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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- 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.
article 1 Citação(ões) na Scopus ANTERIOR INSTABILITY OF THE SHOULDER. RETROSPECTIVE STUDY ON 159 CASES(2011) FERREIRA NETO, Arnaldo Amado; CAMANHO, Gilberto Luis; FELIX, Alessandro Monterroso; BENEGAS, Eduardo; BITAR, Alexandre Carneiro; RAMADAN, Lucas Busnardo; MALAVOLTA, Eduardo AngeliObjective: To analyze the results of 159 patients with anterior instability of the shoulder submitted to arthroscopic treatment from January 2001 to December 2005. Methods: Retrospective study of complete patient records. Results: In 108 patients the Bankart lesion was found, while in 62 patients, SLAP type lesions were found. An average of 2.7 anchors was used. 42 cases presented complications; 14 had pain on effort, 12 had some degree of reduction of external rotation, and 16 had recorrence. The patients who developed complications used an average of 2.5 anchors, while those without complications used an average of 2.8 anchors (p<0.05). Of the 35 patients with anterior glenoid bone lesion, 8 had recorrence, while of the 124 patients without fractures, 8 had recorrence (p<0.05). Of the 113 patients with first-time traumatic dislocations, 12 developed limitation of external rotation, while in 46 atraumatic cases none developed limitation (p<0.05). Of the patients with SLAP lesion, 11 developed pain, while in the cases without this lesion, only 3 presented pain (p<0.05). Conclusion: There were more recurrences (deveria ser plural e recurrences, nao recurrence) in cases of anterior glenoid bone lesion. Post-operative pain was more frequent when the lesion type was SLAP Limitation of external rotation is associated to traumatic instability.- Humeral internal rotation osteotomy for the treatment of Erb-Duchenne-type obstetric palsy: clinical and radiographic results(2013) ASSUNCAO, Jorge Henrique; FERREIRA NETO, Arnaldo Amado; BENEGAS, Eduardo; BOLLIGER NETO, Raul; PRADA, Flavia Santis; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; CAMANHO, Gilberto LuisOBJECTIVE: To evaluate the functional and radiographic results in patients undergoing shoulder anterior soft tissue stretching in association with open reduction and internal rotation osteotomy to centralize the humeral head as a treatment for Erb-Duchenne obstetric palsy sequelae. METHOD: A total of 35 patients underwent this surgical treatment, and the mean follow-up was 4.6 years. The Mallet scale was applied before and after the surgical procedure. A total of 20 patients underwent computed tomography to assess the glenoid version and humeral head subluxation. RESULTS: Functional improvement was achieved, as evidenced by an increase in the Mallet scale score from 12.14 to 16.46 (p<0.001). The correction of retroversion was achieved once the glenoid version ranged from 21.4 to - 12 degrees (p<0.001). The humeral head subluxation improved from 6.5 to 35.2% (p<0.001). Patients older than 6 years of age did not achieve glenohumeral joint improvement with respect to dysplastic abnormalities. CONCLUSION: Internal rotation osteotomy in association with the stretching of anterior soft tissues of the shoulder in patients under the age of 7 years provided improvements in the function, retroversion, and subluxation of the glenohumeral joint.
- Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus(2013) GRACITELL, Mauro Emilio Conforto; LOBO, Frederico Lafraia; FERREIRA, Gustavo Maximiano Aliperti; PALMA, Marcos Vianna da; MALAVOLTA, Eduardo Angeli; BENEGAS, Eduardo; KOJIMA, Kodi Edson; FERREIRA NETO, Arnaldo Amado; SILVA, Jorge dos SantosObjective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r) plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%). Conclusion: The fixation with the Philos(r) plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes.
