ARNALDO AMADO FERREIRA NETO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Does a subscapularis tear combined with a posterosuperior rotator cuff tear affect postoperative functional outcomes?(2020) MALAVOLTA, Eduardo Angeli; CHANG, Veronica Yulin Prieto; MONTECHI, Joao Marcos Nunes; ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; ANDRADE-SILVA, Fernando Brandao; FERREIRA NETO, Arnaldo AmadoBackground: The subscapularis is biomechanically important for the shoulder. However, few studies have clinically assessed its importance using a comparative design. Our objective was to compare the functional outcomes in patients who underwent isolated repair of posterosuperior rotator cuff tears and those with repair of combined tears involving the subscapularis. Methods: We performed a retrospective cohort study evaluating patients who underwent arthroscopic full-thickness rotator cuff repair between January 2013 and May 2017. The patients were divided into 2 groups: isolated repair of posterosuperior tears and repair of combined tears involving the subscapularis. The primary outcome was to evaluate the American Shoulder and Elbow Surgeons (ASES) and University of California, Los Angeles (UCLA) scales at 24 months' follow-up. Result: A total of 326 patients were evaluated: 194 with isolated posterosuperior repairs and 132 with combined subscapularis repairs. Both groups showed significant improvement with the procedure (P <.001). The ASES score at 24 months showed no significant difference (P = .426) between the group without subscapularis repair (median, 90.0; interquartile range [IQR], 24.8) and the group with subscapularis repair (median, 86.3; IQR, 33.2). Similarly, the UCLA score showed no difference between the groups (median, 33.0 [IQR, 6.0] and 32.5 [IQR, 8.8], respectively; P =.190). The preoperative functional evaluation also showed no significant differences between the groups. Conclusion: The functional results did not differ between patients who underwent isolated repair of posterosuperior tears and those with repair of combined tears involving the subscapularis, according to the ASES and UCLA scales at 24 months.
- Rotator cuff repair in patients 50 years of age or younger: A comparative study of functional outcomes in relation to older patients(2023) ASSUNCAO, Jorge Henrique; SILVEIRA, Eric Curi; TAKAYANAGI, Oscar Makoto; SILVA, Fernando Brandao de Andrade e; MALAVOLTA, Eduardo Angeli; FERREIRA NETO, Arnaldo AmadoBackground: Few studies have evaluated the clinical results of surgical treatment of rotator cuff tears in young patients and most of the publications are only case series and with a small number of evaluated individuals. The aim of this study is to compare the clinical outcomes of patients undergoing arthroscopic rotator cuff repair according to age at the time of the procedure.Hypothesis: Patients with 50 years of age or younger undergoing surgical treatment of rotator cuff tear have similar clinical outcomes to older patients.Materials and methods: Retrospective cohort study comparing results obtained after surgical treatment of rotator cuff tears between patients aged 50 years or younger and the older patients by the ASES and UCLA functional scales. Patients undergoing arthroscopy full-thickness rotator cuff repair were included.Results: We evaluated 390 shoulders (377 patients), 94 aged 50 years or younger (median = 46.5 years) and 296 aged over 50 years (median = 60 years). Both groups significantly improved with the procedure after 24 months of follow-up, according to the ASES and UCLA scales (p < 0.001). The groups did not differ in the scores obtained in the preoperative assessments and at 24 months of follow-up. The score obtained on the ASES scale at 24 months of follow-up had a median of 87.2 (IQR = 38) among patients aged 50 years or younger and 90 points (IQR = 26.4) among older patients (p = 0.253). The scores obtained by the UCLA scale were 31 points (IQR = 9) and 33 points (IQR =7) respectively (p = 0.156).Discussion: Our results showed that, after 24 months, the functional results of arthroscopic full-thickness rotator cuff repair did not differ between patients younger than 50 years and older patients. These results are similar to those found by other authors. Both groups of patients achieved significant improvement after the surgical procedure, achieving approximately 90 points on the ASES scale and 32 points on the UCLA scale.(c) 2023 Elsevier Masson SAS. All rights reserved.
- Tomographic evaluation of Hill-Sachs lesions: is there a correlation between different methods of measurement?(2017) ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; BORGO, Gustavo Dias; MALAVOLTA, Eduardo Angeli; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo AmadoBackground Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill-Sachs (HS) lesions. Purpose To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements. Material and Methods We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane. Results Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation (r=0.83; P<0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate. Conclusion The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.
