LUIS EDUARDO PASSARELLI TIRICO
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
34 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 34
- 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.
- 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.
- 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.
- 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.
- Development of a Fresh Osteochondral Allograft Program Outside North America(2016) TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; SANTOS, Luiz Augusto Ubirajara; REZENDE, Marcia Uchoa de; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CROCI, Alberto Tesconi; BUGBEE, William DickObjective. To standardize and to develop a fresh osteochondral allograft protocol of procurement, processing and surgical utilization in Brazil. This study describes the steps recommended to make fresh osteochondral allografts a viable treatment option in a country without previous fresh allograft availability. Design. The process involves regulatory process modification, developing and establishing procurement, and processing and surgical protocols. Results. Legislation: Fresh osteochondral allografts were not feasible in Brazil until 2009 because the law prohibited preservation of fresh grafts at tissue banks. We approved an amendment that made it legal to preserve fresh grafts for 30 days from 2 degrees C to 6 degrees C in tissue banks. Procurement: We changed the protocol of procurement to decrease tissue contamination. All tissues were procured in an operating room. Processing: Processing of the grafts took place within 12 hours of tissue recovery. A serum-free culture media with antibiotics was developed to store the grafts. Surgeries: We have performed 8 fresh osteochondral allografts on 8 knees obtaining grafts from 5 donors. Mean preoperative International Knee Documentation Committee (IKDC) score was 31.99 +/- 13.4, improving to 81.26 +/- 14.7 at an average of 24 months' follow-up. Preoperative Knee Injury and Oseoarthritis Outcome Score (KOOS) score was 46.8 +/- 20.9 and rose to 85.24 +/- 13.9 after 24 months. Mean preoperative Merle D'Aubigne-Postel score was 8.75 +/- 2.25 rising to 16.1 +/- 2.59 at 24 months' follow-up. Conclusion. To our knowledge, this is the first report of fresh osteochondral allograft transplantation in South America. We believe that this experience may be of value for physicians in countries that are trying to establish an osteochondral allograft transplant program.
- Radiographic Landmarks for Locating the Femoral Origin and Tibial Insertion of the Knee Anterolateral Ligament(2014) HELITO, Camilo Partezani; DEMANGE, Marco Kawamura; BONADIO, Marcelo Batista; TIRICO, Luis Eduardo Passareli; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisBackground: Recent anatomic studies have confirmed the presence of a true ligament structure, the anterolateral ligament (ALL), in the anterolateral region of the knee. This structure is involved in the rotatory instability of the knee and might explain why some isolated reconstructions of the anterior cruciate ligament result in a residual pivot shift. Therefore, when considering the least invasive method for reconstruction of this structure, it is important to identify the corresponding bony landmarks on radiographic images. Purpose: To establish radiographic femoral and tibial landmarks for the ALL in frontal and lateral views. Study Design: Descriptive laboratory study. Methods: Ten unpaired cadaver knees were dissected. The attachments of the ALL were isolated and its anatomic parameters were quantified. Its origin and insertion were marked with a 2-mm-diameter metallic sphere, and radiographs were taken from frontal and lateral views. The obtained images were analyzed and the ALL parameters established. Results: The origin of the ALL in the lateral view was found at a point an average SD of 47.5% 4.3% from the anterior edge of the femoral condyle and about 3.7 +/- 1.1 mm below the Blumensaat line. In the frontal view, the origin was about 15.8 +/- 1.9 mm from the distal condyle line. The ALL insertion was an average of 53.2% +/- 5.8% from the anterior edge of the lateral tibial plateau in the lateral view and 7.0 +/- 0.5 mm below the lateral tibial plateau in the frontal view. In anatomic dissections, the origin of the ALL was 1.9 +/- 1.4 mm anterior and 4.1 +/- 1.1 mm distal to the lateral collateral ligament, and the insertion was 4.4 +/- 0.8 mm below the lateral tibial plateau cartilage. Conclusion: The ALL origin on an absolute lateral radiograph of the knee is approximately 47% of the anterior-posterior size of the condyle and 3.7 mm caudal to the Blumensaat line. In a frontal radiograph, the ALL is 15.8 mm from the posterior bicondyle line. The ALL insertion is approximately 53.2% of the anterior-posterior size of the plateau in the lateral view and 7.0 mm below the articular line in the frontal view. Clinical Relevance: Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.
