➢ Argentine orthopaedics was shaped by the influence of Dr. Vittorio Putti (Rizzoli Institute, Bologna, Italy). Dr. Carlos E. Ottolenghi, one of Dr. Putti's most distinguished disciples, together with Dr. José Valls, founded the Instituto de Ortopedia y Traumatología at Hospital Italiano de Buenos Aires in 1926. Prof. Ottolenghi transformed the Orthopaedic Service into a leading academic center and pioneer of subspecialization, serving as a foundational driver of orthopaedic development in Argentina and Latin America, while establishing strong international academic connections and collaborations.➢ Major milestones include the establishment of one of the earliest institutional bone banks and the performance of one of the world's first reported massive bone allograft reconstructions (1948); the performance of the first Charnley total hip replacement in the Americas (1967) and the first total knee replacement in Argentina (1970); and the early adoption of intramedullary nailing (1972), knee arthroscopy (1976), and femoral bone impaction allografting (1987). These contributions helped to define modern orthopaedic practice across Latin America and influenced global reconstructive strategies.➢ Advances such as surgical navigation (2010) and augmented reality (2025) have strengthened its role as a regional and globally connected center of excellence, particularly in musculoskeletal oncology.➢ Over the past 25 years, 180 residents and 160 fellows have been trained in our institute, and more than 500 indexed publications have been produced in the last 10 years, with alumni holding leadership roles across major orthopaedic centers worldwide, amplifying our institute's global footprint.➢ A merit-based, highly selective system based on excellence determines who becomes a staff surgeon. Currently, 85% of the actual staff surgeons completed residency training in our department, fostering a unique sense of institutional identity and perceived belonging. This experience reinforces the concept that excellence in orthopaedics transcends geographic boundaries and can emerge as a global reference from any setting committed to innovation, mentorship, and academic rigor.
To report a series of 9 cases of patients with benign cavitary tumor lesions who underwent intralesional resection (curettage) followed by cavity filling with 45S5 bioactive glass (Aktibone). This is a therapeutic case series study with level IV evidence. Patients diagnosed with benign lytic bone lesions who had a surgical indication for curettage followed by cavity filling with bioactive glass were included. In the postoperative period, patients underwent imaging examinations, which were qualitatively evaluated by a radiologist who determined the radiological diagnosis and the quality of osseointegration. The presence of imaging abnormalities was also assessed, and statistical analysis was performed. Nine patients were included, 7 males and 2 females. The mean age was 25.8 years. The initial diagnoses varied, with enchondromas being the most frequent. The mean follow-up time after surgery was 8.4 months. All patients underwent preoperative radiographs. Most patients showed good clinical progression and good to partial osseointegration. The results reinforce that 45S5 bioactive glass demonstrates good performance as a bone substitute in benign lytic lesions, providing adequate osseointegration and a low complication rate. Level of Evidence IV; Case series. Relatar uma série de 9 casos de pacientes com lesões tumorais cavitárias benignas submetidos a ressecção intralesional (curetagem) e posterior preenchimento com biovidro 45S5 (Aktibone). É um estudo terapêutico do tipo série de casos com nível de evidência IV. Foram incluídos pacientes com diagnóstico de lesão óssea lítica benigna e que tinham indicação cirúrgica de curetagem da lesão e posterior preenchimento da cavidade com o biovidro. No pós-operatório, os pacientes realizaram exames de imagem que foram avaliados de forma qualitativa por um médico radiologista que definiu o diagnóstico radiológico e a qualidade da osseointegração. Também foi observada a presença de anormalidades na imagem e foi realizada análise estatística. Foram incluídos 9 pacientes, sendo 7 homens e 2 mulheres. A média de idade foi 25,8 anos. Os diagnósticos iniciais foram variados, com predominância de encondromas. O tempo de acompanhamento pelo serviço após a realização da cirurgia teve média de 8,4 meses. Todos os pacientes realizaram RX pré-operatório. A maioria dos pacientes tiveram boa evolução e osteointegração boa e parcial. Os resultados obtidos reforçam que o biovidro 45S5 apresenta bom desempenho como substituto ósseo em lesões líticas benignas, proporcionando adequada osteointegração e baixo índice de complicações. Nível de Evidência IV; Série de casos.
