NEI BOTTER MONTENEGRO
Projetos de Pesquisa
Unidades Organizacionais
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
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Feasibility of Magnetic Resonance Angiography in Patients With Legg-Calve-Perthes Disease(2021) GRANGEIRO, Patricia Moreno; RODRIGUES, Joao C.; ANGELI, Luiz R. A. de; LEAO FILHO, Hilton; MONTENEGRO, Nei B.; GUARNIERO, Roberto; DEMPSEY, Molly; KIM, Harry K. W.Background: The etiology of Legg-Calve-Perthes disease (LCPD) remains unknown; however, interruption of medial circumflex femoral artery (MCFA) supply to the femoral head is the key pathogenic factor. The main purpose of this study is to determine the feasibility of using magnetic resonance angiography (MRA) to evaluate the course of the MCFA in the normal and affected hips of patients with unilateral LCPD. Methods: We analyzed 24 patients with unilateral LCPD using a time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS-MRA). The course of the MCFA was divided into 4 segments in the coronal plane and in 3 segments in the axial plane, based on its location with respect to the femoral neck. The visibility of each segment was studied in the normal and affected sides. The segments were defined as not visible when no contrast was seen within the vessel lumen or visible when the lumen was partially or completely visualized with contrast. The statistical analysis was done using the chi(2) test. Results: TRICKS-MRA provided well-defined images of the first 2 segments of the MCFA on both the normal and affected sides of patients with LCPD (P=1). In half of the patients, the third segment was also visible using TRICKS-MRA on both sides (P=1). The fourth segment of the MCFA, which was the ascending lateral epiphyseal segment, was not visible on either side (P=0.49). No significant difference was found between the normal and affected hips in terms of visibility of the 4 segments of the MCFA using TRICKS-MRA. Anastomosis of the MCFA with the inferior gluteal artery was found in 3 hips (2 hips with LCPD and 1 normal hip). Conclusions: TRICKS-MRA provides well-defined images of the arterial supply to the proximal femoral epiphysis in children with LCPD, presenting a noninvasive and radiation-free alternative to conventional angiography. However, the TRICKS-MRA method used did not allow visualization of the ascending lateral epiphyseal segment of MCFA in the affected and the contralateral normal side. We believe that further advancement of this noninvasive imaging technique may open new opportunities for research aimed at evaluating the vascular supply of the femoral head in children.
- MANAGEMENT OF INFANTILE BLOUNT'S DISEASE WITH MOLDED ORTHOSES: A NEW PERSPECTIVE (vol 24, pg 85, 2016)(2016) LUZO, Maria Candida de Miranda; MONTENEGRO, Nei Botter; MASSA, Bruno Sergio Ferreira; ANGELI, Luiz Renato Agrizzi de; CORDEIRO, Felippi Guizardi; GUARNIERO, Roberto
- Initial experience of use of an articulated external fixator in treating Legg-Calvé-Perthes disease by means of arthrodiastasis during the active phase of the disease(2016) LUZO, Carlos Augusto Malheiros; GUARNIERO, Roberto; MONTENEGRO, Nei Botter; GODOY JUNIOR, Rui Maciel deABSTRACT OBJECTIVE: To present the preliminary results from treating patients with Legg-Calvé-Perthes Disease (LCPD) by means of hip arthrodiastasis using a monolateral external fixator applied to the hip and to succinctly describe the surgical technique used, in a prospective study. METHODS: Prospective study on 18 patients with LCPD who underwent surgical treatment by means of the hip arthrodiastasis technique using a monolateral external fixator. There were 13 male and five female patients of mean age 8.5 years, ranging from five to 13 years. All the patients presented unilateral hip impairment: nine on the right side and nine on the left. The results were evaluated at maturity using clinical and radiological criteria. RESULTS: All the patients evolved with improvement of joint mobility, and pain relief was achieved in 88.9% of them. Reossification of the femoral epiphysis occurred within the first three months of the treatment. The hips operated at the necrosis stage of the disease did not passed through the fragmentation stage, thus shortening the evolution of the disease. The results were 77.8% satisfactory and 22.2% unsatisfactory. CONCLUSION: Hip arthrodiastasis with a monolateral external fixator during the active phase of LCPD improved the degree of joint mobility. Use of the arthrodiastasis technique at the necrosis stage or at the fragmentation stage (active phase of the disease) presented satisfactory results from treatment of LCPD.
- DISTAL FEMUR HEMIEPIPHYSIODESIS IN KNEE RECURVATUM •• A NEW SURGICAL TECHNIQUE(2023) MONTENEGRO, Nei Botter; GENEROSO, Talissa Oliveira; SERAFIM, Barbara Lovia Correa; RAMALHO JUNIOR, AmancioIntroduction: The genu recurvatum is characterized by a hyper -extension deformity of the knee in the sagittal plane. Among its causes are conditions such as arthrogryposis, cerebral palsy, poliomyelitis, sequelae of tibial tuberosity fracture and some syndromes with generalized joint hypermobility. Treatment of this deformity can be challenging and, to date, aggressive methods such as femur or tibial osteotomies are the most used for its correction. Objective: This study aimed to describe a new surgical technique for correcting genu recurvatum. Methods: This is a prospective clinical study of children who underwent posterior hemiepiphysiodesis of the distal femur with transphyseal screws. Results: The approach proved to be safe and useful for genu recurvatum deformities, with femoral or articular apex. Conclusion: This approach shows great potential for correcting genu recurvatum in the developing skeleton, being an excellent alternative to the more aggres-sive methods currently used to treat this deformity. Level of evidence IV, Case Series.
