RICCARDO GOMES GOBBI
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
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- 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.
- Are the osseous and tendinous-cartilaginous tibial tuberosity-trochlear groove distances the same on CT and MRI?(2015) HINCKEL, Betina Bremer; GOBBI, Riccardo Gomes; KIHARA FILHO, Eduardo Noda; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; RODRIGUES, Marcelo Bordalo; DEMANGE, Marco KawamuraObjective To verify whether the tibial tuberosity-trochlear groove distance (TT-TG) and the tendinous-cartilaginous TT-TG (the distance between the patellar tendon and trochlear groove: PT-TG) are identical using computed tomography (CT) and magnetic resonance imaging (MRI) techniques. Subjects and methods The TT-TG and PT-TG distances were measured on the same knee samples by three observers (two measurements per observer) using CT and MRI scans collected retrospectively. The reproducibility of the measurements was assessed using the interclass correlation coefficient (ICC). The means and standard deviations of four measurements were calculated for each patient. A paired t-test was used to assess differences between measurements. Results Fifty knee samples (32 with patellar instability and 18 with other conditions) were evaluated. The inter- and intraobserver reliability was excellent for all four measurements (>0.8). On average, the TT-TG distance on MRI was 3.1-3.6 mm smaller than that on CT, and the PT-TG distance on MRI was 1.0-3.4 mm larger than the TT-TG distance on MRI. Conclusion The osseous TT-TG and tendinous-cartilaginous PT-TG distances determined by CT and MRI were not identical.
- Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon(2016) HINCKEL, Betina Bremer; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisAlthough the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.
- Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience(2016) HINCKEL, Betina Bremer; GOBBI, Riccardo Gomes; BONADIO, Marcelo Batista; DEMANGE, Marco Kawamura; PÉCORA, José Ricardo; CAMANHO, Gilberto LuisABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon, was technically safe and presented good objective and subjective clinical results in this case series with a short follow-up.
- Why are bone and soft tissue measurements of the TT-TG distance on MRI different in patients with patellar instability?(2017) HINCKEL, Betina B.; GOBBI, Riccardo G.; KIHARA FILHO, Eduardo N.; DEMANGE, Marco K.; PECORA, Jose Ricardo; RODRIGUES, Marcelo B.; CAMANHO, Gilberto LuisTo determine whether the tibial tuberosity-to-trochlear groove distance (TT-TG) and patellar tendon-to-trochlear groove distance (PT-TG) are equal, whether the bony and cartilaginous points coincide in the trochlea, and whether the insertion of the PT coincides with the most anterior point of the TT in patients with patellar instability. Fifty-three MRI scans of patients with patellar instability were examined. TT-TG and PT-TG were measured by three examiners in 31 knees. Additionally, the bone-cartilage distance in the trochlea [trochlear cartilage to trochlear bone (TC-TB)] and the distance between the mid-point of the PT insertion and the most anterior point of the TT (PT-TT) were measured by one examiner. The intraclass correlation coefficient was used to evaluate the reliability of the measurements between the three examiners. The relationships between the measurements were determined, the means of the measurements were calculated, and the correlations between PT-TG and TT-TG, PT-TT, and TC-TB were assessed. The ICC was above 0.8. PT-TG was 3.7 mm greater than TT-TG. The TC and TB coincided in 73 % of cases, and the mean TC-TB was 0.3 mm. The PT was lateral to the TT in 94 % of the cases, and the mean PT-TT was 3.4 mm. The Pearson's correlation coefficients between PT-TG and TT-TG, PT-TT, and TC-TB were 0.946, 0.679, and 0.199, respectively. TT-TG underestimated PT-TG, primarily due to the lateralization of the PT insertion relative to the most anterior point of the TT. Clinical relevance: our study shows that in patients with patellar instability, there are differences in the absolute values of TT-TG and PT-TG, as previously reported for patients without patellar instability. Hence, normal cut-off values based on case-control studies of TT-TG cannot be equivalently used when measuring PT-TG to indicate TT medialization in patients with patellar instability. It is also important to note that the clinical outcomes cannot be directly compared between patients evaluated using TT-TG versus PT-TG measurements. III.
