bluuebunny/crossref_metadata_2025_split huggingface dataset:
Migratory articular cartilage-derived cells obtained by arthroscopic cartilage biopsy in non-osteoarthritic individuals
Authors: Giglio PN , Levy D , Varone BB , Favaron PO , Bydlowsky SP , Demange MK 
Published: November 2024

Objectives Migratory cartilage-derived cells have potential autologous use in cartilage repair surgery. However, obtaining cells through arthroscopic biopsy has never been reported in subjects without osteoarthritis. This study aimed to characterize cell lines derived from cartilage obtained by arthroscopic biopsies of non-osteoarthritic volunteers. Methods Consent was obtained for eight volunteers undergoing routine knee arthroscopy for ligament or meniscal injury treatment, aged between 18 and 55 years, with no knee osteoarthritis. After arthroscopic inspection, 5-10 mm cartilage fragment was removed from a non-weight-bearing area on the trochlear lateral edge or intercondylar notch, using an arthroscopic gouge.Cell isolation was performed by enzymatic digestion or by explant cell migration. Protein analysis was performed to evaluate the expression of osteogenic, chondrogenic or adipogenic differentiation factors. Results Successful cell cultures were obtained using both methods, enzymatic digestion or cell migration from cartilage biopsy fragments, with no significant differences in stem cell markers and plasticity among cell lines. Cells obtained from both procedures have: fibroblast-like morphology, expression of CD29, CD90, and CD105 markers as well Nanog and SOX2, and can differentiate in adipocytes, chondrocytes, and osteoblasts under appropriate conditions. Cells obtained via migration exhibited lower expression of collagen I and II, and a lower collagen II/collagen I ratio, both positively associated with chondral matrix production. RUNX2 expression, an osteogenic differentiation factor, was also lower in this group. No difference was observed in levels of SOX9, key for chondrogenic differentiation, or syndecan and perlecan gene expression. Conclusion This study showed for the first time chondral explant migration can effectively derive cells from arthroscopic biopsies from non-osteoarthritic individuals, showing comparable and plasticity profiles. Moreover, these cells exhibit important chondrogenic markers and proteins. Further, in vivo studies are needed to better evaluate the regeneration potential of these cell lines.
Outcomes Following Isolated Medial Meniscus Posterior Root Repair Using An Anatomic Transtibial Pull-Out Technique In Patients Aged > 60 Years: A Matched Cohort Study
Authors: Mameri ES , Jackson G , Khan Z , Chahla J 
Published: November 2024

Objectives To compare patient-reported outcomes following anatomic transtibial pull-out repair for isolated medial meniscus posterior root (MMPR) tears in patients > 60 versus ≤60 years of age, as well as the incidence of repair failures. Methods Patients aged ≥18 years undergoing isolated anatomic transtibial pull-out repair for MMPR tears at a single institution between January 2016 and September 2020 were analyzed. Patients with minimum 2-year follow-up were divided based on age: >60 versus ≤60 years. Patients completed IKDC, KOOS JR, and VR12 surveys before surgery and at final follow-up. Differences in outcome scores between age groups, as well as repair failures, defined by the need for repeat arthroscopy, were analyzed. Results Twenty patients aged ≥60 with a mean age of 65.7 ± 4.1 years (range, 60.2 – 74.9 years) were compared to 40 patients ≤ 60 years of age with a mean age of 49.3 ± 9.0 years (range, 23.4 – 59.8). Significant improvement in all outcomes scores was observed in both groups at final follow-up relative to pre-operative values. No significant difference in IKDC, KOOS JR, or VR12-Physical scores was observed between groups. Revision repair was required in one patient (2.5%) under age 60, but no patients over age 60. Conclusion Anatomic transtibial pull-out repair for MMPR tears resulted in improved outcome scores at minimum 2-year follow-up, with no significant differences among our cohorts of patients >60 or ≤60 years of age. While chronologic age should be accounted for when discussing expectations and management of MMPR tears, a specific age cut-off should not exclude consideration for root repair, as appropriately selected patients >60 years of age exhibit non-inferior outcomes compared to patients aged ≤60 years.
Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: A Randomized Controlled Clinical Trial
Authors: De Paula RE , Cordeiro A , Mozella AP , Sobral RD , Cobra HAAB , Albuquerque RSP 
Published: November 2024

Objectives Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy. Methods Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy. They were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05. Results The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p=0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 minutes between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 minutes vs. Autograft: 76.3 ± 15.2 minutes; p=0.02). Conclusion Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time.
Evaluation of fresh homologous osteochondral transplantation in the knee as a salvage therapy: Prospective case series with a minimum follow-up of 10 months
Authors: Gracitelli GC , Carrer RU , Galvão PHSAFG , Franciozi CES , Kubota MS , Rezende FC 
Published: November 2024

