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Chen R, Yu C, Peng H, Chen J, Zhang Y, Yu T. Osteotomy Correction Angle Cut-off Points Can Guide the Operation to Prevent a Significant Decrease in Patella Height. Orthop Surg 2024; 16:628-636. [PMID: 38326241 PMCID: PMC10925517 DOI: 10.1111/os.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/25/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Patients who undergo a biplanar ascending medial open-wedge high tibial osteotomy with an excessive correction angle might experience patella infera and even knee pain after surgery. The purpose of this study was to identify the cut-off points for the degree of knee varus correction of open-wedge high tibial osteotomy, which is related to the symptomatic patellar position change. METHODS This retrospective study included 124 patients (mean age 61.69 ± 6.28 years; 78 women, 46 men) with varying degrees of varus knee osteoarthritis. All patients had undergone standard biplanar medial open-wedge high tibial osteotomy. They were divided into nine groups according to the change in hip-knee-ankle angle. Plain radiographs and three-dimensional CT images were obtained preoperatively and 18 months postoperatively. Patellar height was assessed using the Caton-Deschamps index, the Insall-Salvati index, and the Blackburne-Peel index. The patellofemoral index and patellar tilt were used to evaluate the degree of horizontal displacement of the patella. The varus correction, medial-proximal tibial angles, joint line convergence angles, and hip-knee-ankle angles were also measured. The subjective score was evaluated using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). RESULTS There were significant changes in patella indexes in each group after surgery, among which there was no significant difference in patellar height changes for Groups A to F (p > 0.05), which were significantly lower than those in Group G, H, and I (p < 0.001). The patellar tilt and patellofemoral index also followed the same trend. The improvement in WOMAC scores for Groups G, H, and I was also significantly less for Groups A to F (p < 0.001). CONCLUSION The patellar height, patellar tilt, and patellofemoral index all changed significantly in parallel with increasing degrees of osteotomy correction. The cut-off points for correction angle are 12.5° to 13.4°. When the correction angle is larger than this range, the patellar position can be significantly affected. Postoperative patellofemoral joint pain may be related to the changes in patella position.
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Affiliation(s)
- Renjie Chen
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Clinical MedicineQingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
- Department of Sports MedicineBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Chenghao Yu
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Clinical MedicineQingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Haining Peng
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Clinical MedicineQingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Jinli Chen
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Yi Zhang
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Tengbo Yu
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
- Department of Orthopedic SurgeryQingdao Municipal HospitalQingdaoChina
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Oğuzdoğan GY, Arslan FZ. Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage. J Knee Surg 2023; 36:1357-1364. [PMID: 36041483 DOI: 10.1055/a-1933-3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationships between tibial tubercle-trochlear groove (TT-TG) distance, patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia, and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Three hundred eighty patients with knee magnetic resonance imaging examination were included in this study. Our patients who underwent knee magnetic resonance imaging were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI, and LTI were measured. In patients with ACL tear, age, LT, ML/LT ratio, and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p <0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Increased age, LT, ML/LT ratio, and QPA are predisposed risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligament and meniscal injury.
