Max R. F Ramos

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity

Objective To evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis. Methods From November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°–12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35 kg/m2, and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n = 56, mean age = 39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n = 73, mean age = 41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring. Results There was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR = 8.64). Conclusion The association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

Arthroscopic rotator cuff repair: single-row vs. double-row – clinical results after one to four years

Objective Evaluate and compare the results of single-row (SR) vs. double-row (DR) arthroscopic rotator cuff repair. Methods From December 2009 to May 2013, 115 arthroscopic rotator cuff repairs were performed using suture anchors. After applying the exclusion criteria, there were 75 patients (79 shoulders) to be evaluated, retrospectively, of whom 53 (56 shoulders) attended re-evaluation. The patients were divided into two groups: SR with 29 shoulders, and DR) with 27 shoulders. The scoring systems for clinical evaluation were those of the University of California at Los Angeles (UCLA) and the American Shoulder and Elbow Surgeons (ASES). Results The mean follow-up period in the SR group was 37.8 months vs. 41.0 months in the DR group. The average UCLA score was 30.8 in the SR group vs. 32.6 in the DR group. This difference was not statistically significant (p > 0.05). The averages measured by the ASES score also showed no significant difference – 82.3 and 88.8 in the SR and DR groups, respectively. Conclusion No statistically significant difference was found between SR and DR arthroscopic rotator cuff repair performed by a single surgeon in the comparative analysis of UCLA and ASES scores.