LEANDRO EJNISMAN
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
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Effectiveness of Nonoperative Management of Hip Microinstability(2022) EJNISMAN, Leandro; ELISMAN, Katerina; SAFRAN, Marc R.Background: Hip microinstability has recently gained acceptance as a cause of hip pain. In this condition, the femoral head demonstrates increased motion relative to the acetabulum, which may lead to chondrolabral damage. Even though patients are initially prescribed a trial of nonoperative treatment, the success rates of rehabilitation are unknown. Purpose: To determine the success rate of nonoperative treatment of hip microinstability. Study Design: Case series; Methods: After institutional review board approval was obtained, a retrospective chart review was performed on patients at a university sports medicine practice between January 2013 and July 2016. All patients older than 18 years presenting with hip microinstability who were initially recommended for treatment with physical therapy were enrolled in this study. Formal physical therapy sessions focused on strengthening the hip and core muscles. These sessions took place twice a week for a minimum of 6 weeks in conjunction with a home exercise program. The number of patients who eventually underwent surgical treatment and the clinical scores for the cohort (modified Harris Hip Score [mHHS] and 33-item International Hip Outcome Tool) were recorded. Results: A total of 64 patients (63 female, 1 male), with a mean +/- SD age of 32.2 +/- 10.5 years, were identified and studied. Onset of symptoms was insidious (n = 45; 70.3%), acute atraumatic (n = 12; 18.8%), and traumatic (n = 7; 10.9%). A total of 9 (14.1%) patients were high-level athletes. After a follow-up of 45.7 +/- 14.6 months, 14 (29.8%) patients eventually underwent hip arthroscopy for persistent hip pain. Capsular plication was performed in all surgical cases. High-level athletes were not more likely to need surgery (50% vs 26.8%; P = .34). The mHHS was available in 24 patients who were treated nonoperatively, and it improved from 67.4 to 85.0 (P < .01). Conclusion: More than two-thirds of patients treated for hip microinstability were able to avoid surgery; they were successfully treated nonoperatively with physical therapy and a home exercise program and demonstrated improved clinical outcome scores.
- Are femoroacetabular impingement tomographic angles associated with the histological assessment of labral tears? A cadaveric study(2018) EJNISMAN, Leandro; DOMB, Benjamin G.; SOUZA, Felipe; JUNQUEIRA, Consuelo; VICENTE, Jose Ricardo Negreiros; CROCI, Alberto TesconiPurpose This study sought to investigate the association between tomographic femoroacetabular impingement (FAI) angles and histologically evaluated labral tears. The authors hypothesized that cadavers presenting with cam and pincer morphologies would present a higher prevalence of acetabular labral tears. Methods Twenty fresh cadavers were submitted to computed tomography. Standard FAI angles were measured, including the alpha angle, femoral version, acetabular version, Tonnis angle and center-edge angle. A cam lesion was defined as an alpha angle greater than 50 degrees. A pincer lesion was defined as a center-edge angle greater than 40 degrees, a Tonnis angle less than 0 degrees or acetabular version less than 0 degrees. After dissection, three fragments of each acetabulum, corresponding to the antero-superior, superior and postero-superior acetabular rim, were obtained. These fragments were submitted to routine histological preparation. Each slide was evaluated for possible labral tears. Tears were classified according to their Seldes type. Results The mean age of the cadavers was 50.2 years (SD: 7.4; 13 males). Sixteen (80%) of the cadavers had a cam lesion, and eight cadavers (40%) had a pincer lesion. Histologically, 16 (80%) of the cadavers had a labral tear in at least one region. According to the Seldes classification, 60.7% and 28.6% of these labral tears were type 1 and type 2, respectively. A mixed type of labral tear (10.7%), which represented a new form of Seldes tear, was described. Cadavers with a labral tear had significantly higher alpha angles than other cadavers (53.29 degrees vs 49.33 degrees, p = 0.01). Pincer lesions were not associated with labral tears. We found no association between pincer or cam lesions and Seldes classification. Conclusion Cadavers presenting with higher alpha angles had a higher incidence of labral tears. No association was found between FAI and Seldes classification. Clinical relevance This study demonstrated a high prevalence of FAI abnormalities associated with histological alterations in a cadaveric sample. Joint damage may be present in the early stages of FAI.
