ANDRE PEDRINELLI
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
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
13 resultados
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- 3D COMPUTER TOMOGRAPHY FOR MEASUREMENT OF FEMORAL POSITION IN ACL RECONSTRUCTION(2015) FERNANDES, Tiago Lazzaretti; MARTINS, Nuno Miguel Morais Fonseca; WATAI, Felipe de Andrade; NETO, Cyro Albuquerque; PEDRINELLI, Andre; HERNANDEZ, Arnaldo JoseObjective: To validate intra-and inter-class correlation coefficients of a transparent 3D-TC protocol and investigate relationships between different axial rotations. Methods: Twenty unilateral knee TCs (iSite - Philips) were evaluated by means of a transparent 3D-TC OsiriX Imaging Software (v.3.9.4), 3D MPR protocol. Mathematical model of femoral tunnel projections acquired on vertical and horizontal rotations from -20 to +20 degrees. Height (h'/H) and length (t'/T) of tunnel projections have been analyzed by the Bernard and Hertel's method. Statistics: power of study=80%, ICC, ANOVA, p<0.05 (SPSS-19). Results: Transparent 3D-TC showed high reliability of both intra-observer (h'/H= 0.941; t'/T= 0.928, p<0.001) and inter-observer (h'/H= 0.921; t'/T= 0.890, p<0.001) ICC. ACL Length (t'/T) and Height (h'/H) projections were statistically different on vertical and horizontal rotations: p=0.01 and p<0.001, respectively. Conclusion: This new transparent 3DTC protocol is an accurate and reproducible method that can be applied for ACL femoral tunnel or footprint measurement with high ICC reliability.
- Isokinetic muscle strength and knee function associated with double femoral pin fixation and fixation with interference screw in anterior cruciate ligament reconstruction(2012) FERNANDES, Tiago Lazzaretti; PROTTA, Thiago Rocha; FREGNI, Felipe; BOLLIGER NETO, Raul; PEDRINELLI, Andre; CAMANHO, Gilberto Luis; HERNANDEZ, Arnaldo JoseIntensive scheduling in sports requires athletes to resume physical activity shortly after injury. The purpose of this study was to investigate early isokinetic muscle strength and knee function on bone-patellar tendon-bone (BPTB) ACL reconstruction with double femoral pin fixation or interference screw technique. A prospective study was conducted from 2008 to 2009, with 48 athletes who received femoral BPTB fixation with interference screw (n = 26) or double pin (n = 22). Clinical (IKDC objective score and hop test) and isokinetic muscle strength (peak torque (PT), PT/body weight and flexion/extension rate (F/E) in 60 and 240A degrees/s) were analyzed at 6 months of follow-up. Analysis at baseline showed no differences between groups before surgery related to age, gender, associated injury, Tegner or Lysholm score; thus showing that groups were similar. During follow-up, however, there were significant differences between the two groups in some of the isokinetic muscle strength: PT/BW 60A degrees/s (Double Pin = 200% +/- A 13% vs. Interference Screw = 253% +/- A 16%*, *P = 0.01); F/E 60A degrees/s (Double Pin = 89% +/- A 29%* vs. Interference Screw = 74% +/- A 12%, *P = 0.04). No statistical differences between groups were observed on IKDC objective score, hop test and complications. The significant muscle strength outcome of the interference screw group found in this study gives initial evidence that this fixation technique is useful for athletes that may need accelerated rehabilitation. Early return to sports ability signaled by isokinetic muscle strength is of clinical relevance as it is one of the main goals for athletes' rehabilitation. III.
- BILATERAL LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: CASE REPORT AND REVIEW(2018) FERNANDES, Tiago Lazzaretti; VIDEIRA, Livia Dau; SASAKI, Sandra Umeda; NATALINO, Renato Jose Mendonca; ALMEIDA, Adriano Marques de; PEDRINELLI, Andre; HERNANDEZ, Arnaldo JoseObjectives: Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. Methods: The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. Results: Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28-year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1-and T2-weighted images. These were associated with hemosiderin pigmentation. Conclusion: The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site.
