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
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- 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.
- Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review(2018) HINCKEL, Betina Bremer; GOBBI, Riccardo Gomes; KALEKA, Camila Cohen; CAMANHO, Gilberto Luis; ARENDT, Elizabeth A.The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice. V.
- 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
- Surgical Timing Does Not Interfere on Clinical Outcomes in Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament: A Comparative Study With Minimum 2-Year Follow-Up(2021) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; BONADIO, Marcelo Batista; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; CAMANHO, Gilberto LuisPurpose: To compare the functional outcomes, knee stability, failure rate and complication rates of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction with hamstrings grafts between acute and chronic cases. Methods: Consecutive patients who underwent combined ACL and ALL reconstruction with hamstrings grafts were evaluated. Patients operated on less than 8 weeks after injury were allocated to group 1, and the others were allocated to group 2. Demographic data, knee stability, and functional outcomes of the 2 groups were evaluated. Results: Thirty-four patients in the acute group and 96 in the chronic group were evaluated. The follow-up time was similar between the groups (28.7 +/- 5.2 [24-43] months vs 29.4 +/- 7.2 [24-58] months; P = 0.696). No differences were found between the groups in age, sex, trauma mechanism, presence of knee hyperextension, graft diameter, and meniscal injuries. There was no difference between the groups in the postoperative KT-1000 and in the pre- or postoperative pivot shift. The preoperative KT-1000 was higher in group 2 (7.9 +/- 1.1 vs 7.4 +/- 1.2; P = 0.031). There were no differences in the International Knee Documentation Committee or Lysholm. Three (2.3%) patients developed failure, 1 (2.9%) in group 1 and 2 (2.1%) in group 2. The total complication rate was 10% and did not differ between the groups. Conclusions: Combined ACL and ALL reconstruction has similar outcomes in patients undergoing surgery in the acute and chronic phases. Patients with chronic injury have similar knee stability, functional scores, and failure rates as acute-injury patients, and patients with acute injury have no more complications than chronic patients. Level of Evidence: Level III, retrospective comparative therapeutic trial.
- Extensor mechanism injury, infection, and an extended time between trauma and surgical approach are related to the need for total knee arthroplasty removal after traumatic dehiscence(2023) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; FRANCIOZI, Carlos Eduardo; TKA Traumatic Exposure Study GrpBackground: Surgical wound-related traumatic complications are rarely reported in the lit-erature. Traumatic dehiscence is unpredictable because of the trauma magnitude and the potential of associated injuries. This study aims to report the clinical outcomes and com-plications of a case series due to traumatic dehiscence after total knee arthroplasty (TKA) and establish possible criteria for prognosis for maintaining the implant.Methods: Patients admitted to an emergency room due to traumatic dehiscence after TKA were retrospectively evaluated. Patient data was analyzed and patients who maintained or not the arthroplasty were compared to establish prognosis factors.Results: Thirty-two patients with traumatic dehiscence after TKA were evaluated. The trauma occurred on a mean of 14.3 +/-25.0 days after the surgical procedure, and debride-ment in the operating room was performed on a mean of 6.2 +/-4.9 hours after the trauma. Twenty patients maintained the arthroplasty until the end of follow-up and did not require revision. Factors related to arthroplasty removal were associated extensor mechanism injury (p = 0.026), time from trauma to surgical debridement (p = 0.035), and infection (p = 0.0001)Conclusion: Traumatic dehiscence after total knee arthroplasty is an event with a high rate of complications. Extensor mechanism Injury, infection, and extended time between trauma and surgical intervention were poor prognostic factors for arthroplasty maintenance.
- Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment(2021) HELITO, Camilo Partezani; HELITO, Paulo Victor Partezani; SOBRADO, Marcel Faraco; GIGLIO, Pedro Nogueira; GUIMARAES, Tales Mollica; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; RODRIGUES, Marcelo Bordalo; BERG, Bruno VandePurpose: To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema, and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion. Methods: From 2012 to 2018, patients who had this specific meniscus pathology and underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index, and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score. Results: A total of 69 patients were evaluated. The mean age was 58.6 +/- 7.1 years. The follow-up time was 48.7 +/- 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative International Knee Documentation Committee was 62.6 +/- 15.4, and the mean GPE was 2.3 +/- 2.6. Fourteen patients (20.3%) showed no improvement in pain, and 7 patients (10.2%) presented complications. Groups that improved (GPE 0) and did not improve (GPE < 0) did not present differences regarding age, sex, follow-up time, chondral lesions, or body mass index. Patients without improvement had a greater incidence of smoking (P = .001), varus alignment (P = .008), and more advanced KL classification (P < .001). In the multivariate analysis based on the GPE score, KL classification (P = .038) and smoking (P = .003) were significant. Conclusions: Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment.
