LATERAL EPICONDYLE SLIDING OSTEOTOMY IN KNEE ARTHROPLASTIES WITH VALGUS DEFORMITY.

OBJECTIVE: To evaluate the efficacy and safety of sliding osteotomy of the lateral epicondyle in correcting rigid valgus deformity in knee arthroplasty. METHODS: A retrospective study of patients undergoing total knee arthroplasty with lateral epicondyle sliding osteotomy between 2006 and 2018. The main outcome was the incidence of complications and adverse events. Secondary outcomes were Visual Analog Scale for Pain, varus stress test, and varus knee thrust during gait. RESULTS: 19 knees (19 participants) were included in the study. The mean follow-up was 4.2 years. There were no cases of infection or reoperation due to instability. Two participants (10.5%) had mild or moderate knee pain (VAS pain = 4.6 ± 1.9). Two arthroplasties (10.5%) had mild varus stress. No participant presented varus thrust. CONCLUSION: Sliding osteotomy of the lateral epicondyle allows fast and safe ligament balance of knee valgus deformities. Level of Evidence I, Case series.

Avaliar a eficácia e a segurança da osteotomia de deslizamento do epicôndilo lateral na correção da deformidade em valgo rígida na artroplastia de joelho. Métodos: Estudo retrospectivo de pacientes submetidos à artroplastia total do joelho com osteotomia de deslizamento do epicôndilo lateral entre 2006 e 2018. O principal desfecho foi a incidência de complicações e eventos adversos. Os desfechos secundários foram escala visual analógica para dor, teste de estresse em varo e flambagem em varo do joelho durante a marcha. Resultados: Foram incluídos no estudo 19 joelhos (19 participantes). O seguimento médio foi de 4,2 anos. Não houve nenhum caso de infecção ou reoperação devido à instabilidade. Dois participantes (10,5%) apresentaram algum tipo de dor leve ou moderada no joelho (EVA = 4,6 ± 1,9). Duas artroplastias (10,5%) apresentaram estresse em varo leve. Nenhum participante apresentou flambagem em varo. Conclusão: A osteotomia de deslizamento do epicôndilo lateral possibilitou o balanço ligamentar das deformidades em valgo do joelho de forma rápida e segura. Nível de Evidência IV, Série de Casos.

Challenges of Implementing a Human Multi-Tissue Bank in a Public Hospital in the Interior of São Paulo: Under the Light of the Quality Management System.

BACKGROUND: Human multi-tissue banks (HMTB) are important health institutions specialized in the capture, processing, and distribution of human tissues for transplants and research, aiming for safety and quality in the supply of their products, intended for reconstructive surgeries and injury repair, in addition to contributing to the advancement of research developed in regenerative medicine. This study aims to report and share the experience of implementing an HMTB, as well as creating an institution's own quality management system. METHODS: This is a descriptive study, an experience report type, which identifies historical aspects of an HMTB's actions in the 5 years of implementing and operating the service. RESULTS: Initially, a musculoskeletal tissue bank was established in collaboration with the Department of Orthopedics at the State University of Campinas, São Paulo, Brazil, in June 2018. In 2023, through a management model and associated technologies, the banks of human musculoskeletal and ocular tissues at the institution established the HC-UNICAMP Human Multi-tissue Bank. CONCLUSIONS: The implementation of the HMTB with modern and technological infrastructure, associated with the development and operation of the quality management system, allowed us to provide excellent organization of work processes, as well as obtain the necessary health license to begin activities. It is believed that this report can be an important source of information and recommendations applicable to the implementation of other human HMTBs.

Superior Dislocation of the Patella in a Young Patient without Osteophytes: A Case Report with Discussion about Differential Diagnosis.

We report a case of superior dislocation of the patella in a young woman without degenerative changes. We retrospectively analyzed the clinical and imaging data obtained from the patient. This article describes a rare case of patellar dislocation following a bicycle fall in a 19-year-old woman without any history of patellofemoral complaints. Our literature search yielded 28 case reports; however, most reports describe older individuals with osteoarthritis. Only two reports have previously described this lesion in young patients without osteophytes, but some features, like an increase of the patella tilt, may raise doubts about whether it would be better to classify them as a vertical dislocation of the patella, another quite rare lesion, or just as a variant of a superior dislocation.

PREVALENCE OF JOINT PAIN AND OSTEOARTHRITIS IN OBESE BRAZILIAN POPULATION.

