Acta Ortopédica Brasileira

PROTOCOLO DIGITAL PARA PROJETO CONCEITUAL E VALIDAÇÃO DE UMA ÓRTESE TORNOZELO-PÉ

2025-04-01T21:21:47.184000Z

Araújo Júnior, Rui; Fucs, Patrícia Maria De Moraes Barros;

Abstract Objective: This original article aimed to develop a digital protocol for the conceptual design and validation of Ankle-Foot Orthoses (AFO) using 3D mapping technologies. Methods: A scanned model of the ankle-foot complex of a 12-year-old child with a drop foot was utilized, along with a generic AFO model from a Computer-Aided Design environment. Autodesk Meshmixer and Fusion software were employed for conceptual design and static load analysis. Results: The static load analysis using the Von Mises failure criterion on the AFO model with ABS material demonstrated structural integrity under critical loading conditions. The digital protocol facilitated the design of a functional and patient-specific AFO orthosis. Conclusions: The study successfully established a digital workflow for AFO design and validation, showcasing the potential of 3D technologies in creating customized orthoses for lower limb rehabilitation. Level of Evidence IV; Descriptive Study.

RETURN TO SPORTS FOLLOWING KNEE OSTEOTOMY IN COMPETITIVE ATHLETES – CASE SERIES

2025-04-01T21:21:47.184000Z

Meirelles, Daniel; Bitar, Alexandre Carneiro; D’elia, Caio; Garofo, Guilherme; Terrível, Alberto; Castropil, Wagner;

Abstract Objectives: To analyze the return to the sport and the level of sports practice in a longitudinal cohort of athletes treated with osteotomy around the knee. Methods: Active athletes who underwent osteotomy or knee surgery to treat knee osteoarthritis were included, and their data was collected retrospectively. The primary outcomes were maximum physical activity level before and after the surgery (Tegner score), time to return to maximum activities and reoperation. Results: Twenty athletes with a mean age of 33 years at the time of surgery (standard deviation 8.9 (SD)) and with a mean follow-up of 9.8 years (SD 4) were included. The mean maximum Tegner score achieved before surgery was 8.6 (SD 1.4). Nineteen patients returned to sports (95%), and 13 returned to the same prior level (65%). The median time to return to the maximum level was 13 months (mean 17.9, SD 12.4). The mean maximum postoperative Tegner score was 7.5 (SD 2.0), slightly lower than the maximum achieved before surgery (mean difference:1.1, CI:0.2-1.9, P=0.026). Conclusion: The results of this study suggest that, after osteotomies around the knee, athletes present a high rate of return to sports activities, with most returning at the same level as before the surgery. Level of Evidence IV; Case series.

MICRO-FRAGMENTED ADIPOSE TISSUE IN THE KNEE OSTEOARTHRITIS UNDER LOCAL ANESTHESIA

2025-04-01T21:21:47.184000Z

Varone, Bruno Butturi; Fuller, Henrique; Perini, Daniel; Leal, Daniel Peixoto; Gobbi, Riccardo Gomes; Demange, Marco Kawamura;

Abstract Objective: To assess the feasibility of the entire micro fragmented adipose tissue knee injection procedure under local anesthesia. From the subcutaneous harvesting and microfragmentation process to the intrarticular knee injection. Methods: A patient with bilateral knee osteoarthritis underwent adipose tissue harvesting and bilateral intra-articular micro fragmented adipose tissue knee injection under local anesthesia. Patient-related outcomes were collected before the procedure, 12 months, and 24 months follow-up. Womac, Koos, and VAS were recorded. Results: The visual analog scale, KOOS questionnaire, and WOMAC score all improved in the 12- and 24-month follow-ups. Conclusion: Adipose tissue harvesting and micro fragmented adipose tissue knee injection are procedures that can be performed under local anesthesia and have good patient report outcomes. Level of Evidence IV; Therapeutic Study.

