Guilherme do Val Sella

Avaliação dos resultados das reoperações de pacientes com lesões do manguito rotador

OBJECTIVES: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. METHODS: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de Sao Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow- up. RESULTS: According to the UCLA evaluation criteria, 21 patients (70%) showed excellent or good outcomes; and nine patients (30%) showed fair or poor outcomes. CONCLUSION: Open or arthroscopic surgical treatment of recurrent rotator cuff injuries tended to present worse results than from the primary repair. In this study, we found that 70% of the results were excellent and good. The presence of extensive injuries in the reoperation tended to evolve with larger numbers of unsatisfactory results. In our study, we obtained better results from arthroscopic surgery than from open surgery.

Evaluation of the results from surgical treatment of the terrible triad of the elbow

Objective to evaluate the results from surgical treatment of the terrible triad of the elbow (fracture of the radial head, fracture of the coronoid process and elbow dislocation) and its complications. Methods between August 2002 and August 2010, 15 patients (15 elbows) with the terrible triad were treated by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. Nine (60%) were male and six (40%) were female; their ages ranged from 21 to 66 years, with a mean of 41 years. With the exception of one case that underwent arthroscopic surgery, all the patients underwent open surgery. The fracture of the coronoid process was fixed in 10 patients (66.7%). The fracture of the radial head was treated by means of internal osteosynthesis in 11 cases (73.3%); in three cases (20%), the radial head was resected; and in one case, only the fragment of the fracture was resected. The collateral ligaments, except for one case, were repaired whenever they were found to be injured; ten cases (66.7%) of medial collateral injury and 15 (100%) of lateral collateral injury were found. The mean length of the postoperative follow‐up was 62 months, with a minimum of 12 months. The postoperative evaluation was done by means of the Bruce score. Results more than 80% of the patients recovered their functional ranges of motion but, according to the Bruce score, only 26% of the patients achieved results that were considered satisfactory. Conclusion despite the unsatisfactory results, the functional ranges of motion and elbow function could be restored.

Artroscopia do quadril em atletas

OBJETIVO: Confirmar a importância terapeutica da artroscopia do quadril em atletas cuja dor impede a funcao desportiva da articulacao do quadril, sendo capaz de minimiza-la a ponto de ajudar o retorno a atividade esportiva em niveis satisfatorios. METODOS: Foram analisados 49 pacientes que praticam esporte (51 quadris), submetidos a artroscopia do quadril que apresentavam dor e incapacidade para a pratica esportiva. O seguimento minimo foi de 12 meses e o maximo de 74 meses (media de 39,0 meses). No periodo pre-operatorio avaliou-se a localizacao da dor, sua intensidade segundo a Escala de Expressao Facial (EEF) e o grau de incapacidade utilizando-se o criterio de Harris Hip Score modificado (HHS). Anotaram-se diferentes diagnosticos que levaram a indicacao da artroscopia, como impacto femoroacetabular, lesao do labio acetabular nao secundaria ao impacto femoroacetabular e outros. No periodo pos-operatorio, os pacientes foram avaliados pelos mesmos metodos do periodo pre-operatorio e pela analise subjetiva de retorno ao esporte. RESULTADOS: Baseando-se no HHS e EEF pre e pos-operatorios, a analise estatistica mostrou significância entre os valores. Observou-se alguma melhora em todos os casos e retorno ao esporte, de forma satisfatoria, na maioria deles. CONCLUSAO: Diante do que foi estudado, confirmamos que a artroscopia em atletas com lesoes localizadas no quadril e tecnica eficaz, capaz de promover o retorno a pratica esportiva na maioria dos casos, sem dor e com funcao articular efetiva, desde que bem indicada.

