Acta Ortopedica Brasileira最新文献

WHICH FACTORS CAN DEFINE THE PROGNOSIS OF ARTICULAR FRACTURES OF THE CAPITELLUM AND TROCHLEA? 哪些因素可以决定肱骨小头滑车关节骨折的预后？

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-09-25 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263402e297279

Ligia Gianfaldoni Gattás, Pedro Henrique Avi, Marcelo Fregoneze, José Octávio Soares Hungria, Rodrigo Peixoto Vargas, Caio Zamboni

{"title":"WHICH FACTORS CAN DEFINE THE PROGNOSIS OF ARTICULAR FRACTURES OF THE CAPITELLUM AND TROCHLEA?","authors":"Ligia Gianfaldoni Gattás, Pedro Henrique Avi, Marcelo Fregoneze, José Octávio Soares Hungria, Rodrigo Peixoto Vargas, Caio Zamboni","doi":"10.1590/1413-785220263402e297279","DOIUrl":"10.1590/1413-785220263402e297279","url":null,"abstract":"Introduction: Articular fractures of the distal humerus involving the capitellum and trochlea (AO 13B3) are complex and challenging to manage without consensus in the literature on the most appropriate management.Objective: Evaluate radiographic features and treatment-related factors that may be positively or negatively correlated with the outcome of these fractures.Methods: Sixteen adult patients who underwent surgery between 2007 and 2024 with at least one year of follow-up were analyzed retrospectively. Radiographic characteristics, postoperative range of motion, and complications were evaluated. Statistical analysis used Odds Ratio (OR) and Fisher's Exact Test.Results: Elbow stiffness occurred in 56% of patients, 83% of which were in cases with posterior wall involvement (OR=7.5; p=0.08). Preoperative immobilization for more than seven days was associated with range of motion impairment (60%, OR=3; p=0.58) and ulnar nerve neuropathy (30%, OR=6; p=0.09). All cases of ulnar neuropathy occurred in women with prolonged immobilization (OR=8.08; p=0.09).Conclusion: Posterior wall integrity is a relevant prognostic factor for the final range of motion. The propensity for ulnar neuropathy in women and those with prolonged immobilization, although without statistical significance, suggests the need for larger samples. Level of Evidence II; Retrospective study.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe2","pages":"e297279"},"PeriodicalIF":0.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

TOURNIQUET USE DOES NOT AFFECT BLEEDING AND SURGICAL TIME IN ROBOTIC-ASSISTED KNEE ARTHROPLASTY. 在机器人辅助的膝关节置换术中，止血带的使用不影响出血和手术时间。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-09-25 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263402e290496

João Paulo F Guerreiro, João Vitor Dias Balan, Marsal M H de Vilhena, Sergio Guimarães M V, Paulo Roberto Bignardi, Marcus Vinicius Danieli

{"title":"TOURNIQUET USE DOES NOT AFFECT BLEEDING AND SURGICAL TIME IN ROBOTIC-ASSISTED KNEE ARTHROPLASTY.","authors":"João Paulo F Guerreiro, João Vitor Dias Balan, Marsal M H de Vilhena, Sergio Guimarães M V, Paulo Roberto Bignardi, Marcus Vinicius Danieli","doi":"10.1590/1413-785220263402e290496","DOIUrl":"10.1590/1413-785220263402e290496","url":null,"abstract":"Objective: To compare bleeding and surgical time in patients undergoing Total Knee Arthroplasty (TKA) with robotic assistance with and without the use of a tourniquet.Methods: Retrospective study with analysis of medical records. Patients were divided into two groups: one group in which robotic-assisted TKA was performed using a tourniquet and the other without. The values of hemoglobin (Hb) and hematocrit (Ht) preoperative and 24 hours after surgery, the estimated blood loss, number of transfusions and surgical time were compared between the groups.Results: 108 patients were included, with 59 in the group using a tourniquet and 49 without. There was no difference between the mean Hb and Ht values between the groups preoperatively (p = 0.287 and p = 0.508) and 24 hours (p = 0.252) after surgery. There was also no difference between the estimated blood loss in each group (p = 0.265). Surgical time was not different between groups (p = 0.179). There was no need for transfusions in any patient.Conclusion: Robotic-assisted TKA surgeries, whether performed with or without a tourniquet, showed no significant differences in the drop in Hb and Ht levels 24 hours after surgery, estimated blood loss, transfusions, and surgical time. Level of Evidence III; Retrospective cohort study.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe2","pages":"e290496"},"PeriodicalIF":0.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