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Affiliation(s)
| | - Fatma Zeynep Arslan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
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Lyu L, Li Y, Zhong J, Yao W. Association among peripatellar fat pad edema and related patellofemoral maltracking parameters: a case-control magnetic resonance imaging study. BMC Musculoskelet Disord 2023; 24:678. [PMID: 37626375 PMCID: PMC10463576 DOI: 10.1186/s12891-023-06827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The peripatellar fat pads are critical for protective cushioning during movement, and their endocrine function has been shown to affect osteoarthritis. Magnetic resonance imaging (MRI) is frequently used to visualize edema of the peripatellar fat pads due to injury. In this study, we aimed to assess the relationship between peripatellar fat pad edema and patellofemoral maltracking MRI parameters and investigate the association among cases of peripatellar fat pad edema. METHODS Age- and sex-matched peripatellar fat pad edema cases were identified and divided into superolateral Hoffa, quadriceps, and prefemoral groups. Images were assessed according to tibial tuberosity lateralization, trochlear dysplasia, patellar alta, patellar tilt, and bisect offset. McNemar's test or paired t-tests and Spearman's correlation were used for statistical analysis. Interobserver agreement was assessed with the intraclass correlation coefficient. RESULTS Of 1210 MRI scans, 50, 68, and 42 cases were in the superolateral Hoffa, quadriceps, and prefemoral groups, respectively. Subjects with superolateral Hoffa fat pad edema had a lower lateral trochlear inclination (p = 0.028), higher Insall-Salvati (p < 0.001) and modified Insall-Salvati (p = 0.021) ratios, and lower patellotrochlear index (p < 0.001) than controls. The prefemoral group had a lower lateral trochlear inclination (p = 0.014) and higher Insall-Salvati (p < 0.001) and modified Insall-Salvati (p = 0.004) ratios compared with the control group. In contrast, the patellotrochlear index (p = 0.001) was lower. Mean patellar tilt angle (p = 0.019) and mean bisect offset (p = 0.005) were significantly different between cases and controls. The quadriceps group showed no association. Superolateral Hoffa was positively correlated with prefemoral (p < 0.001, r = 0.408) and negatively correlated with quadriceps (p < 0.001, r = -0.500) fat pad edema. CONCLUSIONS Superolateral Hoffa and prefemoral fat pad edemas were associated with patellar maltracking parameters. Quadriceps fat pad edema and maltracking parameters were not associated. Superolateral Hoffa fat pad edema was positively correlated with prefemoral and negatively correlated with quadriceps fat pad edema.
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Affiliation(s)
- Liangjing Lyu
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China.
| | - Yongliang Li
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China
| | - Jingyu Zhong
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China
| | - Weiwu Yao
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China.
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Abelleyra Lastoria DA, Benny CK, Hing CB. Predisposing factors for Hoffa's fat pad syndrome: a systematic review. Knee Surg Relat Res 2023; 35:17. [PMID: 37296488 DOI: 10.1186/s43019-023-00192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hoffa's fat pad syndrome has been defined as impingement of Hoffa's fat pad, leading to oedema and fibrosis. The primary aim of this systematic review was to identify morphological differences in Hoffa's fat pad between patients with and without Hoffa's fat pad syndrome, evaluating them as risk factors predisposing to its development. The secondary aim was to summarize and evaluate current evidence pertaining to the management of Hoffa's fat pad syndrome. MATERIALS AND METHODS The protocol for this review was prospectively registered (PROSPERO registration: CRD42022357036). Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. All studies evaluating differences in Hoffa's fat pad anatomy under imaging between patients with and without Hoffa's fat pad syndrome were included, as well as those exploring epidemiological factors predisposing to its development (ethnicity, employment status, sex, age and BMI), and studies reporting on the effect of treatment on Hoffa's fat pad morphology. RESULTS A total of 3871 records were screened. Twenty one articles satisfied the inclusion criteria, evaluating 3603 knees of 3518 patients. Patella alta, increased tibial tubercle-tibial groove distance, and increased trochlear angle were found to predispose the development of Hoffa's fat pad syndrome. Trochlear inclination, sulcus angle, patient age and BMI were not associated with this condition. The link between Hoffa's fat pad syndrome and ethnicity, employment, patellar alignment, Hoffa's fat pad composition, physical activity and other pathological processes cannot be established due to lack of evidence. No studies reporting on treatment for Hoffa's fat pad syndrome were identified. Though weight loss and gene therapy may provide symptomatic relief, further research is required to corroborate these claims. CONCLUSION Current evidence suggests that high patellar height, TT-TG distance, and trochlear angle predispose the development of Hoffa's fat pad syndrome. In addition, trochlear inclination, sulcus angle, patient age and BMI do not seem to be associated with this condition. Further research should explore the link between Hoffa's fat pad syndrome and sport as well as other conditions pertaining to the knee. In addition, further study evaluating treatment approaches for Hoffa's fat pad syndrome is required.