Radial tears of the lateral meniscus have limited healing potential and unfavorable biomechanics, and current suture constructs that use capsular rip-stop stitches may increase meniscal extrusion and constrain native motion. This technical note describes an all-inside, crossed, meniscus-based repair for complete or near-complete radial tears of the lateral midbody using a percutaneous needle. Key steps, indications, and rehabilitation are detailed. This construct aims to balance stability with preservation of meniscal mobility and vascularity; prospective clinical studies are required to confirm its long-term efficacy.
Instruments with evidence of validity and supported by theories are necessary for nurses to perform a systematic and accurate assessment that enables clinical reasoning and assertive decision-making, especially when it comes to the process of adapting a person to traumatic spinal cord injury. To perform content validation of the instrument "Guidelines for nursing assessment of the adaptation process of individuals with traumatic spinal cord injury". This is a methodological study, a content validation study. The sample of expert judges was a non-probabilistic snowball sampling method, composed of 12 specialists from the clinical and academic fields of orthopedics, traumatology, and rehabilitation. Data collection was conducted using an online questionnaire via Google Forms®. When analyzing the I-CVI of each item in the instrument, we observed that all were equal to or greater than 0.83, demonstrating that all items reached the adopted cutoff point. Furthermore, there is a sufficiently elevated level of favorable agreement to support the content validity of each criterion and category of the evaluated instrument. The instrument has evidence of content validity according to item, category, and domain regarding comprehensiveness, clarity/appropriate language, pertinence, and relevance.
Lateral condyle fractures of the humerus are the second most common elbow fracture in children. Both Kirschner wires (K-wires) and cannulated screws are widely used for fixation, but the optimal technique remains debated. This study aimed to compare these methods in terms of functional outcomes and complications. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Thirteen comparative studies involving 1,230 pediatric patients were included. Outcomes were analyzed using random-effects models, with risk ratios (RRs) and 95% confidence intervals (CIs). Meta-regression and prediction intervals (PIs) were applied to explore heterogeneity. Screw fixation significantly reduced the risk of postoperative infection (RR = 0.27; 95% CI: 0.12-0.60) and was associated with better functional outcomes (RR = 1.09; 95% CI: 1.01-1.18). No significant differences were observed in overall complications (RR = 0.89; 95% CI: 0.66-1.20), lateral overgrowth, range of motion limitation, or nonunion. Meta-regression did not identify age or fracture severity as effect modifiers. Cannulated screw fixation may be preferable for reducing infection and improving outcomes, but individualized clinical decisions and further high-quality research remain essential. Level of Evidence III; Systematic Review. A fratura do côndilo lateral do úmero é a segunda mais comum do cotovelo da criança. Os fios de Kirschner e os parafusos canulados são amplamente utilizados para sua fixação, mas o dispositivo ideal ainda é discutível. Este estudo teve como objetivo comparar esses métodos considerando os resultados funcionais e as complicações. Foi realizada uma revisão sistemática e uma metanálise, seguindo as diretrizes PRISMA. Treze estudos comparativos envolvendo 1.230 pacientes pediátricos foram incluídos. Os resultados foram analisados usando modelos de efeitos aleatórios, com razões de risco (RRs) e intervalos de confiança (ICs) de 95%. Meta-regressão e intervalos de predição (PIs) foram aplicados para explorar a heterogeneidade. A fixação com parafuso reduziu significativamente o risco de infecção pós-operatória (RR = 0,27; IC 95%: 0,12–0,60) e foi associada a melhores resultados funcionais (RR = 1,09; IC 95%: 1,01–1,18). Nenhuma diferença significativa foi observada considerando: complicações gerais (RR = 0,89; IC 95%: 0,66–1,20), supercrescimento lateral, limitação da amplitude de movimento ou não-união. A meta-regressão não identificou idade ou gravidade da fratura como modificadores de efeito. A fixação com parafuso canulado é preferencial para reduzir infecções e melhorar os resultados, mas decisões clínicas individualizadas e pesquisas futuras de alta qualidade continuam sendo essenciais. Nível de Evidência III; Revisão Sistemática.