- MANAGEMENT OF INFANTILE BLOUNT'S DISEASE WITH MOLDED ORTHOSES: A NEW PERSPECTIVE(2016) MONTENEGRO, Nei Botter; MASSA, Bruno Sergio Ferreira; ANGELI, Luiz Renato Agrizzi deObjective: This retrospective study evaluated treatment with individually contoured molded bracing at early stages of the disease. Methods: We evaluated the medical records of patients undergoing treatment of Blount's disease with molded orthoses for medial decompression between 2010 and 2014. The deformity angle (Drennan's metaphyseal-diaphyseal angle) and Langenskiold classification were measured before and after treatment by a pediatric orthopedic surgeon with over 5 years of practice, blinded for the study and patients. Results: The mean age was 2.57 years old. Four patients were female and six male. Half of the total sample had bilateral disease. The average deformity angle showed a statistically significant reduction after treatment (p < 0.001). Gender and laterality did not statistically influence the change of the deformity angle after treatment (p>0.05). Conclusion: The nightly use of molded orthoses for medial decompression was effective in reducing the metaphyseal-diaphyseal angle in Blount's disease in children under 3 years of age, regardless of gender and bilateral disease. Patients over 3 years old did not benefit from bracing.
- MODIFIED DEGA OSTEOTOMY IN TREATING DEVELOPMENTAL DYSPLASIA OF THE HIP (vol 26, pg 30, 2018)(2018) GUARNIERO, Roberto; SANCHEZ, Fernando Barbosa; MASSA, Bruno Sergio Ferreira; MONTENEGRO, Nei Botter; GRANGEIRO, Patricia Moreno; ANGELI, Luiz Renato Agrizzi De
- HEMIEPIPHYSIODESIS USING EIGHT-PLATE VERSUS BLOUNT STAPLE TO CORRECT GENU VALGUM AND GENU VARUM(2020) RODRIGUES, Natasha Vogel Majewski; GUARNIERO, Roberto; BOAS, Paulo Jose Fortes Villas; MIRANDA, Bruno Rodrigues de; MONTENEGRO, Nei BotterObjective: Our objective is to evaluate whether the use of guided growth with eight-plates is more effective than the use of Blount staples for the correction of the idiopathic genu varum or idiopathic genu valgum. Methods: A systematic review (SR) was carried out according to the appropriate methodology for randomized clinical trials (RCTs). We searched seven databases through a previously defined methodology, and we included RCTs, regardless of language, period of publication and status of publication. Results:Resulted in 6830 articles retrieved. Of theses, we identified 14 potential eligible studies. but just one RCT was included for the SR. The included RCT compares the eight-plate and the Blount staple and showed no statistically significant difference for the outcomes of time to correct the deformity, postoperative pain after 24 hours and postoperative pain after 72 hours. The study is of low or very low level of evidence to determine the most effective technique. We didn't find a RCT that compared the correction of the genu varum..Conclusion: Good quality randomized clinical trials comparing Blount staples versus eight-plaque must be performed to determine which technique is superior for coronal plane corrections.
- REPRODUCIBILITY OF MODIFIED WALDENSTROM CLASSIFICATION IN PERTHES DISEASE(2021) CORDEIRO, Felippi Guizardi; GRANGEIRO, Patricia Moreno; MASSA, Bruno Sergio Ferreira; MONTENEGRO, Nei Botter; GUARNIERO, RobertoObjective: The purpose of our study is to evaluate intraobserver and interobserver reliability of modified Waldenstrom classification system for Legg-Calve-Perthes disease and assess the influence of the professional's area of expertise in the assessment. Methods: Twelve evaluators assessed 40 pairs of pelvic radiographs of patients with Legg-Calve-Perthes disease. After two weeks, a new evaluation was performed by the same evaluators. Kappa and Kendall's W indexes were used to evaluate both intraobserver and interobserver reliability and determine the influence of the evaluators' experience and area of expertise. Results: The average intraobserver kappa value was 0.394, with a reasonable agreement level. The interobserver Kappa value was 0.243 in the first evaluation (95% CI, 0.2270.259 and p < 0.0001) and 0.245 in the second evaluation (95% CI, 0.229-0.260 and p < 0.0001). The Kendall's W values obtained for pediatric orthopedists, radiologists and resident physicians were 0.686, 0.630 and 0.529 ( p < 0.0001), respectively. Conclusion: The modified Waldenstrom classification presented both moderate and reasonable levels of intraobserver agreement, and reasonable level of interobserver agreement. The evaluators' degree of experience and area of expertise influenced the concordance level found.
bookPart Atividades esportivas na infância e adolescência(2022) MONTENEGRO, Nei Botter- Use of inlet radiographs in the assessment of reduction after the surgical treatment of developmental dysplasia of the hip(2017) MASSA, B. S. F.; GUARNIERO, R.; GODOY JR., R. M.; RODRIGUES, J. C.; MONTENEGRO, N. B.; CORDEIRO, F. G.Aims This pilot study aimed to evaluate prospectively the use of inlet radiographs of the hip as an alternative method of the assessment of reduction after the surgical treatment of developmental dysplasia of the hip (DDH). Patients and Methods The children in this study underwent surgery between January 2013 and January 2015. All had inlet radiographs and CT scans post-operatively. Data were analysed by determining inter-observer reliability and intra-observer reproducibility, using the kappa value (K). Differences were settled by discussion between the two observers until a consensus was reached. The sensitivity and specificity of the radiographic and CT results were compared. A total of 26 radiographs were obtained from 23 children, with a mean age of 2.38 years (one to five). Results Similar high levels of intra- and inter-observer agreement were observed (K = 0.834, 95% confidence interval (CI)). There was a high agreement between the radiographic and CT results (K = 0.834, 5% CI), with excellent sensitivity and a specificity of 95.5%. Conclusion These results suggest that inlet radiographs may be a reliable method of assessing the reduction of the hip after the surgical treatment of DDH.