- Lipoma arborescens: caso raro de ruptura do manguito rotador associado à presença de lipoma arborescens na bursa subacromial-subdeltoidea e glenoumeral(2012) BENEGAS, Eduardo; FERREIRO NETO, Arnaldo Amado; TEODORO, Daniel Sabatini; SILVA, Marcos Vinícius Muriano da; OLIVEIRA, Augusto Medaglia de; FILIPPI, Renée Zon; PRADA, Flávia de SantisLipoma arborescens is a rare intra-articular disease that is usually monoarticular and is characterized by extensive proliferation of the synovial villi and hyperplasia of the subsynovial fat. The synovial tissue is progressively replaced by mature fat cells in the synovial membrane. The present study reports a case of a rare condition of lipoma arborescens that was simultaneously intra-articular (glenohumeral joint) and in the subacromial-subdeltoid bursa, in association with a torn supraspinatus tendon. The clinical, histological and radiographic presentations and treatment are discussed here. The description of this case includes radiographic and magnetic resonance evaluations and pathological examination. Although lipoma arborescens is a rare condition, it should be taken into consideration in cases presenting synovial hyperproliferation and synovial fat replacement.
article 2 Citação(ões) na Scopus Reconstrução coracoclavicular com enxerto tendíneo na luxação acromioclavicular crônica(2011) ASSUNCAO, Jorge Henrique; FERREIRA NETO, Arnaldo Amado; BENEGAS, Eduardo; MALAVOLTA, Eduardo Angel; GRACITELLI, Mauro Emilio Conforto; SILVA, Fernando Brandao de Andrade eObjective: The aim of this study is to present the radiographic and functional results of patients undergoing treatment for chronic acromioclavicular dislocation with coracoclavicular ligament reconstruction using tendon graft. Method: Between 2007 and 2008, fifteen patients with chronic Rockwood type III through V acromioclavicular joint dislocations underwent reconstruction of the coracoclavicular ligaments using semitendinosus tendon graft. Two patients were excluded due to inadequate follow up. Thirteen patients were followed up clinically and radiographically after a mean of 16 months (range 12-26 months). Clinical evaluation was performed using the UCLA and Constant scores. Preoperative and postoperative radiographs were compared. Results: In this group of 13 patients followed up for at least one year, the Constant score ranged from 60.9 (26-88) in the preoperative evaluation to 87 (60-98) at the last evaluation during the postoperative period (p< .001). The mean UCLA score improved from 16.8 points (11-27) to 33 (29-35) points. (p=0.001). After 1 year of follow-up, the postoperative radiographic control showed twelve patients (92%) with equal coracoclavicular distance between the affected and unaffected shoulders. No anteroposterior translation in the axial view was present in any of the shoulders operated on. Conclusion: The functional and radiographic results were very satisfactory in patients undergoing reconstruction of chronic acromioclavicular dislocations, with a low recurrence rate. Level of Evidence: Level IV, case series.- Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis(2014) BENEGAS, Eduardo; FERREIRA NETO, Arnaldo Amado; GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; PRADA, Flavia De Santis; BOLLIGER NETO, Raul; MATTAR JR., RamesBackground: Minimally invasive plate osteosynthesis for humeral shaft fractures has been described recently, but there are no randomized studies comparing the clinical results for shoulder function between this technique and locking intramedullary nailing. Methods: A prospective randomized study was performed. Forty-one humeral shaft fractures (40 patients) were randomized to be treated with a minimally invasive plate (n = 21) or a locking intramedullary nail (n = 19). Clinical and radiographic outcome assessments were conducted at 1 year postoperatively. Shoulder function was the primary outcome, as measured by the University of California, Los Angeles Shoulder Scale. Elbow function was measured by the Broberg-Morrey score, and fracture consolidation and complications were the main secondary outcomes. Results: At 1 year postoperatively, no significant difference was found with regard to shoulder function according to the University of California, Los Angeles scale between the minimally invasive plate and locking