ARNALDO AMADO FERREIRA NETO

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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

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  • article 4 Citação(ões) na Scopus
    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 Amado
    Background: 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.
  • article 0 Citação(ões) na Scopus
    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 Amado
    Background: 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.
  • article 5 Citação(ões) na Scopus
    Osteoid osteoma of the glenoid: Arthroscopic treatment
    (2015) MALAVOLTA, E. A.; ASSUNCAO, J. H.; REBOLLEDO, D. C. S.; GRACITELLI, M. E. C.; CORREIA, L. F. M.; FERREIRA NETO, A. A.; CAMARGO, O. P. de
    Osteoid osteoma is a benign tumor that is rarely found in the scapula. We report a clinical case involving a 36-year-old female patient who suffered from progressive pain in her right shoulder for 1 year. This patient was initially diagnosed with impingement syndrome and was treated unsuccessfully with medication and physical therapy for approximately 2 months. Based on imaging exams, a juxta-articular osteoid osteoma of the glenoid was identified. The patient underwent a shoulder arthroscopy that included tumor removal and treatment of the resulting chondral lesion. At 6-, 12- and 36-month assessments, the patient was asymptomatic, with a normal range of motion and experienced a pain intensity corresponding to 0 points on the Visual Analog Scale (VAS) and 35 points on the University of California, Los Angeles (UCLA) Scale. A postoperative MRI indicated the absence of any residual tumor tissue or inflammatory signs. We believe that the approach described in this paper allows juxta-articular osteoid osteomas to be accessed in a minimally invasive manner and permits not only adequate resection but also the treatment of chondral lesions that could remain after tumor resection.
  • article 68 Citação(ões) na Scopus
    Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial
    (2016) GRACITELLI, Mauro E. C.; MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; KOJIMA, Kodi E.; REIS, Paulo R. dos; SILVA, Jorge S.; FERREIRA NETO, Arnaldo A.; HERNANDEZ, Arnaldo J.
    Background: Previous studies have shown good clinical results in patients with proximal humeral fractures (PHFs) treated with locking intramedullary nails or locking plates. Our study compared the clinical and radiographic outcomes in patients with 2- and 3-part surgical neck fractures. Methods: In this prospective, randomized controlled trial, 72 patients with 2- or 3-part surgical neck PHFs were randomly assigned to receive fixation with locking intramedullary nails (nail group) or locking plates (plate group). The primary outcome was the 12-month Constant-Murley score. The secondary outcomes included the Disabilities of the Arm, Shoulder and Hand score, the visual analog scale pain score, the shoulder passive range of motion, the neck-shaft angle, and complication rates. Results: There was no significant mean treatment group difference in the Constant-Murley score at 12 months (70.3 points for the nail group vs. 71.5 points for the plate group; P=.750) or at individual follow-up assessments. There were no differences in the 3-, 6- and 12-month Disabilities of the Arm, Shoulder and Hand scores, visual analog scale scores, and range of motion, except for the medial rotation at 6 months. The neck-shaft angle was equivalent between the groups at 12 months. There were significant differences over 12 months in total complication rates (P=.002) and reoperation rates (P=.041). There were no significant differences for the rotator cuff tear rate (P=.672). Conclusion: Fixation of PHFs with locking plates or locking intramedullary nails produces similar clinical and radiologic results. Nevertheless, the complication and reoperation rates were higher in the nail group. Level of evidence: Level I; Randomized controlled trial; Treatment study (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees.
  • article 0 Citação(ões) na Scopus
    Response to letter to the editor concerning ""The rotation of the humeral head does not alter radiographic evaluation of the head-shaft angle""
    (2016) MALAVOLTA, Eduardo A.; GRACITELLI, Mauro E. C.; ASSUNCAO, Jorge H.; FERREIRA NETO, Arnaldo A.
  • article 22 Citação(ões) na Scopus
    Intraobserver and interobserver agreement in the classification and treatment of proximal humeral fractures
    (2017) GRACITELLI, Mauro E. C.; DOTTA, Thiago A. G.; ASSUNCAO, Jorge H.; MALAVOLTA, Eduardo A.; ANDRADE-SILVA, Fernando B.; KOJIMA, Kodi E.; FERREIRA NETO, Arnaldo A.