article 0 Citação(ões) na Scopus Letter to the Editor Concerning the Article: ""Total Knee Arthroplasty After Lower Extremity Amputation: A Review of 13 Cases""(2014) HELITO, Camilo Partezani; DEMANGE, Marco Kawamura; PECORA, Jose Ricardo; GOBBI, Ricardo Gomes; CAMANHO, Gilberto Luis; TIRICO, Luis Eduardo P.- Is Patient Satisfaction Associated With Clinical Outcomes After Osteochondral Allograft Transplantation in the Knee?(2019) TIRICO, Luis E. P.; MCCAULEY, Julie C.; PULIDO, Pamela A.; DEMANGE, Marco K.; BUGBEE, William D.Background: The association between patient satisfaction and patient-reported outcomes after cartilage repair is not well understood. Purpose: To investigate the association of patient satisfaction with pain, function, activity level, and quality of life after fresh osteochondral allograft (OCA) transplantation in the knee. Study Design: Case-control study; Level of evidence, 3. Methods: This study comprised 371 patients (396 knees) who underwent primary OCA transplantation for osteochondral lesions in the knee between 1997 and 2015. Mean +/- SD patient age was 31.8 +/- 11.6 years, and 62% were male. The majority of grafts (62%) were located on the femoral condyle; the mean number of grafts per knee was 1.5 +/- 0.8; and the median graft area was 6.9 cm(2) (range, 1.8-50 cm(2)). Pain, function, activity level, and quality of life were evaluated pre- and postoperatively via International Knee Documentation Committee scores and Knee injury and Osteoarthritis Outcome Scores. Patient satisfaction with the results of the OCA transplantation was assessed postoperatively. All follow-up evaluations occurring at postoperative 1 year or later were included in the analysis. Results: The mean follow-up time was 5.5 years. Overall, the satisfaction rate was 88.1%, and this rate was constant over time. Satisfaction rates varied by diagnosis, age, sex, and anatomic location of the allograft. Postoperative International Knee Documentation Committee pain, function, and total scores differed between patients who were satisfied and not satisfied (all P < .001). All Knee injury and Osteoarthritis Outcome Score subscale results differed between those who were satisfied and not satisfied (all P < .001). Having a diagnosis of osteochondritis dissecans was the only variable that predicted which patients would be satisfied with the results of the allograft, after controlling for age, sex, anatomic location of the graft, and number of grafts. Conclusion: A consistently high and durable patient satisfaction rate after OCA transplantation was found. Satisfied patients reported lower pain and higher function, activity levels, and quality of life as compared with patients who were not satisfied. Patients with osteochondritis dissecans had a particularly high level of satisfaction with the OCA procedure.
- Valor da avaliação radiográfica pré-operatória dos defeitos ósseos no joelho nas revisões de artroplastia(2012) IAMAGUCHI, Mauricio Masasi; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; TIRICO, Luiz Eduardo Passarelli; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisOBJECTIVE: To evaluate the value of preoperative radiographic evaluations for total knee arthroplasty (TKA) revision. METHODS: Thirty-one knees that were operated between 2006 and 2008, in a consecutive series of cases of TKA revision surgery were analyzed retrospectively. THE FOLLOWING CRITERIA WERE EVALUATED: number of wedges or structured bone grafts used for filling the bone defects; locations of the wedges and bone grafts used; and mean thickness of the polyethylene used. The AORI classification was previously established based on preoperative radiographs, using preestablished criteria. After the analysis, the knees were divided into four groups (I, IIA, IIB and III). RESULTS: The mean number of wedges or grafts used in each knee progressively increased among the groups (group I: 1.33; group IIA: 2; group IIB: 4.33; and group III: 4.83) (P = 0.0012). The commonest locations were medial in the tibia and posteromedial in the femur. There were no statistically significant differences in the thickness of the polyethylene used. CONCLUSION: The AORI classification for bone defects in the knee, based on preoperative radiographs, showed a correlation with increasing need to use wedges and/or structured grafts in TKA revisions. However, up to 46% of the knees in groups I and IIA presented bone defects of up to 5 mm that were not diagnosed by means of preoperative radiographs.
- O uso do transplante osteocondral a fresco no tratamento das lesões osteocondrais do joelho(2012) TÍRICO, Luís Eduardo Passarelli; DEMANGE, Marco KawamuraTreatment of chondral and osteochondral knee lesions in young patients remains a challenge for orthopedic surgeons. The repair techniques currently available in Brazil, such as debridement, microfracture and autologous osteochondral transplantation are insufficient for treating large chondral and osteochondral lesions. Fresh homologous osteochondral transplants have been used in the knee joint in the United States with excellent results. This article had the aims of reviewing the basic science, indi cations, surgical techniques and possible complications and describing the technique of fresh homologous osteochondral transplantation in the knee joint, performed in the Institute of Orthopedics and Traumatology, Hospital das Clinicas, Univer sity of São Paulo.