To evaluate the influence of sagittal femoral morphology on robotic planning parameters and intraoperative soft-tissue balance in robotic-assisted total knee arthroplasty (TKA). It was hypothesised that sagittal femoral morphology has limited impact on intraoperative planning and laxity. This retrospective study analysed a prospectively maintained database of patients undergoing primary robotic-assisted TKA between January 2021 and November 2022. Preoperative radiographic parameters included mechanical hip-knee-ankle angle (mHKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and posterior tibial slope (PTS). Sagittal femoral morphology was assessed using anterior femoral offset (AFO), posterior femoral offset (PFO) and anteroposterior femoral size (AP size). Intraoperative robotic data included femoral resections, femoral flexion, rotation referenced to the posterior condylar axis (PCA) and transepicondylar axis (TEA) and medial-lateral laxity in extension and flexion. Associations between sagittal morphology, planning parameters and soft-tissue balance were analysed using linear and logistic regression models. A total of 212 patients were included. No meaningful associations were found between sagittal femoral morphology and robotic planning parameters, including femoral flexion, distal and posterior resections or femoral rotation (coefficient of determination R2 ≈ 0). Similarly, sagittal morphology was not associated with medial-lateral laxity imbalance in extension or flexion, either at the initial or final assessment (all p > 0.05). Sagittal femoral morphology does not significantly influence robotic planning or intraoperative soft-tissue balance in robotic-assisted TKA. These findings suggest that sagittal anatomy alone is not a primary determinant of surgical planning or gap behaviour, supporting the need for a comprehensive, patient-specific and multiplanar approach. Level III.
Metacarpal fractures have an incidence of 8.4 per 10,000 people/year, representing 18-44% of hand fractures, and are more common in men. Various techniques have been described, such as fixation with Kirschner wires, locking plates, and intramedullary screws. The purpose of this review is to compare the functional outcomes reported in the literature. A scoping review (PRISMA) was conducted, based on the PICO question: "What are the functional outcomes in patients with metacarpal fractures fixed with plates versus intramedullary screws?". Five retrospective studies, one prospective study, two systematic literature reviews, and one meta-analysis were analysed. Kirschner wire fixation is inexpensive and readily available, requires prolonged postoperative immobilisation, and is associated with a high rate of infection. The plate and screws provide the most stable fixation, require extensive soft tissue dissection, and are associated with stiffness, extensor adhesions, and infection. Screw fixation maintains reduction and prevents rotational instability, allowing for early mobilisation. Joint damage does not exceed 8% of the articular surface. A total of 1873 patients were included (295 women and 1578 men), with a mean age of 32years. The fifth metacarpal was the most frequently fractured, and the most common fracture locations were the neck (44.66%), the shaft (38.55%), and the head (10.68%). Regarding functionality, Barrera-Ochoa, DelPrete, and Fatima reported lower QuickDASH scores for intramedullary screw fixation compared to plate fixation (8.62 vs. 4.55). Grip strength was also superior with screws (90.3% for plates, 104.4% for screws). Esteban-Feliu and Barrera report an earlier return to activity, shorter surgical time, less pain, and a lower rate of implant removal procedures in the intramedullary screw group. The authors conclude that intramedullary screw fixation is a safe, effective, and minimally invasive technique with satisfactory clinical results and minimal complications, offering significant functional advantages over plate fixation.
