CAMILO PARTEZANI HELITO
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
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- 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.
- Comparison of Floseal (R) and Tranexamic Acid for Bleeding Control after Total Knee Arthroplasty: a Prospective Randomized Study(2019) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraOBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseal (R) have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal (R) and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81 +/- 1.09 g/dL), followed by the Floseal (R) (3.5 +/- 1.03 g/dL) and TXA (3.03 +/- 1.2 g/dL) groups. The Floseal (R) and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3 +/- 695.7 mL in the control group, 546.5 +/- 543.5 mL in the TXA group and 331.2 +/- 278.7 mL in the Floseal (R) group. Both TXA and Floseal (R) had significantly less output than the control group, and Floseal (R) had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseal (R) was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal (R) showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal (R) group.
- Regarding ""Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study""(2019) GOBBI, Riccardo Gomes; GIGLIO, Pedro Nogueira; HELITO, Camilo Partezani; PECORA, Jose Ricardo
- 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.
- Anterolateral ligament of the knee: a step-by-step dissection(2019) LIMA, Diego Ariel de; HELITO, Camilo Partezani; DAGGETT, Matthew; MONTEIRO NETO, Francisco Magalhaes; LIMA, Lana Lacerda de; LEITE, Jose Alberto Dias; CAVALCANTE, Maria Luzete CostaBackgroundThe number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL.MethodsTwenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL.ResultsA transverse incision is performed in the iliotibial band (ITB), around 10cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy's tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60 degrees flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy's tubercle and the fibula (4.0mm to 7.0mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.00.4cm and mean width of 5.5 +/- 0.8mm.Conclusions p id=Par4 The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study.
- High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries(2019) FERRETTI, Andrea; MONACO, Edoardo; REDLER, Andrea; ARGENTO, Giuseppe; CARLI, Angelo De; SAITHNA, Adnan; HELITO, Paulo Victor Partezani; HELITO, Camilo PartezaniBackground: Broad variation in the reported rate of magnetic resonance imaging (MRI)-detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)-injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (kappa) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears (P <.001). No correlation was found between ALL lesions and iliotibial band lesions (P = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (kappa coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear.
- Regarding ""Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies""(2019) SAITHNA, Adnan; MONACO, Edoardo; MURAMATSU, Koichi; HELITO, Camilo Partezani; REDLER, Andrea; SONNERY-COTTET, Bertrand; FERRETTI, Andrea
- Magnetic Resonance Imaging Evaluation of the Anterolateral Ligament in Acute Anterior Cruciate Ligament Injuries in an Adolescent Population(2019) HELITO, Camilo Partezani; HELITO, Paulo Victor Partezani; ASSIRATI, Luiz Felipe Boulitreau; LONGO, Carlos Henrique; BORDALO-RODRIGUES, Marcelo; SOUZA, Felipe Ferreira dePurpose: To evaluate the frequency of anterolateral ligament (ALL) injuries in acute anterior cruciate ligament (ACL) injuries in adolescent patients usingmagnetic resonance imaging (MRI) and characterize other potential intra-and extra-articular knee injuries that are associated with ALL injuries. Methods: Patients between 14 and 17 years of age with acute ACL injuries (trauma for < 3 weeks before examination) were retrospectively evaluated withMRI over 24 months (January 2016-December 2017). Among this population, ALLwas classified as not visible, normal, or injured. Injuries were separated into strains (partial injuries), complete injuries, or Segond fractures. Possible abnormalities of the menisci, collateral ligaments, popliteal tendon, posterior cruciate ligament (PCL), iliotibial tract (ITT), and bone injurieswere evaluated. Associationswere calculated between ALL injuries and injuries of these other knee structures, aswell as age and gender. Results: ALL was visible in 171 of the 184 MRI-evaluated knees (92.9%). ALLwas considered normal in 68 (39.8%) and damaged in 103 (60.2%) patients. ALL injuries were considered partial in 56 (54.4%) and total in 44 (42.7%) cases. Only 3 (2.9%) cases were Segond fractures. ALL injuries were associated with ITT (P<. 0001), lateralmeniscus (P =.04), lateral collateral ligament (P = .01), popliteal tendon(P =.001), and medial collateral ligament (P =.009) injuries, in addition to bone contusions in the lateral compartment of the knee (P <.0001). There was no correlation between ALL injuries and medial meniscus (P = .054) or PCL (P =.16) injuries. Conclusions: MRI evaluationshowedALL injuries are present in 60.2% of acuteACL injuries inadolescent patients. These injuries are associatedwith the medial and lateral collateral ligaments, ITT, lateralmeniscus injuries, and bone contusions, but they are not associated with medial meniscus or PCL injuries.
