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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- 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.
- Humeral internal rotation osteotomy for the treatment of Erb-Duchenne-type obstetric palsy: clinical and radiographic results(2013) ASSUNCAO, Jorge Henrique; FERREIRA NETO, Arnaldo Amado; BENEGAS, Eduardo; BOLLIGER NETO, Raul; PRADA, Flavia Santis; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; CAMANHO, Gilberto LuisOBJECTIVE: To evaluate the functional and radiographic results in patients undergoing shoulder anterior soft tissue stretching in association with open reduction and internal rotation osteotomy to centralize the humeral head as a treatment for Erb-Duchenne obstetric palsy sequelae. METHOD: A total of 35 patients underwent this surgical treatment, and the mean follow-up was 4.6 years. The Mallet scale was applied before and after the surgical procedure. A total of 20 patients underwent computed tomography to assess the glenoid version and humeral head subluxation. RESULTS: Functional improvement was achieved, as evidenced by an increase in the Mallet scale score from 12.14 to 16.46 (p<0.001). The correction of retroversion was achieved once the glenoid version ranged from 21.4 to - 12 degrees (p<0.001). The humeral head subluxation improved from 6.5 to 35.2% (p<0.001). Patients older than 6 years of age did not achieve glenohumeral joint improvement with respect to dysplastic abnormalities. CONCLUSION: Internal rotation osteotomy in association with the stretching of anterior soft tissues of the shoulder in patients under the age of 7 years provided improvements in the function, retroversion, and subluxation of the glenohumeral joint.
- A stress fracture of the base of the acromion: a case report(2014) MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; SUNADA, Edwin Eiji; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoBackground: Stress fractures of the base of the acromion are rare and tend to progress well when conservatively treated. The need for surgery due to this type of fracture has only been reported in two case reports. Case presentation: A 39-year-old patient, manual laborer, with a stress fracture at the base of the acromion that required surgical treatment due to persistent symptoms and consolidation failure. Conclusion: We described a new mechanism of injury for stress fractures of the base of the acromion. After the failure of conservative treatment, the patient exhibited good results with osteosynthesis with a plate and screws, with no need for a bone graft.
- Full-thickness supraspinatus tendon tears: correlation of findings by arthroscopy and magnetic resonance imaging(2015) MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; ARAUJO, Alex Oliveira de; SEITO, Carlos Augusto; GRACITELLI, Mauro Emilio Conforto; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo AmadoThe main aim of this study was to correlate measurements of the width and retraction of isolated full-thickness supraspinatus tendon tears determined by magnetic resonance imaging (MRI) with measurements recorded by arthroscopy using a continuous millimetre scale. A total of 53 individuals with isolated supraspinatus tears and retraction < 30 mm underwent arthroscopy at our centre. Tear width and retraction measured by arthroscopy (reference standard) and MRI (index test) on a continuous millimetre scale were compared. All measurements were performed by a single radiologist blinded to intra-operative findings and one surgeon who had previous access to MRI results. The average tear retraction was 12.60 +/- 4.89 mm by arthroscopy and 16.81 +/- 6.29 mm by MRI. Those measures exhibited moderate correlation (r = 0.643, p < 0.001) and an average difference of 4.21 mm (p < 0.001). Average tear width was 12.87 +/- 4.15 mm by arthroscopy and 14.19 +/- 5.20 by MRI. Those measures exhibited moderate correlation (r = 0.526, p < 0.001) and an average difference of 1.32 mm, which was not statistically significant (p = 0.109). Measures of retraction and width obtained by MRI and arthroscopy exhibited moderate correlation in small- or medium-sized supraspinatus tears.
- Biceps tenotomy or tenodesis in association with rotator cuff repair: is there an influence on functional results? A retrospective cohort study(2022) MALAVOLTA, Eduardo Angeli; SOUSA, Alana Caselato de; GRACITELLI, Mauro Emilio Conforto; ASSUNCAO, Jorge Henrique; SILVA, Fernando Brandao de Andrade e; FERREIRA NETO, Arnaldo AmadoBACKGROUND: Instability or tears of the long head of the biceps tendon (LHBT) may be present in more than 35% of rotator cuff repairs (RCR). OBJECTIVE: To compare clinical results from patients undergoing arthroscopic RCR, according to the pro-cedure performed at the LHBT. DESIGN AND SETTING: Retrospective cohort study designed at the shoulder and elbow clinic of Insti-tuto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. METHODS: Functional results among patients were compared using the American Shoulder and Elbow Surgeons (ASES) and University of California Los Angeles (UCLA) scales, according to the LHBT approach adopted: no procedure, tenotomy or tenodesis. RESULTS: We evaluated 306 shoulders (289 patients): 133 underwent no procedure at the LHBT, 77 tenot-omy and 96 tenodesis. The ASES scale at 24 months showed no difference (P = 0.566) between the groups without LHBT procedure (median 90.0; interquartile range, IQR 29), tenotomy (median 90.0; IQR 32.1) or tenodesis (median 94.4; IQR 22.7); nor did the UCLA scale (median 33; IQR 7 versus median 31; IQR 8 versus median 33; IQR 5, respectively, P = 0.054). The groups differed in the preoperative functional assessment according to the ASES and UCLA scale, such that the tenodesis group started from higher values. However, there was no difference in pre and postoperative scores between the groups. CONCLUSION: Tenodesis or tenotomy of the LHBT, in the sample analyzed, did not influence the clinical results from RCR, as assessed using the ASES and UCLA scales.