FUNCTIONAL OUTCOME OF WEBER OSTEOTOMY IN CHRONIC ANTERIOR GLENOHUMERAL DISLOCATION IN YOUNG PATIENTS. 年轻慢性盂肱前脱位韦伯截骨术的功能效果。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-09-25 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263402e297312

Felipe Bosco Mendes da Silva, Stela da Silva Chiquetto, Marcio Alves Cruz, Fernando Kenji Kikuta, Sergio de Paula Coelho, Guilherme Grisi Mouraria

{"title":"FUNCTIONAL OUTCOME OF WEBER OSTEOTOMY IN CHRONIC ANTERIOR GLENOHUMERAL DISLOCATION IN YOUNG PATIENTS.","authors":"Felipe Bosco Mendes da Silva, Stela da Silva Chiquetto, Marcio Alves Cruz, Fernando Kenji Kikuta, Sergio de Paula Coelho, Guilherme Grisi Mouraria","doi":"10.1590/1413-785220263402e297312","DOIUrl":"10.1590/1413-785220263402e297312","url":null,"abstract":"Objective: This study aimed to evaluate the functional outcomes of humeral head derotational osteotomy according to the Weber technique as a therapeutic alternative for the treatment of chronic anterior shoulder dislocation in young patients.Methods: This prospective case series included patients younger than 50 years who underwent clinical and radiographic evaluation. Outcomes were assessed using plain radiographs, computed tomography (CT), the Visual Analog Scale (VAS) for pain, the 36-Item Short Form Health Survey (SF-36), and range of motion measurements. The mean age of the participants was 47.67 years.Results: The procedure resulted in a significant reduction in pain, with a mean decrease of 5.7 points on the VAS, as well as improvements of 30° in extension and 28° in external rotation (p < 0.05). The SF-36 demonstrated an average improvement of 27 points in overall quality of life and functional status, and 54 points in the pain domain. No cases of recurrent dislocation were observed.Conclusion: Weber humeral head derotational osteotomy provides satisfactory functional recovery, significant pain relief, and may be considered a viable treatment option for chronic anterior glenohumeral dislocation in young patients. Level of Evidence IV; Case Series.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe2","pages":"e297312"},"PeriodicalIF":0.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

BIOMECHANICAL STUDY OF PULLOUT RESISTANCE OF CORTICAL SCREWS IN SWINE LUMBAR VERTEBRAE. 猪腰椎皮质螺钉抗拔的生物力学研究。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-09-25 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263402e297893

Rogério Lúcio Chaves de Resende, Jefferson Soares Leal, Jefferson J Vilela, Renato de Mello Guimarães, Ângelo Ribeiro Vaz de Faria, Marco Antônio Percope de Andrade

