Raphael Serra Cruz

Instituto Nacional de Traumatologia e Ortopedia | INTO · Cirurgia do Joelho

Objectives: Anterior cruciate ligament (ACL) tears are one of the most common injuries among athletes. However, the ability to fully restore rotational stability with ACL reconstruction (ACLR) remains a challenge because up to 25% of patients may present with a residual pivot shift following surgery. Advocacy for reconstruction of the anterolateral...

Posterolateral corner injuries represent a complex injury pattern, with damage to important coronal and rotatory stabilizers of the knee. These lesions commonly occur in association with other ligament injuries, making decisions regarding treatment challenging. Grade III posterolateral corner injuries result in significant instability and have poor...

The superficial medial collateral ligament (sMCL) and associated knee structures are the most commonly injured structures of the knee. Most isolated sMCL tears are treated nonoperatively. Several studies have described different algorithms for treatment of sMCL lesions, as well as different types of techniques, both in the acute and in chronic sett...

Abstract: Preservation of meniscal tissue has been proven to be the best approach in most cases of meniscal tears. Currently available techniques for treating a peripheral meniscal tear include inside-out, outside-in, and all-inside techniques. Each of these techniques present potential advantages and disadvantages. Despite technologic advances in...

Recurrent patellar instability can be very debilitating and may require surgical intervention. A thorough workup must be completed in this subset of patients. Risk factors for recurrent instability include patella alta, trochlear dysplasia, an increased tibial tubercleetrochlear groove distance, and insufficiencies in the medial retinacular structu...

Bone loss can be a problem in knee arthroplasties, whether primary or revision. There are several classifications to quantify bone loss, both in relation to the depth of the defect and the integrity of the bone ring, distinguishing contained or non-contained defects. There are various proposals for correcting the bone defect, according to its exten...

Bone loss can be a problem in knee arthroplasties, whether primary or revision. There are several classifications to quantify bone loss, both in relation to the depth of the defect and the integrity of the bone ring, distinguishing contained or non-contained defects. There are various proposals for correcting the bone defect, according to its exten...

The literature has shown a significant decrease in failure rates when the anterior cruciate ligament (ACL) reconstruction was associated with an extra-articular reinforcement technique such as the anterolateral ligament (ALL) or the iliotibial band tenodesis (ITBT) using the modified Lemaire technique. As much as there is a progressive decrease in...

A pandemia pelo SARS-CoV-2 alterou o fluxo hospitalar nas unidades de atendi¬mento médico em todo o mundo, com di¬minuição drástica no número de cirurgias ortopédicas. Procedimentos eletivos foram, em sua grande maioria, suspensos, sendo mantidas apenas as consultas e cirurgias de emergência. O presente estudo buscou ava¬liar as taxas de mortalidad...

Os grupamentos musculares do corpo humano são divididos em compartimentos separados por fortes membranas fasciais, pouco flexíveis denominadas septos intermusculares. Qualquer condição que aumente o volume no interior de um compartimento e/ou reduza a sua capacidade em expandir-se para suportar a um aumento de pressão pode levar a um quadro de sínd...

O skate é um esporte que tem suas origens na cultura californiana da década de 1950, quando surfistas instalaram rodas de patins sob tábuas de madeira para se divertirem em dias de mar flat (sem ondas). Desde então, tanto os equipamentos quanto o esporte evoluíram muito. A introdução das rodas de poliuretano e as modificações no formato possibilita...

O Surfe é praticado em estreita relação com fenômenos naturais, sendo influenciado pela intensidade e direção da ondulação (ou swell), intensidade e direção do vento, posição geográfica e características da praia, relevo e tipo do fundo do mar, correntes marítimas e variações da maré, que em conjunto determinam o tamanho, a forma e intensidade das...

Symptomatic articular cartilage injuries are often seen in young active patients and athletes. Magnetic resonance imaging screening examinations have frequently identified such lesions in athletic patients. Patellofemoral chondral defects were previously identified as the most common knee cartilage lesion in high-level athletes. Chondral defects me...

When there is a rupture in the meniscal roots or close to them, the menisci suddenly and considerably reduce their capacity to absorb the axial mechanical load that passes through the knee, quickly leading to the development of a process of chondral degeneration. The varus deformity of the lower limb (when the mechanical axis crosses the medial com...

Purpose: To analyze clinical and functional outcomes of patients submitted to posterior meniscal root repair of the medial or lateral meniscus in different settings, with at least 6 months of follow-up. Patients and methods: Retrospective multicentric study assessing epidemiological characteristics and clinical-functional results of 22 patients...

Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prog...

Meniscal ramp lesions are a “hot topic” because of increasing recognition that they have important biomechanical consequences and also that they occur much more frequently than was previously understood. Historically, ramp lesions have been underdiagnosed because of the low sensitivity of MRI and inadequate visualization through standard arthroscop...

Chronic proximal patellar tendinopathy is a challenging condition for its troublesome management in the active patient and difficulty in defining the failure of conservative treatment to indicate surgery. Usually, patients with chronic proximal patellar tendinopathy have already tried several physiotherapeutic modalities and are away from their pre...