BACKGROUND: High body mass index, as well as maintaining this condition for a long period of time, are important risk factors for the development of osteoarthritis. AIM: To determine joint pain and osteoarthritis prevalence in patients referred to bariatric surgery. METHODS: Morbidly obese patients referred to bariatric surgery responded to the visual analogue pain scale (VAS) and the WOMAC questionnaire. X-rays of the hips and knees were evaluated. The primary endpoints were self-reported joint pain and the diagnosis of osteoarthritis by clinical and radiological criteria of the American College of Rheumatology. RESULTS: 141 patients were interviewed (85.1% women) with a mean age of 40 years. The mean body mass index was 46. The lumbar spine and knee joint were the most commonly reported as painful (77.9% and 73.2% respectively). Prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8%. Age, mean VAS and WOMAC scores were higher in the osteoarthritic individuals. CONCLUSION: There is prevalence of 90.1% of pain symptoms in morbidly obese patients referred to bariatric surgery. The prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8% in this sample.

Gait analysis in short-term follow-up of medial opening wedge high tibial osteotomy.

BACKGROUND: Biomechanical gait changes are proposed as adaptations to medial knee osteoarthritis (OA), and little is known about which parameters can be modified early by high tibial osteotomy (HTO) surgery. The aim of this study was to identify early gait changes in a postoperative period of 6 months as compared to a control group, in three different spatial planes. METHODS: Twenty-one patients with OA were submitted to three-dimensional gait analysis preoperatively and 6 months after HTO surgery. Sixteen healthy individuals were selected for the control group. RESULTS: Compared to the control group, OA patients walked more slowly, with a shorter stride length, and with a higher knee varus and flexion angles. The gait changes detected in the postoperative of 6 months were a significant reduction in knee varus angle and adductor moment in coronal plane; an important reduction in knee extension and an increased extensor moment in sagittal plane; also an increased foot external rotation angle in axial plane was observed. Flexion angle peak in swing phase, adductor and flexor moments were the gait parameters with postoperatively results that were closer to those of the control group. CONCLUSIONS: Even in a short follow-up of 6 months, HTO determines positive results in biomechanical gait, not only in the coronal plane but also in the sagittal and axial planes and should be taken into account during the rehabilitation process.

Prevalence of joint pain and osteoarthritis in obese brazilian population / Prevalência de dor articular e osteoartrite na população obesa brasileira

ABSTRACT Background: High body mass index, as well as maintaining this condition for a long period of time, are important risk factors for the development of osteoarthritis. Aim: To determine joint pain and osteoarthritis prevalence in patients referred to bariatric surgery. Methods: Morbidly obese patients referred to bariatric surgery responded to the visual analogue pain scale (VAS) and the WOMAC questionnaire. X-rays of the hips and knees were evaluated. The primary endpoints were self-reported joint pain and the diagnosis of osteoarthritis by clinical and radiological criteria of the American College of Rheumatology. Results: 141 patients were interviewed (85.1% women) with a mean age of 40 years. The mean body mass index was 46. The lumbar spine and knee joint were the most commonly reported as painful (77.9% and 73.2% respectively). Prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8%. Age, mean VAS and WOMAC scores were higher in the osteoarthritic individuals. Conclusion: There is prevalence of 90.1% of pain symptoms in morbidly obese patients referred to bariatric surgery. The prevalence of knee osteoarthritis was 63.1% and hip osteoarthritis was 40.8% in this sample.

RESUMO Racional: Alto índice de massa corpórea, assim como a manutenção desta condição por longo período de tempo, são importantes fatores de risco para o desenvolvimento de osteoartrite. Objetivo: Determinar a prevalência de dor articular e osteoartrite em pacientes aguardando cirurgia bariátrica. Métodos: Pacientes obesos mórbidos responderam à escala e questionário (VAS e WOMAC) de dor e função. Radiografias dos quadris e joelhos foram avaliadas. Os desfechos primários foram dor articular referida nos questionários e o diagnóstico de osteoartrite feito através dos critérios clinicoradiológicos do Colégio Americano de Reumatologia. Resultados: Cento e quarenta e um pacientes foram entrevistados (85,1% mulheres) com idade média de 40 anos. A média do índice de massa corpórea foi de 46. Coluna lombar e joelhos foram as regiões mais comumente referidas com dor (77,9% e 73,2% respectivamente). A prevalência de osteoartrite dos joelhos foi de 63,1% e dos quadris foi de 40,8%. Idade, média da escala visual de dor e resultados do questionário de WOMAC foram maiores nos indivíduos com osteoartrite. Conclusão: Há prevalência de 90,1% de sintomas dolorosos nos pacientes obesos mórbidos encaminhados para cirurgia bariátrica. A osteoartrite dos joelhos foi de 63,1% e de quadris de 40,8%.

