FABIO JANSON ANGELINI
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
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- Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty(2014) HELITO, Camilo Partezani; JUNQUEIRA, Jader Joel Machado; GOBBI, Ricardo Gomes; ANGELINI, Fabio Janson; REZENDE, Marcia Uchoa; TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisOBJECTIVES: Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. METHOD: A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. RESULTS: There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. CONCLUSION: Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.
- 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.
- Combined reconstruction of the posterior cruciate ligament and medial collateral ligament using a single femoral tunnel(2017) BONADIO, Marcelo Batista; HELITO, Camilo Partezani; FONI, Noel Oizerovici; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco Kawamura; ANGELINI, Fabio JansonLesions of the medial collateral ligament (MCL) are the most common knee ligament injuries, and lesions associated with the anterior cruciate ligament or the posterior cruciate ligament (PCL) in knee dislocations should be reconstructed to prevent failure of the central pivot reconstruction. The purpose of this study was to evaluate the outcomes of combined PCL/MCL reconstruction using a single femoral tunnel with a minimum 2-year follow-up. A retrospective study of thirteen patients with combined PCL/MCL injuries was conducted. The patients underwent PCL and MCL reconstruction using an Achilles tendon allograft with a single tunnel in the medial femoral condyle, thereby avoiding tunnel conversion. All patients achieved a range of motion of at least 100A degrees. The mean loss of extension and flexion values compared to the contralateral side was 1A degrees A +/- 2A degrees and 9A degrees A +/- 10A degrees, respectively. Our results included 26 reconstructions with three (11.5 %) failures, two in the PCL (15.3 %) and one in the MCL (7.6 %), in three different patients. In the final evaluation, the mean IKDC subjective score was 71.63 +/- 16.23, the mean Lysholm score was 80.08 +/- 13.87, and the median Tegner score was 6 (range = 2-7). The PCL/MCL reconstruction technique using a single femoral tunnel and an Achilles tendon allograft is safe, avoids the convergence of tunnels in the medial femoral condyle, has excellent results, and is reproducible. IV.
- 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.
- Screw loosening and iliotibial band friction after posterolateral corner reconstruction(2014) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; DEMANGE, Marco Kawamura; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; ANGELINI, Fabio JansonBackground: Many reconstruction techniques have already been developed for treating posterolateral corner (PLC) injuries, with still no consensus regarding what would be the best option. Some techniques use non-bone tunnel fixation, attaching the graft to the femur using a cortical screw with toothed washer. The main objective of the present study is to evaluate complications related to fixation performed by a screw and toothed washer technique. Methods: A prospective study with surgical reconstruction of the PLC structures of the knee between January 2008 and December 2009 was performed. PLC reconstruction included reconstruction of the lateral collateral ligament, popliteofibular ligament and popliteal muscle tendon. Fixation of the grafts in the femur was achieved by means of a 4.5 mm screw with a toothed washer. The assessments were done using the following methods: objective IKDC, subjective IKDC, Lysholm and Tegner. Radiographic evaluations were performed immediately after the operation, at 3, 6 and 12 months after surgery, and yearly thereafter. Complications were documented. Results: The mean subjective IKDC score after the operation was 69.2; Lysholm scale was 80.7. Two patients presented failure of reconstructions of the PLC. In the radiographic evaluations, signs of loosening of the screw with toothed washer in the femur were observed in eight cases (66.6%). Six patients (50%) complained of lateral pain after the operation. Conclusion: The technique of femoral fixation was shown to be efficient in restoration of stability. However there was a high rate of complications secondary to implant, such as loosening of the screws and iliotibial tract friction.
- Anatomical study on the anterolateral ligament of the knee(2013) HELITO, Camilo Partezani; MIYAHARA, Helder de Souza; BONADIO, Marcelo Batista; TIRICO, Luis Eduardo Passareli; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; ANGELINI, Fabio Janson; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisOBJECTIVE: Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. METHODS: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. RESULTS: The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed. CONCLUSION: The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.
- Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up(2015) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; DEMANGE, Marco Kawamura; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; ANGELINI, Fabio JansonPurpose A technique for combined reconstruction of the anterior cruciate ligament (ACL) and posterolateral corner (PLC) with a single femoral tunnel was recently described. This technique aims to avoid tunnel confluence in the lateral femoral condyle. Because there have been no studies on the functional outcomes and possible complications of this technique, our goal is to demonstrate a two-yearminimum follow-up of patients who underwent this type of reconstruction. Methods Nine patients were prospectively evaluated. The ACL was reconstructed with an anatomic single bundle, and the PLC structures reconstructed were the lateral collateral ligament, the popliteus tendon, and the popliteofibular ligament. Patients were evaluated using the objective and subjective International Knee Documentation Committee (IKDC) and the Lysholm and Tegner scales before and after the surgical procedure. Results The mean follow-up period of the studied patients was 27.3 months. The mean subjective IKDC score rose from 43.6 to 84.0, and the Lysholm score rose from 62.1 to 90.8. In the final assessment, six patients were classified as IKDC A and three as IKDC B. According to the Tegner scale, five patients were able to return to their level of activity prior to the injury. There were no reconstruction failures. One patient experienced postoperative infection and pain in the lateral scar. Conclusions The results of the reconstruction of ACL injuries associated with PLC with a single femoral tunnel produced a good functional outcome and a low incidence of complications.
- External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee(2015) ANGELINI, Fabio Janson; HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GUIMARES, Tales Molica; BARRETO, Ronald Bispo; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; ALBUQUERQUE, Roberto Freire da Mota eTo assess whether the use of an articulated external fixator provides improvements in the mobility, stability and subjective function of patients undergoing ligament reconstruction. Thirty-three patients with sub-acute and chronic knee dislocation were subjected to multi-ligament reconstruction surgery. These patients were randomly allocated to two groups for immobilization after reconstruction: group 0-control (18 patients), with rigid knee bracing, and group 1-articulated external fixator (15 patients). The stability of the reconstructed ligaments was assessed after at least 14 months (26.6-month average) postoperatively by physical examination. Deficit of extension and flexion was measured in relation to the unaffected contralateral knee, and the Lysholm knee scoring scale questionnaire was applied. There was no difference in the assessment of joint stability between the groups. In group 1, patients showed less flexion deficit (4.8A degrees A A +/- A 5.4A degrees vs. 18.2A degrees A A +/- A 14.8A degrees, p < 0.05), and the percentage of patients with a flexion deficit of 5A degrees or less were higher compared with group 0 (64 vs. 18 %, p < 0.05). There was no difference between groups in relation to extension loss. Group 1 also presented better Lysholm scores, with 73 % of patients rated as excellent or good compared with 35 % in group 0 (p < 0.05). Compared with the control rehabilitation protocol with rigid knee bracing in extension, the use of an articulated external fixator in the treatment of chronic multi-ligament-injured knees provided the same ligament stability, better final range of motion and improved Lysholm score. Patients presenting with chronic multi-ligament instability should be considered for articulated external fixation to supplement reconstruction procedures. Randomized controlled trial, Level I.