Objectives Evaluate the clinical outcome and satisfaction of patients submitted to fresh homologous osteochondral transplantation in the knee as a salvation therapy. Methods A total of eight knees from seven patients who were submitted to fresh Homologous Osteochondral Transplantation by a single surgeon were analyzed preoperatively and followed up by a period between ten months and five years and five months. We reported the clinical outcomes through the use of IKDC (International Knee Documentation Committee) and KOOS (Knee and Osteoarthritis Outcome Score) - quality of life item. Results This is a sample of complex cases, all of them submitted to previous surgeries with no success on the related operated knees. There was a range of improvement in function, with 7 of the 8 operated knees showing clinical and statistically significant improvement, according to the IKDC score, only one patient was not satisfied with the procedure and all of them showed improvement in the quality of life item on the KOOS score. There was no failure case, any infection or need for a new surgery in the operated patients. Conclusion Fresh Homologous Osteochondral Transplantation is a safe salvage therapy method in our country to treat large osteochondral lesions when other previous procedures failed. Despite the small sample size of this case series, there were a great positive clinical outcomes without associated complications.
Immunohistochemical Analysis of the Quadriceps Femoris Muscle Before and After Total Knee Arthroplasty
Authors: Kawatake EH , Pochini AC , Cohen M , Luzo MVM , Martinez CAR , Pereira JA 
Published: November 2024

Objectives The number of total knee arthroplasties (TKA) has increased steadily with the aging of the population. This surgical procedure is recognized for its success in pain relief and restoration of knee function. However, decreased quadriceps femoris (QF) muscle strength after TKA is frequently observed but with unknown etiology. Evidence suggests that the location of the operative incision (i.e., surgical access) can influence QF muscle structure and function. The present study aimed to assess the fiber type composition, structure and assembly of the QF's vastus medialis (VM) and vastus lateralis (VL) muscles before and after TKA. Methods Muscle biopsies (VM and VL muscles) were collected from patients previously submitted to TKA via the medial parapatellar route and undergoing TKA revision (main group, n=9) and patients with osteoarthrosis (OA) who will undergo TKA (control group: n=18). The biopsied muscle tissue was prepared, stored, and then sectioned in a cryostat at -25ºC. The tissue sections were evaluated using routine staining techniques in pathological anatomy and histochemistry. Results The normal mosaic pattern of the medial and lateral knee muscles was observed in the main and control groups, with no evidence of peripheral nerve damage. Notably, 88.9% of the patients exhibited mild to severe VL atrophy, while only 11.1% of patients in the control group presented this feature (p<0.001). Conclusion The medial parapatellar incision for TKA surgical access does not generate definitive morphological changes in the VM and VL muscle fibers but may contribute to VL atrophy.
The Medial Cross And The Anteromedial Region Of The Knee Revisited, A Cadaveric Study
Authors: PB Jorge , DE Oliveira , JMD Malpaga , SMG Canuto , CP Helito , MM Horita 
Published: November 2024

Objectives The medial knee structures have a primary role in valgus and rotational stress stabilizing, making them important in the global assessment of the ligament-injured knee and choosing the most adequate treatment This study aimed to conduct a layer-by-layer dissection of the knee anteromedial side and to describe, qualitatively and quantitatively, the anatomy and histology of the Anterior Oblique Ligament (AOL) and its relationship with what the authors call The Medial Cross, an important ligament complex that stabilizes the Medial Pivot Methods 35 fresh-frozen knees resulting from transfemoral amputations, which were exclusively performed for vascular reasons, were dissected. Structures were identified after meticulous dissection, respecting the same protocol, measured with a digital caliper rule (Mitutoyo TM)., and histologically studied for data. Results The Medial Cross is represented by the superficial Medial Collateral Ligament, the AOL (anterior region), and the Posterior Oblique Ligament (POL). The Anterior Oblique Ligament was found in all dissected knees. It the mean length was 31,47 ± 5.06 mm. This structure presented ligament histology with densely organized collagen fibrils. Conclusion The 35 dissections reported in this study demonstrate a ligamentous structure, called AOL, in the knee medial region. It originates from the anterior border of the medial epicondyle and inserts more widely, under the articular surface, thus having a fan shape. It is in an extracapsular situation, not directly related to the medial meniscus, and represent the Medial Cross anterior arm. Studying and revisiting the medial compartment can provide important information for understanding joint instability, and promoting better results in ligament reconstructions.
Can We Not Use A Tourniquet In Total Knee Arthroplasty?
Authors: JPF Guerreiro , CW Janeiro , B Zarpelon , PM Calzavara , PR Bignardi , MV Danieli 
Published: November 2024

