MARCO KAWAMURA DEMANGE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
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
85 resultados
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- Simultaneous anterior cruciate ligament reconstruction and computer-assisted open-wedge high tibial osteotomy: A report of eight cases(2011) DEMANGE, Marco Kawamura; CAMANHO, Gilberto Luis; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; TIRICO, Luis Eduardo Passarelli; ALBUQUERQUE, Roberto Freire da Mota eEight patients, aged 37-50 years, with chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis and varus deformity underwent simultaneous arthroscopic ACL reconstruction and open-wedge high tibial osteotomy controlled by a computer navigation system. Despite preoperative planning, the surgeon may need to choose a different osteotomy site during the procedure, invalidating the previous plans. The intraoperative wire control for osteotomies is not precise. The navigation system can help obtain precise alignment during high tibial osteotomy. The average preoperative mechanical axis was 7.5 of varum (sd +/- 1.17 degrees), the average postoperative axis was 1.2 degrees of valgus (sd +/- 1.04 degrees) (p<0.01), and the average correction of the mechanical axis was 8.7 degrees (sd +/- 0.76 degrees). The site of the osteotomy was 3.9 cm (3.5-4.8 cm, sd +/- 0.35 mm) from the articular line, with an inclination of 27.9 degrees (24-35, sd +/- 4.8). The simultaneous use of these procedures allowed proper correction of the knee axis during the surgery. The surgery can be performed concomitantly with ACL reconstruction.
- Evaluation of the isometry of different points of the patella and femur for medial patellofemoral ligament reconstruction(2016) GOBBI, Riccardo Gomes; PEREIRA, Cesar Augusto Martins; SADIGURSKY, David; DEMANGE, Marco Kawamura; TIRICO, Luis Eduardo Passarelli; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisBackground: The location of patellar and femoral fixation of the graft in medial patellofemoral ligament reconstructions has been widely discussed. This study aimed to assess the distances between different patellar and femoral fixation points to identify the least anisometric pairs of points. Methods: Ten cadaver knees were attached to an apparatus that simulated an active range of motion of 120, with three metallic markers fixed onto the medial side of the patella, and seven markings onto the medial epicondyle. The examined points included the proximal patella pole (1), the patellar center (3), the midpoint between points 1 and 3 (2), a point directly on the epicondyle (6), points 5 mm anterior (5) and posterior (7) to the epicondyle, points 5 mm anterior to point 5 (4) and 5 mm posterior to point 7 (8), and points 5 mm proximal (9) and distal (10) to the epicondyle. The distances between patella and femur points were measured by a photogrammetry system at 15 degrees intervals. Findings: The pair of points that exhibited the lowest average variability in distance, and hence was the most isometric, was the patella center combined with the anterior to the medial femoral epicondyle. The pairs of points that exhibited the highest average variability in distance, and hence were the least isometric, were the ones located distal or posterior to the medial femoral epicondyle, with less influence by the patellar location. Interpretation: Surgeons should avoid positioning the graft distally or posterior to the epicondyle due to the increase in anisometry.
- Combined Reconstruction of the Anterolateral Ligament in Patients With Anterior Cruciate Ligament Injury and Ligamentous Hyperlaxity Leads to Better Clinical Stability and a Lower Failure Rate Than Isolated Anterior Cruciate Ligament Reconstruction(2019) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraPurpose: To compare functional outcomes, residual instability, and rupture rates in patients with ligamentous hyperlaxity undergoing isolated anterior cruciate ligament (ACL) reconstruction or combined ACL and anterolateral ligament (ALL) reconstruction. Methods: Two groups of patients were evaluated and compared retrospectively. Both groups consisted of patients with ACL injuries and associated ligamentous hyperlaxity, defined based on the modified Beighton scale with a minimum score of 5. Group 1 patients underwent anatomical ACL reconstruction, and group 2 patients underwent anatomical ACL reconstruction combined with ALL reconstruction. Group 1 consisted of historical controls. The presence of associated meniscal injury, subjective International Knee Documentation Committee and Lysholm functional scores, KT-1000 measurements, the presence of a residual pivot-shift, and the graft rupture rate were evaluated. The study was performed at University of Sao Paulo in Brazil. Results: Ninety patients undergoing ACL reconstruction with ligamentous hyperlaxity were evaluated. The mean follow up was 29.6 +/- 6.2 months for group 1 and 28.1 +/- 4.2 months for group 2 (P = .51). No significant differences were found between the groups regarding Beighton scale, gender, the duration of injury before reconstruction, follow-up time, preoperative instability, or associated meniscal injuries. The mean age was 29.9 +/- 8.1 years in group 1 and 27.0 +/- 9.1 years in group 2 (P = .017). In the final evaluation, group 2 patients showed better anteroposterior clinical stability as evaluated by KT-1000 arthrometry (P = .02), better rotational stability as evaluated by the pivot-shift test (P = .03) and a lower reconstruction failure rate (21.7% [group 1] vs 3.3% [group 2]; P = .03). Clinical evaluations of postoperative functional scales showed no differences between the 2 groups (P = .27 for International Knee Documentation Committee; P = .41 for Lysholm). Conclusions: Combined ACL and ALL reconstruction in patients with ligamentous hyperlaxity resulted in a lower failure rate and improved knee stability parameters compared to isolated ACL reconstruction. No differences were found in the functional scales.
