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- EFAS Fellowship ProgramPublication . Corte Real, N
- Consecutive Ankle Sprain Classification and Injury Systematization (CASCaIS), Uma Nova Classificação de Entorse Lateral do Tornozelo Baseada no Teste de Pivot: Estudo Prospetivo de CoortePublication . Guerra-Pinto, F; Caetano, J; Alçada, R; Brito Camacho, A; Pacheco, J; Lacerda, D; Alves-da-Silva, T; Côrte-Real, N; Guimarães Consciência, JIntroduction: The biggest challenge in the treatment of acute ankle sprain is the uncertainty of the prognosis. The traditional classifications have several interpretations and little correlation with prognosis. In this study we propose a new classification for acute ankle sprain only based on clinical criteria. Material and methods: We prospectively evaluated all patients with an ankle sprain, aged between 18 and 45 years, admitted to a hospital during a 24 month period. The minimum follow-up period was 12 months. The sprains were classified, in the first few days (CASCaIS-Initial), according to autonomous gait capacity, inspection and palpation. After a few weeks (CASCaIS-Deferred), it was complemented with the mechanical evaluation of ligaments through the ankle pivot test. Results: Among the 49 patients who completed the follow-up, none of those who had a pivot-negative test progressed to chronic ankle instability (CAI). Nine of the 33 patients (27%) with a positive pivot progressed to CAI (p = 0.022). The evaluation of CASCaIS-Deferred demonstrated an association with CAI (p = 0.018). Conclusion: This classification proved to be a simple, inexpensive, and reliable tool that clinicians can use to determine the prognosis of the sprain.
- Anchorless Onlay Dynamic Anterior Stabilization of the Shoulder Using a Guided Posterior Double Endobutton FixationPublication . Maia Dias, C; Alçada, R; Ribeiro da Silva, MThe treatment of shoulder instability in the presence of a subcritical glenoid defect poses challenges, as simple Bankart seems insufficient, and the Latarjet procedure may be excessive. Recently, a dynamic anterior stabilization technique involving anterior transposition of the long head of the biceps (LHB) through a subscapularis split was described for that purpose. Previously published results demonstrated good short-term results, but several technical pitfalls have also been mentioned. We describe an onlay, anchorless, and intra-articular knotless method of fixing the LHB into the anterior glenoid that provides the important stabilizing "sling effect" of the dynamic anterior stabilization while avoiding some of the pitfalls described by other techniques.
- EFAS fellowship programPublication . Corte-Real, N; Lopez-Capdevila, L; Samaila, EM
- Monoartrite persistente do joelho como apresentação de doença de Lyme: Um desafio diagnóstico – Relato de casoPublication . Alçada, R; Gonçalves, NP; Torres, R; Lourenço, MH; Flor de Lima, B; Guerra Pinto, F
- Knotted or knotless double-row rotator cuff repair retear rates: a systematic review and meta-analysisPublication . Figueiredo, JA; Sarmento, M; Moura, N; Gomes, DS; Cartucho, ABackground: Arthroscopic rotator cuff tear repair techniques used to rely on knot-tying double row techniques, but the advent of knotless transosseous equivalent procedures introduced a new variable to the debate. The purpose of this study is to determine which technique is associated with lower retear rates. For its' biomechanical advantages, the authors' hypothesis is that knotless techniques would have lower retear rates. Methods: A systematic literature search was performed via PubMed and Google Scholar by two independent reviewers following PRISMA guidelines. Papers reporting retear rates after rotator cuff arthroscopic repair using knotted double-row or knotless transosseous equivalent techniques, evaluated by magnetic resonance imaging at least 6 months after surgery, were retrieved. Studies that do not differentiate between techniques and nonclinical reports were excluded. Eligible data was analyzed with Review Manager 5.4.1 using Mantel-Haenszel statistics with a fixed effect model. Results: The authors' initial literature search retrieved 511 reports. After the selection process, 24 articles were available for this review, and 9 were eligible for meta-analysis. A comparison of 1888 subjects from noncomparative reports and a meta-analysis of reports in which both techniques were studied could not show a statistically significant difference in technique retear rates. Discussion and conclusion: The current report revealed no significant difference in retear rates between the two arthroscopic repair techniques. Studies' quality was a limitation. Only two reported level 1 evidence. This review could not control variables such as cuff tear size, tissue quality, or individual comorbidities. Larger and longer follow-up studies could be helpful to further investigate this topic.
- Anterior Cruciate Ligament Reconstruction Using a Tibial-Pedicled Quadrupled Semitendinosus Autograft With Dual Adjustable-Loop Cortical SuspensionPublication . Rodeia, J; Alçada, R; Baptista, F; Goes, RAnterior cruciate ligament reconstruction is one of the most commonly performed procedures in knee surgery. Despite its frequency, numerous technical variations exist, and several aspects remain controversial. Hamstring tendons are among the most frequently used autografts, and there is growing interest in techniques that preserve the gracilis tendon. Additionally, preservation of the tibial insertion of the hamstrings has recognized biological and mechanical advantages. In this technical note, we describe a technique that aims to combine the advantages of both approaches: the benefits of using a short single semitendinosus graft, preserving the gracilis tendon, which is associated with lower donor-site morbidity and improved flexion strength compared with traditional 2-tendon harvests, and the advantages of maintaining the tibial attachment of the semitendinosus, which include improved graft vascularization and a secondary point of tibial fixation. This method uses a tibial-pedicled, quadrupled semitendinosus graft combined with a dual adjustable-loop cortical suspension device. The technique is reproducible, is cost-effective, and may offer both biological and mechanical benefits over conventional approaches.