- Medial Patellofemoral Ligament, Medial Patellotibial Ligament, and Medial Patellomeniscal Ligament: Anatomic, Histologic, Radiographic, and Biomechanical Study(2017) HINCKEL, Betina B.; GOBBI, Riccardo G.; DEMANGE, Marco K.; PEREIRA, Cesar Augusto M.; PECORA, Jose Ricardo; NATALINO, Renato Jose M.; MIYAHIRA, Luciana; KUBOTA, Bruno S.; CAMANHO, Gilberto LuisPurpose: To describe the anatomy (quantitative macroscopic and histologic), radiographic parameters of the insertions, and biomechanical characteristics of the medial ligamentous restrictors of the patella (medial patellofemoral ligament [MPFL], medial patellotibial ligament [MPTL], and medial patellomeniscal ligament [MPML]) in cadaveric knees. Because the MPTL and the MPML are not as well known as the MPFL, they were the focus of this study. Methods: MPFLs, MPTLs, and MPMLs from 9 knees were dissected. Histologic evaluations were conducted. Length, width, and insertion relations with anatomic references were determined. Metallic spheres were introduced into the insertion points of each ligament, and anteroposterior and lateral radiographs were taken. The distances of the insertions from the baselines were measured on radiographs. Tensile tests of the ligaments were performed. Results: All the samples showed dense connective tissue characteristic of ligaments. The MPTL was inserted into the proximal tibia (13.7 mm distal to the joint line) and in the distal end of the patella (3.6 mm proximal to the distal border). The MPTL had a length of 36.4 mm and a width of 7.1 mm. The MPML was inserted into the medial meniscus and distally in the patella (5.7 mm proximal to the distal border). Per radiography, on the anteroposterior view, the tibial insertion of the MPTL was 9.4 mm distal to the joint line and in line with the medial border of the medial spine. On the lateral view, the patellar insertions of the MPTL and MPML were 4.8 and 6.6 mm proximal to its distal border, respectively. The MPTL was stiffer than the MPFL (17.0 N/mm vs 8.0 N/mm, P =.024) and showed less deformation in the maximum tensile strength (8.6 mm vs 19.3 mm, P =.005). Conclusions: The MPTL inserts into the proximal tibia and into the distal pole of the patella. The MPML inserts into the medial meniscus and into the distal pole of the patella. They present with identifiable anatomic and radiographic parameters. Grafts commonly used for ligament reconstructions should be adequate for reconstruction of the MPTL. Clinical Relevance: The study contributes to the anatomic, radiographic, and biomechanical knowledge of the MPTL to improve the outcomes of its reconstruction.
- Translation and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese(2017) SILVA, Adriana Lucia Pastore e; CROCI, Alberto Tesconi; GOBBI, Riccardo Gomes; HINCKEL, Betina Bremer; PECORA, José Ricardo; DEMANGE, Marco KawamuraABSTRACT OBJECTIVE: Translation, cultural adaptation, and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese and verification of its measurement properties, reproducibility, and validity. In 2012, the new version of the Knee Society Score was developed and validated. This scale comprises four separate subscales: (a) objective knee score (seven items: 100 points); (b) patient satisfaction score (five items: 40 points); (c) patient expectations score (three items: 15 points); and (d) functional activity score (19 items: 100 points). METHOD: A total of 90 patients aged 55-85 years were evaluated in a clinical cross-sectional study. The pre-operative translated version was applied to patients with TKA referral, and the post-operative translated version was applied to patients who underwent TKA. Each patient answered the same questionnaire twice and was evaluated by two experts in orthopedic knee surgery. Evaluations were performed pre-operatively and three, six, or 12 months post-operatively. The reliability of the questionnaire was evaluated using the intraclass correlation coefficient (ICC) between the two applications. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The ICC found no difference between the means of the pre-operative, three-month, and six-month post-operative evaluations between sub-scale items. CONCLUSION: The Brazilian Portuguese version of The 2011 KS Score is a valid and reliable instrument for objective and subjective evaluation of the functionality of Brazilian patients who undergo TKA and revision TKA.