Aula expositiva resumindo o que há de mais recente nos estudos que avaliam os fatores de risco relacionados a lesões em corredores.

The goal of this study was to report a surgical technique used in a revision anterior cruciate ligament (ACL) reconstruction case, consisting of an adaptation of the anterolateral iliotibial band tenodesis technique (modified Lemaire technique) combined with ACL reconstruction using an adjustable fixation mechanism. Rotational overload was one of t...

O Menisco fornece ao leitor um conteúdo de referência no assunto, atra-vés de uma completa sequência de informações e ensinamentos. Aborda a anatomia, indicações e técnicas cirúrgicas, métodos de reabilitação, além de temas avançados como transplante meniscal, artroplastia uni-compartimental biológica e Scafold Meniscus. O enfoque é o mais prático...

Explanação sobre as causas, tratamento e prevenção da síndrome da banda iliotibial em atletas de endurance.

Apresentação realizada durante a Jornada de Cirurgia de Joelho, realizada pela regional Rio de Janeiro da SCBJ, em Itaipava, nos dias 24 e 25 de Agosto. A apresentação introduz alguns conceitos de lesão de raiz meniscal e foca em alguns princípios de técnicas cirúrgicas.

The purpose of this study was to test the validity of dynamic leg length discrepancy (DLLD) during gait as a radiation-free screening method for measuring anatomic leg length discrepancy (ALLD). Thirty-three subjects with mild leg length discrepancy walked along a walkway and the dynamic leg length discrepancy (DLLD) was calculated using a motion a...

The variability of symptoms and the fact that they are not easily recognized in imaging studies make the diagnosis and treatment of posterior meniscal roots lesions a challenging task to the orthopedist. In recent years, a more precise understanding of the anatomy and biomechanical impair of the knee joint in these cases has enabled great advances...

Background A subset of patients have clinical internal and/or external knee rotational instability despite no apparent injury to the cruciate or collateral ligaments. Purpose/Hypothesis The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial, and anteromedial structures of the kne...

Objectives The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial and anteromedial structures of the knee on rotational kinematics in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and...

A lesão da raiz posterior do menisco constitui uma patologia que requer elevado grau de suspeição para que seu diagnóstico seja realizado. Para isso é importante que o ortopedista conheça bem suas características epidemiológicas, clínicas e de imagem. Após estudos biomecânicos compararem o padrão de distribuição de cargas de joelhos com lesão das r...

A variabilidade da sintomatologia e o fato de não serem facilmente reconhecidas nos exames de imagem tornam o diagnóstico e o tratamento das lesões das raízes posteriores dos meniscos tarefas desafiadoras para o ortopedista. Nos últimos anos, uma compreensão mais precisa da anatomia e do comprometimento biomecânico da articulação do joelho nessas l...

Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, p...

Background: Anterior cruciate ligament (ACL) tears are one of the most common injuries among athletes. However, the ability to fully restore rotational stability with ACL reconstruction (ACLR) remains a challenge, as evidenced by the persistence of rotational instability in up to 25% of patients after surgery. Advocacy for reconstruction of the an...

Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to...

Abstract: The lateral meniscus plays a critical role in the stability and health of the knee. Treating patients who have undergone a total lateral meniscectomy or functional equivalent is challenging, especially young and active patients. Current literature regarding meniscal tears supports that repair should be the first surgical option. Moreover,...

The medial meniscus is crucial for knee homeostasis. Treating patients who have undergone a subtotal or total meniscectomy, or equivalent irreparable tear pattern, can be extremely challenging, especially in young, active patients. The importance of meniscal preservation has been reported by several authors. Meniscal repair is now widely accepted a...

Fibular collateral ligament (FCL) injuries can lead to varus instability of the knee, causing a varus thrust gait and resulting in increased forces on the medial compartment of the knee. In the long term, this can result in meniscal injuries and medial compartment osteoarthritis. Varus instability is also reported to increase forces on the cruciate...

Background: Recent biomechanical studies have demonstrated that an extra-articular lateral knee structure, most recently referred to as the anterolateral ligament (ALL), contributes to overall rotational stability of the knee. However, the effect of anatomic ALL reconstruction (ALLR) in the setting of anterior cruciate ligament (ACL) reconstructio...

Abstract: Articular cartilage damage of the knee can cause severe morbidity. Owing to its avascular nature, articular cartilage has limited potential for self-healing and increased propensity to progress to osteoarthritis. Treatment of large, full-thickness cartilage defects is still a challenge for orthopaedic surgeons but has recently achieved hi...

Background: Bone marrow aspirate concentrate (BMAC) has emerged as a novel treatment for pathology of the knee. Despite containing a limited number of stem cells, BMAC serves as a source of growth factors that are thought to play an important role as a result of their anabolic and anti-inflammatory effects. To our knowledge, there is no systematic...

Background: Recent investigations have described the structural and functional behavior of the anterolateral ligament (ALL) of the knee through pull-apart and isolated sectioning studies. However, the secondary stabilizing role of the ALL in the setting of a complete anterior cruciate ligament (ACL) tear has not been fully defined for common simul...