To translate and culturally adapt the Unité Rhumatologique des Affections de la Main (URAM) scale, a specific instrument for functional assessment in Dupuytren's disease (DD), into Brazilian Portuguese. Following the methodology of Beaton (2000), the scale underwent five stages: translation, synthesis, back-translation, expert committee, and pre-testing. After adaptation, the Brazilian version of the scale (URAM-BR) was administered to 40 patients with Dupuytren's contracture. Internal consistency was tested using Cronbach's alpha, reproducibility was analyzed using the intraclass correlation coefficient (ICC), and construct validity was analyzed by correlation with the Brazilian version of QuickDASH. The URAM-BR showed excellent internal consistency (α = 0.930-0.938), significant reproducibility (ICC > 0.89), and moderate-to-strong construct validity (r = 0.69, p < 0.001). The adapted version proved to be clear, reliable, and appropriate to the Brazilian cultural context. The URAM-BR is a valid, reliable, and reproducible instrument for functional assessment of patients with DD in Brazil. Level of evidence IV; Observational cross-sectional instrument validation study. Traduzir e adaptar culturalmente para o português do Brasil a escala Unité Rhumatologique des Affections de la Main (URAM), instrumento específico para avaliação funcional na Doença de Dupuytren (DD). Seguindo a metodologia de Beaton (2000), a escala passou por cinco etapas: tradução, síntese, retrotradução, comitê de especialistas e pré-teste. Após a adaptação, a versão brasileira da escala (URAM-BR) foi aplicada em 40 pacientes com contratura de Dupuytren. A consistência interna foi testada pelo alfa de Cronbach, a reprodutibilidade foi analisada pelo Coeficiente de Correlação Intraclasse (ICC), e a validade de construto pela correlação com a versão brasileira da QuickDASH. O URAM-BR apresentou excelente consistência interna (α = 0,930–0,938), reprodutibilidade significativa (ICC > 0,89) e validade de construto moderada-forte (r = 0,69, p < 0,001). A versão adaptada demonstrou ser clara, confiável e adequada ao contexto cultural brasileiro. O URAM-BR é um instrumento válido, confiável e reprodutível para avaliação funcional de pacientes com DD no Brasil. Nível de evidência IV; estudo observacional transversal de validação de instrumento.
Injuries to the posterolateral corner (PLC) of the knee represent a complex clinical entity that is frequently underdiagnosed and undertreated, often leading to persistent instability and failure of concomitant ligament reconstructions. Although open surgical approaches to the PLC have been extensively described, the role of arthroscopy in the diagnosis and management of these injuries remains less clearly defined despite increasingly encouraging clinical and biomechanical results. The aim of this narrative review was to analyze the role of knee arthroscopy in the diagnosis, evaluation, and treatment of PLC injuries. A comprehensive literature review was performed focusing on studies investigating arthroscopic findings, diagnostic signs, and arthroscopic or arthroscopy-assisted techniques for PLC management. Relevant clinical, anatomical, biomechanical, and surgical studies were analyzed to provide an integrated arthroscopy-oriented perspective. Arthroscopy enables direct visualization of key posterolateral structures and identification of characteristic diagnostic findings, such as the lateral drive-through sign, potentially improving detection of subtle or combined PLC injuries. In addition, arthroscopic assessment facilitates evaluation of associated intra-articular lesions and may contribute to more accurate characterization of injury patterns. Emerging arthroscopic and arthroscopy-assisted reconstruction techniques may offer advantages in selected cases by supporting tailored surgical strategies, accurate graft positioning, and reduced surgical morbidity. Knee arthroscopy is assuming an increasingly important role in the comprehensive management of PLC injuries, extending beyond the treatment of associated intra-articular pathology alone. Integration of arthroscopy into the diagnostic and therapeutic algorithm of PLC injuries may improve surgical decision-making and patient-specific management. Nevertheless, further high-quality clinical studies are required to establish standardized arthroscopic criteria and validate the long-term clinical advantages of arthroscopy-guided approaches.
This technical note describes a knotless trans-tendon proximal-pulley repair with distal suture-bridge fixation and bioinductive collagen patch augmentation for high-grade partial gluteus medius and minimus tears. The technique preserves intact tendon fibers, restores broad footprint compression, and supports biologic healing through a resorbable collagen scaffold. Detailed steps emphasize anatomic anchor placement, controlled tensioning, and efficient suture management to improve construct reliability. This combined mechanical and biologic augmentation offers a promising option for enhancing tendon healing and optimizing outcomes in patients with degenerative high-grade partial-thickness abductor tears.