- BIOLOGICAL ENHANCEMENTS FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION(2019) LEITE, Chilan Bou Ghosson; DEMANGE, Marco KawamuraThe anterior cruciate ligament (ACL) is mostly responsible for providing knee stability. ACL injury has a marked effect on daily activities, causing pain, dysfunction, and elevated healthcare costs. ACL reconstruction (ACLR) is the standard treatment for this injury. However, despite good results, ACLR is associated with a significant rate of failure. In this context, the mechanical and biological causes must be considered. From a biological perspective, the ACLR depends on the osseointegrati on of the graft in the adjacent bone and the process of intra-articular ligamentization for good results. Here, we discuss the mechanisms underlying the normal graft healing process after ACLR and its biological modulation, thus, presenting novel strategies for biological enhancements of the ACL graft.
- Fatigue meniscal tears: a description of the lesion and the results of arthroscopic partial meniscectomy(2016) DEMANGE, Marco Kawamura; GOBBI, Riccardo Gomes; CAMANHO, Gilberto LuisPurpose The purpose of this study was to describe the clinical outcomes of partial meniscectomy in patients with ""fatigue meniscal tear"", which presents as a non-traumatic tear with abrupt onset of symptoms of a radial tear in the transition between the middle and posterior thirds of the meniscus. Methods We prospectively followed 71 patients with ""fatigue meniscal tear"" (41 women and 30 men, mean age of 63 years, SD 6.9 years) recruited among 497 patients with isolated medial meniscal lesions treated between January 2006 and June 2011. Inclusion criteria were spontaneous abrupt onset knee pain, minor or no trauma, no radiographic or MRI osteoarthritis, no bone oedema, pre-operative magnetic resonance image of medial meniscus tear, and arthroscopic evaluation demonstrating radial or vertical flap tear in the body to posterior horn junction of the medial meniscus. We followed all patients for a minimum of two years and reviewed their clinical symptoms, physical exam, functional outcome, and patient satisfaction at last follow-up. Results The average follow-up was 4.2 years, with a minimum follow-up of two years. Among the 71 patients, there were 59 (83.1 %) good or excellent results and 12 (16.9 %) poor results. These 12 patients demanded further treatment because of persistent pain, with three of the patients developing subchondral bone fracture. All patient complaints and poor outcomes could be identified in the initial six months after surgery. There was no gender difference in the subgroup analysis. Conclusion Our findings indicate that patients with ""fatigue meniscal tear"" benefit from arthroscopic partial meniscectomy, with only 16.9 % reporting unfavourable results.
- Effect of muscle contractions on cartilage: morphological and functional magnetic resonance imaging evaluation of the knee after spinal cord injury(2016) DEMANGE, Marco Kawamura; HELITO, Camilo Partezani; HELITO, Paulo Victor Partezani; SOUZA, Felipe Ferreira de; GOBBI, Riccardo Gomes; CRISTANTE, Alexandre FogaçaABSTRACT OBJECTIVE: To evaluate the effect of complete absence of muscle contractions on normal human cartilage in the presence of joint motion. METHODS: Patients with complete acute spinal cord injuries were enrolled. All patients underwent magnetic resonance imaging (MRI) on both knees as soon as their medical condition was stable and at six months after the primary lesion. All patients received rehabilitation treatment that included lower-limb passive motion exercises twice a day. The MRIs were analyzed by two radiologists with expertise in musculoskeletal disorders. A region of interest was established at the patellar facets and trochlea, and T2 relaxation times were calculated. The area under the cartilage T2 relaxation time curve was calculated and standardized. RESULTS: Fourteen patients with complete spinal cord injuries were enrolled, but only eight patients agreed to participate in the study and signed the informed consent statement. Two patients could not undergo knee MRI due to their clinical conditions. Initial knee MRIs were performed on six patients. After six months, only two patients underwent the second bilateral knee MRI. Both patients were neurologically classified as Frankel A. An increase in T2 values on the six-month MRI was observed for both knees, especially in the patellofemoral joint. CONCLUSION: The absence of muscle contractions seems to be deleterious to normal human knee cartilage even in the presence of a normal range of motion. Further studies with a larger number of patients, despite their high logistical complexity, must be performed to confirm this hypothesis.
