PEDRO NOGUEIRA GIGLIO
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
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- Tibial Tubercle Osteotomy With Distalization Is a Safe and Effective Procedure for Patients With Patella Alta and Patellar Instability(2021) LEITE, Chilan B. G.; SANTOS, Tarsis P.; GIGLIO, Pedro N.; PECORA, Jose R.; CAMANHO, Gilberto L.; GOBBI, Riccardo G.Background: Tibial tubercle osteotomy with concomitant distalization for the treatment of patellar instability remains controversial, as it may cause anterior knee pain and chondral degeneration. Purpose: To evaluate radiographic, clinical, and functional outcomes in patients who had patellar instability with patella alta and underwent tibial tubercle osteotomy with distalization (TTO-d) as well as medial patellofemoral ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were 25 patients (31 cases) (mean age at surgery, 28.7 years; range, 14-33 years) with patellar instability and patella alta who underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, and amount of distalization were assessed. Clinical and functional variables included J-sign, anterior knee pain, apprehension test, Tegner activity level, and Kujala score. Results: The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm (range, 7-24 mm); the mean CDI changed from 1.37 (1.25-1.7) preoperatively to 1.02 (0.9-1.12) postoperatively (P = .001); and the mean amount of tibial tubercle distalization was 8.80 mm (range, 4-16 mm). Lateral release (22 cases; 71.0%), medialization of tibial tubercle (17 cases; 54.8%), and autologous chondrocyte implantation (4 cases; 12.9%) were other associated procedures. The J-sign improved in 30 cases (96.8%; P = .001), and there was a complete resolution of anterior knee pain in 22 cases (71.0%; P = .001). An exploratory analysis showed that patellar cartilage defect severity was correlated with persistent pain (P = .005). The apprehension test became negative in all cases (P = .001). The median Kujala score increased from 52 to 77 (P = .001), and the median Tegner activity level improved from 3 to 4 (P = .001). No cases of osteotomy nonunion were reported. One case (3.2%) of patellar instability recurrence and 3 cases (6.5%) with painful hardware were observed. Conclusion: TTO-d resulted in good radiographic, clinical, and functional outcomes providing proper patellar stability to patients with patella alta. TTO-d appears to be a safe and efficient procedure with low complication rates, providing an additional tool for the personalized treatment of patellar instability.
- Knee Hyperextension Greater Than 5 degrees Is a Risk Factor for Failure in ACL Reconstruction Using Hamstring Graft(2021) GUIMARAES, Tales Mollica; GIGLIO, Pedro Nogueira; SOBRADO, Marcel Faraco; BONADIO, Marcelo Batista; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; HELITO, Camilo PartezaniBackground: The degree of knee hyperextension in isolation has not been studied in detail as a risk factor that could lead to increased looseness or graft failure after anterior cruciate ligament (ACL) reconstruction. Purpose: To analyze whether more than 5 degrees of passive knee hyperextension is associated with worse functional outcomes and greater risk of graft failure after primary ACL reconstruction with hamstring tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A cohort of patients who had primary ACL reconstruction with hamstring tendon autografts was divided into 2 groups based on passive contralateral knee hyperextension greater than 5 degrees (hyperextension group) and less than 5 degrees (control group) of hyperextension. Groups were matched by age, sex, and associated meniscal tears. The following data were collected and compared between the groups: patient data (age and sex), time from injury to surgery, passive knee hyperextension, KT-1000 arthrometer laxity, pivot shift, associated meniscal injury and treatment (meniscectomy or repair), contralateral knee ligament injury, intra-articular graft size, follow-up time, occurrence of graft failure, and postoperative Lysholm knee scale and International Knee Documentation Committee subjective form scores. Results: Data from 358 patients initially included in the study were analyzed; 22 were excluded because the time from injury to surgery was greater than 24 months, and 22 were lost to follow-up. From the cohort of 314 patients, 102 had more than 5 degrees of knee hyperextension. A control group of the same size (n = 102) was selected by matching among the other 212 patients. Significant differences in the incidence of graft failure (14.7% vs 2.9%; P = .005) and Lysholm knee scale score (86.4 +/- 9.8 vs 89.6 +/- 6.1; P = .018) were found between the 2 groups. Conclusion: Patients with more than 5 degrees of contralateral knee hyperextension submitted to single-bundle ACL reconstruction with hamstring tendons have a higher failure rate than patients with less than 5 degrees of knee hyperextension.
- The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study(2019) GOBBI, Riccardo Gomes; HINCKEL, Betina Bremer; TEIXEIRA, Paulo Renan Lima; GIGLIO, Pedro Nogueira; LUCARINI, Bruno Romano; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraBackground: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. Purpose: To compare the anatomy of the vastus medialis using magnetic resonance imaging in patients with patellar instability to a control group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A group of patients with patellar instability were sex-matched with a control group with anterior cruciate ligament tears, meniscal injuries, or sprains; patients younger than 15 years were excluded. The anatomy of the vastus medialis was examined by the distance between the distal origin of the vastus medialis in the femur and the medial femoral condyle, the distance from the proximal pole of the patella to the most distal insertion of the muscle and its ratio to the length of the articular surface of the patella, and a qualitative description of the insertion position of the muscle fibers (directly in the patella or the medial retinaculum). Results: Both groups comprised 78 knees (48 female; 61.5%). The mean age in the control and patellar instability groups was 30.2 +/- 7.8 years and 25.6 +/- 7.5 years, respectively (P = .001). The distance from the vastus origin to the condyle was 27.52 +/- 3.49 mm and 26.59 +/- 3.43 mm, respectively (P = .041); the distance from the proximal pole of the patella to the most distal muscle insertion was 17.59 +/- 5.54 mm and 15.02 +/- 4.18 mm, respectively (P < .001); and the ratio of this distance to the joint surface was 0.586 +/- 0.180 and 0.481 +/- 0.130, respectively (P < .001). In 75.6% of knees in the patellar instability group, the insertion of the vastus was into the medial retinaculum and not into the patella compared with 52.6% in the control group (P = .003; odds ratio, 2.8). Conclusion: The distal insertion of the vastus medialis differed in knees with patellar instability, with a more proximal insertion and less patellar coverage relative to controls, and was more frequently found in the retinaculum instead of directly in the patella.