- MESENCHYMAL CELLS IN ROTATOR CUFF REPAIR -TECHNIQUE DESCRIPTION AND CASE REPORTS(2023) MALAVOLTA, Eduardo Angeli; MICELI, Vinicius Lamboglia; ASSUNCAO, Jorge Henrique; ANDRADE-SILVA, Fernando Brandao; GRACITELLI, Mauro Emilio Conforto; TATSUI, Nelson Hidekazu; ESPIRANDELLI, Luiz Cesar; NETO, Arnaldo Amado FerreiraObjective: To describe a protocol of obtention of mesenchymal stem cells and to report their use as a biological adjuvant in three patients undergoing arthroscopic rotator cuff repair. Methods: Case series of patients who underwent arthroscopic repair of isolated full-thickness supraspinatus tear using mesenchymal stem cells obtained from the bone marrow as a biological adjuvant. All patients were operated on at the same institution, by a surgeon with 13 years of experience. The cells were applied at the end of the procedure, at the tendon-bone interface, at an approximate concentration of 2,000,000 mesenchymal cells/mm3 and a total volume of 5 ml. Results: All patients improved with the procedure, with one excellent and two good results. All cases overcame the minimally important clinical difference. All cases reached tendon healing, without partial or complete re-tears. We observed no complications. Conclusion: Arthroscopic rotator cuff repair with added mesenchymal cells obtained from bone marrow and submitted to a cell expansion process led to good functional results and healing in all cases in the sample, with no complications. Level of Evidence IV, Case Series.
- ARTHROSCOPIC LATARJET PROCEDURE: SAFETY EVALUATION IN CADAVERS(2013) GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo Amado; BENEGAS, Eduardo; MALAVOLTA, Eduardo Angeli; SUNADA, Edwin Eiji; ASSUNCAO, Jorge HenriqueObjective: To evaluate the safety of arthroscopic Latarjet procedure in cadavers. Methods: Twelve cadaveric shoulders underwent arthroscopic Latarjet procedure in our laboratory for arthroscopy, by four different surgeons. Following surgery, the specimens were subjected to radiographic examination and evaluated by an independent examiner. Nineteen parameters were evaluated, including the coracoid graft fixation, positioning and angulation of the screws, neurological damage and integrity of tendons. Results: Four procedures were considered to be satisfactory, with no difference among the surgeons. The mean angulation of the screws was 27.2 degrees. The subscapularis splitting was, on average, 17.8mm from the upper edge. The coracoid graft was properly positioned relative to equator of the glenoid in 11 cases. There was no injury to the axillary or musculocutaneous nerves. The main complications were: interposition of soft tissue, suprascapular nerve injury, articular deviation of the graft, diastasis and conjoined tendon injury. Conclusion: The arthroscopic Latarjet procedure is a complex technique in which each step must be precise to reduce the risk of complications. Our study showed a high risk of failure of the procedure. Level of Evidence IV, Case Series.
- Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study(2020) RAMADAN, Lucas Busnardo; BAPTISTA, Eduardo; SOUZA, Felipe Ferreira de; GRACITELLI, Mauro Emilio Conforto; ASSUNCAO, Jorge Henrique; ANDRADE-SILVA, Fernando Brandao; FERREIRA-NETO, Arnaldo Amado; MALAVOLTA, Eduardo AngeliBACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.
- Platelet-Rich Plasma in Rotator Cuff Repair A Prospective Randomized Study(2014) MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo Amado; ASSUNCAO, Jorge Henrique; BORDALO-RODRIGUES, Marcelo; CAMARGO, Olavo Pires deBackground: Although platelet-rich plasma (PRP) has been used in rotator cuff repair, most authors have been unable to report the advantages of this method in clinical trials. Hypothesis: The use of PRP promotes better functional and structural results in arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective, randomized, double-blind study with 2 groups of 27 patients each (PRP group and control group). Complete supraspinatus tears with retraction of less than 3 cm were subjected to arthroscopic single-row repair; at the end of the surgical procedure, liquid PRP prepared by apheresis was given to the patients in the PRP group with autologous thrombin. The outcomes were assessed by the University of California at Los Angeles (UCLA) and Constant scales, visual analog scale (VAS) for pain, and magnetic resonance imaging (MRI) before and 3, 6, 12, and 24 months after surgery. The significance level was 5%. Results: The 2 groups of patients exhibited significant clinical improvement (P < .001). Between the preoperative assessment and 24-month follow-up, the mean UCLA score increased from 13.63 3.639 to 32.70 +/- 3.635 and from 13.93 +/- 4.649 to 32.44 +/- 4.318 in the control and PRP groups, respectively (P = .916). The mean Constant score increased from 47.37 +/- 11.088 to 85.15 +/- 9.879 in the control group and from 46.96 +/- 11.937 to 84.78 +/- 14.048 in the PRP group (P = .498). The mean VAS score varied from 7.00 +/- 1.939 and 6.67 +/- 1.617 before surgery to 1.15 +/- 1.916 and 0.96 +/- 2.244 at the 24-month assessment in the control and PRP groups, respectively (P = .418). The only difference was in the mean UCLA score at 12 months, with 30.04 +/- 4.528 in the control group and 32.30 +/- 3.506 in the PRP group (P = .046). The control group exhibited 1 case of a complete retear and 4 partial retears, and the PRP group exhibited 2 cases of partial retears (P = .42). Conclusion: Platelet-rich plasma prepared by apheresis and applied in the liquid state with thrombin did not promote better clinical results at 24-month follow-up. Given the numbers available for analysis, the retear rate also did not change.
