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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- 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.
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.- 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.
- THE POLYMORPHISM OF METALLOPROTEINASES 1 AND 13 AND POSTTRAUMATIC ELBOW STIFFNESS(2022) PINTO, Gustavo De Mello Ribeiro; ASSUNCAO, Jorge Henrique; SANTOS, Maria Cristina Leme Godoy Dos; GODOY-SANTOS, Alexandre Leme; GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; SILVA, Fernando Brandao De Andrade e; FERREIRA NETO, Arnaldo AmadoIntroduction: To evaluate the relationship between the genetic polymorphism of matrix metalloproteinases 1 and 13 and post-traumatic elbow stiffness, as well as the association of other risk factors with this condition. Materials and methods: We evaluated 20 patients with posttraumatic elbow stiffness and 12 controls with traumatic elbow disorders without contracture. Deoxyribonucleic acid (DNA) was obtained from buccal mucosa epithelial cells of the volunteers. The MMP-1 and MMP-13 genotypes were determined using PCR-restriction fragment length polymorphism assays. Results: We did not find any significant differences in the frequency of genotypes and alleles between the test and control groups for the polymorphism of metalloproteinases 1 and 13. We observed that genotypes 10/20 and 2G/2G of MMP-1 were present in 65% (13/20) of patients with articular stiffness and 50% (6/12) of controls (p = 0.599). Genotypes A/A and A/G of MMP-13 were obtained in 95% (19/20) of patients and 91.6% (11/12) of controls (p = 0.491). Among the prognostic factors for elbow stiffness, only immobilization time correlated positively. The mean immobilization time for cases and controls were 16 +/- 10 days and 7 +/- 7 days, respectively (p = 0.017). Conclusion: The genetic polymorphism of MMP-1 at position -1607 and MMP-13 at position -77 was not associated with post-traumatic elbow stiffness.
- EFFECT OF SUBSCAPULARIS TEARS ON FUNCTIONAL SCORES OF PATIENTS UNDERGOING ROTATOR CUFF REPAIR(2019) MALAVOLTA, Eduardo Angel; CHANG, Veronica Yulin Prieto; CASTRO, Marcello Traeallibozzi Pinto de; ANDRADE-SILVA, Fernando Brandao; ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoObjective: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. Methods: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. Results: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. Conclusion: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores.
- MULTIFOCAL OSTEONECROSIS SECONDARY TO OCCUPATIONAL EXPOSURE TO ALUMINUM(2017) ASSUNCAO, Jorge Henrique; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; FILIPPI, Renee Zon; FERREIRA NETO, Arnaldo AmadoMultifocal osteonecrosis is a rare disease; chronic use of corticosteroids is considered the main risk factor. Patients with chronic renal failure can develop aluminum toxicity, which can lead to osteomalacia and encephalopathy. An association between osteonecrosis and aluminum toxicity has been reported among patients with dialytic renal insufficiency. Occupational exposure to aluminum rarely causes lung disease and no cases of bone lesions resulting from exposure to this metal have been reported. In this manuscript, we describe a novel case of a patient with multifocal osteonecrosis associated with chronic occupational exposure to aluminum.
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 ARTHROPLASTY IN OSTEOARTHRITIS: CORRELATION BETWEEN FUNCTION AND RADIOGRAPHIC PARAMETERS(2013) GRACITELLI, Mauro Emilio Conforto; DUARTE, Fernando Aires; TOFFOLI, Rogerio Padovani; BURNATO, Joao Henrique; MALAVOLTA, Eduardo Angeli; FERREIRA NETO, Arnaldo AmadoObjectives: To evaluate the correlation between radiographic parameters and functional assessments of patients with osteoarthritis of the shoulder who underwent shoulder arthroplasty and to describe the functional outcomes of this procedure in our institution. Methods: We evaluated 21 patients (22 shoulders) who underwent shoulder arthroplasty between 1998 and 2010 and with a minimum follow-up of 12 months. Clinical evaluation was performed using the Constant-Murley scale, UCLA, EVA and by measuring the active motion. We analysed preoperative (distance between the top of the head and the humerus and the acromion, superior migration, neck angulation, medial ""offset"", subluxation, glenoid erosion) and postoperative radiographic parameters (rod inclination, migration of components and loosening). Results: Patients showed significant improvement in all parameters: flexion (p = 0.0083), abduction (p = 0.0266), external rotation (p = 0.0062), Constant-Murley (p = 0.0001), UCLA (p < 0.0001) and VAS (p = 0.0002). The superior migration of the humerus showed a significant correlation with UCLA and Constant-Murley scores (p = 0.0480 and p = 0.0110, respectively). The other radiographic parameters showed no correlation with the clinical outcomes. Conclusion: The superior migration of the humerus is related to worse clinical scores.
- TREATMENT OF RECURRENT ANTERIOR SHOULDER DISLOCATION WITH BRISTOW-LATARJET PROCEDURE(2021) FERREIRA FILHO, Arnaldo Amado; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; ASSUNCAO, Jorge Henrique; SILVA, Fernando Brandao De Andrade E; BOLLIGER NETO, Raul; FILHO, Americo Zoppi; FERREIRA NETO, Arnaldo AmadoObjectives: To describe the clinical and radiographic results of patients with traumatic recurrent anterior shoulder dislocation treated with the Bristow-Latarjet procedure. Methods: Retrospective case series including 44 patients (45 shoulders) who underwent the Bristow-Latarjet procedure. The graft was fixed ""standing"" in 84% of the shoulders, and ""lying"" in 16%. Results: The follow-up was 19.25 +/- 10.24 months. We obtained 96% of good results, with 2 recurrences presented as subluxation. Graft healing occurred in 62% of cases. The graft was positioned below the glenoid equator in 84% of the cases, and less than 10 mm from its edge in 98%. The external rotation had a limitation of 20.7 degrees +/- 15.9 degrees, while the internal rotation was limited in 4.0 degrees +/- 9.6 degrees. The limitation of rotation and the position of the graft (""standing"" or ""lying"") did not correlate with graft healing (p>0.05). Bicortical fixation was positively correlated with healing (p<0.001). Conclusion: The Bristow-Latarjet technique is indicated for the treatment of recurrent anterior dislocations and subluxations of the shoulder. It is a safe treatment method, which can be used in people with intense physical activity. Limiting shoulder mobility does not prevent patients from returning to their usual occupations.