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 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 1 Citação(ões) na Scopus
    Fracture of the clavicle and second rib: an indirect injury from tricep dips
    (2016) MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; GRACITELLI, Mauro E. C.; LOBO, Frederico L.; FERREIRA NETO, Arnaldo A.
    Due to the recent rise in the interest in strength training, an increment in the number of lesions is expected, whether of the tendons, muscles, or bones. We describe a case of fracture involving the middle third of the clavicle and the second rib in a low-demand weightlifter. The fractures occurred suddenly while performing a triceps dips exercise, and the patient had no previous symptoms. He was treated conservatively and was able to return to sports six later. To our knowledge, this is the first study describing the association of these fractures triggered by a single event of muscle. contraction.
  • 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 132 Citação(ões) na Scopus
    Platelet-Rich Plasma in Rotator Cuff Repair A Prospective Randomized Study
    (2014) MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo Amado; ASSUNCAO, Jorge Henrique; BORDALO-RODRIGUES, Marcelo; CAMARGO, Olavo Pires de
    Background: Although platelet-rich plasma (PRP) has been used in rotator cuff repair, most authors have been unable to report the advantages of this method in clinical trials. Hypothesis: The use of PRP promotes better functional and structural results in arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective, randomized, double-blind study with 2 groups of 27 patients each (PRP group and control group). Complete supraspinatus tears with retraction of less than 3 cm were subjected to arthroscopic single-row repair; at the end of the surgical procedure, liquid PRP prepared by apheresis was given to the patients in the PRP group with autologous thrombin. The outcomes were assessed by the University of California at Los Angeles (UCLA) and Constant scales, visual analog scale (VAS) for pain, and magnetic resonance imaging (MRI) before and 3, 6, 12, and 24 months after surgery. The significance level was 5%. Results: The 2 groups of patients exhibited significant clinical improvement (P < .001). Between the preoperative assessment and 24-month follow-up, the mean UCLA score increased from 13.63 3.639 to 32.70 +/- 3.635 and from 13.93 +/- 4.649 to 32.44 +/- 4.318 in the control and PRP groups, respectively (P = .916). The mean Constant score increased from 47.37 +/- 11.088 to 85.15 +/- 9.879 in the control group and from 46.96 +/- 11.937 to 84.78 +/- 14.048 in the PRP group (P = .498). The mean VAS score varied from 7.00 +/- 1.939 and 6.67 +/- 1.617 before surgery to 1.15 +/- 1.916 and 0.96 +/- 2.244 at the 24-month assessment in the control and PRP groups, respectively (P = .418). The only difference was in the mean UCLA score at 12 months, with 30.04 +/- 4.528 in the control group and 32.30 +/- 3.506 in the PRP group (P = .046). The control group exhibited 1 case of a complete retear and 4 partial retears, and the PRP group exhibited 2 cases of partial retears (P = .42). Conclusion: Platelet-rich plasma prepared by apheresis and applied in the liquid state with thrombin did not promote better clinical results at 24-month follow-up. Given the numbers available for analysis, the retear rate also did not change.
  • 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 15 Citação(ões) na Scopus
    Early versus late repair of rotator cuff tears in rats
    (2018) CAVINATTO, Leonardo; MALAVOLTA, Eduardo Angeli; PEREIRA, Cesar Augusto Martins; MIRANDA-RODRIGUES, Manuela; SILVA, Luiza Campos Moreira; GOUVEIA, Cecilia Helena; NETTO, Cesar de Cesar; MATTAR, Rames Junior; FEREIRA NETO, Arnaldo Amado
    Background: In the event of a traumatic rotator cuff tear, patients are routinely advised that early surgical intervention produces an optimal repair, despite a lack of direct evidence to support this recommendation. To address this knowledge gap, massive rotator cuff tears in rats were assessed by biomechanical and bone morphometric analyses after early or late repair. Methods: Combined supraspinatus and infraspinatus tendon tears of the left shoulder were created in 21 adult Wistar rats, which were divided into 2 groups. The tendons of the injured shoulder in the animals in group I were surgically repaired 8 weeks after the injury. Under the same anesthesia, the same injury was created on the right shoulder, which was immediately repaired. The rats from group I were euthanized 8 weeks after the repairs. No repair was performed in the rats from group II, which were euthanized 8 weeks after the injury. Tissues from both groups were harvested and biomechanically tested for supraspinatus tendon and bone morphometry analysis of the humeral head. Results: All biomechanical properties were significantly increased in the early repair group compared with the late repair group. No significant differences were observed in bone morphometry of the humeral head when early and late repair groups were compared. Conclusion: Early surgical repair of a massive rotator cuff tear leads to improved biomechanical properties of the tissue after healing. Proximal humerus bone morphometry was unaffected by surgical repair timing.
  • article 4 Citação(ões) na Scopus
    Prognostic Factors for Clinical Outcomes After Arthroscopic Rotator Cuff Repair
    (2023) MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; ANDRADE-SILVA, Fernando Brandao; GRACITELLI, Mauro Emilio Conforto; KIYOMOTO, Henry Dan; FERREIRA NETO, Arnaldo Amado
    Background: Limited knowledge exists regarding prognostic factors after rotator cuff repair. Purpose: To identify pre- and perioperative predictors for functional outcomes after arthroscopic rotator cuff repair. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent arthroscopic rotator cuff repair between January 2013 and April 2019 and who had preoperative magnetic resonance imaging scans. The procedures were performed by 4 shoulder surgeons at a single institution. Excluded were patients who had previous surgeries, those who underwent open surgery, and those without 12- and 24-month follow-up clinical data. Patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES] Standardized Shoulder Assessment Form and University of California, Los Angeles [UCLA] Shoulder Rating Scale scores) were assessed preoperatively and at 6, 12, and 24 months postoperatively. Using multiple linear regression analysis, the authors evaluated the influence of 29 variables relating to patient, lesion, and procedure characteristics on postoperative outcomes, with the 24-month ASES score as the dependent variable. Results: The study sample consisted of 474 patients (500 shoulders). The median ASES score increased from 41.6 preoperatively to 88.3 at 24 months (P <.001), and the median UCLA score increased from 14 preoperatively to 32 in the same period (P <.001). The following variables were found to be independent predictors for higher 24-month postoperative ASES score: male sex, absence of rheumatologic disease, older age, lower degree of supraspinatus muscle fatty degeneration, acromioplasty, and a higher preoperative ASES score. Conclusion: The prognostic factors for better clinical results at 24 months after arthroscopic rotator cuff repair were male sex, absence of rheumatologic disease, older age, lower degree of fatty degeneration of the supraspinatus muscle, concomitant acromioplasty, and higher preoperative ASES score.