- Femoroacetabular Impingement: Have We Hit a Global Tipping Point in Diagnosis and Treatment? Results From the InterNational Femoroacetabular Impingement Optimal Care Update Survey (IN FOCUS)(2016) KHAN, Moin; AYENI, Olufemi R.; MADDEN, Kim; BEDI, Asheesh; RANAWAT, Anil; KELLY, Bryan T.; SANCHETI, Parag; EJNISMAN, Leandro; TSIRIDIS, Eleftherios; BHANDARI, MohitPurpose: This international survey was conducted to assess the perceptions of orthopaedic surgeons regarding the diagnosis and management of femoroacetabular impingement (FAI) as well as to explore the current demographic characteristics of surgeons performing FAI surgery. Methods: A survey was developed using previous literature, focus groups, and a sample-to-redundancy strategy. The survey contained 46 questions and was e-mailed to national orthopaedic associations and orthopaedic sports medicine societies for member responses. Members were contacted on multiple occasions to increase the response rate. Results: Nine hundred orthopaedic surgeons from 20 national and international organizations completed the survey. Surgeons responded across 6 continents, 58.2% from developed nations, with 35.4% having sports fellowship training. North American and European surgeons reported significantly greater exposure to hip arthroscopy during residency and fellowship training in comparison to international respondents (48.0% and 44.5% respectively, v 25.6%; P < .001). Surgeons performing a higher volume of FAI surgery (> 100 cases per year) were significantly more likely to have practiced for more than 20 years (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.01 to 3.63), to be practicing at an academic hospital (OR, 2.25; 95% CI, 1.22 to 4.15), and to have formal arthroscopy training (OR, 46.17; 95% CI, 20.28 to 105.15). High-volume surgeons were over two-fold more likely to practice in North America and Europe (OR, 2.26; 95% CI, 1.08 to 4.72). Conclusions: The exponential rise in the diagnosis and surgical management of FAI appears to be driven largely by experienced surgeons in developed nations. Significant variability exists regarding the diagnosis and management of FAI. Our analysis suggests that although FAI management is early in the innovation cycle, we are at a tipping point toward wider uptake and use.
- Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic(2020) HINCKEL, Betina B.; BAUMANN, Charles A.; EJNISMAN, Leandro; CAVINATTO, Leonardo M.; MARTUSIEWICZ, Alexander; TANAKA, Miho J.; TOMPKINS, Marc; SHERMAN, Seth L.; CHAHLA, Jorge A.; FRANK, Rachel; YAMAMOTO, Guilherme L.; BICOS, James; ARENDT, Liza; FITHIAN, Donald; FARR, JackOrthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sportmedicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
- Biologics in hip preservation(2018) EJNISMAN, Leandro; SAFRAN, Marc R.The identification and understanding of non-arthritic hip conditions has grown rapidly in the last two decades. New pathologies have been described including femoroacetabular impingement, hip microinstability, deep gluteal syndrome and greater trochanteric pain syndrome. Even though the treatment of these disorders has yielded good clinical results, there is always a desire to improve outcomes and the speed in which they are attained. Biologic therapies have emerged as a new or adjunctive modality to improve clinical outcomes of hip pathology, as well as, a potential way to accelerate healing times and return to play. This review focuses on the use of current biologic therapies, specifically platelet-rich plasma, hyaluronic acid and stem cells, in the treatment of various hip pathologies.