- Muscle Injury: Pathophysiology, Diagnosis, and Treatment(2022) SANTANNA, João Paulo Cortez; PEDRINELLI, André; HERNANDEZ, Arnaldo José; FERNANDES, Tiago LazzarettiAbstract Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.
- The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports(2014) FERNANDES, Tiago Lazzaretti; FREGNI, Felipe; WEAVER, Kayleen; PEDRINELLI, Andre; CAMANHO, Gilberto Luis; HERNANDEZ, Arnaldo JoseThe purpose of this study was to radiographically investigate the influence of femoral tunnel placement in ACL reconstruction on early outcomes and return to sports due to anatomic and nonanatomic positioning. A prospective study was conducted from 2008 to 2010, with 86 athletes who underwent ACL reconstruction between anteromedial (AM) footprint and high AM position. Knee functional outcomes (IKDC objective and subjective, Tegner score, and Lysholm scale) return to sports and complications were analyzed at 6- and 12-month follow-up. At follow-up, it was observed that tunnel projection along Blumensaat's line was correlated with functional outcomes on Tegner scale (at 6 and 12 months) and IKDC subjective (at 12 months). There was a significant difference in mean tunnel projection along Blumensaat's line when analyzing return to sports (73 +/- A 1.4 and 79 +/- A 1.7 %, respectively, for projections on return vs. no return to sports, p = 0.02) and complications (73 +/- A 1.3 vs. 78 +/- A 1.6 %, respectively, for projections on no complications vs. complications, p = 0.03). No differences were stated on coronal view. These correlations between tunnel positioning on functional outcomes could not be explained by demographic or baseline characteristics. The clinical relevance of this study is that tunnel positioning along AM footprint and high AM position represented by tunnel projection along Blumensaat's line is associated with early return to sports on previous Tegner level and better functional outcome in athletes. III.
- ANTEROMEDIAL OR CENTRAL ANATOMIC ACL RECONSTRUCTION? A CADAVERIC HIP-TO-TOE STUDY(2023) FERNANDES, Tiago Lazzaretti; SOUZA, Michel Oliveira; NETO, Cyro Albuquerque; ARAUJO, Paulo Henrique; PEDRINELLI, Andre; HERNANDEZ, Arnaldo JoseObjective: To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods: Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results: The Central REC group showed a smaller degree of internal rotation (0.6 & DEG; & PLUSMN; 0.3 & DEG; vs. 1.8 & DEG; & PLUSMN; 0.3 & DEG;, respectively, P < 0.05) and no difference in anterior translation (4.7 mm & PLUSMN; 0.4 mm vs. 4.5 mm & PLUSMN; 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion: The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.
- Description of an evaluation system for knee kinematics in ligament lesions, by means of optical tracking and 3D tomography,(2014) FERNANDES, Tiago Lazzaretti; RIBEIRO, Douglas Badillo; ROCHA, Diogo Cristo da; ALBUQUERQUE, Cyro; MARTINS PEREIRA, César Augusto; PEDRINELLI, André; HERNANDEZ, Arnaldo JoséObjective: To describe and demonstrate the viability of a method for evaluating knee kine matics, by means of a continuous passive motion (CPM) machine, before and after anterio cruciate ligament (ACL) injury. Methods: This study was conducted on a knee from a cadaver, in a mechanical pivot-shif simulator, with evaluations using optical tracking, and also using computed tomography. Results: This study demonstrated the viability of a protocol for measuring the rotation an translation of the knee, using reproducible and objective tools (error<0.2mm). The mech anized provocation system of the pivot-shift test was independent of the examiner an always allowed the same angular velocity and traction of 20 N throughout the movement. Conclusion: The clinical relevance of this method lies in making inferences about the in viv behavior of a knee with an ACL injury and providing greater methodological quality in futur studies for measuring surgical techniques with grafts in relatively close positions.
- Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis(2021) FERNANDES, Tiago Lazzaretti; MOREIRA, Hugo Henrique; ANDRADE, Renato; SASAKI, Sandra Umeda; BERNARDO, Wanderley Marques; PEDRINELLI, Andre; ESPREGUEIRA-MENDES, Joao; HERNANDEZ, Arnaldo JoseBackground: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials. Results: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, -0.14; 95% confidence interval, -0.27 to -0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. Conclusion: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.
- A BIOMECHANICAL COMPARISON OF MATCHED FOUR-STRAND AND FIVE-STRAND SEMITENDINOSUS-GRACILIS GRAFTS(2021) BARROS, Marcos Amstalden; COSTA, Sandokan Cavalcante; JARAMILLO, Diego Eduardo Rubio; ALMEIDA, Adriano Marques de; PEREIRA, Cesar Augusto Martins; FERNANDES, Tiago Lazzaretti; NARDELLI, Julio Cesar Carvalho; ANNICHINO, Marcel Fruschein; PEDRINELLI, Andre; HERNANDEZ, Arnaldo JoseIntroduction: Recent studies have shown that the likelihood of semitendinosus-gracilis graft rupture is inversely correlated to its diameter. A graft can be prepared in a five-strand or four-strand fashion to increase its diameter. However, the biomechanical superiority of five-strand semitendinosus-gracilis grafts is still under debate. Objective: This study aimed to evaluate the biomechanical characteristics of matched four-strand and five-strand human semitendinosus-gracilis grafts. Methods: We evaluated semitendinosus-gracilis tendons harvested from ten fresh human male and female cadavers, aged 18-60 years. Four-strand or five-strand grafts were prepared with the tendons and fixed to wooden tunnels with interference screws. Each graft was submitted to axial traction at 20 mm/min until rupture; the tests were donor matched. Data were recorded in real time and included the analysis of the area, diameter, force, maximum deformation and stiffness of the grafts. Results: The diameter, area and tunnel size were significantly greater in the five-strand grafts than in the four-strand grafts. There were no significant differences in biomechanical properties. The area and diameter of the graft were positively correlated to stiffness, and inversely correlated to elasticity. There was no significant correlation between graft size and maximum force at failure, maximum deformation or maximum tension. Conclusion: Five-strand hamstring grafts have greater area, diameter and tunnel size than fourstrand grafts. There were no significant differences in biomechanical properties. In this model using interference screw fixation, the increases in area and diameter were correlated with an increase in stiffness and a decrease in elasticity.
- COMPARISON BETWEEN RENDERING 3D-CT AND TRANSPARENT 3D-CT IN ACL TUNNEL POSITIONING(2017) BARROS, Marcos Amstalden; FERNANDES, Tiago Lazzaretti; DIMITRIOU, Dimitris; PEDRINELLI, Andre; HERNANDEZ, Arnaldo JoseObjective: To compare the transparent 3D computed tomography (CT) image protocol against conventional 3D-CT image-rendering protocol to assess femoral tunnel position in anatomic anterior cruciate ligament (ACL) reconstructions. Methods: Eight knee CT scans from cadavers were analyzed by image rendering 3D-CT protocol, using Rhinoceros (R) software. The central point of the ACL tunnel was set using the sagittal plane. Same CT scans were analyzed using transparent 3D-CT measurement protocol with OsiriX (R) software. Central point of the ACL tunnel was set using sagittal, coronal and axial planes. The grid system described by Bernard and Hertel was used to compare tunnel positions between protocols, using height and length parameters. Results: There was a significant difference between measurements using image rendering 3D-CT and transparent 3D-CT protocol for height (23.8 +/- 7.9mm and 33.0 +/- 5.0mm, respectively; p=0.017) and no differences for length (18.6 +/- 4.2mm and 18.3 +/- 4.5mm, respectively; p=0.560). Conclusion: Height in transparent CT protocol was different and length was the same as compared to 3D-CT rendering protocol in Bernard and Hertel method for tunnel measurements.