Browsing by Author "Varanda, P"
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- Acetabular retroversion: Diagnosis and treatmentPublication . Direito-Santos, B; França, G; Nunes, J; Costa, A; Rodrigues, EB; Silva, AP; Varanda, PAcetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. The pathophysiological basis of AR is an anterior acetabular hyper-coverage and an overall pelvic rotation.The delay or the non-diagnosis of AR could have an impact in the overall management of femoroacetabular impingement (FAI). AR is a subtype of (focal) pincer deformity.The objective of this review was to clarify the pathophysiological, diagnosis and treatment fundaments inherent to AR, using a current literature review.Radiographic evaluation is paramount in AR: the cross-over, the posterior wall and ischial spine signs are classic radiographic signs of AR. However, computed tomography (CT) evaluation permits a three-dimensional characterization of the deformity, being more reliable in its recognition.Acetabular rim trimming (ART) and periacetabular osteotomy (PAO) are the best described surgical options for the treatment of AR.The clinical outcomes of both techniques are dependent on the correct characterization of existing lesions and adequate selection of patients. Cite this article: EFORT Open Rev 2018;3:595-603. DOI: 10.1302/2058-5241.3.180015.
- Granuloma eosinofílico na clavícula. Apresentação atípica de uma patologia raraPublication . Gomes, M; Tavares, N; Leal, F; Resende, V; Varanda, P; Silva, BO granuloma eosinofílico de localização óssea é uma lesão benigna e apresenta geralmente um curso indolente. Esta entidade foi descrita em 1940 por Lichtenstein e Jaffe e a sua etiologia permanece desconhecida, sendo sugerida a sua associação a outros síndromes. A sua localização mais comum é a nível do crânio, fémur e coluna vertebral e pode apresentar-se como uma lesão simples ou lesões múltiplas. Tem geralmente bom prognóstico, não havendo contudo um consenso quanto ao seu tratamento. Os autores presentam o caso de um homem de 36 anos que apresentava um granuloma eosinofílico de localização atípica – a clavícula – complicado com fratura patológica. Foi submetido a tratamento cirúrgico com excisão da massa tumoral e estabilização com placa e enxerto de ilíaco tricortical autólogo. Foi conseguido um excelente resultado funcional que se mantinha no follow-up a três anos. Não existe na literatura, ao conhecimento dos autores, qualquer descrição de um caso de fratura patológica na apresentação de um granuloma eosinofílico.
- Osteochondral transplantation using autografts from the upper tibio-fibular joint for the treatment of knee cartilage lesionsPublication . Espregueira-Mendes, J; Pereira, H; Sevivas, N; Varanda, P; Vieira da Silva, M; Monteiro, A; Oliveira, JM; Reis, RLPURPOSE: Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic. Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern. This study aims to assess clinical results and safety profile of autologous osteochondral graft from the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee. METHODS: Thirty-one patients (22 men and 9 women) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint, between 1998 and 2006. Clinical assessment included visual analog scale (VAS) for pain and Lysholm score. All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good, fair (inferior to 1 mm incongruence), and poor (incongruence higher than 1 mm registered in any frame). Donor zone status was evaluated according to specific protocol considering upper tibio-fibular joint instability, pain, neurological complications, lateral collateral ligament insufficiency, or ankle complaints. RESULTS: Mean age at surgery was 30.1 years (SD 12.2). In respect to lesion sites, 22 were located in weight-bearing area of medial femoral condyle, 7 in lateral femoral condyle, 1 in trochlea, and 1 in patella. Mean follow-up was 110.1 months (SD 23.2). Mean area of lesion was 3.3 cm2 (SD 1.7), and a variable number of cylinders were used, mean 2.5 (SD 1.3). Mean VAS score improved from 47.1 (SD 10.1) to 20.0 (SD 11.5); p = 0.00. Similarly, mean Lysholm score increased from 45.7 (SD 4.5) to 85.3 (SD 7.0); p = 0.00. The level of patient satisfaction was evaluated, and 28 patients declared to be satisfied/very satisfied and would do surgery again, while 3 declared as unsatisfied with the procedure and would not submit to surgery again. These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone. MRI score significantly improved at 18-24 months comparing with pre-operative (p = 0.004). No radiographic or clinical complications related to donor zone with implication in activity were registered. CONCLUSIONS: This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint is effective to treat osteochondral defects in the knee joint. No relevant complications related to donor zone were registered.