- Letter regarding ""Management of the exposed total knee prosthesis, a six-year review""(2017) HELITO, Camilo Partezani; BONADIO, Marcelo Batista; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura
- Plateau-patella angle: An option for the evaluation of patellar height in patients with patellar instability(2017) BONADIO, Marcelo Batista; HELITO, Camilo Partezani; TORRES, Julio Augusto do Prado; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraBackground: Patellar instability is a debilitating disease. An important factor related to recurrent dislocation is patellar height. A new method of patellar height measurement, the plateau-patella angle (PPA), was proposed in 2011. However, to date, there is no study evaluating the use of this method in patients with patellar instability. The aim of this study was to evaluate the PPA in patients with recurrent patellar dislocation. Methods: This was a retrospective evaluation of the radiographs of 78 knees with patellar instability. Patellar height was measured using the Insall-Salvati (VS), Caton-Deschamps (C/D) and Blackburne-Peel (B/P) indices and the PPA. The qualitative and quantitative correlations between the various methods and between observers were calculated. Results: The PPA had a Pearson correlation of 0.76 (P <0.001) with the I/S index, 0.78 (P < 0.001) with the C/D index and 0.90 (P < 0.001) with the B/P index. In the qualitative correlation using the Spearman coefficient, the PPA had a correlation of 0.52 (P < 0.001) with the I/S index, 0.72 (P < 0.001) with the C/D index and 0.70 (P < 0.001) with the B/P index. The correlations between the conventional methods were as follows: 0.57 (P < 0.001) between the I/S and C/D indices; 0.61 (P < 0.001) between the I/S and B/P indices; and 0.73 (P < 0.001) between the C/D and B/P indices. Conclusion: The determination of the PPA is a reproducible method that is consistent with the methods currently used to measure patellar height in patients with recurrent patellar dislocation.
- Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: Long-term outcomes of 45 cases(2012) OLIVEIRA, Vitor G.; D'ELIA, Luis Fernando; TIRICO, Luis Eduardo Passarelli; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CAMANHO, Gilberto L.; ANGELINI, Fabio Janson; DEMANGE, Marco K.BACKGROUND: Posttraumatic knee stiffness is a very debilitating condition. Judet's quadricepsplasty technique has been used for more than 50 years. However, few reports of quadricepsplasty results exist in the literature. METHODS: We report the results of 45 cases of posttraumatic arthrofibrosis of the knee treated with Judet's quadricepsplasty. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). RESULTS: The degree of flexion increased from 33.6 degrees (range, 5-80 degrees) preoperatively to 105 degrees (range, 45-160 degrees) immediately after surgery, followed by a slight fall in the range of motion (ROM) in the late postoperative period, which reached an average of 84.8 degrees. There was no significant correlation between knee strength and the patient's gender, but there was a slight trend of lower strength with age. Although Judet's quadricepsplasty technique dates from more than 50 years ago, it still provides good outcomes in the treatment of rigid knees of various etiologies. In general, all cases showed the same pattern of a small decrease in the ROM in the late postoperative period. CONCLUSION: Judet's quadricepsplasty can increase the ROM of rigid knees. The ROM obtained with the surgery persists long term. (J Trauma. 2012; 72: E77-E80.
article 2 Citação(ões) na Scopus High Potential for Complications After Traumatic Exposure in Patients With a Total Knee Replacement(2020) HELITO, Camilo Partezani; SOBRADO, Marcel Faraco; NEGRELLI, Marco Aurelio Cotegipe; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; ANGELINI, Fabio JansonObjective. The purpose of this study is to describe cases of traumatic exposure during the early postoperative period in patients with a total knee replacement (TKR) and to report the treatments instituted and complications of this adverse event. Methods. A retrospective review of postoperative patients with TKR performed at the Universidade de Sao Paulo from 2001 to 2017 who subsequently were treated at the emergency room due to trauma to the TKR region accompanied by surgical wound dehiscence in deep planes and implant exposure was conducted. The initial treatment, evolution, and complications of each patient were reported. Results. In 16 years, there were 3224 TKRs performed at the study institution. Among this population, 4 (0.1%) patients had trauma dehiscence of the surgical wound during the immediate postoperative period. All patients were women between the ages of 64 and 88 years with comorbidities (eg, diabetes mellitus and/or hypertension). The mean time between the surgery and trauma was 6.7 +/- 6.2 days. All patients underwent surgical cleaning, debridement with polyethylene exchange, and primary closure of the surgical wound and received adjuvant treatment with broad-spectrum antibiotic therapy. Of the 4 patients affected, 3 developed an infection, 3 required new surgery after initial cleaning, 2 lost their prostheses, and 1 lost a limb, requiring a transfemoral amputation. Conclusions. Traumatic dehiscence with implant exposure during the initial postoperative period of TKR is an infrequent event (0.1%) with a high potential for complications (75%), which may lead to loss of the prosthesis and even the limb. Measures should be taken to prevent falls and gather reports from several centers to broaden the knowledge of this rare event, identify prognostic factors, and define the best treatment algorithm.