The release of a pneumatic tourniquet during total knee arthroplasty (TKA) causes an abrupt increase in blood flow to the lower limb, which may result in transient haemodynamic instability. The aim of this study was to quantify the magnitude and duration of these changes in a real-world clinical setting. A multicentre retrospective observational study was conducted including 149 patients undergoing primary TKA under pneumatic tourniquet ischemia. Systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) were recorded at three time points: baseline (pre-release), 3 minutes (T3), and 6 minutes (T6) after tourniquet release. Statistical analysis was performed using repeated-measures ANOVA or the Friedman test, according to data distribution, with p < 0.05 considered statistically significant. Following tourniquet release, a significant immediate decrease in SBP and DBP was observed (p < 0.001), with mean reductions of 19.8% and 21.2%, respectively, at T3. HR showed a mild but significant increase (p = 0.012). SpO2 decreased slightly (p = 0.034) without clinical relevance. Transient arrhythmias were recorded in 8.7% of patients. At 6 minutes post-release, all parameters returned to baseline values. Tourniquet release during TKA is associated with transient haemodynamic changes and early recovery. These findings support the need for reinforced monitoring in patients classified as ASA III and/or with ischemia times longer than 85 minutes, and provide a rationale for future prospective studies incorporating advanced haemodynamic monitoring. Level of evidence Level III, retrospective study.
Spinal cord compression is a neurological condition caused by pressure on the spinal cord, with etiologies including degenerative, neoplastic, infectious, traumatic, and malformative causes. It primarily affects the elderly, with symptoms ranging from pain and sensory-motor deficits to paralysis. The diagnosis is based on clinical evaluation and magnetic resonance imaging. Surgical treatment includes traditional open decompression and the endoscopic technique, the latter involving less trauma and quicker recovery. To review and compare the outcomes of spinal cord decompression via open and endoscopic approaches. A search in the PUBMED database with the strategy: (decompre*[title] OR lamin*[title] OR discec*[title] OR micro*[title]) AND ((endosc*[title] OR minima*[title] OR percut*[title]) AND (open*[title] OR traditional[title])), with a 10-year time frame. 22 studies were identified; after reviewing titles and abstracts, 11 were excluded, leaving 11 articles that formed the sample. Minimally invasive techniques showed clinical efficacy comparable to open approaches in the treatment of lumbar disc herniation and lumbar spinal stenosis, with advantages in perioperative parameters. Variations in outcomes related to pain, function, complications, and reoperations suggest that the choice of technique should be individualized, considering the clinical presentation, the complexity of the lesion, and surgical expertise. Level of evidence II; review article. A compressão medular é uma condição neurológica causada por pressão sobre a medula espinhal, com etiologias degenerativas, neoplásicas, infecciosas, traumáticas e malformativas. Afeta principalmente idosos, com sintomas variando de dor e déficit sensitivo-motor a paralisia. O diagnóstico baseia-se na avaliação clínica e na ressonância magnética. O tratamento cirúrgico inclui a descompressão aberta tradicional e a técnica endoscópica, esta com menor trauma e recuperação mais rápida. Revisar e comparar os desfechos da descompressão medular por via aberta e endoscópica. Pesquisa na base PUBMED com a estratégia: (decompre*[title] OR lamin*[title] OR discec*[title] OR micro*[title]) AND ((endosc*[title] OR minima*[title] OR percut*[title]) AND (open*[title] OR traditional[title])), com corte temporal de 10 anos. Foram identificados 22 estudos; após leitura de títulos e resumos, 11 foram excluídos, restando 11 artigos que compuseram a amostra. As técnicas minimamente invasivas apresentaram eficácia clínica comparável às abordagens abertas no tratamento da hérnia de disco lombar e da estenose espinhal lombar, com vantagens em parâmetros perioperatórios. Variações nos desfechos de dor, função, complicações e reoperações sugerem que a escolha técnica deve ser individualizada, considerando o quadro clínico, a complexidade da lesão e a expertise cirúrgica. Nível de evidência II; artigo de revisão.