DIAGNOSTIC COMPETENCE IN BONE TUMORS: INFLUENCE OF ONCO-ORTHOPEDIC TRAINING

2025-04-01T21:21:47.184000Z

Daou, Julia Pozzetti; Giannotti, Caio Falk; Garcia, Jairo Greco; Petrilli, Marcelo De Toledo; Viola, Dan Carai Maia; Garcia Filho, Reynaldo Jesus;

Abstract Understanding the nature of musculoskeletal tumors is crucial for appropriate management and to secure a favorable prognosis. Orthopedists’ ability to identify these pathologies early and accurately is paramount. There is a requirement to raise awareness within the orthopedic community regarding the necessity of referrals to orthopedic oncology specialists, as delays in initiating proper treatment can compromise patient prognosis. Objective: The objective was to assess the capability of non-specialist orthopedists in identifying bone lesions suggestive of tumors and thus classify them by employing a questionnaire with radiographs and comparison with specialists. We aim to gain an in-depth understanding of their diagnostic competence and provide insights into teaching the subject in orthopedic residency programs. Methods: The sample consisted of 90 participants who answered the questionnaire: 18 orthopedic oncology specialists, 58 non-specialist orthopedists, and 14 orthopedic residents. Results: Specialists achieved an average accuracy of 12.50 ± 1.07, while non-specialists scored 10.00 ± 0.60 (p<0.001). Among non-specialists, there was no statistical significance when comparing whether they underwent specialization internship during residency nor the duration of the year of such training. The period since graduation also indicated no differences. Conclusion: This study highlights the importance of referring patients with suspected tumors to specialized orthopedists. Level of Evidence V; Expert Opinion.

TREATMENT OF PATIENTS WITH GIANT CELL BONE TUMOR IN NORTHERN BRAZIL, IN 2020 AND 2021

2025-04-01T21:21:47.184000Z

Couto Filho, Fernando Brasil Do; Yonamine, Eduardo Sadao; Magno, Felipe Guimarães; Favacho-Silva, Ana Beatriz; Brito, Carlos Rafael Alves De; Brito, Thiago Raphael Brasil;

Abstract Objective: This study aimed to evaluate the profile of patients diagnosed with giant cell tumors treated at the Ophir Loyola Hospital. Method: An analytical study in the form of a retrospective cohort, conducted through a review of patient medical records and imaging exams of individuals treated at the hospital between January 1, 2020, and December 31, 2021. Result: A total of 19 patients were evaluated, with an average time of 10.5 months between diagnostic suspicion and the first consultation with the Orthopedic Oncology team. Conclusion: Among the patients studied, 73% were presented with advanced-stage disease, requiring aggressive surgical treatment with wide resection and replacement with an endoprosthesis. Level of Evidence II; Retrospective Prognostic Study.

GIANT CELL TUMOR OF THE DISTAL RADIUS: FACTORS ASSOCIATED WITH LOCAL RECURRENCE

2025-04-01T21:21:47.184000Z

Rabuske, William Bernardo Specht; Ghert, Michelle; Antunes, Bruno Pereira; Galia, Carlos Roberto; Pestilho, Julie Francine Cerutti Santos; Silveira, Gabriella Sityá Moojen Da; Toller, Eduardo Areas; Camargo, Olavo Pires De; Engel, Edgard Eduard; Nakagawa, Suely Akiko; Guedes, Alex; Becker, Ricardo Gehrke;

Abstract Objectives: To assess patient and tumor characteristics and treatment outcomes, focusing on local recurrence rates based on treatment type. Methods: This is a retrospective review of cases of GCTB of the distal radius, identified from the databases of 74 patients in Brazilian institutions specializing in musculoskeletal tumor treatment. Data were collected from electronic and paper medical records by 18 centers between 1989 and 2021. Variables included demographic data, clinical presentation, treatment-related factors, and primary outcome (local recurrence rate). Results: Among the 74 patients in the study, the mean age at diagnosis was 32.6 years, with a slight female predominance. Pathological fractures on presentation were observed in 15.7% of patients, and pulmonary metastasis in 1.4%. Treatment approaches were divided equally between intralesional curettage and en bloc resection. The overall local recurrence rate was 25.7% and was higher in patients treated with intralesional curettage (35.1%) compared to resection (16.2%). Conclusions: The study confirms high recurrence risk with intralesional curettage, emphasizing the need for standardized protocols and improved surgical techniques to reduce recurrence rates and enhance outcomes for distal radius GCTB patients. Level of Evidence III; Retrospective Cohort Study.