Objectives To analyze whether there is more bleeding in patients undergoing Total Knee Arthroplasty (TKA) without the use of a tourniquet. Secondary objectives were to analyze surgical and hospitalization time, need for transfusion and complication rate. Methods Retrospective study with analysis of medical records. Patients were divided into two groups: one group in which TKA was performed using a tourniquet and the other without. The values of drops in hemoglobin and hematocrit 24 and 48 hours after surgery, surgical time, hospital stay, need for transfusion and the rate of complications up to six months postoperatively were compared. Results 104 patients were operated on during the period, 94 of which were included in the study. There was no difference between the mean values of hemoglobin and hematocrit between groups, preoperatively (p 0.675 and p 0.265), 24h (p 0.099 and p 0.563) and 48h (p 0.569 and p 0.810) after surgery. Surgical time and length of hospital stay were also not different between groups (p 0.484 and p>0.05). There was no difference regarding the need for transfusions, nor regarding the rate of complications analyzed. Conclusion We can don’t use of a tourniquet in TKA surgeries without significant change in the value of hemoglobin and hematocrit levels at 24 and 48 days after surgery when compared to the group using a tourniquet. Likewise, there was no significant difference in the total duration of surgeries, length of stay, need for transfusions or in the rates of complications analyzed.
Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using the Rectus Femoris Tendon: Surgical Technique
Authors: BG Barroso , SMG Canuto , CP Helito , MCF Rego , FS Martins , MCF Rego 
Published: November 2024

Objectives: Present a combined ACL and anterolateral ligament (ALL) reconstruction technique using a rectus femoris tendon graft harvested in a minimally invasive approach without specialized instruments. Methods: The graft is harvested from the lateral portion of the rectus femoris tendon. The distal end is detached from the patella, and dissection is extended proximally by 8 cm, ensuring preservation of the intermediate and deep layers of the quadriceps tendon (QT). A closed tendon stripper is carefully pushed with the knee at 20 degrees of flexion. The graft is folded asymmetrically, with the distal portion forming a double or triple graft for the ACL, and the proximal portion remaining unfolded for the ALL. The femoral tunnel is made using an outside-in technique, replicating both the ACL and ALL footprints. Results: The graft length typically ranges from 28 to 35 cm, and the ACL portion diameter ranges from 8 to 10 mm. The technique showed a low rate of complications and provided adequate control of pivot shift. Advantages include predictable graft diameter, use of standard instruments, and preservation of hamstring strength. Disadvantages include potential quadriceps strength reduction, risk of hematoma, an additional incision, and the need for an extra screw for ligament fixation. Conclusion: To our knowledge, this is the first report of a combined ACL and ALL reconstruction technique using a QT graft. The minimally invasive rectus femoris graft approach offers a viable alternative for combined ACL and ALL reconstruction in both primary and revision surgeries.
Distal Femur Morphology in a Brazilian Population: Challenging the Universal Use of 3-Degrees of External Rotation
Authors: Mameri ES , Ballarini IK , Leonel MB , Ferreira MC , Kubota MS , Luzo MVM 
Published: November 2024

Objectives: To assess the external rotation angle between the transepicondylar axis (TEA) and the posterior condylar axis (PCA) in a Brazilian population, to determine whether the universal use of 3-degrees external rotation of the femoral component is appropriate during total knee arthroplasty (TKA) in this population. Methods: The TEA rotation relative to the PCA was measured in 167 magnetic resonance imaging (MRI) exams using four different methods for the PCA, based on posterior reference points: (A) cartilage references; (B) bony references; (C) lateral posterior reference and medial cartilage reference; and (D) lateral cartilage reference and medial bony reference. The measurements were statistically compared to the traditional 3-degrees external rotation used in TKA instrumentation. An analysis of variance was conducted to assess differences between the measurement methods. Results: Mean TEA external rotation for methods A, B, C, and D was 5.44º ± 2.39º, 4.94º ± 2.10º, 8.56º ± 2º, and 2.33º ± 2º, respectively. All measurement methods showed significant differences compared to the traditional 3-degrees external rotation (p<.0001). Significant differences were also found between all measurement methods (p<.0001), except between methods A and B (p=0.1614). Conclusion: Using cartilage or bony reference points for the PCA, the TEA in the Brazilian population is approximately 5-degrees externally rotated. The traditional 3-degrees femoral component rotation may be insufficient for this population, particularly in valgus knees. This highlights the importance of an individualized approach to achieve optimal component rotational alignment during TKA.
Patelloplasty Versus Traditional Patellar Retention in TKA
Authors: DE PADUA VITOR BARION CASTRO , ZANETTI JULIANO , DE FARIA JOSE LEONARDO ROCHA , DE PAULA MOZELLA ALAN 
Published: November 2024