Anterior cruciate ligament revision (ACLRev) remains a complex and demanding procedure. Although an increasing number of studies identified factors associated with graft failure and revision outcomes, clear and practical guidelines are still limited. To address these gaps, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy developed a consensus aimed at standardizing indications for ACLRev. Although this initiative provided important guidance, some questions remain unresolved, such as the optimal graft choice and the management of associated procedures. The aim of this review is to provide an updated overview of current literature regarding preoperative planning, surgical techniques and ACLRev management. ACLRev is currently indicated after previous anterior cruciate ligament reconstruction resulting in knee instability, particularly in younger patients with high-functional demands. ACLRev may be performed as a one- or two-stage procedure. A two-stage approach is appropriate in case of infection, arthrofibrosis or insufficient bone stock that precludes secure and anatomical graft fixation. Autografts are generally preferred, particularly in young active patients, due to lower reported failure rates. Increasing attention has been directed to treatment of associated pathologies, such as ramp and root lesions, associated ligamentous instabilities (medial and lateral) or bony malalignment. Additional extraarticular anterolateral procedures are frequently used to reduce failure rates and improve rotational stability. Conversely, the role of slope-reducing osteotomies in ACLRev remains less defined, with good outcomes reported in small case series. Despite the growing body of clinical research, several issues remain unresolved, including the optimal individualized graft selection and indications for combined procedures. This manuscript summarizes the most recent evidence on ACLRev management, with emphasis on graft selection, indications for extraarticular anterolateral procedures, management of medial instability and principles of slope correction. Future high-level studies are needed, particularly addressing peripheral soft-tissue management and osseous corrections, to establish guidelines and enhance clinical outcomes for patients undergoing ACLRev. LEVEL OF EVIDENCE: Level V, expert opinion.
Osteochondral lesions of the talus are a frequent cause of ankle pain and functional limitation, particularly in physically active patients. The purpose of this prospective study was to assess patient-reported outcomes, return to sport and work and safety after second-generation patient-specific focal talar resurfacing in patients with symptomatic talar osteochondral lesions. Between October 2021 and July 2023, 40 patients were screened and 20 underwent implantation of a customized focal talar resurfacing implant. Outcomes were collected preoperatively and at 3, 6, 12 and 24 months using the Foot and Ankle Outcome Score (FAOS), visual analogue scale pain at rest and during activity and the EuroQol 5-dimension 5-level questionnaire. Time to return to sport and work and adverse events (complications, reoperations and treatment failures) were recorded. Changes over time were assessed with repeated-measures analysis of variance. Best-case and worst-case sensitivity analyses explored the impact of incomplete 24-month follow-up on treatment-failure estimates. Seventeen patients completed the 24-month follow-up. The mean FAOS total increased from 58.6 ± 16.6 preoperatively to 97.3 ± 4.9 at 24 months. Pain improved from 4.3 ± 2.7 to 0.0 ± 0.0 at rest and from 6.8 ± 1.7 to 0.1 ± 0.3 during activity. Seventeen of 20 patients returned to sport at a mean of 5.1 ± 3.2 months, and mean time to return to work was 4.2 ± 3.0 months. Three complications occurred, including one treatment failure requiring revision surgery. The observed treatment-failure rate was 1/20 (5%). Patient-specific talar resurfacing was associated with sustained improvements in pain, function and quality of life at 24 months, with high rates of return to sport and work. Larger studies with longer follow-up are needed to confirm durability and refine patient selection. Level II.