FREQUENCY AND MODALITY OF EXERCISE ON PAIN AND INDEPENDENCE IN ELDERLY INDIVIDUALS WITH OSTEOARTHRITIS: A CROSS-SECTIONAL STUDY

2025-04-01T21:21:47.184000Z

Bersotti, Felipe Marrese; Silva, Reniery Pereira Da; Alonso, Angelica Castilho; Brech, Guilherme Carlos; Serrão, Paula Regina Mendes Da Silva; Ervilha, Ulysses Fernandes;

Abstract Background: Regular physical exercise promotes pain relief, reducing the central facilitation of pain mechanisms. Objective: Evaluate the effect of different frequencies of physical exercise (once, twice, or three times a week) on different modalities (aerobic training, stretching training, and strength training), on the pain in the knee joint, and on the level of independence on people with knee osteoarthritis. Methods: Is cross-sectional and used the STROBE-Checklist: cross-sectional studies. A total of 193 elderly people were evaluated, pain and functional independence were analyzed. Results: For the pain variable, there was a statistical difference in favor of the intervention in the comparisons control versus strength 1 and 2 times a week and stretching 3 times a week already in the Lawton variable, only the comparison control versus aerobic 1 time a week did not prove to be statistically dignified. Conclusion: The exercise modality and the weekly frequency seem to affect the perception of pain, stretching exercises performed three times a week, as well as muscle strengthening exercises, regardless of weekly frequency are efficient in joint pain analgesia. Practicing muscle strength exercises, regardless of weekly frequency and aerobic and stretching exercises at least twice a week, increases and/or maintains IADL. Level of Evidence II; Cross-sectional Study.

SUBSCAPULAR INJURY: PROSPECTIVE COMPARISON OF PHYSICAL EXAMINATION, MRI AND ARTHROSCOPY

2025-04-01T21:21:47.184000Z

Ribeiro Filho, Hélio Gonçalves; Ferreira, José Rodrigo Da Silva; Dantas, Flávio Wildon; Ritta, Rodrigo De Araújo Santa;

Abstract Rotator cuff injury is the most frequent etiology of shoulder pain, with 24% of these injuries involving the subscapular tendon. Objective: To correlate the findings of three clinical tests (Gerber test, Belly Press test, and Bear Hug test) with Magnetic Resonance Imaging (MRI) and arthroscopic findings of subscapular lesions. Methods: Prospective cross-sectional study, from November 2023 to March 2024, with 50 patients with rotator cuff injury, evaluating sensitivity, specificity, and accuracy among clinical tests, MRI, and arthroscopic findings. Results: 50 patients formed the sample, with 29 (58%) men and 21 (42%) women aged 42 to 86 years. We found a specificity of 88% and an accuracy of 54% in MRI. Regarding the Gerber test, the Belly Press test, and the Bear Hug test, the sensitivity was 64%, 64%, and 76%, with specificity of 75% for the Gerber and Belly Press tests and accuracy of 74% for the Bear Hug test. Conclusion: We concluded that the Bear Hug test showed higher sensitivity and accuracy in detecting subscapular tendon lesions, with MRI being the most specific method. Level of Evidence II; Prospective Study.

CLINICAL AND RADIOLOGICAL PARAMETERS IN MALIGNANT SPINAL TUMORS: A DESCRIPTIVE ANALYSIS

2025-04-01T21:21:47.184000Z

Menezes, Marcelo Diniz De; Pontes, Mariana Demétrio De Sousa; Herrero, Carlos Fernando Pereira Da Silva;

Abstract Objective: To describe the clinical and radiological parameters of spine malignant tumors. Methods: This is a therapeutic study of the descriptive retrospective type. Clinical evaluation included age, sex, tumor lesions, treatments, surgical procedures, and complications. The radiological evaluation analyzed radiographic exams, computed tomographies, and MRIs, focusing on morpho-pathological characteristics and the treatments employed. Results: Among the 236 patients evaluated, the majority were female, aged 6 to 91 years. The main complaint reported was low back pain. The most commonly used surgical approach was the posterior access, including pedicle fixation and decompression of the spinal canal. The most prevalent complication observed was infection. The majority of patients had primary breast tumors. The predominantly affected segment of the spine was the thoracic. Upon analyzing the portions of the spine affected, it was observed that the posterior arch portion was the most commonly affected. Conclusion: The clinical and radiological presentation of patients with metastatic lesions in the spine in our sample was similar to reports in the literature. Surgical outcomes aligned with previous expectations. Initial symptoms were noted, varying intervals between symptoms, diagnosis, and treatment. Level of Evidence III; Comparative Retrospective Study.