{"title":"BIOMECHANICAL STUDY OF PULLOUT RESISTANCE OF CORTICAL SCREWS IN SWINE LUMBAR VERTEBRAE.","authors":"Rogério Lúcio Chaves de Resende, Jefferson Soares Leal, Jefferson J Vilela, Renato de Mello Guimarães, Ângelo Ribeiro Vaz de Faria, Marco Antônio Percope de Andrade","doi":"10.1590/1413-785220263402e297893","DOIUrl":"10.1590/1413-785220263402e297893","url":null,"abstract":"Introduction: This study aimed to evaluate the mechanical resistance to pullout of the lumbar cortical bone trajectory (CBT) screw with and without transfixation of the second cortical in a biomechanical assay in swine vertebrae.Methods: A pullout test was performed in 16 swine vertebrae (L5 and L6) fixed with 32 CBT screws using the same protocol. Of these, 16 were inserted in a monocortical manner according to the original technique and 16 through a modified technique which included the transfixation of the second cortical bone.Results: The average maximum load value for pulling out the inserted screws with the modified technique including the transfixation of the second cortical bone was 140.50 Kgf (± 56.56), while in the original technique it was 95.69 Kgf (± 42.19) (p = 0.004).Conclusion: The biomechanical tests applied to the studied sample showed that the pullout resistance of the CBT screws inserted with the bicortical technique was, on average, 46% higher than the screws inserted according to the original monocortical technique. Level of Evidence II; Experimental study.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe2","pages":"e297893"},"PeriodicalIF":0.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

INTRAOPERATIVE ASSESSMENT OF COMPONENTS IN NAVIGATED KNEE ARTHROPLASTY IN THE ELDERLY. 老年人导航式膝关节置换术中各组件的术中评估。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-09-25 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263402e297565

Marcos Vinicius Amorim Silva, Adriano Ferro Rotondano, Rebecca Gomes Moura Bastos, Edimar Gomes Custodio

{"title":"INTRAOPERATIVE ASSESSMENT OF COMPONENTS IN NAVIGATED KNEE ARTHROPLASTY IN THE ELDERLY.","authors":"Marcos Vinicius Amorim Silva, Adriano Ferro Rotondano, Rebecca Gomes Moura Bastos, Edimar Gomes Custodio","doi":"10.1590/1413-785220263402e297565","DOIUrl":"10.1590/1413-785220263402e297565","url":null,"abstract":"Objective: This study aims to evaluate the sizing and positioning of femoral and tibial components in Primary Total Knee Arthroplasty (TKA) procedures conducted at the Instituto Ortopédico de Goiânia (IOG), Goiânia, Goiás Brazil.Methodology: Elderly patients undergoing primary TKA with the use of SCORE® prostheses and the Amplivision Navigation System were included in the study. The size and positioning of the femoral and tibial components were analyzed. Data collection was performed using the Amplivision system and statistical analysis was conducted using Minitab21 software. The study was approved by the Ethics Committee and is in accordance with the Brazilian General Data Protection Law (LGPD).Results: All patients received the SCORE® prosthesis, with a higher prevalence of procedures on the right knee (60%). No statistically significant differences were observed in the positioning of femoral and tibial components.Conclusion: Surgical navigation proved to be effective in optimizing the sizing and positioning of implants, contributing to the technical quality of the procedure and the durability of prosthetic components. Level of Evidence: III, Cross-Sectional Observational Study.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe2","pages":"e297565"},"PeriodicalIF":0.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: LABRAL REPAIR FOR ANTERIOR SHOULDER INSTABILITY - MORE THAN TWO ANCHORS VERSUS UP TO TWO ANCHORS. 来自巴西肩关节外科学会的循证评论和建议：前肩不稳定的唇侧修复-多于两个锚与最多两个锚。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-08-31 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263401e308949

Paulo Henrique Schmidt Lara, Paulo Santoro Belangero, Márcio Schiefer, Leonardo Zanesco, Marcos Rassi Fernandes, Joel Murachovsky, João Felipe de Medeiros, Eduardo Angeli Malavolta

