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
8 resultados
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- Tomographic evaluation of Hill-Sachs lesions: is there a correlation between different methods of measurement?(2017) ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; BORGO, Gustavo Dias; MALAVOLTA, Eduardo Angeli; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo AmadoBackground Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill-Sachs (HS) lesions. Purpose To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements. Material and Methods We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane. Results Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation (r=0.83; P<0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate. Conclusion The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.
- 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 deBackground: 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.
- 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 AmadoIntroduction 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.
- 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.
- 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
- 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.
- Accuracy of preoperative MRI in the diagnosis of subscapularis tears(2016) MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; GUGLIELMETTI, Cesar L. B.; SOUZA, Felipe F. de; GRACITELLI, Mauro E. C.; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo A.The subscapularis has received little attention in the orthopedic literature, although such lesions are evident in up to 40 % of arthroscopies. An accurate diagnosis is important in clinical practice, as it affects both patient prognosis and surgical planning. The aim of this study was to evaluate the accuracy of preoperative MRI for the identification of subscapularis tears. Our secondary aim involved the identification of factors that may be predictive for the presence of subscapularis tears. This retrospective case series included patients undergoing shoulder arthroscopy due to rotator cuff injury. MRI was performed using a 1.5 T unit, and the results were assessed by a musculoskeletal radiologist. The findings were compared to those of arthroscopic inspection. A total of 93 shoulders were analyzed. The overall accuracy was 82 %, with values of 79 % for partial tears and 89 % for full-thickness tears. Tears requiring repair demonstrated an accuracy of 88 %. Infraspinatus tears, fatty degeneration of the subscapularis, biceps instability and age were identified as predictive factors for the presence of injury. MRI of the shoulder demonstrated an accuracy of 82 % for the diagnosis of subscapularis tears. The accuracy values for partial and full-thickness tears were 79 and 89 %, respectively. III, development of diagnostic criteria with universally applied reference-nonconsecutive patients.
- Clinical and Structural Evaluations of Rotator Cuff Repair With and Without Added Platelet-Rich Plasma at 5-Year Follow-up: A Prospective Randomized Study(2018) MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; ASSUNCAO, Jorge Henrique; FERREIRA NETO, Arnaldo Amado; BORDALO-RODRIGUES, Marcelo; CAMARGO, Olavo Pires deBackground: Platelet-rich plasma (PRP) has been studied with the objective of reducing the retear rate and improving functional outcomes after rotator cuff repair. Only one study to date has reported its midterm effect. Hypothesis: PRP promotes better functional and structural results in arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: All patients underwent arthroscopic single-row repair of small to medium supraspinatus tears. At the end of the surgical procedure, liquid PRP prepared by apheresis with autologous thrombin was applied in the tendon-to-bone interface in the PRP group. The outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scales and the visual analog scale (VAS) for pain at 6, 12, 24, and 60 months after surgery and magnetic resonance imaging at 12 and 60 months. Results: Of 54 patients initially randomized, we analyzed the clinical outcomes in 51 (25 control, 26 PRP) and the structural outcomes in 44 (22 each group). At 60-month follow-up, the mean UCLA scores were 32.5 +/- 3.8 and 32.1 +/- 4.6 in the control and PRP groups, respectively (P = .992). The mean Constant scores were 82.0 +/- 9.5 in the control group and 82.1 +/- 11.0 in the PRP group (P = .699). The mean VAS scores were 1.4 +/- 1.8 and 1.5 +/- 2.1 in the control and PRP groups, respectively (P = .910). None of the clinical assessments at 6, 12, and 24 months in either group produced statistically significant differences, and both groups showed significant improvements throughout the follow-up time in the 3 evaluations (P < .001). The control group exhibited 1 full-thickness retear (Sugaya type IV) and 11 partial-thickness retears (Sugaya type III), while the PRP group had 7 partial-thickness retears (Sugaya type III). The overall number of retears did not differ between groups (P = .203). Conclusion: PRP obtained by apheresis and applied in liquid form with the addition of thrombin at the end of single-row repair of supraspinatus tears did not promote better clinical or structural results at 60-month follow-up. Registration: NCT01029574 ( ClinicalTrials. gov identifier)