- The Role of Anterior Capsular Laxity in Hip Microinstability A Novel Biomechanical Model(2019) JOHANNSEN, Adam M.; BEHN, Anthony W.; SHIBATA, Kotaro; EJNISMAN, Leandro; THIO, Timothy; SAFRAN, Marc R.Background: Hip microinstability is an increasingly recognized source of hip pain and disability. Although the clinical entity has been well described, the pathomechanics of this disease remain poorly understood. Purpose/Hypothesis: The purpose of this study was to determine the role of capsular laxity in atraumatic hip microinstability. Our hypothesis was that cyclic stretching of the anterior hip capsule would result in increased hip range of motion and femoral head displacement. Study Design: Controlled laboratory study. Methods: In this study, 7 hip specimens met inclusion criteria (age, 18-46 years). Specimens were stripped of all soft tissue, aligned, cut, and potted by use of a custom jig. A materials testing system was used to cyclically stretch the anterior hip capsule in extension and external rotation while rotating about the mechanical axis of the hip. A motion tracking system was used to record hip rotation and displacement of the femoral head relative to the acetabulum in the anterior-posterior, medial-lateral, and superior-inferior directions. Testing was conducted at baseline, after venting, and after capsular stretching. Results: With the hip in anatomic neutral alignment, cyclic stretching of the anterior hip capsule resulted in increased hip rotation (P < .01). Femoral head displacement significantly increased relative to the vented state in the medial-lateral (P\. 001), anterior-posterior (P=.013), and superior-inferior (P=.036) planes after cyclic stretching of the anterior hip capsule. Conclusion: The anterior hip capsule plays an important role in controlling hip rotation and femoral head displacement. This study is the first to display significant increases in femoral head displacement through a controlled cyclic stretching protocol of the anterior hip capsule. Clinical Relevance: This study is directly applicable to the treatment of atraumatic hip microinstability. The results quantitatively define the relative importance of the hip capsule in controlling femoral head motion. This allows for a better understanding of the pathophysiological process of hip microinstability and serves as a platform to develop effective surgical techniques for treatment of this disease.
- Contributions of the Capsule and Labrum to Hip Mechanics in the Context of Hip Microinstability(2019) JOHANNSEN, Adam M.; EJNISMAN, Leandro; BEHN, Anthony W.; SHIBATA, Kotaro; THIO, Timothy; SAFRAN, Marc R.Background: Hip microinstability and labral pathology are commonly treated conditions with increasing research emphasis. To date, there is limited understanding of the biomechanical effects of the hip capsule and labrum on controlling femoral head motion. Purpose/Hypothesis: The purpose of this study was to determine the relative role of anterior capsular laxity and labral insufficiency in atraumatic hip microinstability. Our hypotheses were that (1) labral tears in a capsular intact state will have a minimal effect on femoral head motion and (2) the capsule and labrum work synergistically in controlling hip stability. Study Design: Controlled laboratory study. Methods: Twelve paired hip specimens from 6 cadaveric pelvises (age, 18-41 years) met the inclusion criteria. Specimens were stripped of all soft tissue except the hip capsule and labrum, then aligned, cut, and potted using a custom jig. A materials testing system was used to cyclically stretch the anterior hip capsule in extension and external rotation, while rotating about the mechanical axis of the hip. Labral insufficiency was created with a combined radial and chondrolabral tear under direct visualization. A motion tracking system was used to record hip internal-external rotation and displacement of the femoral head relative to the acetabulum in the anterior-posterior, medial-lateral, and superior-inferior directions. Testing variables included baseline, postventing, postcapsular stretching, and postlabral insufficiency. Results: When comparing the vented state with each experimental pathologic state, increases in femoral head motion were noted in both the capsular laxity state and the labral insufficiency state. The combined labral insufficiency and capsular laxity state produced statistically significant increases (P < .001) in femoral head translation compared with the vented state in all planes of motion. Conclusion: Both the anterior capsule and labrum play a role in hip stability. In this study, the anterior hip capsule was the primary stabilizer to femoral head translation, but labral tears in the setting of capsular laxity produced the most significant increases in femoral head translation.