Objectives Resurfacing the patella in total knee arthroplasty(TKA) is a controversial procedure. Although there are some advantages to replace the patella, there is a conservative trend among surgeons who prefer to retain it, leading to a faster procedure, preserving bone stock, with fewer complications and similar outcomes. Traditional procedure consists in removing the osteophytes and performing a denervation around the patella. A different approach is to perform patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea. Objective:to compare traditional preservation and patelloplasty in primary TKA. Methods 25patients underwent bilateral non-simultaneous TKA with the preservation of the native patella, and the same implant in both knees. On one side, patellar denervation and osteophytes resection was performed, and on the other one, patelloplasty. All implants were patellar "friendly" throclea design. 19 patients were evaluated with the average age of 74 years(61 to 89), BMI of 29.7, and the follow up of 4.3 years(2.9 to 7.8) in the traditional patella preservation group and 1.7 years(0.6 to 2.8) in the patelloplasty. The patients were asked which side had the most satisfactory result, in their opinion. Range of motion(ROM), VAS, and KSS, Forgotten knee, KOOS and LEE scores were also evaluated. Results 8(42%) of the patients didn't have a preference side, 7(37%) preferred traditional preservation knee, and 4(21%) the patelloplasty. Regarding pain, VAS was 1.2 in the traditional and 2 in the patellopalsty. The ROM was similar, showing 126.4 degrees in the traditional side and 126 in the patelloplasty. The differences in KSS(score and function), Forgotten, KOOS and LEE scores between both groups, were not statistically significant. Conclusion Patelloplasty is a safe procedure, with few complications, relieving pain, with functional outcomes similar to those of the traditional procedure.
Fast Track protocol in total knee arthroplasty: results with 38 months follow-up
Authors: DE CAMPOS GUSTAVO CONSTANTINO , ALVES PEDRO BEZZAN RODRIGUES , CARDILLO IGOR CANO PAVESI , GRACITELLI GUILHERME CONFORTO , DE MELLO ALVES JUNIOR WILSON 
Published: November 2024

Objectives To define an enhanced recovery after surgery (ERAS) protocol, or “Fast-track” protocol, for primary total knee arthroplasty (TKA) and present the results of patients submitted to this protocol. Methods This was a retrospective review of 70 patients (86 knees) submitted to TKA following an ERAS protocol between 2013 and 2018. Range of motion, quadriceps strengh, 6-minute walk test, VAS, WOMAC and SF-36 questionnaires were completed at baseline and at last follow-up. Lenght of stay (LOS), blood count, complications and readmission rates were also analysed. Results 86 TKAs were analysed. All parameters evaluated (extension deficit, quadriceps deficit, walking test, EVA, WOMAC, SF-36) were significantly improved at one year follow-up, with the exception of knee flexion deficit. Mean LOS was 2,4 days. There were no readmissions. One patient needed blood transfusion. Conclusion We present a feasible ERAS protocol that provided a safe short LOS with excelent results.
Surgical Technique for Revision of Anterior Cruciate Ligament Reconstruction, Combined with Postero-Lateral Corner and Anterolateral Ligament Reconstruction Using the Same Femoral Tunnel for Reconstruction of These Structures
Authors: MELO VINICIOS BARRETO , DE GUSMÃO CANUTO SÉRGIO MARINHO , FONSECA LORRAN COQUE , BLUNCK SAULO SANTOS 
Published: November 2024

Objectives The reconstruction of the anterior cruciate ligament (ACL) is the most performed knee surgery in Brazil; consequently, the number of failures in this reconstruction has increased. Each year, the exponential rise in ACL revision surgeries is linked to undiagnosed and untreated injuries. Possible causes of failures should be assessed, including the size and positioning of femoral and tibial tunnels, neglected ligament and meniscal injuries, rotational instabilities, and axis deviations. This article aims to describe a surgical technique for revising ACL reconstruction, associated with the posterolateral corner and anterolateral ligament, using the same femoral tunnel with autograft. Therefore, the article emphasizes the importance of preoperative diagnosis and the treatment of meniscal and ligament injuries associated with ACL injury. This new technique proves to be reliable, easily reproducible, providing adequate stability, reducing the number of femoral tunnels, and minimizing the chance of tunnel convergence, utilizing autologous grafts. Methods description of Surgical Technique for Revision of Anterior Cruciate Ligament Reconstruction, Combined with Posterolateral Corner and Anterolateral Ligament Reconstruction Using the Same Femoral Tunnel for Reconstruction of These Structures. Results Patients who underwent ACL revision with the technique described presented adequate anterolateral and rotational stability, compared to other reconstruction techniques of the posterolateral corner and anterolateral ligament. Conclusion The surgical technique described above generated stability in the revision of the ACL, as it was associated with simple peripheral ligament reconstruction using autologous tendons. This new technique appears to be reliable, easy to reproduce, generating adequate stability, thus reducing the number of femoral tunnels and the chance of confluence of these tunnels.