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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- 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.
- ANATOMICAL STUDY OF THE POSTEROLATERAL LIGAMENT COMPLEX OF THE KNEE: LCL AND POPLITEUS TENDON(2021) SOBRADO, Marcel Faraco; HELITO, Camilo Partezani; MELO, Lucas da Ponte; ASPERTI, Andre Marangoni; GOBBI, Riccardo Gomes; ANGELINI, Fabio JansonObjective: To analyse the distances between the femoral insertions of the popliteus tendon (PT) and the lateral collateral ligament (LCL) through dissections of cadaveric specimens in a mixed population. Methods: Fresh cadavers were dissected, and the anthropometric data of all specimens were recorded. The distances from the origin of the PT to the LCL in the femoral region and the diameter of each structure were measured using a digital calliper. Results: In total, 11 unpaired knees were dissected, eight men and three women, with an average age of 71.5 +/- 15.2 years, weight of 57.2 +/- 15.6 kg, and a mean height of 170.5 +/- 8.2 cm. The distance from the center of the femoral footprint of the LCL to the PT was 10.0 +/- 2.4 mm. The distances between the edges closest to each other and those more distant from each other were 3.1 +/- 1.1 mm and 16.3 +/- 2.4 mm, respectively. Conclusion: The distance between the midpoints of the PT and the LCL in our mixed population is smaller than the distances often reported in the literature. PLC reconstruction with separate tunnels for the LCL and PT may not be technically possible for individuals of any population. Level of Evidence III, Diagnostic studies.
- 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.
article 2 Citação(ões) na Scopus High Potential for Complications After Traumatic Exposure in Patients With a Total Knee Replacement(2020) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; NEGRELLI, Marco Aurelio Cotegipe; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; ANGELINI, Fabio JansonObjective. The purpose of this study is to describe cases of traumatic exposure during the early postoperative period in patients with a total knee replacement (TKR) and to report the treatments instituted and complications of this adverse event. Methods. A retrospective review of postoperative patients with TKR performed at the Universidade de Sao Paulo from 2001 to 2017 who subsequently were treated at the emergency room due to trauma to the TKR region accompanied by surgical wound dehiscence in deep planes and implant exposure was conducted. The initial treatment, evolution, and complications of each patient were reported. Results. In 16 years, there were 3224 TKRs performed at the study institution. Among this population, 4 (0.1%) patients had trauma dehiscence of the surgical wound during the immediate postoperative period. All patients were women between the ages of 64 and 88 years with comorbidities (eg, diabetes mellitus and/or hypertension). The mean time between the surgery and trauma was 6.7 +/- 6.2 days. All patients underwent surgical cleaning, debridement with polyethylene exchange, and primary closure of the surgical wound and received adjuvant treatment with broad-spectrum antibiotic therapy. Of the 4 patients affected, 3 developed an infection, 3 required new surgery after initial cleaning, 2 lost their prostheses, and 1 lost a limb, requiring a transfemoral amputation. Conclusions. Traumatic dehiscence with implant exposure during the initial postoperative period of TKR is an infrequent event (0.1%) with a high potential for complications (75%), which may lead to loss of the prosthesis and even the limb. Measures should be taken to prevent falls and gather reports from several centers to broaden the knowledge of this rare event, identify prognostic factors, and define the best treatment algorithm.- 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.