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.
- 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.
- Does the supraspinatus tear pattern affect the results of the arthroscopic repair?(2020) MALAVOLTA, Eduardo Angeli; ANDRADE-SILVA, Fernando Brandão; CANHOS, André Lange; ASSUNÇÃO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoAbstract Objective To evaluate the influence of the supraspinal tear pattern on the pre- and postoperative functional evaluations. Methods A retrospective cohort study comparing patients with supraspinatus crescent-shaped tears versus L- or U-shaped tears. We included patients undergoing complete supraspinatus arthroscopic repair. We did not include patients with subscapularis or infraspinatus repair, those submitted to open surgery, or those in whom only partial repair was achieved. The clinical scales used were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) and the Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), which were applied 1 week before and 24 months after the procedure. Results We analyzed 167 shoulders (from 163 patients). In the preoperative period, the ASES scale was significantly higher in the crescent-shaped pattern (43.5 ± 17.6 versus 37.7 ± 13.8; p = 0.034). The UCLA scale followed the same pattern (15.2 ± 4.6 versus 13.5 ± 3.6; p = 0.028). In the postoperative period, however, there was no significant difference. According to the ASES scale, crescent-shaped tears scored 83.7 ± 18.7 points, and L- or U-shaped tears scored 82.9 ± 20.1 (p = 0.887). The values were 30.9 ± 4.9 and 30.5 ± 5.6 (p = 0.773) respectively, by the UCLA scale. Conclusion Crescent-shaped and L- or U-shaped supraspinatus tears have similar postoperative functional results. In the preoperative period, the functional results are superior in crescent-shaped tears.
- 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.
- Glenoid track evaluation by a validated finite-element shoulder numerical model(2020) PECORA, Jose Otavio Reggi; NEVES JUNIOR, Alexandre T.; ROESLER, Carlos Rodrigo M.; FANCELLO, Eduardo Alberto; MALAVOLTA, Eduardo A.; GRACITELLI, Mauro Emilio C.; ASSUNCAO, Jorge Henrique; NETO, Arnaldo Amado F.Background: The limits of the glenoid track have been defined through methods that do not take properly into account the physiological articular forces involved in the articular contact, which may interfere with its size. Finite elements numerical models can simulate joint forces more realistically. Objective: To evaluate the glenoid track in a finite element numerical model of the shoulder. Methods: We developed a finite element numerical model of the shoulder, based on imaging exams of a volunteer, including the proximal humerus, scapula, their respective articular cartilages, and the rotator cuff muscles. An algorithm to balance the weight of the arm calculated muscle, wrapping, and articular reaction forces. The model has freedom of translation in three axes. The articular contact characteristics and glenoid track's dimensions according to the literature references were evaluated in 60 degrees, 90 degrees and 120 degrees of abduction, all at the 90 degrees external rotation. Results: The model's anatomy and physiology were validated. The value of the glenoid track (according to Yamamoto's parameters) was 86% of glenoid length at 90 degrees abduction before loading of forces, and 79% afterwards. The glenoid track at 60 degrees, 90 degrees and 120 degrees of abduction (Omori's parameters) corresponded, respectively, to 71%, 88% and 104% of glenoid length before loading of forces, and 76%, 84% and 103% afterward. Conclusion: The numerical model is suitable for the shoulder articular contact evaluation. The articular contact analysis ratifies the glenoid track concept and contributes to its evolution. This value is influenced by glenohumeral joint forces, which should be considered for the analysis.
- Family Predisposition for Rotator Cuff Tear and Other Tendinopathies – A Case-Control Study(2020) ASSUNÇÃO, Jorge Henrique; TENRREIRO, Breno Faria; GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; FERREIRA NETO, Arnaldo AmadoAbstract Objective To evaluate the prevalence of family history of rotator cuff tear and the presence of tendinopathy in other joints in patients with rotator cuff tears and to compare them with paired controls. To estimate the odds ratio for rotator cuff tear for these two risk factors. Methods We performed a case-control study comparing patients submitted to treatment for rotator cuff tear with asymptomatic controls. All cases and controls were evaluated by imaging exams and matched by age (±2 years) and gender. We conducted an interview using a standardized questionnaire, and collected data on various risk factors. Results We evaluated 144 patients, 72 per group. Patients with rotator cuff tears reported a higher number of consanguineous relatives who underwent treatment for the same disease and tendon injuries in other joints compared to the controls (p= 0.005 and p= 0.045 respectively). Individuals with a family history of treatment for rotator cuff tear or with tendinopathies in other joints were more likely to present a rotator cuff tear, with odds ratios of 3.3 (95% confidence interval [95%CI] = 1.4–7.7) and 2.7 (95%CI = 1.1–6.9) respectively. Conclusions Patients with rotator cuff tear have a higher prevalence of family members with the same disease and tendinopathies or tendon injuries in other joints. The presence of consanguineous relatives with treatment for rotator cuff and tendinopathies in other joints are risk factors for the presence of rotator cuff tears.
- Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach(2020) GRACITELLI, Mauro E.C.; GUGLIELMETTI, César L.B.; BOTELHO, Caio A.S.; MALAVOLTA, Eduardo A.; ASSUNÇÃO, Jorge H.; FERREIRA NETO, Arnaldo A.Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.
- Isokinetic evaluation of the shoulder and elbow after Latarjet procedure(2020) MALAVOLTA, Eduardo A.; CRUZ, Diego G.; GRACITELLI, Mauro Emilio Conforto; ASSUNCAO, Jorge H.; ANDRADE-SILVA, Fernando B.; ANDRUSAITIS, Felix R.; FERREIRA NETO, Arnaldo A.Background/Hypothesis: The Latarjet procedure changes the anatomy of the shoulder, moving the coracoid process distally through an incision in the subscapularis muscle. Some authors have studied the effect of this surgery on shoulder rotator strength. Our hypothesis is that the Latarjet procedure decreases elbow supination and flexion strength. Methods: A retrospective case series, evaluating patients submitted to the Latarjet procedure between May 2013 and June 2017. Movements of the elbow (supination, pronation, flexion and extension) and shoulder (internal and external rotation) were evaluated bilaterally using a Biodex System 3 isokinetic dynamometer (Biodex Medical Systems, New York) in concentric/concentric mode. Results: We evaluated 20 patients with an average follow-up of 36 months. In the elbow, we observed a 9.1% decrease in supination strength at a speed of 60 degrees/s (p = 0.044), without statistical difference at 120 degrees/s (p = 0.570). In the shoulder, there was a 13.5% decrease in external rotation strength at 60 degrees/s and 4.5% at 180 degrees/s (p = 0.009 and p= 0.040, respectively). The other movements did not demonstrate any statistically significant differences. Conclusion: After the Latarjet procedure, the supination strength at 60 degrees/s was decreased, as was the external rotation strength of the shoulder at 60 degrees/s and 180 degrees/s. We did not observe any reduction in strength for shoulder flexion or internal shoulder rotation.