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
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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.
- 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.
- 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.- 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.
- 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.
- Evaluation of quality of life and walking ability among amputated patients and those who refused to undergo amputation following infection of total knee arthroplasty: Small case series(2015) HELITO, Camilo Partezani; BRITO, Andre Thiago Scandiuzzi de; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; TIRICO, Luis Eduardo P.; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisBackground: Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking. Objectives: To evaluate the quality of life and walking ability among patients who underwent amputation and among those who refused to undergo amputation following infection of a total knee arthroplasty. Study design: Retrospective case series. Methods: Patients who received an indication for amputation following an infection of a total knee arthroplasty were evaluated retrospectively. The patients were divided between those who accepted the amputation procedure and those who refused amputation (four amputee vs four non-amputees). Walking ability and quality of life were evaluated using the Short Form-36 questionnaire. Results: The average physical health was 27.4 for the amputees and 31.3 for the non-amputees. The average mental health was 49.9 for the amputees and 47.1 for the non-amputees. In relation to walking ability, only one (25%) of the amputees was able to walk, as opposed to 100% in the non-amputee groups. Conclusion: Twenty-five percent of the amputee patients continued to be able to walk. The functional outcome of non-amputee patients was better, with 100% being able to walk, though with limitations.
- Results of revision total knee arthroplasty using press-fit cementless stem(2013) IAMAGUCHI, Maurcio Masasi; CASTRO FILHO, Fernando Bley Vicente de; GOBBI, Riccardo Gomes; TIRICO, Luis Eduardo Passarelli; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisObjective: To show our experience with press-fit cementless stem and metaphyseal fixation with cement in a selected series of patients who underwent revision total knee arthroplasty. Methods: Thirty-four patients (35 knees) underwent revision total knee arthroplasty using the press-fit technique. Minimum follow-up was one year (mean 2.2 years) with a maximum length of three years. Results: Of 34 patients, 20 were women and 14 were men. There was one death due to causes not related to arthroplasty and one patient dropout. There were no cases in which further review was necessary. Patients who underwent revision had clinical and functional improvement demonstrated by the results of the KSS, results of the SF-36 quality of life questionnaire, through gains in range of motion and improved limb alignment. Conclusion: There was postoperative clinical and functional improvement in comparison to the preoperative status in revision total knee arthroplasty with press-fit cementless stem. Level of Evidence IV, Case Series.