AI is increasingly used for medical education and assessment, yet effectiveness on specialized exams remains underexplored. We aim to compare multiple AI models with national human averages on SBCOC entrance exams (2021-2023), evaluate answer accuracy and citation reliability, and contrast models. Five models-ChatGPT-4 (standard and literature-trained), ChatGPT-o1-pro, Gemini, and Meta Llama 3.1-answered official SBCOC exams (50 items/year) individually using a unified prompt and identical images. Each response included one choice (A-D) and a cited source. Outcomes were accuracy and source reliability (peer-reviewed articles/textbooks versus websites). Statistics used chi-square tests and one-way ANOVA with Tukey post-hoc (p<0.05). Across 150 questions, ChatGPT-o1-pro led (66%, 62%, 68%) and exceeded human national averages each year (p<0.05). Gemini (40%, 28%, 38%) and Meta Llama 3.1 (32%, 44%, 50%) underperformed relative to humans, while both ChatGPT-4 versions hovered near the ≥50% pass threshold without significant differences. Regarding sources, ChatGPT-o1-pro and Llama predominantly cited articles or books, ChatGPT-4 alternated between literature and websites, and Gemini did not specify references. ChatGPT-o1-pro outperformed the national human average and mostly used credible sources; ChatGPT-4 matched humans, while Gemini and Meta Llama 3.1 lagged. Level of evidence IV; Case series. A IA é cada vez mais usada na educação e avaliação médicas, mas sua efetividade em exames especializados permanece pouco explorada. O objetivo foi comparar modelos de IA às médias humanas nos exames de ingresso da SBCOC (2021–2023), avaliar acurácia e confiabilidade das citações e contrastar modelos. Cinco modelos—ChatGPT-4 (padrão e treinado com literatura), ChatGPT-o1-pro, Gemini e Meta Llama 3.1—responderam às provas da SBCOC (50 itens/ano) individualmente, com prompt unificado e imagens idênticas. Cada resposta continha uma alternativa (A–D) e uma fonte. acurácia e confiabilidade das fontes (artigos/livros vs. sites). Estatística: qui-quadrado e ANOVA de uma via com pós-teste de Tukey (p<0,05). Em 150 questões, o ChatGPT-o1-pro liderou (66%, 62%, 68%) e superou médias humanas em todos os anos (p<0,05). Gemini (40%, 28%, 38%) e Meta Llama 3.1 (32%, 44%, 50%) abaixo dos humanos; ambas as versões do ChatGPT-4 próximas ao limiar de aprovação ≥50%, sem diferenças significativas. Quanto às fontes, ChatGPT-o1-pro e Llama citaram predominantemente artigos/livros; o ChatGPT-4 alternou entre literatura e sites; Gemini não especificou referências. O ChatGPT-o1-pro superou a média humana e usou majoritariamente fontes confiáveis; o ChatGPT-4 igualou os humanos; Gemini e Meta Llama 3.1 ficaram aquém. Nível de evidência IV; série de casos.
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The addition of a lateral extra-articular reinforcement to anterior cruciate ligament reconstruction has been shown to enhance rotational stability and protect the intra-articular graft. Although several techniques using the iliotibial band have been described, most rely on fixation devices that increase surgical cost and complexity. This Technical Note describes a low-cost, reproducible technique for combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis using the iliotibial band, with femoral press-fit fixation for both grafts. This approach eliminates the need for fixation hardware, simplifies the procedure, and may facilitate its adoption in a wide range of surgical settings worldwide.
Pheochromocytomasand paragangliomas (PPGLs) are rare catecholamine-secreting tumors that can affect systemic physiology, including bone metabolism. Although they are typically associated with genetic syndromes such as MEN2 and von Hippel-Lindau disease, PPGLs are not commonly linked to primary bone tumors. However, recent findings suggest a novel cancer syndrome involving both PPGLs and giant cell tumor of bone (GCTB) through H3F3A mutations. We report a rare case of a 53-year-old woman with multicentric GCTB, initially diagnosed at age 24, who subsequently developed bilateral pheochromocytomas. Following multiple recurrences of skeletal tumors and eventual leg amputation, imaging and biochemical evaluation revealed bilateral adrenal tumors with markedly elevated catecholamine levels. Genetic analysis identified mosaicism for a pathogenic H3F3A (G35W) variant in both adrenal and bone tumors. Surgical resection of both adrenal glands normalized catecholamine levels and resolved hypertension. The patient has remained tumor-free and normotensive for five years following adrenalectomy. This case supports the existence of a shared pathogenic mechanism linking PPGLs and GCTBs, likely mediated by postzygotic H3F3A mutations. Recognition of this association is crucial for early diagnosis, genetic counseling, and management of similar cases.