intramedullary nail (31.4 points vs 31.2 points, P = .98). There was also no difference in elbow function (94.8 points vs 94.1 points, P = .96). Complications were similar between the groups, without significant differences regarding infection (P > .99), symptomatic shoulder stiffness (P = .488), and neurapraxia of the lateral cutaneous nerve of the forearm (P = .475). Fracture union was achieved in all but 1 patient (2.4%) in the intramedullary nail group within 1 year after the surgical procedure. Conclusion: There is no significant difference in shoulder function between antegrade intramedullary nailing and minimally invasive plate osteosynthesis for the treatment of displaced humeral shaft fractures, despite the limited power of our study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
article 5 Citação(ões) na Scopus ARTHROSCOPIC TREATMENT OF ACUTE ACROMIOCLAVICULAR JOINT DISLOCATION USING SUTURE ANCHORS(2011) CAVINATTO, Leonardo Muntada; IWASHITA, Renato Akira; FERREIRA NETO, Arnaldo Amado; BENEGAS, Eduardo; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; SILVA, Fernando Brandao de Andrade e; ASSUNCAO, Jorge Henrique; HELITO, Paulo Victor PartezaniObjective: To present the clinical and radiographic results of a case series of patients with acute acromioclavicular dislocation (MD) treated by arthroscopic coracoclavicular fixation with suture anchors. Method: Twenty patients with AAD with less than 30 days since the injury were submitted to a coracoclavicular stabilization procedure using 2 suture anchors placed at the base of the coracoid process. Each suture anchor was connected to 2 strands of No.2 nonabsorbable-braided sutures, which were passed through the holes drilled in the clavicle and tied to the upper surface of the clavicle. The coracoclavicular distance was measured and compared to the opposite side using radiographic evaluation. Constant and UCLA scores were used to determine clinical and functional evaluation after 6 months. Results: Of the initial twenty cases, six were submitted to a new surgical procedure and were excluded from the study. Of the fourteen patients remaining, only two maintained the initial reduction, while the remainder presented some degree of reduction loss. The Constant and UCLA score averages were 94.79 (82-100) and 32.64 (26-35) respectively. Conclusion: The technique had a high incidence of reduction loss after 6 months of follow up. The clinical and functional evaluation was satisfactory, with a high average score. Level of Evidence: Level III, retrospective study.- Plasma rico em plaquetas no reparo artroscópico das roturas completas do manguito rotador(2012) MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; SUNADA, Edwin Eiji; BENEGAS, Eduardo; PRADA, Flavia de Santis; BOLLIGER NETO, Raul; RODRIGUES, Marcelo Bordalo; FERREIRA NETO, Arnaldo Amado; CAMARGO, Olavo Pires deOBJECTIVE: To evaluate shoulder functional results and the re tear rate of arthroscopic repair of the rotator cuff augmented with platelet-rich plasma (PRP). METHODS: Prospective case series with single-row arthroscopic repair of the rotator cuff augmented with PRP. Only cases of isolated supraspinatus tears with retraction of less than 3 cm were included in this series. The PRP used was obtained by apheresis. It was applied on liquid consistency in its activated form, with the addition of autologous thrombin. Patients were evaluated after 12 months of the surgical procedure. The Constant-Murley, UCLA and VAS scales were used, and the retear rate was assessed using magnetic resonance imaging (MRI). RESULTS: Fourteen patients were evaluated (14 shoulders). The mean Constant-Murley score was 45.64 ± 12.29 before the operation and evolved to 80.78 ± 13.22 after the operation (p < 0.001). The UCLA score increased from 13.78 ± 5.66 to 31.43 ± 3.9 (p < 0.001). The patients' pain level decreased from a median of 7.5 (p25% = 6, p75% = 8) to 0.5 (p25% = 0, p75% = 3) (p = 0.0013) according to the VAS score. None of the patients presented complete retear. Three patients (21.4%) showed partial retear, without transfixation. Only one patient developed complica tions (adhesive capsulitis). CONCLUSION: Patients submitted to arthroscopic rotator cuff repair augmented with PRP showed significant functional improvement and none of them had com plete retearing.