Hip arthroscopy in athletes

To confirm the therapeutic importance of hip arthroplasty in athletes whose pain precludes sportive function of the hip joint, being able to minimize it to the extent of helping on the return of sports practice at satisfactory levels. Methods: 49 athlete patients (51 hips) submitted to hip arthroscopy complaining of pain and inability to practice sports were assessed. Follow-up time ranged from 12 to 74 months (mean: 39.0 months). Preoperatively, pain site, severity according to Facial Expression Scale (FES) and the degree of disability using the modified Harris Hip Score (HHS) were assessed. Different diagnoses were provided, which led to the indication of arthroscopy, such as femoralacetabular impact, acetabular lip injury not secondary to femoral-acetabular impact, etc. Postoperatively, the patients were assessed by using the same methods as used at baseline and by the subjective analysis of return to sports activities. Results: Based on pre-and postoperative HHS and FES, the statistical analysis showed significance between values. We found some improvement in all cases and return to sports activities at a satisfactory level in most of the cases. Conclusion: As a result of our study, we confirm that arthroscopy in athletes with local hip injuries is an effective technique, able to promote the return to sports practice in most of the cases, without pain, and with an effective joint function, provided well indicated.

Avaliação dos resultados do reparo artroscópico de lesões do manguito rotador em pacientes com até 50 anos de idade

OBJECTIVE: To assess the results from arthroscopic surgical treatment of rotator cuff injuries among patients under 50 years of age. METHODS: Sixty-three patients with rotator cuff injuries who underwent arthroscopic surgical treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, in the Fernandinho Simonsen wing of Santa Casa Medical School, Sao Paulo, between August 1998 and December 2007, were reassessed. The study included all patients with rotator cuff injuries who were under 50 years of age and had been followed up postoperatively for at least 24 months. RESULTS: According to the UCLA evaluation criteria, 59 patients (92%) showed excellent and good results; five (8%) showed fair results; and none showed poor results. The postoperative evaluation showed that the mean range of motion was 145˚ for elevation, 47˚ for lateral rotation and T10 for medial rotation. Unsatisfactory results were associated with prolonged duration of the injury, with a statistically significant relationship. CONCLUSION: Arthroscopic repair of rotator cuff injuries in young patients produces excellent or good results for most patients.

Avaliação dos resultados do tratamento cirúrgico das fraturas-luxações da extremidade proximal do antebraço no adulto

OBJETIVO: Avaliar os resultados obtidos no tratamento das fraturas-luxacoes da extremidade proximal do antebraco (FLEPA), procurando identificar fatores que possam influenciar no prognostico desse tipo de lesao traumatica. METODOS: De outubro de 1994 a dezembro de 2005, 30 pacientes com FLEPA foram submetidos ao tratamento cirurgico. Em todos os casos, o seguimento ambulatorial minimo foi de 12 meses. As lesoes foram classificadas pelo metodo de Chick et al. A media de idade foi de 48 anos, com minima de 25 e maxima de 76 anos. Os mecanismos de trauma foram: queda da propria altura em 17 pacientes (57%), acidentes de via publica em 11 casos (37%), trauma direto em um caso (3%) e agressao fisica em um caso (3%). As fraturas expostas corresponderam a oito casos (27%). Realizou-se a analise estatistica pelo teste exato de Fisher para avaliar os seguintes dados: exposicao do foco de fratura e resultados; sexo e resultados; mecanismo de trauma e resultados; idade e mecanismo de trauma; sexo e mecanismo de trauma. RESULTADOS: Em 11 casos (37%) os resultados foram satisfatorios e em 19 casos (63%), insatisfatorios. Estabeleceu-se apenas relacao estatistica significativa entre exposicao da fratura e resultados. CONCLUSAO: Os tratamentos das FLEPA tem, em sua maioria, resultados insatisfatorios, principalmente nas fraturas expostas, fato estatisticamente significativo neste estudo. Nao foi possivel definir outros fatores prognosticos. Encontrou-se tendencia a melhores resultados nos pacientes do sexo feminino, nos idosos e nas vitimas de traumas de baixa energia.

Functional evaluation of arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis

Objective to evaluate the functional result from arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis, defined as incapacity to actively raise the arm above 90°, while complete passive elevation was possible. Methods we reevaluated 38 patients with a mean follow-up of 51 months (minimum of 24). We analyzed the pseudoparalysis reversion rate and the functional result obtained. Results according to the assessment criteria of the University of California in Los Angeles (UCLA), 31 (82%) patients had good and excellent results, two (5%) had fair results and five (13%) had poor results. The mean active elevation went from 39° before the operation to 139° after the operation (p < 0.05); the mean active lateral rotation went from 30° to 48° (p < 0.05) and the mean active medial rotation went from level L3 to T12 (p < 0.05). Conclusion arthroscopic repair of rotator cuff injuries produced good and excellent results in 82% of the cases and a statistically significant improvement of active range of motion, with reversion of the pseudoparalysis in 97.4% of the cases. It is therefore a good treatment option.

