RICCARDO GOMES GOBBI

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Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: MARCELO BATISTA BONADIO ×

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  • article 4 Citação(ões) na Scopus
    Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel
    (2021) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; CAMANHO, Gilberto Luis; ANGELINI, Fabio Janson
    The objective of this study is to report the functional outcomes, complications, and reconstruction failure rate of patients undergoing posterolateral complex reconstruction with a single femoral tunnel technique. Patients with posterolateral complex injuries associated with injury of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), or both undergoing surgical treatment with the single femoral tunnel technique were included in the study. The International Knee Documentation Committee (IKDC) and Lysholm's scales were evaluated, in addition to age, gender, time between trauma and surgery, trauma type, range of motion (ROM) restrictions, peroneal nerve injury, and reconstruction failure. Sixty-six patients were included. Eighteen underwent ACL and posterolateral complex (PLC) reconstruction (group 1), 24 underwent ACL, PCL, and PLC reconstruction (group 2), and 24 underwent PCL and PLC reconstruction (group 3). The mean follow-up was 63 months. The subjective IKDC was 83.7 +/- 14.6 for group 1, 74.3 +/- 12.6 for group 2, and 66.3 +/- 16.0 for group 3 ( p <0.001). The Lysholm's score was 87.112.8 for group 1, 79.5 +/- 15.0 for group 2, and 77.7 +/- 15.2 for group 3 ( p =0.042). There were six reconstruction failures among the patients (9.1%) with no differences among the groups ( p =0.368). Female gender and reconstruction failure were associated with worse outcomes. Patients undergoing reconstruction of PLC structures with the single femoral tunnel technique achieved good functional outcomes and a failure rate similar to literature. Patients undergoing only combined ACL reconstruction showed better outcomes than patients undergoing combined PCL reconstruction. Female gender was associated with a worse functional outcome irrespective of the injury type.
  • article 38 Citação(ões) na Scopus
    Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament? Dissection by Layers and a Description of Its Superficial and Deep Layers
    (2016) HELITO, Camilo Partezani; AMARAL JR., Carlos do; NAKAMICHI, Yuri da Cunha; GOBBI, Riccardo Gomes; BONADIO, Marcelo Batista; NATALINO, Renato Jose Mendonca; PECORA, Jose Ricardo; CARDOSO, Tulio Pereira; CAMANHO, Gilberto Luis; DEMANGE, Marco Kawamura
    Background: No consensus exists regarding the anatomic characteristics of the knee anterolateral ligament (ALL). A critical analysis of the dissections described in previous studies allows the division of the ALL into 2 groups with similar characteristics. The presence of considerable variability suggests that the authors may not be referring to the same structure. Purpose/Hypothesis: To perform a lateral anatomic dissection, by layers, seeking to characterize the 2 variants described for the ALL on the same knee. We hypothesized that we would identify the 2 variants described for the ALL and that these variants would have distinct characteristics. Study Design: Descriptive laboratory study. Methods: Thirteen unpaired cadaveric knees were used in this study. The dissection protocol followed the parameters described in previous studies. Immediately below the iliotibial tract, we isolated a structure designated as the superficial ALL, whereas between this structure and the articular capsule, we isolated a structure designated as the deep ALL. The 2 structures were measured for length at full extension and at 90 degrees of flexion and for distance from the tibial insertion relative to the Gerdy tubercle. Potential contact with the lateral meniscus was also evaluated. After measurements were obtained, the 2 dissected structures underwent histologic analysis. Results: The superficial ALL presented a posterior and proximal origin to the center of the lateral epicondyle, its length increased on knee extension, and it exhibited no contact with the lateral meniscus. The deep ALL was located in the center of the lateral epicondyle, its length increased on knee flexion, and it presented a meniscal insertion. Both structures had a similar tibial insertion site; however, the insertion site of the deep ALL was located more posteriorly. The analysis of the histological sections for both structures indicated the presence of dense and well-organized collagen fibers. Conclusion: This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL. Clinical Relevance: This study clarifies numerous controversies encountered in anatomic studies of the ALL. Knowledge regarding the existence of 2 distinct structures in the anterolateral knee will allow more accurate evaluation of their functions and characteristics.
  • article 91 Citação(ões) na Scopus
    Radiographic Landmarks for Locating the Femoral Origin and Tibial Insertion of the Knee Anterolateral Ligament
    (2014) HELITO, Camilo Partezani; DEMANGE, Marco Kawamura; BONADIO, Marcelo Batista; TIRICO, Luis Eduardo Passareli; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis
    Background: 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. Purpose: To establish radiographic femoral and tibial landmarks for the ALL in frontal and lateral views. Study Design: Descriptive laboratory study. Methods: 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. Results: 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. Conclusion: 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. Clinical Relevance: Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.