{"title":"EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: LABRAL REPAIR FOR ANTERIOR SHOULDER INSTABILITY - MORE THAN TWO ANCHORS VERSUS UP TO TWO ANCHORS.","authors":"Paulo Henrique Schmidt Lara, Paulo Santoro Belangero, Márcio Schiefer, Leonardo Zanesco, Marcos Rassi Fernandes, Joel Murachovsky, João Felipe de Medeiros, Eduardo Angeli Malavolta","doi":"10.1590/1413-785220263401e308949","DOIUrl":"10.1590/1413-785220263401e308949","url":null,"abstract":"Introduction: Anterior shoulder instability is a common condition that mainly affects young adults. It is most often traumatic and is frequently associated with a Bankart lesion, characterized by detachment of the anteroinferior glenoid labrum. When conservative treatment fails, surgical repair is usually indicated. Biomechanical studies suggest that a greater number of anchors may increase the contact area and provide greater stability between the labrum and the glenoid, promoting a more stable reconstruction of the capsulolabral complex.Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026 to evaluate whether the use of more than two anchors is more effective than the use of up to two anchors for the arthroscopic treatment of anterior shoulder instability in adults. The certainty of the evidence was assessed with the GRADE approach.Results: One randomized controlled trial and two cohort studies were included. For function and complications, there was no evidence showing that the use of three or more anchors was more effective than the use of two anchors. For recurrence, there was evidence, although the certainty of the evidence was very low, that the use of three or more anchors was more effective than the use of up to two anchors.Conclusion: The surgeon should individually assess patient- and disease-related characteristics to make the best treatment decision. Regarding recurrence, the SBCOC Consensus Project suggests a preference for three or more anchors, given a trend toward a lower recurrence rate. Level of evidence II; Systematic review.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe1","pages":"e308949"},"PeriodicalIF":0.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: HYALURONIC ACID INJECTION VERSUS PHYSIOTHERAPY FOR ROTATOR CUFF TENDINOPATHY IN ADULTS. 来自巴西肩关节外科学会的循证评论和建议：透明质酸注射与物理疗法治疗成人肩袖肌腱病变。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-08-31 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263401e308948

Marcos Rassi Fernandes, Leonardo Zanesco, Joel Murachovsky, Guilherme Grisi Mouraria, Paulo Henrique Schmidt Lara, Paulo Santoro Belangero, João Felipe de Medeiros, Eduardo Angeli Malavolta

{"title":"EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: HYALURONIC ACID INJECTION VERSUS PHYSIOTHERAPY FOR ROTATOR CUFF TENDINOPATHY IN ADULTS.","authors":"Marcos Rassi Fernandes, Leonardo Zanesco, Joel Murachovsky, Guilherme Grisi Mouraria, Paulo Henrique Schmidt Lara, Paulo Santoro Belangero, João Felipe de Medeiros, Eduardo Angeli Malavolta","doi":"10.1590/1413-785220263401e308948","DOIUrl":"10.1590/1413-785220263401e308948","url":null,"abstract":"Introduction: Rotator cuff tendinopathy is a common cause of shoulder pain and disability, and the optimal nonoperative strategy remains debated. Physiotherapy is the mainstay of initial management, whereas hyaluronic acid injection has been proposed as an alternative or adjunct; their comparative effectiveness is uncertain.Methods: An evidence-based systematic review was conducted in PubMed, Embase, Cochrane Library, and the Regional Portal of the Virtual Health Library (BVS) up to February 2026. Randomized controlled trials comparing hyaluronic acid injection with physiotherapy in adults with rotator cuff tendinopathy were included. Outcomes were pain, function, range of motion, and quality of life. Certainty of evidence was assessed with the GRADE approach.Results: Two randomized controlled trials (130 participants) met the eligibility criteria. Hyaluronic acid injection was associated with greater short-term improvement in pain, range of motion, and quality of life than physiotherapy, particularly within the first three months. Functional outcomes were inconsistent: one trial reported comparable improvement between groups, whereas the other favored hyaluronic acid. Certainty of evidence was very low because of small sample sizes, risk of bias, and imprecision.Conclusion: Very low-quality evidence suggests that hyaluronic acid injection may provide superior short-term benefits over physiotherapy for rotator cuff tendinopathy, mainly up to three months. The available evidence remains limited and at high risk of bias; further high-quality studies are required. Level of evidence II; Systematic review.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe1","pages":"e308948"},"PeriodicalIF":0.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: REVERSE ARTHROPLASTY FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS. 来自巴西肩肘外科学会的循证评论和建议：老年患者复杂肱骨近端骨折的反向关节置换术。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-08-31 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263401e303258