    Background: There is controversy surrounding the reliability of radiographic measurements and existing classifications for proximal humeral fractures. Methods: Ten orthopedists, divided into 2 groups by length of experience, evaluated radiographs in 3 views from 40 proximal humeral fractures. We evaluated 11 radiographic criteria (including the Neer and pathomorphologic classifications, head-shaft angle, displacement of the humeral shaft, and lesser and greater tuberosities) and treatment indication. We also analyzed the criteria that most influenced the choice of treatment. Results: Interobserver reliability was substantial for the presence of fracture of the greater tuberosity (kappa = 0.749) and medial metaphyseal comminution (kappa = 0.627) and moderate for the pathomorphologic classification (kappa = 0.504), displacement of the greater tuberosity (kappa = 0.422), and treatment decision (kappa = 0.565). Intraobserver reliability was substantial for treatment indication (kappa = 0.620) and presence of displacement of the fracture of the greater tuberosity (kappa = 0.627 and 0.611) and moderate for the Neer (kappa = 0.490) and pathomorphologic (kappa = 0.607) classifications. The results were influenced by the observer's experience. The surgical indication was influenced by the pathomorphologic classification in 50% of the evaluators (odds ratio, 4.85; range, 3.30-8.65). Conclusion: The pathomorphologic classification has higher reliability than the Neer classification and was the factor that most influenced the surgical decision. The determination of the presence of fracture and displacement of the greater tuberosity and medial metaphyseal comminution is reliable with the use of simple radiographs, and the results were influenced by the observer's experience. Level of evidence: Basic Science Study; Validation of Classification System (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
  • article 34 Citação(ões) na Scopus
    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 Amado
    Introduction 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.
  • article 5 Citação(ões) na Scopus
    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 Ferreira
    Purpose: 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.
  • article 9 Citação(ões) na Scopus
    Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation
    (2020) GUGLIELMETTI, Cesar L. B.; GRACITELLI, Mauro E. C.; ASSUNCAO, Jorge H.; ANDRADE-SILVA, Fernando B.; PESSA, Mariana M. Nicolosi; LUZO, Maria Candida; NETO, Arnaldo A. Ferreira; MALAVOLTA, Eduardo A.
    Background: There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. Methods: Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. Results: Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108 degrees in the surgical group and 88 degrees in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17 degrees and 27% in the conservative group and 41 degrees and 59% in the surgical group (P<.001). Conclusion: Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.
  • article 23 Citação(ões) na Scopus
    Serial structural MRI evaluation of arthroscopy rotator cuff repair: does Sugaya's classification correlate with the postoperative clinical outcomes?
    (2016) MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge Henrique; RAMOS, Frederico F.; FERREIRA, Thiago C.; GRACITELLI, Mauro E. C.; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo A.
    Sugaya's classification is the most commonly used for postoperative evaluation of rotator cuff repairs. However, the correlation between this classification and clinical outcomes after supraspinatus tendon repair were not performed with serial MRI examinations in standardized time intervals. This prospective case series involved 54 patients undergoing repair of the supraspinatus tendon tear. Magnetic resonance imaging (MRI, 1.5 T) was used to determine the Sugaya's classifications at 3, 6, and 12 months, and these data were correlated with the visual analog scale for pain (VAS), Constant and University of California at Los Angeles (UCLA) assessments. Patients with types I, II, and a parts per thousand yenIII of Sugaya's classification experienced pain of 1.27 +/- 1.95, 1.00 +/- 1.40, and 3.43 +/- 3.36, respectively (p = 0.010), according to the VAS. The Constant and UCLA scales did not differ significantly. Type II predominated, though their percentage decreased over time (from 77.8 to 66.7 %), whereas type I became more frequent (from 1.9 to 20.4 %). The pain was more intense in patients classified as types III, IV, or V of Sugaya's classification. The postoperative appearance of the supraspinatus tendon was not correlated with the Constant and UCLA scales. The occurrence of type II, the most prevalent, decreased over time, whereas the occurrence of type I increased; these differences were not significant. Level de evidence: prospective cohort evaluation-level III.