Osteoid osteoma of the acromion simulating acromioclavicular pain.

The osteoid osteoma is a benign bone tumour that usually presents with nocturnal pain in young adults, relieved by rest and anti‐inflammatories. It can affect any bone; however, their occurrence is rare in the acromion. The authors describe a case of osteoid osteoma located in the acromion, with symptoms that simulated acromion claviculararthrosis. The diagnosis was made by CT scan and treatment was excision of the nidus through arthroscopy. The diagnosis was confirmed by histopathology. In the outpatient segment, the patient remained asymptomatic, with complete recovery of function of the affected limb.

Avaliação dos resultados do tratamento cirúrgico artroscópico da instabilidade anterior traumática do ombro com sutura da lesão na margem cruentizada da cavidade glenoidal

OBJETIVO: Avaliar os resultados clinicos dos pacientes portadores de instabilidade anterior traumatica do ombro tratados cirurgicamente por visualizacao artroscopica, utilizando âncoras bioabsorviveis e com o uso da tecnica de cruentizacao da margem anterior da cavidade glenoidal para a reparacao da lesao de Bankart. METODO: Entre marco de 2006 e outubro de 2008 foram operados 27 ombros de 27 pacientes com diagnostico de instabilidade anterior traumatica do ombro, com media de idade de 28 anos e numero de luxacoes previas variando entre dois e 25 episodios. O sexo masculino predominou com 24 (89%) pacientes. O tempo minimo de seguimento foi de 24 meses, com uma media de 36 meses, e nenhum paciente tinha cirurgia previa no ombro acometido ou lesao ossea significativa na margem glenoidal. A avaliacao clinica pos-operatoria foi realizada por meio da escala de Rowe. Para medirmos o grau de amplitude articular pre-operatoria e pos-operatoria, utilizamos o metodo descrito pela Academia Americana de Cirurgioes Ortopedicos (AAOS). RESULTADO: Pelos criterios de Rowe, 25 pacientes (93%) obtiveram resultados excelentes e dois (7%) resultados ruins, nenhum paciente apresentou resultado bom ou regular. Vinte e tres pacientes estavam satisfeitos com o resultado obtido (85%), retornando as suas atividades sem limitacoes, e quatro pacientes (15%) tinham algum grau de limitacao. Houve recidiva da instabilidade em dois pacientes (7%). CONCLUSAO: O tratamento da instabilidade traumatica anterior do ombro por visualizacao artroscopica com a tecnica de cruentizacao da margem articular anterior da cavidade glenoidal, para reparacao da lesao de Bankart, proporcionou excelentes resultados em 93% dos pacientes operados.

Evaluation of the functional results after rotator cuff arthroscopic repair with the suture bridge technique

Objective To evaluate the results of arthroscopic treatment of large and extensive rotator cuff injuries (RCI) that involved the supra and infraspinatus muscles using the suture bridge (SB) technique. Methods Between July 2010 and November 2014, 37 patients with RCI who were treated with SB technique were evaluated. The study included all patients with a minimum follow-up of 12 months who underwent primary surgery of the shoulder. Twenty-four patients were male and 13 were female. The mean age was 60 years (45–75). The dominant side was affected in 32 cases. The most common cause of injury was trauma (18 cases). The mean preoperative motion was 123°, 58°, T11. Through magnetic resonance imaging, 36 fatty degenerations were classified according to Goutallier. Patients underwent rotator cuff repair with SB technique, which consists of using a medial row anchor with two Corkscrew® fibertape® or fiberwire® at the articular margin, associated with lateral fixation without stitch using PushLocks® or SwiveLocks®. Results The mean age was 60 years and mean fatty degeneration was 2.6. The mean range of motion (following the AAOS) in the postoperative evaluation was 148° of forward elevation, 55° in lateral rotation and medial rotation in T9. Using the criteria of the University of California at Los Angeles (UCLA), 35 (94%) patients had excellent and good results; one (2.7%), fair; and one (2.7%), poor. Conclusion Arthroscopic repair of a large and extensive RCI using SB technique had good and excellent results in 94% of the patients.