- Patellar Tendon-Trochlear Groove Angle Measurement A New Method for Patellofemoral Rotational Analyses(2015) HINCKEL, Betina B.; GOBBI, Riccardo G.; KIHARA FILHO, Eduardo N.; DEMANGE, Marco K.; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisBackground: The tibial tubercle trochlear groove (TT-TG) is used as the gold standard for patellofemoral malalignment. Purpose: To assess 3 patellar tendon trochlear groove (PT-TG) angle measurement techniques and the PT-TG distance measurement (tendinous cartilaginous TT -TG) as predictors of patellar instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Three PT -TG angle measurements and the PT -TG distance were measured in 82 participants with patellar instability and 100 controls using magnetic resonance imaging (MRI). Measurement landmarks were the line tangent to the posterior femoral condyles, the deepest point of the trochlea, the transepicondylar line, and the patellar tendon center. All measurements were recorded once by 1 examiner, and the measurements were recorded twice by 2 examiners in a random group of 100 knees. Mean values and standard deviations (SDs) were obtained. Normality cutoff values were defined as 2 and 3 SDs above the mean in the control group. The sensitivity, specificity, and positive likelihood ratio (LR+) were calculated. Inter- and intrarater reliability were assessed based on the intraclass correlation coefficient (ICC). Results: The measurements from the patellar instability and control groups, respectively, for angle 1 (16.4 degrees and 8.4 degrees), angle 2 (31 degrees and 15.6 degrees), angle 3 (30.8 degrees and 15.7 degrees), PT-TG distance (14.5 and 8.4 mm), and patellar tilt (21.1 and 7.5) were significantly different (P < .05). The angle measurements showed greater sensitivity, specificity, and LR+ than the PT -TG distance. Inter- and intrarater ICC values were > 0.95 for all measurements. Conclusion: The PT-TG angle and the PT-TG distance are reliable and are different between the patellar instability and control groups. PT-TG angles are more closely associated with patellar instability than PT-TG distance. Clinical Relevance: PT-TG angle measurements show high reliability and association with patellar instability and can aid in the assessment of extensor mechanism malalignment. A more sensitive and specific evaluation of extensor mechanism malalignment can improve patient care by preventing both redislocation and abnormal tracking of overlooked malalignment and complications of unnecessary tibial tuberosity medialization.
- The Effect of Mechanical Varus on Anterior Cruciate Ligament and Lateral Collateral Ligament Stress: Finite Element Analyses(2016) HINCKEL, Betina B.; DEMANGE, Marco K.; GOBBI, Riccardo G.; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisThe current study analyzed changes in anterior cruciate ligament (ACL) and lateral collateral ligament stress as a result of mechanical varus. In an exploratory pilot study, progressive mechanical varus was introduced to a male finite element model of the lower limb at different knee flexion angles. Nine situations were analyzed (combinations of 0 degrees, 30 degrees, and 60 degrees knee flexion and 0 degrees, 5 degrees, and 10 degrees varus). The ACL stress was measured via changes in section force, von Mises stress, and fiber stress. Lateral collateral ligament stress was measured via changes in section force. For all 3 measures of the ACL, maximum stress values were found in extension, stress decreased with flexion, and the effect of varus introduction was most significant at 30 degrees flexion. With 60 degrees flexion, varus introduction produced a decrease in section force and von Mises stress and a small increase in fiber stress. In all situations and stress measures except fiber stress at 60 degrees flexion, stress was concentrated at the posterolateral bundle. For the lateral collateral ligament, the introduction of 5 degrees and 10 degrees varus caused an increase in section force at all degrees of flexion. Stress in the ligament decreased with flexion. Mechanical varus of less than 10 degrees was responsible for increased ACL stress, particularly at 0 degrees and 30 degrees knee flexion, and for increased lateral collateral ligament stress at all degrees of flexion. Stress was mostly concentrated on the posterolateral bundle of the ACL.