The rectus femoris tendon is a valuable alternative to hamstring and patellar tendon autografts, providing a long, robust, and consistently sized graft with low donor-site morbidity. With the patient supine and the knee flexed, a vertical incision is made over the lateral third of the quadriceps tendon, approximately 3 cm proximal to the patella. After longitudinal opening of the quadriceps fascia, the rectus femoris tendon is identified and carefully separated from the vastus lateralis, preserving a small rim for closure. Before tendon release and graft extraction, an arthroscope (30°) is introduced to enhance visualization of adjacent structures, confirm the tendon trajectory, and optimize the dissection plane, improving precision and reducing the risk of inadvertent capsular violation, traumatic arthrotomy and graft amputation during harvest. A 10-mm full-thickness tendon strip is harvested above the vastus intermedius, released distally to the superior pole of the patella, and retrieved proximally using a closed tendon stripper to obtain a 27- to 33-cm graft. The final arthroscope inspection confirms integrity of the remaining quadriceps tendon components and excludes iatrogenic arthrotomy. This technique provides reliable graft dimensions while preserving extensor mechanism function and is suitable for isolated anterior cruciate ligament reconstruction as well as multiligament knee reconstruction procedures.
To evaluate the evolution of surgical outcomes in patients undergoing surgery for spinal metastases from solid tumors over more than two decades in a single tertiary referral center. The present retrospective comparative study included 2 cohorts of patients who underwent surgical treatment for spinal metastases: cohort 1 (2002-2015) and cohort 2 (2018-2024). Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Major postoperative complications (grades III-IV) were analyzed per patient and compared between cohorts. A total of 301 patients were included (175 in cohort 1 and 126 in cohort 2). The more recent cohort demonstrated significantly improved overall survival (log-rank p  < 0.001), with a hazard ratio for mortality of 0.61 (95%CI: 0.48-0.78) compared with the earlier cohort. Early survival at 30 and 90 days also improved in cohort 2. Overall complication rates were similar between groups; however, cohort 2 showed a significant reduction in local complications. Surgical outcomes for spinal metastases improved over time, particularly in early survival and the reduction of local complications. These findings suggest that refinement in patient selection, prognostic stratification, and multidisciplinary perioperative care may have contributed to this temporal improvement. Avaliar a evolução dos desfechos cirúrgicos em pacientes submetidos à cirurgia para metástases vertebrais de tumores sólidos ao longo de mais de duas décadas em um único serviço terciário. Estudo retrospectivo comparativo envolvendo 2 coortes de pacientes submetidos a tratamento cirúrgico para metástases vertebrais: coorte 1 (2002–2015) e coorte 2 (2018–2024). A sobrevida global foi estimada pelo método de Kaplan-Meier e comparada pelo teste log-rank. Complicações maiores pós-operatórias (graus III–IV) foram analisadas por paciente e comparadas entre as coortes. Foram incluídos 301 pacientes (175 na coorte 1 e 126 na coorte 2). A coorte mais recente apresentou aumento significativo da sobrevida global (log-rank p  < 0,001), com razão de risco para mortalidade de 0,61 (IC95%: 0,48–0,78) em relação à coorte anterior. Observou-se também melhora da sobrevida precoce nos marcos de 30 e 90 dias. A incidência global de complicações foi semelhante entre os grupos, porém houve redução significativa das complicações locais na coorte 2. Os desfechos cirúrgicos das metástases vertebrais demonstraram melhora ao longo do tempo, especialmente em relação à sobrevida precoce e à redução das complicações locais. Esses achados sugerem que o refinamento da seleção de pacientes, da estratificação prognóstica e do cuidado perioperatório multidisciplinar pode ter contribuído para essa evolução.