- Patient-specific implants for lateral unicompartmental knee arthroplasty(2015) DEMANGE, Marco K.; KEUDELL, Arvind Von; PROBST, Christian; YOSHIOKA, Hiroshi; GOMOLL, Andreas H.Purpose The lateral compartment of the knee is biomechanically and anatomically different from the medial compartment. Most commercially available unicompartmental implants are not designed specifically for the lateral compartment. Patient-specific custom-made unicompartmental knee arthroplasty (UKA) are designed to provide optimal fit on both femoral and tibial surfaces. This study aimed to determine if the use of patient-specific lateral unicompartmental implants provide better bone coverage than standard, off-the-shelf commercially available unicompartmental implants in lateral unicompartmental knee arthroplasties. As a secondary question, we wished to determine if patient-specific unicompartmental implants provide good clinical outcomes in surgical treatment of lateral unicompartmental osteoarthritis. Methods We prospectively evaluated 33 patients who underwent lateral unicompartmental arthroplasty using patient-specific implants and instrumentation with a minimum of 24 months of follow-up. We analysed bone coverage observed in plain radiographs in 33 patient-specific lateral unicompartmental arthroplasties and compared to 20 lateral unicompartmental arthroplasties performed with commercially-available, standard off-the-shelf unicondylar implants. Results The mean tibial implant lateral coverage mismatch in the patient-specific implant group was 1.0 mm (S.D. 1.2, range 0-5.7 mm) versus 3.3 mm (S.D. 2.43, range 0.4-7.8 mm) in the conventional implant group (p < 0.01). In the patient specific cohort, pre-operative limb alignment was 3.3 (valgus) and post-operative limb alignment was -0.9 (varus). The Knee Society score improved from 48 (S.D. 16.2) to 95 (S.D. 7.6). Survivorship in the patient-specific implant group was 97% at an average follow up of 37 months, versus 85% at a follow-up period of 32 months for the standard implant group. Conclusions Patient-specific lateral unicompartmental knee replacements demonstrated better tibial coverage and provide excellent short-term clinical and radiological results as compared to a standard lateral UKA.
- Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report(2018) CAVALHEIRO, Camila Maftoum; GOBBI, Riccardo Gomes; HINCKEL, Betina Bremer; DEMANGE, Marco Kawamura; PÉCORA, José Ricardo; CAMANHO, Gilberto LuisABSTRACT Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature.A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.
- Trochlear dysplasia and patellar instability in patients with Down syndrome(2015) MOREIRA, Tiago Amaral Rebouças; DEMANGE, Marco Kawamura; GOBBI, Riccardo Gomes; MUSTACCHI, Zan; PÉCORA, José Ricardo; TÍRICO, Luis Eduardo Passarelli; CAMANHO, Gilberto LuisOBJECTIVE: To analyze occurrences of trochlear dysplasia in patients with Down syndrome in the presence and absence of femoropatellar instability. METHODS: Eleven knees with stable patellae and thirteen with unstable patellae in patients with Down syndrome were compared. Radiographs were produced to evaluate patellar height, trochlear angle and femoropatellar congruence angle. RESULTS: The prevalence ratio for a high patella between the unstable and the stable patients was 1.01 using the Insall-Salvati index and 0.68 using the Caton-Deschamps index. For an abnormal congruence angle, the prevalence ratio was 2.04. An increased congruence angle was only found in four cases, all presenting instability. CONCLUSIONS: Trochlear dysplasia was only found in cases of instability. The trochlear groove angle and the femoropatellar congruence angle correlated with the presence of patellar instability.
- Performance of alpha-defensin lateral flow test after synovial fluid centrifugation for diagnosis of periprosthetic knee infection(2021) ABDO, Rodrigo Calil Teles; GOBBI, Riccardo Gomes; LEITE, Chilan Bou Ghosson; PASOTO, Sandra Gofinet; LEON, Elaine Pires; LIMA, Ana Lucia Lei Munhoz; BONFA, Eloisa; PECORA, Jose Ricardo; DEMANGE, Marco KawamuraBACKGROUND The quantitative alpha-defensin enzyme-linked immunosorbent assay (ELISA) demands a prior synovial fluid centrifugation, whereas this processing is not routinely required prior to the alpha-defensin lateral flow test. AIM To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection (PJI) diagnosis. METHODS Fifty-three cases were included in this study: 22 classified as PJI and 31 classified as aseptic cases, according to Musculoskeletal Infection Society 2013 criteria. Synovial fluid samples were submitted to centrifugation, and the supernatant was evaluated by ELISA and lateral flow tests. The sensitivity (SE), specificity (SP) and accuracy of each method were calculated as well as the agreement between those two methods. RESULTS In all of the 31 samples from aseptic patients, alpha-defensin ELISA and lateral flow tests showed negative results for infection. Regarding the 22 infected patients, the lateral flow test was positive in 19 cases (86.4%) and the ELISA was positive in 21 (95.5%). Sensibility, SP and accuracy were, respectively, 86.4% (95%CI: 65.1%-97.1%), 100% (95%CI: 88.8%-100%) and 93.2% (95%CI: 82.8%-98.3%) for the lateral flow test and 95.5% (95%CI: 77.2%-99.9%), 100% (95%CI: 88.8%-100%) and 98.1% (95%CI: 89.9%-100%) for ELISA. An agreement of 96.2% between those methods were observed. No statistical difference was found between them (P = 0.48). CONCLUSION Alpha-defensin lateral flow test showed high SE, SP and accuracy after a prior synovial fluid centrifugation, achieving comparable results to ELISA. Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition, a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.