- Accuracy of magnetic resonance imaging (MRI) for subscapularis tear: a systematic review and meta-analysis of diagnostic studies(2019) MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; YEN, Talitha Koo; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo AmadoIntroduction The accuracy of MRI for subscapularis tear is lower than that of overall rotator cuff tears. Until now, no systematic reviews and meta-analysis have been conducted to compile these data. The purpose of this study was to determine, through a systematic review and meta-analysis, the diagnostic accuracy of MRI in the detection of subscapularis tendon tears. Materials and methods A systematic review of PubMed, EMBASE, and MEDLINE databases up to April 2017 was performed. All studies assessing the sensitivity and specificity of the MRI (index test) compared to arthroscopic surgical findings (reference test) for subscapularis tendon tear were included. A meta-analysis was performed to calculate pooled sensitivity, specificity, sROC curve, and diagnostic odds ratio values. Results A total of 497 citations were identified. After applying the eligibility criteria, 14 articles were included, including 1858 shoulders with 613 subscapularis tears. For overall subscapularis tears, sensitivity was 0.68 (95% CI 0.64-0.72) and specificity was 0.90 (95% CI 0.89-0.92). Sensitivity was 0.93 (95% CI 0.83-0.98) for full-thickness tears and 0.74 (95% CI 0.66-0.82) for partial tears. Specificity was 0.97 (95% CI 0.94-0.98) for full-thickness tears and 0.88 (95% CI 0.85-0.91) for partial tears. Analyzing only studies with field of strength1.5T, sensitivity was 0.80 (95% CI 0.76-0.84) and specificity 0.84 (95% CI 0.81-0.87). Conclusion MRI is an accurate method for diagnosing subscapularis tendon tears; however, its accuracy is lower than that of overall rotator cuff tears, due to its lower sensitivity.
- PROGNOSTIC FACTORS FOR CLINICAL OUTCOMES AFTER ROTATOR CUFF REPAIR(2015) PECORA, Jose Otavio Reggi; MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; MARTINS, Joao Paulo Sobreiro; FERREIRA NETO, Arnaldo AmadoObjective: To identify prognostic factors of postoperative functional outcomes. Methods: Retrospective case series evaluating patients undergoing rotator cuff repair, analyzed by the UCLA score (pre and 12-month postoperative) and Magnetic Resonance Imaging (preoperative). Patients' intrinsic variables related to the injury and intervention were evaluated. Multivariate linear regression analysis was performed to determine variables impact on postoperative functional assessment. Results: 131 patients were included. The mean UCLA score increased from 13.17 +/- 3.77 to 28.73 +/- 6.09 (p < 0,001). We obtained 65.7% of good and excellent results. Age (r = 0.232, p = 0.004) and reparability of posterosuperior injuries (r = 0.151, p = 0.043) correlated with the functional assessment at 12 months. After multivariate linear regression analysis, only age was associated (p = 0.008). Conclusions: The surgical treatment of rotator cuff tears lead to good and excellent results in 65.6% of patients. Age was an independent predictor factor with better clinical outcomes by UCLA score in older patients.
- No Clinical or Radiographic Difference Seen in Arthroscopic Bankart Repair With Knotted Versus Knotless Suture Anchors: A Randomized Controlled Trial at Short-Term Follow-Up(2022) LOBO, Frederico Lafraia; GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; LEAO, Renata Vidal; SILVA, Fernando Brandao de Andrade e; ASSUNCAO, Jorge Henrique; NETO, Arnaldo Amado FerreiraPurpose: The objective of this study was to compare the clinical and radiographic results of patients undergoing arthroscopic repair of labral lesions using knotted and knotless anchors. Methods: Sixty-four patients with anterior labral lesions (bone defects of the glenoid up to 13.5% or up to 20% if the instability severity index score was less than 4) and without other shoulder pathologies were randomly assigned to 2 groups, with 32 patients in each group. Clinical outcomes were assessed 6, 12, and 24 months after surgery by the Rowe score, Western Ontario shoulder instability index (WOSI), single assessment numeric evaluation (SANE), visual analog scale for pain (VASp), range of motion, and rate of post-operative recurrence. Postoperative magnetic resonance imaging (MRI) was performed, and the anterior and inferior labrum glenoid height indexes and anterior and inferior labral slopes were measured. The primary endpoint was the Rowe score at 24 months postoperatively. Results: Fifty-one patients, 24 in the knotted group and 27 in the knotless group, completed 24 months of follow-up. At 24 months, the Rowe scores were 81.7 +/- 19.9 points and 85.9 +/- 14 points, respectively (P = .623); the WOSI scores were 509.2 +/- 480.1 points and 555.9 +/- 393.6 points, respectively (P = .533); the SANE scores were 90.7 +/- 18.7 points and 89.2 +/- 14.8 points, respectively (P = .427); and the VASp scores were 1.7 +/- 2.5 points and 2.5 +/- 2.7 points, respectively (P = .275). There was no significant difference in range of motion, postoperative recurrence, or MRI parameters between the groups. All subjects (100%) in both groups exceeded the minimal clinically important difference of 9.7 for the Rowe score (P > .999). Conclusion: Repair of Bankart's lesion through the use of knotted and knotless suture anchors yielded similar clinical and radiographic results on analysis at 24 months after operation.