João Antonio Matheus Guimarães

The addition of a lateral extra‐articular reinforcement to anterior cruciate ligament reconstruction has been shown to enhance rotational stability and protect the intra‐articular graft. Although several techniques using the iliotibial band have been described, most rely on fixation devices that increase surgical cost and complexity. This Technical Note describes a low‐cost, reproducible technique for combined anterior cruciate ligament reconstruction and lateral extra‐articular tenodesis using the iliotibial band, with femoral press‐fit fixation for both grafts. This approach eliminates the need for fixation hardware, simplifies the procedure, and may facilitate its adoption in a wide range of surgical settings worldwide.

To compare the magnitude of subsidence between single- (SW) and double-wedge (DW) femoral stems in primary total hip arthroplasties (THAs), and to identify factors associated with clinically relevant subsidence. Retrospective cohort study with 82 patients (164 hips) undergoing bilateral THA between 2012 and 2022, each receiving type-I (Corail) and -II (Summit) stems, both manufactured by DePuy Synthes. Subsidence was measured radiographically up to 6 months postoperatively and was considered clinically relevant when greater than 3 mm. Radiographic variables included cortical enlargement index (CEI) and canal fill rate (CFR). Statistical analyses included paired t-test, logistic regression, and Spearman correlation. The mean subsidence was 1.93 ± 1.16 mm in type-I stems and 2.23 ± 1.57 mm in type-II (p = 0.181). Clinically relevant subsidence occurred in 18.2% of type-I stems and 31.7% of type-II (OR = 2.07; p = 0.050). Greater subsidence was observed in the first surgery in bilateral arthroplasties (p = 0.006). There was no significant correlation between subsidence, age, body mass index (BMI), CEI, or CFR. The DW stems were associated with a higher risk of clinically relevant subsidence. In bilateral THA, subsidence is more pronounced at first surgery, with no detectable influence of demographic or radiographic factors.

Resumo: Comparar a magnitude do afundamento entre hastes femorais de cunha única (CU) e dupla (CD) em artroplastias totais do quadril (ATQs) primárias e identificar fatores associados a afundamentos clinicamente relevantes. Estudo de coorte retrospectiva com 82 pacientes (164 quadris) submetidos a ATQ bilateral entre 2012 e 2022, cada um recebendo haste tipo I (Corail) e II (Summit), ambas fabricadas pela DePuy Synthes. O afundamento foi mensurado radiograficamente até 6 meses de pós-operatório, sendo considerado clinicamente relevante quando superior a 3 mm. Variáveis radiográficas incluíram o índice de alargamento cortical (IAC) e a taxa de preenchimento do canal (TPC). As análises estatísticas incluíram teste t pareado, regressão logística e correlação de Spearman. O afundamento médio foi de 1,93 ± 1,16 mm nas hastes tipo I e 2,23 ± 1,57 mm nas tipo II (p = 0,181). Afundamentos clinicamente relevantes ocorreram em 18,2% das hastes tipo I e 31,7% das tipo II (OR = 2,07; p = 0,050). Observou-se maior afundamento na primeira cirurgia em artroplastias bilaterais (p = 0,006). Não houve correlação significativa entre afundamento e idade, IMC, IAC ou TPC. As hastes de CD apresentaram maior risco de afundamento clinicamente relevante. Em ATQs bilaterais, o afundamento é mais pronunciado na primeira cirurgia, sem influência detectável de fatores demográficos ou radiográficos.

To describe a randomized clinical trial designed to evaluate the impact of three extra-articular reinforcement techniques combined with anterior cruciate ligament reconstruction (ACLR) on postoperative muscle function, activity levels, and return-to-sport in high-performance athletes. The primary hypothesis is that these techniques will differentially influence joint stability and recovery trajectories. A prospective, quasirandomized, single-blind trial intending to enroll 220 athletes, between 18 and 45-years-old, with isolated ACL injuries. Participants will be allocated via block randomization to one of three procedures: lateral extra-articular tenodesis (LET), involving fixation of a iliotibial band strip near the anterolateral ligament (ALL) at 30° knee flexion for rotational stability; single-bundle ALL reconstruction (ALL-S), using a gracilis graft between the femoral epicondyle and Gerdy's tubercle; and double-bundle ALL (ALL-D), employing two graft limbs in a double tibial tunnel located between Gerdy's tubercle and the fibular head, with a single femoral fixation at the anatomical position of the ALL. Assessments will occur preoperatively and at 3, 6, 9, 12, and 24-months postsurgery, including joint laxity, quadriceps morphology, functional performance, and knee isokinetic strength. Furthermore, self-reported outcomes, such as the International Knee Documentation Committee's (IKDC), 36-Item Short Form Health Survey (SF-36), and Tegner scale, will also be collected. Linear mixed-effects models will analyze outcomes, adjusting for meniscal repair status. Upon completion, this study is expected to identify the most effective extra-articular technique for restoring knee stability and function, potentially guiding surgical decision-making. Our findings may optimize rehabilitation protocols and reduce reinjury rates in athletes. This protocol describes a comprehensive clinical trial that addresses important gaps in current knowledge regarding optimal surgical approaches for ACLR in athletes.

