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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- 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.
- 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.
- 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.
- Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament(2015) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GOBBI, Riccardo Gomes; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraWe present a new technique for the combined intra- and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament.
- Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate(2015) TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; BONADIO, Marcelo Batista; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; PECORA, Jose RicardoDistal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy.
- 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.