Marcus Vinícius Galvão Amaral, Leonardo Zanesco, Gustavo de Mello Ribeiro Pinto, Maurício de Paiva Rafaelli, Thiago Barbosa Caixeta, Paulo Cesar Faiadi Piluski, Marcelo Costa de Oliveira Campos, Eduardo Angeli Malavolta

{"title":"EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: REVERSE ARTHROPLASTY FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS.","authors":"Marcus Vinícius Galvão Amaral, Leonardo Zanesco, Gustavo de Mello Ribeiro Pinto, Maurício de Paiva Rafaelli, Thiago Barbosa Caixeta, Paulo Cesar Faiadi Piluski, Marcelo Costa de Oliveira Campos, Eduardo Angeli Malavolta","doi":"10.1590/1413-785220263401e303258","DOIUrl":"10.1590/1413-785220263401e303258","url":null,"abstract":"Introduction: Complex (Neer 3- or 4-part) proximal humeral fractures in elderly patients are associated with high complication and failure rates after open reduction and internal fixation with locking plates (ORIF-LP). Reverse shoulder arthroplasty (RSA) has emerged as an alternative, but its comparative effectiveness remains debated.Methods: We conducted an evidence-based review of systematic reviews and randomized controlled trials including elderly patients with Neer 3- or 4-part fractures, identified through PubMed, Embase, Cochrane Library, and BVS (search to August 2025). High-quality systematic reviews were prioritized, and individual RCTs were added when necessary. Risk of bias and certainty of evidence were assessed using Cochrane methods and the GRADE approach.Results: Four systematic reviews and three RCTs met the inclusion criteria. Across network meta-analyses and direct comparisons, RSA provided superior shoulder function, with higher Constant and Oxford scores at 2 and 5 years than ORIF-LP. RSA also tended to reduce complication and reoperation rates, although event numbers were small and confidence intervals were wide. Overall certainty was low for function and very low for complications and reoperations.Conclusions: In elderly patients with complex proximal humeral fractures requiring surgery, RSA appears to yield better functional outcomes and fewer reoperations than ORIF-LP, supporting its use as the preferred surgical option, while acknowledging the low certainty of evidence. Level of evidence II; Systematic review.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe1","pages":"e303258"},"PeriodicalIF":0.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: HYALURONIC ACID INFILTRATION FOR ELBOW EPICONDYLITIS IN ADULTS. 来自巴西肩关节外科学会的循证评论和建议：透明质酸浸润治疗成人肘关节上髁炎。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-08-31 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263401e303257

Gustavo de Mello Ribeiro Pinto, Leonardo Zanesco, Marcus Vinícius Galvão Amaral, Fábio Teruo Matsunaga, João Artur Bonadiman, João Felipe de Medeiros, Marcelo Costa de Oliveira Campos, Eduardo Angeli Malavolta

