from the tibial insertion of the ALL to the articular surface of the tibia, ALL thickness, and ALL width. The 2 sets of measurements were analyzed using the Spearman correlation coefficient (rho) and Bland-Altman plots. Results: The ALL was clearly observed in all dissected knees and MRI scans. It originated anterior and distal to the LCL, close to the lateral epycondile center, and showed an anteroinferior path toward the tibia, inserting between the Gerdy tubercle and the fibular head, around 5mm under the lateral plateau. The r values tended to increase together for all studied variables between the 2 methods, and all were statistically significant, except for thickness (P =.077). Bland-Altman plots showed a tendency toward a reduction of ALL thickness and width by MRI compared with anatomic dissection. Conclusion: MRI scanning as described can accurately assess the ALL and demonstrates characteristics similar to those seen under anatomic dissection. Clinical Relevance: MRI can accurately characterize the ALL in the anterolateral region of the knee, despite the presence of structures that might overlap and thus cause confusion when making assessments based on imaging methods.
- External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee(2015) ANGELINI, Fabio Janson; HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GUIMARES, Tales Molica; BARRETO, Ronald Bispo; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; ALBUQUERQUE, Roberto Freire da Mota eTo assess whether the use of an articulated external fixator provides improvements in the mobility, stability and subjective function of patients undergoing ligament reconstruction. Thirty-three patients with sub-acute and chronic knee dislocation were subjected to multi-ligament reconstruction surgery. These patients were randomly allocated to two groups for immobilization after reconstruction: group 0-control (18 patients), with rigid knee bracing, and group 1-articulated external fixator (15 patients). The stability of the reconstructed ligaments was assessed after at least 14 months (26.6-month average) postoperatively by physical examination. Deficit of extension and flexion was measured in relation to the unaffected contralateral knee, and the Lysholm knee scoring scale questionnaire was applied. There was no difference in the assessment of joint stability between the groups. In group 1, patients showed less flexion deficit (4.8A degrees A A +/- A 5.4A degrees vs. 18.2A degrees A A +/- A 14.8A degrees, p < 0.05), and the percentage of patients with a flexion deficit of 5A degrees or less were higher compared with group 0 (64 vs. 18 %, p < 0.05). There was no difference between groups in relation to extension loss. Group 1 also presented better Lysholm scores, with 73 % of patients rated as excellent or good compared with 35 % in group 0 (p < 0.05). Compared with the control rehabilitation protocol with rigid knee bracing in extension, the use of an articulated external fixator in the treatment of chronic multi-ligament-injured knees provided the same ligament stability, better final range of motion and improved Lysholm score. Patients presenting with chronic multi-ligament instability should be considered for articulated external fixation to supplement reconstruction procedures. Randomized controlled trial, Level I.