- Study of the Nerve Endings and Mechanoreceptors of the Anterolateral Ligament of the Knee(2019) LIMA, Diego Ariel de; HELITO, Camilo Partezani; LIMA, Lana Lacerda de; LEITE, Jose Alberto Dias; CAVALCANTE, Maria Luzete CostaPurpose: To describe the morphology and distribution of the anterolateral ligament of the knee (ALL) nerve endings, aiming to understand the interaction between the proprioceptive system and knee mechanics. Methods: Twenty ALLs were obtained from fresh frozen cadavers. The ligaments were measured, weighed, and cut. Sections (10 mu m) were prepared in hematoxylin and eosin-stained slides to analyze tissue integrity, and 50-mu m sections were subjected to immunofluorescence with the protein gene product 9.5 as primary antibody and Alexa Fluor 488 as secondary antibody, followed by microscopic analysis. Results: The ALL was identified in 100% of the dissections, exhibiting a mean (+/- standard deviation) length of 4.0 +/- 0.4 cm, a mean width of 5.5 +/- 0.8 mm, and a mean weight of 0.9 +/- 0.2 g. The histological sections in hematoxylin and eosin showed dense, well-organized collagen and the presence of vascular tissue. All the specimens analyzed contained type I (Ruffin-like) mechanoreceptors and free nerve endings (type IV), varying from parallel to intertwined fibers. Unclassified nerve endings with different irregular shapes were also found. The neural elements occupied 0.6% +/- 0.3% of the ligament area, and most were observed near the origin of ALL insertions. Conclusion: The ALL exhibits a peripheral nerve structure, primarily type I and IV mechanoreceptors. These findings suggest that the ALL is important for the proprioception and anterolateral stabilization of the knee.
- EXTRA-ARTICULAR RECONSTRUCTION ASSOCIATED WITH THE ANTERIOR CRUCIATE LIGAMENT IN BRAZIL(2019) HELITO, Camilo Partezani; AMARAL JUNIOR, Carlos do; CAMARGO, Danilo Bordini; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; DEMANGE, Marco KawamuraObjective: To assess the knowledge and technical preferences of Brazilian knee surgeons in relation to the treatment of Anterior Cruciate Ligament (ACL) injuries using intra-articular reconstruction in combination with extra-articular reconstruction. Methods: A questionnaire consisting of 16 questions about intra-articular ACL reconstruction in combination with extra-articular procedures and about the Anterolateral Ligament (ALL) was applied at the 48th Brazilian Congress of Orthopedics. Results: One hundred thirty-seven surgeons answered the questionnaire. Most surgeons perform 10-30 ACL reconstructions per year, with the transtibial technique appearing as the most common. Most surgeons find some percentage of residual pivot-shift after reconstructions, but the minority performs extra-articular procedures on a routine basis. The main indications for extra-articular reconstruction are revision and profuse pivot-shift cases. Most surgeons consider the ALL a true ligament, but 46.7% with less biomechanical importance and 32.3% with greater importance in knee stability. However, 91.4% had a positive perception of the reconstruction of this structure. Conclusion: Although the preferred technique is still the transtibial procedure, combined anatomical reconstructions already make up more than 50% of cases. Extra-articular reconstructions associated with the ACL are still performed by the minority of Brazilian surgeons, but 91.4% of them report having had a positive perception with their reconstruction.