IMPACT OF COVID-19 ON HAND AND WRIST ORTHOPEDIC SURGERIES IN A PRIVATE SERVICE

2025-04-01T21:21:47.184000Z

Wataya, Erick Yoshio; Rodriguez, Katherine Vanessa Tenezaca; Macedo, Lucas Sousa; Escudero, Ricardo Boso; Sorrenti, Luiz; Althoff, Bernardo Figueira; Herrera, Ana Katherina Abarca; Rodrigues, Maurício Pinto; Costa, Antonio Carlos Da; Saito, Mateus; Nakamoto, João Carlos;

Abstract Objective: Evaluate the impact of COVID-19 on elective and emergency hand and wrist surgeries operated in a private orthopedic center. Methods: A retrospective study included hand and wrist surgeries in a private orthopedic center. The total surgeries were computed and separated into elective or emergency surgeries. The numbers were analyzed by month, quarter, and year before and after the pandemic (March 2020). Results: Eight hundred and forty-three surgeries from March 2018 to February 2022 were included. The mean monthly cases of the initial 12 months of the pandemic (15.3) were statistically equal to previous periods (17.3 and 17.2), but the period from March 2021 to February 2022 showed an increase (20.5; p = 0.037). The first four months of the pandemic had a mean (8.3) lower than the previous period (14.0; p = 0.002), but soon there was a significant increase in the following four months (19.3; p = 0.002). As a historical standard, elective surgeries were greater than an emergency in this institution. Still, in the first two quarters of the pandemic, there was a reduction in elective cases, equaling the emergency. Conclusion: An important but relatively brief impact on surgical volume was observed in hand and wrist surgeries during COVID-19. A significant reduction in elective cases happened at the pandemic’s beginning followed by a fast recovery after four months. Nível de Evidência II; Estudo Retrospectivo.

PEDIATRIC FRACTURES IN A TERTIARY PUBLIC HOSPITAL: WHAT ARE WE DEALING WITH?

2025-04-01T21:21:47.184000Z

Almeida, Leonardo Lima De; Engel, Edgard Eduard; Volpon, Jose Batista;

Abstract Objective: Orthopedic trauma is significant in modern society due to its incidence and its impact on healthcare and social interactions. Concerns include the risk of permanent sequelae affecting individual development and causing social stigma. Fractures, while not the most lethal lesion, may result in physical variable disability; publications show that about 30% of children experience fractures by skeletal maturity, primarily from low-energy trauma. This study aims to identify the fracture patterns in the immature skeleton at a tertiary-level public hospital. Methods: Individuals with skeletally immature fractures of the locomotor system, treated at a tertiary-level emergency unit from January 2016 to January 2020, were included. Data collected included social characteristics, trauma origin, fracture descriptors, and treatment modality. Age groups: infant, preschool, school-age, adolescent. Trauma energy is classified as low, moderate, or high. Results: A total of 926 cases were recorded in 505 patients, with a predominance of males. The most affected bones were the radius (29.5%), humerus (24.2%), and ulna (15.8%). The metaphysis was the most common location (46.7%), followed by the diaphysis (33.2%). Falls accounted for the largest portion, at 64.7%, with the majority (364) being low-energy trauma. High-energy trauma, such as pedestrian accidents and car accidents, represented 13.7%, and of these, 54.2% were polytraumatized. Conclusion: Fractures of the forearm persist as the most common, particularly at the distal third of the radius, with males being more exposed. Climatic seasonality and cultural traits such as soccer practice have little impact on the epidemiology of fractures. The results obtained in this investigation resemble those obtained by international literature. Level of Evidence III; Retrospective Cohort Study.

BEST PROSTHESIS FOR UNICOMPARTMENTAL KNEE ARTHROSIS: FIXED OR MOBILE?

2025-04-01T21:21:47.184000Z

Cardoso, Fabrício Luz; Gomez, Deusimar Cristian Dos Santos; Severino, Fabrício Roberto; Fucs, Patrícia Maria Moraes De Barros De;

Abstract This study aimed to compare fixed-bearing and mobile-bearing knee unicompartmental arthroplasty implants in adults (in the medial compartment) to determine which is better for each patient and their particularities. The research focused on postoperative assessments with a follow-up of at least a 2-year, examining both quality of life and mid-term functionality in the medium term. A systematic keyword search was executed in the PubMed, EMBASE, and Cochrane databases, employing a filter for randomized clinical trials and without language limitations. The search yielded 113 articles from March 28, 2024, including 83 from PubMed, 12 from EMBASE, and 18 from the Cochrane Library. The study found insufficient evidence to establish the superiority of one prosthetic type over the other regarding post-operative function, pain, complications, revisions, and quality of life after a 2-year follow-up. Literature highlights uncertainties in comparing UKA types due to varied assessment tools. No conclusive evidence favors either type regarding post-op function, pain, complication rates, revisions, or quality of life after 2 years. Urgent need for standardized, long-term, multicenter studies to inform evidence-based clinical practice. Level of Evidence I; Systematic review of randomized controlled trials.