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Affiliation(s)
| | | | - Caroline Blanca Hing
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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Pascual-Leone N, Chipman DE, Meza BC, Mintz DN, Fabricant PD, Green DW. Concomitant anterior medializing osteotomy and MPFL reconstruction improves patellar tilt when compared to MPFL reconstruction alone. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07396-x. [PMID: 37062043 DOI: 10.1007/s00167-023-07396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/17/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Understanding how surgical procedures influence anatomic factors associated with patellofemoral instability can help guide surgeons when planning treatments for individual patients. This study sought to understand how patellar tilt is affected in adolescent patients with elevated pre-operative tibial tuberosity to trochlear groove (TT-TG) values undergoing medial patellofemoral ligament reconstruction (MPFLR) with or without an anterior medializing osteotomy (AMZ). METHODS Utilizing a prospective database of 274 patellofemoral instability patients who underwent MPFLR ± AMZ by one of two orthopedic surgeons at a single institution, those who underwent MPFLR + AMZ were identified. Pre-operative and post-operative magnetic resonance imaging (MRI) were used to measure TT-TG distance, while radiographs were used to measure patellar tilt (tilt). Patients were matched based on age at surgery (within 2 years) and pre-operative TT-TG distance (within 2 mm) to a comparison cohort of patients who underwent isolated MPFLR (iMPFLR) without osseous procedures. RESULTS A total of 56 patients were analyzed (28 per group). The mean age of the cohort was 15.5 ± 2.0 years and was similar between both groups (15.9 ± 1.9 versus 15.1 ± 2.0 years [n.s]). When comparing the two cohorts, significant pre- to post-operative decreases in patellar tilt for both MPFLR + AMZ (6.6 degrees, p < 0.001) and iMPFLR (3.9 degrees, p = 0.013) were noted. While there were no differences in pre-operative patellar tilt (21.2 ± 3.5 versus 21.1 ± 3.4 [n.s]), post-operatively, MPFLR + AMZ had significantly less patellar tilt than iMPFLR (13.2 ± 5.5 versus 16.5 ± 4.4, p = 0.017). CONCLUSIONS This study found that patellar tilt significantly improved in participants undergoing either MPFLR + AMZ or iMPFLR. In addition, those undergoing MPFLR + AMZ were found to have significantly lower post-operative tilt than those undergoing iMPFLR. If patellar tilt is found pre-operatively to be significantly elevated and a risk for future dislocations, these findings suggest that surgeons might strongly consider MPFLR with AMZ to further address the increased tilt. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicolas Pascual-Leone
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Danielle E Chipman
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Blake C Meza
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Douglas N Mintz
- Department of Radiology & Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Peter D Fabricant
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel W Green
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
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Xu Z, Song Y, Deng R, Zhang Z, Wang H, Yu JK. Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment. Orthop J Sports Med 2022; 10:23259671221125218. [PMID: 36329949 PMCID: PMC9623427 DOI: 10.1177/23259671221125218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/07/2022] Open
Abstract
Background Femoral torsion can be evaluated from different femoral segments. The
pathological thresholds for femoral torsion of different segments and the
influence of segmental femoral torsion on patellofemoral alignment remain
unknown. Purpose To compare femoral torsion between patients with recurrent patellar
dislocation and healthy individuals, to determine the statistical
physiological range and pathological thresholds of femoral torsion in
different segments, and to investigate the influence of femoral torsion on
patellofemoral malalignment. Study Design Cross-sectional study; Level of evidence, 3. Methods We retrospectively reviewed the records of patients with patellar dislocation
who received surgical treatment in our department between 2019 and 2020.
Healthy participants were recruited as the control group. The control
patients were asymptomatic and had no history of lower extremity disorders.