Resumo: Descrever um ensaio clínico que pretende avaliar o impacto de técnicas de reforço extra-articular combinadas com a reconstrução do ligamento cruzado anterior (R-LCA) na função muscular, atividade física e retorno ao esporte em atletas de alto rendimento. A principal hipótese é que essas técnicas influenciarão diferentemente a estabilidade articular e a recuperação. Estudo prospectivo, quase-aleatório e simples-cego pretendendo incluir 220 atletas, entre 18 e 45 anos de idade, com lesões isoladas do LCA. Os participantes serão randomizados em blocos para um dos três procedimentos: tenodese extra-articular lateral (TEL), consistindo na fixação de uma faixa da banda iliotibial próximo à origem femoral do ligamento anterolateral (LAL) com 30° de flexão do joelho para estabilidade rotatória; reconstrução do LAL com feixe único (LAL-U) utilizando um enxerto de tendão Grácil entre o Cabeça da fíbula e a tuberosidade de Gerdy; ou LAL com feixe duplo (LAL-D), empregando dois ramos do enxerto em um duplo tunel tibial entre o tuberculo de gerdy e a cabeça da fibula e fixação femoral unica na posição anatomica do LAL. As avaliações ocorrerão no pré-operatório e aos 3, 6, 9, 12 e 24 meses pós-cirúrgico, incluindo lassidão articular, morfologia do quadríceps, desempenho funcional e força isocinética. Além disso, dados autorrelatados, como o da International Knee Documentation Committee (IKDC), 36-Item Short Form Health Survey (SF-36), e a escala de Tegner também serão coletados. Modelos lineares de efeitos mistos serão usados, para análise, ajustando-se ao reparo meniscal. Após a conclusão do estudo, esperamos identificar a técnica de reforço extra-articular mais eficaz para restaurar estabilidade e função do joelho, orientando decisões cirúrgicas. Os achados podem otimizar a reabilitação e reduzir recidivas em atletas. Este protocolo aborda um ensaio clínico detalhado, referente a lacunas importantes no conhecimento atual sobre as melhores abordagens cirúrgicas para R-LCA em atletas.

Objective: To compare bone microarchitecture and fracture patterns between elderly men and women with similar spine and hip bone mineral densities (BMDs). Subjects and methods: Twenty-eight men and 84 age-BMI-BMD-matched women aged 65 years and older with at least one major osteoporotic fracture underwent laboratory tests, dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and trabecular bone score (TBS). Results: There were no sex differences in biochemistry, BMD or lowest T-scores. TBS values were low in 67% [...] ABSTRACT Objective: To compare bone microarchitecture and fracture patterns between elderly men and women with similar spine and hip bone mineral densities (BMDs). Subjects and methods: Twenty-eight men and 84 age-BMI-BMD-matched women aged 65 years and older with at least one major osteoporotic fracture underwent laboratory tests, dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and trabecular bone score (TBS). Results: There were no sex differences in biochemistry, BMD or lowest T-scores. TBS values were low in 67%

Objective: This study aimed to map the scientific production of the National Institute of Traumatology and Orthopedics (INTO) over its 50 years of history. Methods: We conducted a descriptive bibliometric study in the PubMed, Scopus, and BVS databases, retrieving 522 articles published between 2007 and 2024. We identified the co-citation networks of INTO-affiliated authors, the keyword networks with the main topics addressed in the publications, and the institution's interaction network with other research and teaching entities. Results: There was a progressive growth in publications linked to INTO. In the last six years (2019–2024), the annual average number of publications increased by 44.83% compared with the previous period. The keywords with the highest co-occurrence were related to applied research, mainly with an epidemiological profile, but also to different study designs in basic and translational research. Conclusions: The analysis revealed a higher frequency of collaboration with public universities (UFRJ, UFF, UERJ, and USP). The institution's scientific production presented a well-articulated scientific collaboration network. Part of INTO's mission was evidenced through its work in public health research for health promotion in orthopedics and its contribution to the production of data for the formulation of public policies. Level of Evidence V; Descriptive Studies with Qualitative Approach.

Purpose: This study aims to evaluate changes in the coagulation profile of patients with knee periprosthetic infections (PJI) and determine its diagnostic value in this complication. Methods: A prospective study was conducted with 112 patients who underwent revision surgery for total knee arthroplasty in a single tertiary hospital between January 2021 and December 2022. Results: 51 patients were diagnosed with PJI. D-dimer (p = 0.001), fibrinogen (p = 0.0007), platelets (0.01), and international normalized ratio (p = 0.01) were significantly higher in patients with PJI. Conclusions: Patients with PJI display altered coagulation profile. The evaluation of coagulation-related markers has limited value for diagnosing PJI. Further studies are needed to understand the impact of such alterations on patients’ outcomes.