  • article 14 Citação(ões) na Scopus
    Surgical Timing Does Not Interfere on Clinical Outcomes in Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament: A Comparative Study With Minimum 2-Year Follow-Up
    (2021) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; CAMANHO, Gilberto Luis
    Purpose: To compare the functional outcomes, knee stability, failure rate and complication rates of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction with hamstrings grafts between acute and chronic cases. Methods: Consecutive patients who underwent combined ACL and ALL reconstruction with hamstrings grafts were evaluated. Patients operated on less than 8 weeks after injury were allocated to group 1, and the others were allocated to group 2. Demographic data, knee stability, and functional outcomes of the 2 groups were evaluated. Results: Thirty-four patients in the acute group and 96 in the chronic group were evaluated. The follow-up time was similar between the groups (28.7 +/- 5.2 [24-43] months vs 29.4 +/- 7.2 [24-58] months; P = 0.696). No differences were found between the groups in age, sex, trauma mechanism, presence of knee hyperextension, graft diameter, and meniscal injuries. There was no difference between the groups in the postoperative KT-1000 and in the pre- or postoperative pivot shift. The preoperative KT-1000 was higher in group 2 (7.9 +/- 1.1 vs 7.4 +/- 1.2; P = 0.031). There were no differences in the International Knee Documentation Committee or Lysholm. Three (2.3%) patients developed failure, 1 (2.9%) in group 1 and 2 (2.1%) in group 2. The total complication rate was 10% and did not differ between the groups. Conclusions: Combined ACL and ALL reconstruction has similar outcomes in patients undergoing surgery in the acute and chronic phases. Patients with chronic injury have similar knee stability, functional scores, and failure rates as acute-injury patients, and patients with acute injury have no more complications than chronic patients. Level of Evidence: Level III, retrospective comparative therapeutic trial.
  • article 0 Citação(ões) na Scopus
    Letter regarding ""Management of the exposed total knee prosthesis, a six-year review""
    (2017) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura
  • article 17 Citação(ões) na Scopus
    The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention
    (2020) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; DEMANGE, Marco Kawamura; GOBBI, Riccardo Gomes
    Background Wound healing complications are causal factors of prosthesis infection and poor postoperative evolution of patients after total knee arthroplasty (TKA). Negative-pressure wound therapy (NPWT) can be an option to minimize these complications. The aim of this study is to compare the complications of patients undergoing TKA who used a portable NPWT device in the immediate postoperative period with those of a control group. Methods A total of 296 patients were evaluated. Patients were divided into two groups: those who used NPWT for seven days in the postoperative period (Group 1 - prospective evaluated) and those who used conventional dressings (Group 2 - historical control group). Epidemiological data, comorbidities, local parameters related to the surgical wound and complications were evaluated. Results The groups did not differ in regard to sex, age and clinical comorbidities. Overall, 153 (51.7%) patients had at least one risk factor for wound complications. Patients who used NPWT had a lower rate of complications (28.5% vs. 45.7%,p = 0.001) and a lower rate of reintervention in the operating room (2% vs. 8.5%, p = 0.001). Patients in group 1 had a lower incidence of hyperaemia (14.7% vs. 40.2%,p = 0.01), skin necrosis (2.1% vs. 8.5%,p = 0.04) and wound dehiscence (3.1% vs 10.1%,p = 0.03). The use of NPWT was a protective factor for the presence of complications, with an odds ratio of 0.36 (95% CI 0.206-0.629). Conclusion The number of complications related to the wound after TKA is high; however, most of them are minor and have no impact on the treatment and clinical evolution of patients. The use of NPWT decreased the number of surgical wound complications, especially hyperaemia, dehiscence and necrosis, and reduced the need for reintervention.
  • article 5 Citação(ões) na Scopus
    Plateau-patella angle: An option for the evaluation of patellar height in patients with patellar instability
    (2017) BONADIO, Marcelo Batista; HELITO, Camilo Partezani; TORRES, Julio Augusto do Prado; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco Kawamura
    Background: Patellar instability is a debilitating disease. An important factor related to recurrent dislocation is patellar height. A new method of patellar height measurement, the plateau-patella angle (PPA), was proposed in 2011. However, to date, there is no study evaluating the use of this method in patients with patellar instability. The aim of this study was to evaluate the PPA in patients with recurrent patellar dislocation. Methods: This was a retrospective evaluation of the radiographs of 78 knees with patellar instability. Patellar height was measured using the Insall-Salvati (VS), Caton-Deschamps (C/D) and Blackburne-Peel (B/P) indices and the PPA. The qualitative and quantitative correlations between the various methods and between observers were calculated. Results: The PPA had a Pearson correlation of 0.76 (P <0.001) with the I/S index, 0.78 (P < 0.001) with the C/D index and 0.90 (P < 0.001) with the B/P index. In the qualitative correlation using the Spearman coefficient, the PPA had a correlation of 0.52 (P < 0.001) with the I/S index, 0.72 (P < 0.001) with the C/D index and 0.70 (P < 0.001) with the B/P index. The correlations between the conventional methods were as follows: 0.57 (P < 0.001) between the I/S and C/D indices; 0.61 (P < 0.001) between the I/S and B/P indices; and 0.73 (P < 0.001) between the C/D and B/P indices. Conclusion: The determination of the PPA is a reproducible method that is consistent with the methods currently used to measure patellar height in patients with recurrent patellar dislocation.
  • article 25 Citação(ões) na Scopus
    Anatomical study on the anterolateral ligament of the knee
    (2013) HELITO, Camilo Partezani; MIYAHARA, Helder de Souza; BONADIO, Marcelo Batista; TIRICO, Luis Eduardo Passareli; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; ANGELINI, Fabio Janson; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis
    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.
  • article 26 Citação(ões) na Scopus
    Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon
    (2016) HINCKEL, Betina Bremer; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis
    Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.
  • article 22 Citação(ões) na Scopus
    Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience
    (2016) HINCKEL, Betina Bremer; GOBBI, Riccardo Gomes; BONADIO, Marcelo Batista; DEMANGE, Marco Kawamura; PÉCORA, José Ricardo; CAMANHO, Gilberto Luis
    ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon, was technically safe and presented good objective and subjective clinical results in this case series with a short follow-up.