The differences in femoral torsion between the study and control groups were
compared. The diagnostic capacity of femoral torsion in different segments
and their correlation with patellar tilt were investigated. The mean value
and 95% CI of femoral torsion in different segments were established using
data from healthy volunteers. Results A total of 60 patients with patellar dislocation and 100 healthy volunteers
were included in this study. The total, mid, and distal femoral torsion
values differed significantly between the study and control groups
(P < .01). Total femoral torsion had the highest
diagnostic value (area under the receiver operating curve = 0.733). Total
torsion (r = 0.432; P < .001), mid
torsion (r = 0.242; P = .002), and distal
torsion (r = 0.324; P < .001) showed
significant correlations with patellar tilt. The pathological thresholds of
excessive femoral torsion of the total, proximal, mid, and distal femoral
segments were 24.73°, 46.68°, –6.55°, and 14.92°, respectively. Conclusion Patients with patellar dislocation had greater femoral torsion than healthy
individuals in multiple femoral segments. Excessive mid, distal, and total
torsion was associated with more significant patellar tilt.
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Affiliation(s)
- Zijie Xu
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Yifan Song
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Ronghui Deng
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Zining Zhang
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Haijun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China.,Jia-Kuo Yu, MD, PhD, and Haijun Wang, MD, Sports Medicine
Department, Beijing Key Laboratory of Sports Injuries, Peking University Third
Hospital, Institute of Sports Medicine, Peking University, No. 49 North Garden
Road, Haidian District, Beijing 100191, China (
and ,
respectively)
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China.,Jia-Kuo Yu, MD, PhD, and Haijun Wang, MD, Sports Medicine
Department, Beijing Key Laboratory of Sports Injuries, Peking University Third
Hospital, Institute of Sports Medicine, Peking University, No. 49 North Garden
Road, Haidian District, Beijing 100191, China (
and ,
respectively)
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Martinez-Cano JP, Gobbi RG, Giglio PN, Arendt E, Costa GB, Hinckel BB. Magnetic resonance imaging overestimates patellar height compared with radiographs. Knee Surg Sports Traumatol Arthrosc 2022; 30:3461-3469. [PMID: 35357529 DOI: 10.1007/s00167-022-06953-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the inter-observer and inter-method reliability for patellar height measurements between conventional radiographs (CR) and magnetic resonance imaging (MRI) using one or two slices. METHODS This was a reliability study, with 60 patients divided in two groups: 30 patients with patellar instability (patella group) and 30 patients with anterior cruciate ligament or meniscus injury (control group). CR and MRI were evaluated by two independent observers. Insall-Salvati index (IS) and Caton-Deschamps index (CD) were measured using three different methods: CR, one-slice MRI or two-slice MRI. Intra-class correlation coefficients (ICC) were calculated for inter-observer reliability and inter-method reliability. Bland-Altman agreement was also calculated. RESULTS The inter-observer reliability was very good for the IS with ICCs of 0.93, 0.84 and 0.82, for the CR, one-slice MRI and two-slice MRI, respectively. Similarly, for the CD the ICCs were good, 0.76, 0.80 and 0.75 for the CR, one-slice MRI and two-slice MRI, respectively. No differences were found between the patella and the control group. The inter-method analysis results were: ICCs for IS (0.83, 0.86, 0.93) and CD (0.72, 0.82, 0.83), for the comparisons of CR/one-slice MR, CR/two-slice MRI and one-slice MRI/two-slice MRI, respectively. The Bland-Altman mean differences showed an 8% and a 7% increase on IS values with one-slice MRI and two-slice MRI compared to CR results, while the increase was of 9% and 1% in CD for the respective comparisons with CR. CONCLUSION MRI can overestimate patellar height compared to CR, as much as an 8% increase in Insall-Salvati values when using one- or two-slice MRI measurements, and up to a 9% increase in Caton-Deschamps value when using the one-slice MRI method. It is recommended to use the CR as the preferred method when measuring patellar height. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Riccardo Gomes Gobbi
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Nogueira Giglio
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
| | - Elizabeth Arendt
- Department of Orthopaedic Surgery, Medical School, University of Minnesota, Minneapolis, USA
| | | | - Betina B Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA
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