Geraldo Sérgio de Mello Granata Júnior

Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases,

Objective to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. Method a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patients function was applied preoperatively and postoperatively after a mean follow-up of 22 months. Results in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3° of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. Conclusion the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.

Posterior cruciate ligament reconstruction by means of tibial tunnel: anatomical study on cadavers for tunnel positioning

Objective to determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia. Methods sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL) was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB) and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3) were measured. Results in the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm. Conclusion the guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.

Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: association with aging male.

Abstract Introduction: The aim of this study was to evaluate the association between frequency of the posterior cruciate ligament (PCL) mechanoreceptors and age in men. Methods: Nineteen normal right knees harvested from human male cadavers were evaluated. Age ranged from 17 to 64 years with a mean of 35 years old. PCL was separated for sampling in femoral and tibial portions. Topographic distribution and frequency within the ligament texture were determined employing the Pro-Image digital analysis system. Mechanoreceptors were counted and classified according to the criteria proposed by Freeman & Wyke. Results: A total of 1820 mechanoreceptors were found, Type II being the most frequent one. Analysis of the femoral portion of the ligament showed an equivalent predominance of Types II and IV mechanoreceptors. Tibial portion had a predominance of Type II mechanoreceptors, followed by Type IV. At this portion, receptors Types I and III were less commonly identified. Conclusion: In the tibial portion of the PCL, there is predominance of Type II mechanoreceptors followed by Types IV, I and III mechanoreceptors, respectively. No relationship was found between the total number of mechanoreceptors and age in the femoral and tibial portions of the PCL.

Meniscal repair by all-inside technique with Fast-Fix device

Objective The objective of this study is to evaluate the results and effectiveness of the technique of meniscal repair type all-inside using Fast-Fix device. Methods A retrospective cohort study evaluating 22 patients with meniscal surgery between January 2004 and December 2010 underwent meniscal repair technique for all-inside with the Fast-Fix device with or without ACL reconstruction. Function and quality of life outcomes were chosen by the IKDC and Lysholm score, before and postoperatively, and reoperation rates, relying to the time of final follow-up. Statistical analysis was performed using the Students t test. Results The mean follow-up was 59 months (16–84). The Lysholm score showed 72% (16 patients) of excellent and good results (84–100 points), 27% (6 patients) fair (65–83 points) and no cases classified as poor (<64 points). According to the IKDC: 81% (18 patients) of excellent and good results (75–100 points), 18% of cases regular (50–75 points) and no patient had poor results (<50 points). There were no failures or complications. Conclusion The technique of meniscal repair type all-inside using the Fast-Fix device is safe and effective for the treatment of meniscal lesions in the red zone or red-white with or without simultaneous ACL reconstruction, with good and excellent results in most patients Level 4 Study.

The role of fibrin glue and suture on the fixation of ultra frozen preserved meniscus transplantation in rabbits

Objective: To evaluate the ability of fibrin adhesive in promoting the meniscus fixation within two, four and eight weeks compared to the conventional soft-tissue suture technique. Materials and Methods: 36 right medial menisci of rabbits preserved at negative 73° Celsius for 30 days were transplanted to animals of the same sample and fixed with soft-tissue suture or fibrin glue. After 2, 4 or 8 weeks, the appearance of the menisci and the quality of fixation were macroscopically checked and evaluated by a scoring system. The findings were subjected to the statistical study of variance analysis (p ≤ 0.05%). Results: The deep-frozen meniscus preservation maintained the integrity of the meniscus transplant, and, macroscopically, there was no significant reduction of the length of the meniscus in all post-transplant periods (p = 0.015). The menisci fixed with fibrin showed slight changes in color and surface roughness. There were no signs of rejection or infection in both groups. Suture fixation scoring was superior (p = 0.015) in all periods (80% of total fixation) as compared to the setting promoted by fibrin (20% of total fixation). Conclusion: The homologous transplantation of the meniscus of rabbits experienced various degrees of integration to the knee according to the fixation method; the surgical soft tissues suturing technique was shown to be superior in the evaluation of scores compared to the fixation with fibrin adhesive.

O papel do adesivo de fibrina e da sutura na fixação do transplante de menisco preservado por ultracongelamento em coelhos

OBJETIVO: Avaliar a capacidade do adesivo de fibrina em promover a fixacao do menisco ao longo de duas, quatro e oito semanas comparando com a tecnica convencional de fixacao por sutura a tecidos moles. METODOS: 36 meniscos mediais direitos de coelhos preservados a 73°C negativos por 30 dias foram transplantados para os animais da mesma amostra e fixados com sutura ou cola de fibrina. Apos duas, quatro ou oito semanas a aparencia dos meniscos e a qualidade da fixacao foram verificadas macroscopicamente e avaliadas por um sistema de escores. Os achados foram submetidos a estudo estatistico de analise de variância por postos (p < 0,05%). RESULTADOS: A preservacao por ultracongelamento manteve a integridade macroscopica dos meniscos transplantados. Apos todos os periodos pos-transplante tambem nao houve reducao significante da extensao dos meniscos (p = 0,015). Os meniscos fixados com fibrina mostraram discretas alteracoes de coloracao e rugosidade de superficie. Nao houve sinais de rejeicao ou infeccao em ambos os grupos. A avaliacao por escores da fixacao pela sutura foi superior (p = 0,015) em todos os periodos (80% de fixacao total) do que a fixacao promovida pela fibrina (20% de fixacao total). CONCLUSAO: O transplante homologo do menisco de coelho sofreu diferentes graus de integracao ao joelho de acordo com a tecnica de fixacao; a tecnica operatoria com sutura aos tecidos moles mostrou-se superior na avaliacao de escores em relacao a fixacao com adesivo de fibrina.