GILBERTO LUIS CAMANHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder
6 resultados
Resultados de Busca
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- 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.
- 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.
- PROTOCOL FOR TREATING ACUTE INFECTIONS IN CASES OF TOTAL KNEE ARTHROPLASTY(2019) PECORA, Jose Ricardo; LIMA, Ana Lucia Munhoz; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; CAMANHO, Gilberto LuisObjective: To retrospectively evaluate the results after applying a protocol for treating acute infections in cases of total knee arthroplasty and to establish factors predictive of success or failure. Methods: Thirty-two patients who were diagnosed with acute infection of the knee following total arthroplasty between 2004 and 2009 were retrospectively evaluated. Infections following arthroplasty were treated in accordance with the protocol for acute infections following arthroscopy recommended at our institution. Results: With application of a treatment protocol for acute infections following total knee arthroplasty, 26 patients (81.2%) had good results and 6 (18.8%) had unsatisfactory results. Statistical analysis showed that the variables correlated with a worse prognosis were age (p = 0.038) and number of surgical debridement procedures performed (p = 0.038). Conclusion: Our treatment routine was effective for infection. Prosthesis revision was performed in 2 cases when the initial surgical debridement failed to control the infection.
- Clinical results of pulsed signal therapy on patellofemoral syndrome with patellar chondropathy(2019) GOBBI, Riccardo Gomes; SILVA, Adriana Lucia Pastore e; DEMANGE, Marco Kawamura; PECORA, Jose Ricardo; ESPREGUEIRA-MENDES, Joao; CAMANHO, Gilberto LuisThis study was designed to evaluate the effect of pulsed signal therapy (PST) on patellofemoral pain syndrome associated with patellar chondropathy. A prospective randomized double-blind placebo controlled trial included 25 patients (41 knees) between 20 and 50 years with pain due to isolated patellofemoral syndrome with chondropathy. PST group received nine 60-min daily sessions of PST treatment. Control group received the same protocol of blinded placebo treatment. The main outcome was change from baseline Kujala score at 3 months. After 3 months, patients in the control group received effective treatment (placebo post-treatment). All patients were then followed, for up to 12 months. Seventeen knees (5 males and 12 females, mean age 36.7 +/- 7.9) received placebo and 24 knees (8 males and 16 females, mean age 35.5 +/- 8.9) received PST. By the third month, PST group exhibited a mean change from baseline of 9.63 +/- 7.5 Kujala points, compared to 0.53 +/- 1.8 in the placebo group (P < 0.001). A significant progressive improvement was seen in the PST group between the 3rd and 6th and between the 6th and 12th month (P < 0.016). Patients initially allocated in the control group also improved at 3 months (P < 0.001) and 6 months (P = 0.005) post-effective treatment. In conclusion, PST in patellofemoral pain syndrome with chondropathy was effective compared to placebo at 3 months, showing an important improvement of Kujala score. The improvement was progressive and maintained up to 12 months. PST is safe and should be considered as a non-invasive option for management of this condition. Bioelectromagnetics. 40:83-90, 2019. (c) 2019 Bioelectromagnetics Society
- The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study(2019) GOBBI, Riccardo Gomes; HINCKEL, Betina Bremer; TEIXEIRA, Paulo Renan Lima; GIGLIO, Pedro Nogueira; LUCARINI, Bruno Romano; PECORA, Jose Ricardo; CAMANHO, Gilberto Luis; DEMANGE, Marco KawamuraBackground: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. Purpose: To compare the anatomy of the vastus medialis using magnetic resonance imaging in patients with patellar instability to a control group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A group of patients with patellar instability were sex-matched with a control group with anterior cruciate ligament tears, meniscal injuries, or sprains; patients younger than 15 years were excluded. The anatomy of the vastus medialis was examined by the distance between the distal origin of the vastus medialis in the femur and the medial femoral condyle, the distance from the proximal pole of the patella to the most distal insertion of the muscle and its ratio to the length of the articular surface of the patella, and a qualitative description of the insertion position of the muscle fibers (directly in the patella or the medial retinaculum). Results: Both groups comprised 78 knees (48 female; 61.5%). The mean age in the control and patellar instability groups was 30.2 +/- 7.8 years and 25.6 +/- 7.5 years, respectively (P = .001). The distance from the vastus origin to the condyle was 27.52 +/- 3.49 mm and 26.59 +/- 3.43 mm, respectively (P = .041); the distance from the proximal pole of the patella to the most distal muscle insertion was 17.59 +/- 5.54 mm and 15.02 +/- 4.18 mm, respectively (P < .001); and the ratio of this distance to the joint surface was 0.586 +/- 0.180 and 0.481 +/- 0.130, respectively (P < .001). In 75.6% of knees in the patellar instability group, the insertion of the vastus was into the medial retinaculum and not into the patella compared with 52.6% in the control group (P = .003; odds ratio, 2.8). Conclusion: The distal insertion of the vastus medialis differed in knees with patellar instability, with a more proximal insertion and less patellar coverage relative to controls, and was more frequently found in the retinaculum instead of directly in the patella.