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
9 resultados
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- Medications and Nutritional Supplements in Athletes during the 2000, 2004, 2008, and 2012 FIFA Futsal World Cups(2015) PEDRINELLI, Andre; EJNISMAN, Leandro; FAGOTTI, Lorenzo; DVORAK, Jiri; TSCHOLL, Philippe M.Objective. To examine the use of medications and nutritional supplements among top-level male futsal players during international tournaments. Materials and Methods. This retrospective survey of the four consecutive 2000 to 2012 FIFA(Federation Internationale de Football Association) Futsal World Cup tournaments analyzes data about the use of medications and nutritional supplements by each player prior to every match. A total of 5264 reports on 1064 futsal players were collected from the 188 matches played. Results. A total of 4237 medications and 8494 nutritional supplements (0.8 and 1.6 per player per match, resp.) were prescribed, and 64% of the players used at least one type of medication over the four tournaments. The most frequently prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (41.1%), whereby 45.7% of all players consumed at least one NSAID during the tournament and 27.4% did so prior to every match. Conclusions. The intake of medications, particularly of NSAIDs, is frequently high among top-level futsal players and follows a similar pattern to that found in FIFA Football World Cups. Campaigns should be instituted to understand this prescription practice by team physicians involving professional football players, with the aim to decrease its use and to prevent athletes from potential short-and long-term risks.
- Multiple deep tissue cultures in primary total hip arthroplasty: prognostic value for periprosthetic infection(2022) FERRO, Fernando P.; BESSA, Felipe S.; MIYAHARA, Helder; EJNISMAN, Leandro; VICENTE, Jose R. N.; CROCI, Alberto T.Background: The risk of infection after total hip replacement (THR) is significant, with negative impact on quality of life and high costs. Bacteria can contaminate the surgical site despite aseptic techniques; however, there is debate regarding the benefit of identifying bacteria during the primary procedure. Although taking multiple samples for culture is a well-established practice in revision arthroplasty, doing so in primary cases remains controversial. We aimed to investigate whether there is a prognostic value in the culture of samples taken during primary THR, seeking a correlation between the positivity of the cultures and subsequent prosthetic joint infection (PJI). Methods: Deep samples (capsule, femoral and acetabular bone) were collected from 426 patients undergoing elective primary THR. Follow-up was at least 3 years. Microbiological profiles of cultures were analysed. Patient data were reviewed for the identification of risk factors presumably associated with a higher risk of PJI. Results: 54 surgeries (12.6%) had positive cultures. 16 cases (3.8%) developed infection, of which 5 had a positive culture in the primary surgery. Infection rate was 9.3% in patients with positive culture and 3% in those with negative culture (p < 0.05), with an odds ratio of 3.34 (95% CI, 1.09-10.24). Patients with previous hip surgery had an infection rate of 8.5%, compared to 2.9% in patients with no previous surgery (p < 0.05). Conclusions: Routinely harvesting microbiologic samples in primary THR is not justified, as it has no consequence in clinical decision for most patients. It might be recommended in selected cases that are suspected to be at high risk for infection, especially previously operated patients (conversion arthroplasty).
- 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.
- Inter and intra-observer agreement of the 3-dimensional CT based anterior inferior iliac spine classification system shows fair-to-moderate agreement among high volume hip surgeons(2023) EFRIMA, Ben; AMAR, Eyal; ROTMAN, Dani; ELIAS, Avital; EJNISMAN, Leandro; BONIN, Nicolas; ALBAGLI, Assaf; BENADY, Amit; SEGAL, Ortal; RATH, EhudPurpose The purpose of this multicenter, multinational study is to evaluate the agreement level of the Hetsroni's classification system across high-volume hip surgeons who specialize in hip preservation surgeries. Methods Four surgeons from three countries reviewed a digital survey that included 93 3D CT images of the hip from 53 patients. The population was composed of individuals who had undergone a pelvis CT scan in a tertiary hospital between 2000 and 2016. Each rater reviewed the images and classified each image according to AIIS subtype I, II, or III. After a minimum of two months, the raters repeated the survey. The inter-rater and intra-rater agreement was then assessed. The kappa values were calculated to determine variability. Results Inter-rater agreement levels yielded fair agreement for both sessions (Kappa = 0.4, p value < 0.001 in the first and Kappa = 0.27, p value < 0.001 in the second). Inter-rater agreement levels separating non-pathological Type I from pathological Types II and III yielded moderate to fair inter-rater agreement levels (K = 0.47, p value < 0.001 in the first session and k = 0.32, p value < 0.001 in the second). Intra-rater reliability displayed moderate agreement (average K = 0.53). Conclusion The current 3D CT-based AIIS classification system shows fair-to-moderate inter- and intra-rater agreement among high-volume hip surgeons. According to this study, the agreement of the Hetsroni classification system is not able to be sufficiently reproduced. Since accurate classification of the AIIS morphology is imperative in establishing proper treatment for SSI, this classification system there is therefore limited in its clinical value.
- 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.
- Regarding ""Global Discrepancies in the Diagnosis, Surgical Management, and Investigation of Femoroacetabular Impingement""(2015) EJNISMAN, Leandro; MIYAHARA, Helder de Souza; GURGEL, Henrique Melo de Campos; VICENTE, Jose Ricardo Negreiros; CROCI, Alberto Tesconi