JORGE HENRIQUE ASSUNCAO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
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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- Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft(2022) BERALDO, Rodrigo Alves; GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; SILVA, Fernando Brandão de Andrade e; FERREIRA NETO, Arnaldo AmadoAbstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.
- Superior Capsular Reconstruction with Fascia Lata Allograft for Irreparable Supraspinatus Tendon Tears(2019) GRACITELLI, Mauro Emilio Conforto; BERALDO, Rodrigo Alves; MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; OLIVEIRA, Danilo Ricardo Okiishi de; FERREIRA NETO, Arnaldo AmadoAbstract Superior capsular reconstruction is a recently described procedure for the treatment of irreparable supraspinatus tendon tears. Graft options that have been previously described include autogenous fascia lata and decellularized dermal graft. No studies were published with the use of fascia lata allograft. The purpose of this technical note is to describe the surgical technique of superior capsular reconstruction using fascia lata allograft. The procedure is performed by arthroscopic visualization, with the patient positioned in the lateral decubitus position. The authors describe a technique based on the use of a double-pulley knot in the glenoid and greater tuberosity, facilitating the procedure and allowing the graft to be brought into the subacromial space in the definitive position, with the appropriate tension. The allografts are available from this institution's tissue bank, cryopreserved and submitted to microbiological and histopathological evaluation. Superior capsular reconstruction is a promising surgery. The technique described in the present technical note shows a viable arthroscopic alternative, with a smaller number of anchors when compared with other techniques.
- Impact of proximal humerus version on neck-shaft angle: A clinical study(2017) ASSUNCAO, J. H.; MALAVOLTA, E. A.; BERALDO, R. A.; GRACITELLI, M. E. C.; BORDALO-RODRIGUES, M.; FERREIRA NETO, A. A.Background Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affects neck-shaft angle on standard radiographs in patients with complaints of shoulder pain. Hypothesis Shoulder rotation does not affect neck-shaft angle. Materials and methods A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30° external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter- and intra-observer reliability was evaluated by Intraclass Correlation Coefficient (ICC). Results Neck-shaft angle on true AP view did not differ between neutral rotation and 30° external rotation: 132° ± 6° and 130° ± 9°, respectively (P > 0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145° ± 6°: i.e., significantly different (P < 0.001) to the other two positions. Intra- and inter-observer correlation demonstrated excellent reliability. Conclusions Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30° external rotation. Intra- and inter-observer correlation showed excellent reliability. Level of evidence II Comparative prospective study. © 2017 Elsevier Masson SAS
- Rotator cuff repair in the Brazilian Unified Health System: Brazilian trends from 2003 to 2015(2017) MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; BERALDO, Rodrigo Alves; PINTO, Gustavo de Mello Ribeiro; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoABSTRACT OBJECTIVE: To assess the historical trend of rotator cuff repairs in Brazil between 2003 and 2015, using the database of the Brazilian Unified Health System's (Sistema Único de Saúde [SUS]) Department of Informatics (DataSUS). METHODS: Historical series using DataSUS. Surgeries performed between 2003 and 2015 were included and data relating to cuff tear repair were assessed, including decompression procedures were included. The numerator was the total number of rotator cuff repair and the denominator, the total population of the assessed locality. Population data were based on information from the Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTS: During the period, 50,207 surgeries were performed. The rate was presented as number of procedures per 100,000 inhabitants, and increased from 0.83 to 2.81, a growth of 238%. In 2015, the South region had the highest rate, 6.32, followed by the Southeast, 3.62, while the North had the lowest rate, 0.13. The growing trend can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast. CONCLUSION: The rate of rotator cuff repairs in Brazil performed through the SUS increased from 0.83 to 2.81 between 2003 and 2015, representing a growth of 238%, but remains lower than that of developed countries. A trend of growth can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast.
- Impact of shoulder rotation on neck-shaft angle: A clinical study(2017) ASSUNCAO, J. H.; MALAVOLTA, E. A.; BERALDO, R. A.; GRACITELLI, M. E. C.; BORDALO-RODRIGUES, M.; FERREIRA NETO, A. A.Background: Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affect sneck shaft angle on standard radiographs in patients with complaints of shoulder pain. Hypothesis: Shoulder rotation does not affect neck-shaft angle. Materials and methods: A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30 degrees external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter-and intra-observer reliability was evaluated by intraclass correlation coefficient (ICC). Results: Neck-shaft angle on true AP view did not differ between neutral rotation and 30 degrees external rotation: 132 +/- 6 degrees and 130 +/- 9 degrees, respectively (P > 0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145 +/- 6 degrees : i.e., significantly different (P < 0.001) to the other two positions. Intra-and inter-observer correlation demonstrated excellent reliability. Conclusions: Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30 degrees external rotation. Intra-and inter-observer correlation showed excellent reliability.