Natural Type II Collagen Hydrogel, Fibrin Sealant, and Adipose-Derived Stem Cells as a Promising Combination for Articular Cartilage Repair.

Objective Articular cartilage is an avascular tissue with limited ability of self-regeneration and the current clinical treatments have restricted capacity to restore damages induced by trauma or diseases. Therefore, new techniques are being tested for cartilage repair, using scaffolds and/or stem cells. Although type II collagen hydrogel, fibrin sealant, and adipose-derived stem cells (ASCs) represent suitable alternatives for cartilage formation, their combination has not yet been investigated in vivo for focal articular cartilage defects. We performed a simple experimental procedure using the combination of these 3 compounds on cartilage lesions of rabbit knees. Design The hydrogel was developed in house and was first tested in vitro for chondrogenic differentiation. Next, implants were performed in chondral defects with or without ASCs and the degree of regeneration was macroscopically and microscopically evaluated. Results Production of proteoglycans and the increased expression of collagen type II (COL2α1), aggrecan (ACAN), and sex-determining region Y-box 9 (SOX9) confirmed the chondrogenic character of ASCs in the hydrogel in vitro. Importantly, the addition of ASC induced a higher overall repair of the chondral lesions and a better cellular organization and collagen fiber alignment compared with the same treatment without ASCs. This regenerating tissue also presented the expression of cartilage glycosaminoglycan and type II collagen. Conclusions Our results indicate that the combination of the 3 compounds is effective for articular cartilage repair and may be of future clinical interest.

Isokinetic evaluation after two-stage bicruciate reconstruction.

OBJECTIVE: To assess the functional balance of the knee after bicruciate reconstruction and its correlation with clinical score. METHODS: 14 patients (11 men and three women), mean age 29.9±7.65 years, mean BMI 26.2±2.51 kg/m(2) underwent surgical reconstruction of the Posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL) in two stages, with a mean interval of 3 months between procedures. With a mean follow-up period of 27.33 months, the isokinetic knee analysis was performed at 60°/s and 180°/s and the Lysholm and Tegner scores were applied. RESULTS: The Lysholm score was 86.8±11.1 points and the Tegner score showed a deficit of 30% compared to pre-injury level. In isokinetic evaluation, the deficit of the operated quadriceps average torque was 17.05% at 60°/s and 12.16% at 180°/s, while the average flexor torque deficit was 3.43% at 60°/s and 5.82% at 180°/s. Although it was observed torque deficit between members, there were no statistical differences regarding the functional balance between hamstrings and quadriceps. CONCLUSION: Although the results of isokinetic evaluation has shown a functional balance of the knee (flexor-extensor), which may have contributed to the good subjective Lysholm score in the bicruciate two-stage reconstruction, two-stage reconstruction did not restore the pre-injury functional level. Level of Evidence IV, Case Series.

Opening-wedge high tibial osteotomy with and without bone graft.

Medial opening-wedge has gained popularity in comparison to other techniques of high tibial osteotomy. This technique involves the creation of a gap in the tibia. Filling the gap with autologous iliac bone graft was recommended in the classic description, to prevent complications such as correction loss or delayed bone union. No previous reports have compared grafted and nongrafted osteotomies. This study hypothesized that the use of autologous bone graft in medial opening-wedge high tibial osteotomy (MOWHTO) less than 12.5 mm is unnecessary. A prospective randomized clinical trial was conducted. Forty-six opening-wedge high tibial osteotomies were carried out between April 2007 and December 2008. All had fixation with a type of Puddu stainless steel plate and screws. Patients were randomly divided by software analysis into two groups: group A had osteotomies that were filled with autologous bone graft and group B had osteotomies that were unfilled. Autologous iliac bone graft was harvested in both groups. Clinical and radiographic evaluations were performed twice monthly by blinded investigators. The rates of complications were compared between the groups. There was no difference in demographic data. Mean time to clinical bone union in group A was 12.4 weeks (confidence interval [CI] 11.2-13.6) and in group B was 13.7 weeks (CI 12.5-14.9), but this difference was not significant (P = 0.13). Signals of correction loss occurred in one patient (4.35%) in group A, and in two patients (8.70%) in group B. All osteotomies had achieved bone union. It was concluded that time to bone union was not statistically different between the group with bone graft and the group without graft.