{"title":"EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: HYALURONIC ACID INFILTRATION FOR ELBOW EPICONDYLITIS IN ADULTS.","authors":"Gustavo de Mello Ribeiro Pinto, Leonardo Zanesco, Marcus Vinícius Galvão Amaral, Fábio Teruo Matsunaga, João Artur Bonadiman, João Felipe de Medeiros, Marcelo Costa de Oliveira Campos, Eduardo Angeli Malavolta","doi":"10.1590/1413-785220263401e303257","DOIUrl":"10.1590/1413-785220263401e303257","url":null,"abstract":"Introduction: Elbow epicondylitis is a common tendinopathy in adults, and infiltration is frequently used when initial conservative treatment fails. Hyaluronic acid and corticosteroids are among the most widely used injectable agents, but their comparative effectiveness remains uncertain.Methods: We performed an evidence-based review of randomized controlled trials and systematic reviews comparing hyaluronic acid with corticosteroid injections for adult elbow epicondylitis. PubMed, Embase, the Cochrane Library, and BVS were searched through August 2025. Main outcomes were pain and elbow function; risk of bias and certainty of evidence were assessed using Cochrane and GRADE approaches.Results: Of 94 records, three studies met the eligibility criteria (one systematic review and two randomized trials), all focused on lateral epicondylitis. Very low-quality evidence suggests that hyaluronic acid provides greater improvement in pain and function than corticosteroids from 8 weeks to 6 months in acute cases, whereas in chronic lateral epicondylitis, corticosteroid injections appear more effective than hyaluronic acid for pain relief and functional recovery up to 6 weeks.Conclusions: Current evidence, though very limited and at high risk of bias, supports preferential use of corticosteroids for short-term symptom control and hyaluronic acid for medium- to long-term pain and functional improvement in adult lateral epicondylitis. Level of evidence II; Systematic review.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe1","pages":"e303257"},"PeriodicalIF":0.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EVIDENCE-BASED REVIEW & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: REVERSE VERSUS ANATOMIC TOTAL ARTHROPLASTY FOR THE TREATMENT OF PRIMARY GLENOHUMERAL OSTEOARTHRITIS WITH AN INTACT ROTATOR CUFF IN PATIENTS AGED 70 YEARS OR OLDER. 来自巴西肩肘外科学会的循证回顾和建议：70岁及以上患者肩关节袖完整的原发性盂肱骨关节炎的反向与解剖全关节置换术治疗。

IF 0.6 4区医学

Acta Ortopedica Brasileira Pub Date : 2026-08-31 eCollection Date: 2026-01-01 DOI: 10.1590/1413-785220263401e306296

Marcos Rassi Fernandes, Leonardo Zanesco, Joel Murachovsky, Guilherme Grisi Mouraria, Paulo Henrique Schmidt Lara, Paulo Santoro Belangero, João Felipe de Medeiros, Eduardo Angeli Malavolta

{"title":"EVIDENCE-BASED REVIEW & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: REVERSE VERSUS ANATOMIC TOTAL ARTHROPLASTY FOR THE TREATMENT OF PRIMARY GLENOHUMERAL OSTEOARTHRITIS WITH AN INTACT ROTATOR CUFF IN PATIENTS AGED 70 YEARS OR OLDER.","authors":"Marcos Rassi Fernandes, Leonardo Zanesco, Joel Murachovsky, Guilherme Grisi Mouraria, Paulo Henrique Schmidt Lara, Paulo Santoro Belangero, João Felipe de Medeiros, Eduardo Angeli Malavolta","doi":"10.1590/1413-785220263401e306296","DOIUrl":"10.1590/1413-785220263401e306296","url":null,"abstract":"Introduction: Anatomic total shoulder arthroplasty (ATSA) has long been indicated for the treatment of degenerative joint diseases in patients with an intact rotator cuff. However, age-related rotator cuff degeneration may negatively impact outcomes. Reverse total shoulder arthroplasty (RTSA), initially indicated for cuff tear arthropathy, has progressively expanded its indications, including elderly patients with an intact rotator cuff.Methods: A systematic review of the literature was conducted in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases up to November 2025, with the aim of comparing ATSA and RTSA regarding functional outcomes, complication rates, and the need for reoperation in patients aged 70 years or older with primary shoulder osteoarthritis and an intact rotator cuff.Results: Only one systematic review met the inclusion criteria, encompassing four observational studies, with a total of 2.731 arthroplasties. RTSA showed a lower reoperation rate compared with ATSA. Functional outcomes favored ATSA, although based on limited data. No statistically significant differences were observed between the techniques regarding complication rates. The overall quality of evidence was classified as very low.Conclusions: In patients aged 70 years or older with primary glenohumeral osteoarthritis and an intact rotator cuff, RTSA is associated with a lower revision rate, whereas ATSA demonstrates superior functional outcomes, with similar complication rates between the two techniques. Level of evidence II; Systematic review.","PeriodicalId":55563,"journal":{"name":"Acta Ortopedica Brasileira","volume":"34 spe1","pages":"e306296"},"PeriodicalIF":0.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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