MAURO EMILIO CONFORTO GRACITELLI
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
7 resultados
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- 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. deOsteoid 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.
- Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair(2022) MALAVOLTA, Eduardo A.; YAMAMOTO, Gustavo J.; BUSSIUS, Daniel T.; ASSUNCAO, Jorge H.; ANDRADE-SILVA, Fernando B.; GRACITELLI, Mauro E. C.; FERREIRA NETO, Arnaldo A.Background/Hypothesis: Minimal clinically important difference (MCID) is a vital tool in the analysis of clinical results. It allows the determination of clinical relevance of statistical data. Our hypothesis was that specific differences between preoperative and postoperative scores would be able to accurately predict patient perception of improvement and satisfaction as reflected by anchor and distribution-based questions. Methods: Retrospective cohort with patients that underwent rotator cuff repair. We evaluated the University of California at Los Angeles Shoulder Rating Scale (UCLA) and the American Shoulder and Elbow Surgeons Assessment Form (ASES) before and 12-months after surgery. Anchor-based, distribution-based and minimum detectable change (MDC) approaches were utilized. Results: We evaluated 289 shoulders. The MCID for the UCLA scale was 4.5 points using the anchor method, 2.5 by the distribution method and 3.6 by MDC. Patients with a baseline score > 20 presented a lower MCID (1.5, 1.1 and 1.7, respectively). For the ASES score, the MCID was 6.1 by the anchor method, 10.5 based on the distribution method and 26.3 by MDC. In the group of patients above the 60 point cutoff, the obtained values were 2.4, 4.9 and 13.6, respectively. Conclusion: The mean MCID value for the UCLA shoulder score is 3.5 points, ranging from 2.5 points (distribution method) to 4.5 points (anchor method). The mean MCID value for the ASES score was 15.2 points, ranging from 6.1 (anchor method) to 26.3 (MDC). Patients groups presenting with higher preoperative scores showed lower MCID values. This fact needs to be considered in postoperative comparisons between treatment groups. Level of evidence: Basic Science Study, Validation of Outcomes Instruments/Classification Systems.
- Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers(2014) NEGRI, J. H.; MALAVOLTA, E. A.; ASSUNCAO, J. H.; GRACITELLI, M. E. C.; PEREIRA, C. A. M.; BOLLIGER NETO, R.; CROCI, A. T.; FERREIRA NETO, A. A.Background: Few biomechanical studies have assessed the resistance of the ligamentous structures of the sternoclavicular joint, and none have reproduced the physiological movements of the joint. Determiningthe structures that are injured in sternoclavicular dislocations is important for the surgical planning of acute or chronic ligament reconstruction. Methods: Forty-eight joints from 24 human cadavers were studied, and they were divided into 4 groups of 12 joints each (retraction, protraction, depression and elevation). Biomechanical testing assessed primary and secondary failures. The mechanical resistance parameters between movements that occurred on the same plane (depression versus elevation, protraction versus retraction) were compared. Results: The posterior sternoclavicular ligament was the most injured structure during the protraction test, but it was not injured during retraction. The anterior sternoclavicular ligament was the most affected structure during retraction and depression. The costoclavicular ligament was the most affected structure during elevation. Joint resistance was significantly greater during protraction movements when compared to retraction (P < 0.05). Conclusion: The anterior sternoclavicular ligament was the most affected structure during retraction and depression movements. During protraction, lesions of the posterior sternoclavicular ligament were most frequent during elevation, and the costoclavicular ligament was the most frequently injured ligament. The resistance of the sternoclavicular joint was significantly greater during protraction movement when compared to retraction.
- 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.
- Comments on: ""Centering osteotomy for treatment of posterior shoulder dislocation in obstetrical palsy"" by PR Vilaca, MK Uezami, A Zoppi Filho published in Orthop Tramatol Surg Res 2012; 98: 199-205(2013) FERREIRA NETO, A. A.; ASSUNCAO, J. H.; FERREIRA FILHO, A.; MALAVOLTA, E. A.; GRACITELLI, M. E. C.
- 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.
- 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.