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
16 resultados
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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.
- Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator(2015) ANGELINI, F. J.; HELITO, C. P.; BONADIO, M. B.; ALBUQUERQUE, R. F. da Mota e; PECORA, J. R.; CAMANHO, G. L.Introduction: Knee dislocations are defined as ligament injuries involving at least two of the four most important knee ligaments. Results from recent studies have shown a tendency towards improvement of the functional outcomes with use of an articulated external fixator during the postoperative period following multiligament reconstruction. Our hypothesis was that good knee stability and early gain of range of motion could be achieved with the use of the external fixator after ligament reconstructions. Methods: Fourteen patients with knee dislocations were evaluated after multiligament reconstruction in association with use of a lateral monoplanar external fixator for six weeks. Reconstructions were performed using grafts from a tissue bank. Range of motion was measured after one, two, three, six, twelve months and at the final evaluation at a mean time of 49 months. The assessments were made using objective and subjective IKDC, Lysholm and Tegner scales. Results: The mean scores were 71.7 for the subjective IKDC score, 81.5 for the Lysholm score. No patient was able to return to previous Tegner score. Out of the 45 ligament reconstructions performed, only four failed during the follow-up time. The mean range of motion of the knee presented a progressive increase from the first to the twelfth month, from 67.8 degrees. to 115.7 degrees. Two cases of superficial infection on the site of the external fixator pins were observed. Conclusion: The use of an external fixator enabled early rehabilitation with range of motion gains starting from the first postoperative month, a low rate of reconstruction failure and minimal complications. Nevertheless, none of the patients returned to the level of activity prevailing prior to the injury.
- 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.
- 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.
- Tricks and tips for physical examination of the multiligament injured knee: what we can not forget(2018) BONADIO, Marcelo Batista; HELITO, Camilo Partezani; ANGELINI, Fabio JansonThe multiligament knee injury may present some challenges in its evaluation during the physical examination. Due to the wide range of lesion patterns and instabilities, a systematic approach to physical examination is essential in such cases. The initial evaluation by inspection and palpation, followed by with the specific tests for each structure, with the evaluation of the cruciate ligaments, then the lateral and medial ligaments in an organized way allows a more accurate diagnosis. It is very important the ability to recognize the meaning of the result of each physical examination test and its variations, to avoid common misinterpretation. This article aims to present the physical examination of the multiligament injured knee in an organized way, pointing out the tips and tricks for the best diagnosis and correct treatment.
- 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.
- 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.
- Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients(2023) SANCHEZ-MUNOZ, Enrique; HERNANZ, Beatriz Lozano; ZIJL, Jacco A. C.; WOLTERBEEK, Nienke; TIRICO, Luis Eduardo Passarelli; ANGELINI, Fabio Janson; VERDONK, Peter C. M.; VUYLSTEKE, Kristien; ANDRADE, Renato; ESPREGUEIRA-MENDES, Joao; VALENTE, Cristina; FIGUEROA, Francisco; FIGUEROA, David; FERNANDEZ, Antonio MaestroBackground: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. Hypothesis: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. Study Design: Cohort study; Level of evidence, 3. Methods: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. Results: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. Conclusion: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.
- EXTENSOR MECHANISM ALLOGRAFT IN TOTAL KNEE ARTHROPLASTY(2013) HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; TOZI, Mateus Ramos; FELIX, Alessandro Monterroso; ANGELINI, Fabio Janson; PECORA, Jose RicardoObjective: To analyze the experience with allograft transplantation of the extensor mechanism in total knee arthroplasty and compare results with the international experience. Methods: We retrospectively evaluated three cases of extensor mechanism allograft after total knee arthroplasty performed in our hospital with the aid of one of the few tissue banks in Brazil and attempt to establish whether our experiences were similar to others reported in the world literature regarding patient indication, techniques, and outcomes. Results: Two cases went well with the adopted procedure, and one case showed bad results and progressed to amputation. As shown in the literature, the adequate tension of the graft, appropriate tibial fixation and especially the adequate patient selection are the better predictors of good outcomes. Previous chronic infection can be an unfavorable predictor. Conclusion: This surgical procedure has precise indication, albeit uncommon, either because of the rarity of the problem or because of the low availability of allografts, due to the scarcity of tissue banks in Brazil.
- 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.