MARCELO BATISTA BONADIO
Projetos de Pesquisa
Unidades Organizacionais
PAHC, 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
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- 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 JansonThe 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.
- 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 KawamuraBackground: 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.
- 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 LuisBackground: 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.
- Posterolateral reconstruction combined with one-stage tibial valgus osteotomy: Technical considerations and functional results(2019) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; DEMANGE, Marco Kawamura; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; ANGELINI, Fabio JansonBackground: To report the functional outcomes and complications from reconstructing the knee posterolateral complex (PLC), associated with one-stage opening-wedge tibial valgus osteotomy, and discuss the technical feasibility of this procedure. Methods: Five patients with chronic PLC injuries and varus deviation of the mechanical axis, associated with central pivot injuries or not, underwent medial opening-wedge high tibial osteotomy combined with PLC reconstruction. The lateral collateral ligament, popliteal tendon, and popliteofibular ligament were reconstructed using a single femoral tunnel. Patients were assessed on physical examination, range-of-motion and functional scales, and radiographs. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee Injury and Osteoarthritis Outcome score (KOOS) were determined. Results: Five patients were evaluated: four presented with central pivot injury, and one had an isolated PLC injury. The mean time between injury and surgery was 40 +/- 6.5 months (+/- is indicating standard deviation value). Four patients had minimal residual instability on physical examination, with a lateral opening at varus stress of +/- 3 + at 30 degrees flexion. The means of the IKDC score, Lysholm score, and KOOS were 67.8 +/- 9.2, 83.0 +/- 9.3, and 79.2 +/- 5.9, respectively. All patients showed satisfactory consolidation of osteotomy in 2.6 +/- 0.9 months. Conclusions: The results of this series indicate that one-stage PLC ligament reconstruction associated with medial opening-wedge valgus osteotomy is feasible and shows satisfactory functional results with a low rate of complications. A one-stage procedure might be indicated for young patients with high functionality and more pronounced posterolateral instabilities.
- Biomechanical study of strength and stiffness of the knee anterolateral ligament(2016) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; ROZAS, Joao Stefan; WEY, Joao Marcelo Pedroso; PEREIRA, Cesar Augusto Martins; CARDOSO, Tulio Pereira; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraBackground: Recent studies clearly characterize the anatomical parameters of the knee anterolateral ligament (ALL). The potential clinical importance of this ligament is exemplified by some patients with possible combined Anterior Cruciate Ligament (ACL) and ALL rupture who do not progress satisfactorily following isolated ACL reconstruction. Previous biomechanical studies have assessed the resistance parameters of the ALL in order to address potential reconstruction strategies; however, these have reported conflicting results. Thus, this study aimed to evaluate the linear resistance of the ALL by means of a biomechanical study in cadaveric knees. Methods: Fourteen cadaveric knees were used. The ALL was dissected, and all structures that connect the femur and the tibia, except for the ALL, were sectioned. The ALL was subjected to a tensile test with the knee around 30 to 40 degrees, in a way that the ALL was aligned with the machine. The strength at the maximum resistance limit, deformation and stiffness of the ALL were evaluated. Results: The mean maximum strength of the ALL was 204.8 +/- 114.9 N. The stiffness was 41.9 +/- 25.7 N/mm and the deformation 10.3 + /- 3.5 mm. Conclusion: The ALL has a mean ultimate tensile strength of 204.8 N. This suggests that simple bands of all autologous or homologous grafts commonly used in clinical practice for ligament reconstruction around the knee possess the required biomechanical resistance characteristics for ALL reconstruction.
- Anterolateral Ligament Reconstruction: A Possible Option in the Therapeutic Arsenal for Persistent Rotatory Instability After ACL Reconstruction(2018) HELITO, Camilo Partezani; SAITHNA, Adnan; BONADIO, Marcelo B.; DAGGETT, Matt; MONACO, Edoardo; DEMANGE, Marco K.; SONNERY-COTTET, Bertrand
- Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury(2016) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GOBBI, Riccardo Gomes; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraThis study sought to determine the safety limits for performing a femoral bone tunnel to reconstruct the knee anterolateral ligament (ALL) by establishing its distance from the lateral collateral ligament (LCL) and the popliteus muscle tendon (PT) on the lateral femoral condyle. Anatomic study on 48 knee cadaveric specimens. The femoral attachments of the studied structures were isolated, and the distance between them was measured. For each cadaver, the percentage of cases in which at least 50 % of the LCL and PT would be injured when using 4- to 12-mm-diameter drills in an ALL reconstruction procedure was evaluated. The LCL and PT were 3.8 mm and 10.2 mm distant from the ALL, respectively. A 4-mm tunnel would cause LCL injury in 8.3 % of cases, with increasing incidence of injury up to 87.5 % with a 12-mm drill. Injury to the PT would start with the 10-mm drill, causing injury in 2.0 % of cases. Performing a tunnel in the center of the ALL may cause an iatrogenic injury to the LCL origin. No cases of PT injury are expected to occur with drills smaller than 10 mm.
- CORRELATION BETWEEN MAGNETIC RESONANCE IMAGING AND PHYSICAL EXAM IN ASSESSMENT OF INJURIES TO POSTEROLATERAL CORNER OF THE KNEE(2014) BONADIO, Marcelo Batista; HELITO, Camilo Partezani; GURY, Lucas Archanjo; DEMANGE, Marco Kawamura; PECORA, Jose Ricardo; ANGELINI, Fabio JansonObjective: Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. Methods: We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. Results: We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). Conclusion: Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis.
- High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction(2022) SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; ANGELINI, Fabio Janson; HELITO, Camilo PartezaniThe aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% ( n =10) were women, with a mean age of 38.81.3 years. The time from injury to surgery was 31.1 +/- 6.1 months, and the follow-up time was 6.1 +/- 0.5 years. The mean final KOOS was 79.3 +/- 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% ( n =40) presented a KL classification of >= 2 and were defined as having radiographic osteoarthritis (OA). As 11.7% ( n =7) also presented arthritis in the contralateral knee, in 53.2% ( n =33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio=13.2 [ p =0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.
- Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury(2020) SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; HELITO, Paulo Victor Partezani; GUIMARAES, Tales Mollica; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; HELITO, Camilo PartezaniBackground: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. Purpose: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. Results: A total of 182 patients were evaluated. Postoperative mean +/- SD follow-up was 33.6 +/- 7.1 and 36.1 +/- 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 +/- 1.2 mm vs 7.2 +/- 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 +/- 10.7 vs 89.1 +/- 6.6; P = .035) and Lysholm scores (85.9 +/- 10.1 vs 92.0 +/- 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. Conclusion: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.