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Malavolta EA, Yamamoto GJ, Bussius DT, Assunção JH, Andrade-Silva FB, Gracitelli MEC, Ferreira Neto AA. Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. Orthop Traumatol Surg Res 2022; 108:102894. [PMID: 33746073 DOI: 10.1016/j.otsr.2021.102894] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Eduardo A Malavolta
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil.
| | - Gustavo J Yamamoto
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil
| | - Daniel T Bussius
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil
| | - Jorge H Assunção
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil
| | - Fernando B Andrade-Silva
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil
| | - Mauro E C Gracitelli
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil
| | - Arnaldo A Ferreira Neto
- Orthopedic and Traumatology Departament, Medicine School of University of São Paulo, Rua Capote Valente 361, apto 212, 05409-001 São Paulo, SP, Brazil
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Gracitelli MEC, Guglielmetti CLB, Botelho CAS, Malavolta EA, Assunção JH, Ferreira Neto AA. Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach. Rev Bras Ortop 2020; 55:570-578. [PMID: 33093721 PMCID: PMC7575365 DOI: 10.1055/s-0039-1700827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Mauro E C Gracitelli
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - César L B Guglielmetti
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Caio A S Botelho
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo A Malavolta
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge H Assunção
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo A Ferreira Neto
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Malavolta EA, Cruz DG, Gracitelli MEC, Assunção JH, Andrade-Silva FB, Andrusaitis FR, Ferreira Neto AA. Isokinetic evaluation of the shoulder and elbow after Latarjet procedure. Orthop Traumatol Surg Res 2020; 106:1079-1082. [PMID: 32739217 DOI: 10.1016/j.otsr.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
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°/s (p=0.044), without statistical difference at 120°/s (p=0.570). In the shoulder, there was a 13.5% decrease in external rotation strength at 60°/s and 4.5% at 180°/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°/s was decreased, as was the external rotation strength of the shoulder at 60°/s and 180°/s. We did not observe any reduction in strength for shoulder flexion or internal shoulder rotation. LEVEL OF EVIDENCE IV, case series.
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Guglielmetti CLB, Gracitelli MEC, Assunção JH, Andrade-Silva FB, Pessa MMN, Luzo MC, Ferreira Neto AA, Malavolta EA. Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation. J Shoulder Elbow Surg 2020; 29:1522-1529. [PMID: 32713463 DOI: 10.1016/j.jse.2020.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
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° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° 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.
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Affiliation(s)
- César L B Guglielmetti
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mauro E C Gracitelli
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Jorge H Assunção
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernando B Andrade-Silva
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana M Nicolosi Pessa
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Candida Luzo
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Arnaldo A Ferreira Neto
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo A Malavolta
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Gracitelli MEC, Malavolta EA, Assunção JH, Ferreira Neto AA, Silva JS, Hernandez AJ. Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures. Expert Rev Med Devices 2017; 14:733-739. [PMID: 28792243 DOI: 10.1080/17434440.2017.1364624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Proximal humerus fractures (PHF) are common fractures and are the third most common type of fractures among older adults. The most commonly used implants include the locking plate and the locking intramedullary nail. Areas covered: The aim of this study is to perform a literature review of biomechanical and clinical studies that compare the locking plate and intramedullary nail for PHF osteosynthesis. Expert commentary: Twelve clinical studies and seven biomechanical studies were identified that met this criterion. The findings of this review showed that intramedullary nailing and locking plate fixation yielded similar functional results, but with contrasting complication rates. The biomechanical studies showed controversial results, with most of the studies demonstrating better biomechanical properties for the intramedullary nail. Different types of intramedullary nail for PHF have different characteristics, with curvilinear nails presenting a higher risk of complications.
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Affiliation(s)
- Mauro E C Gracitelli
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Eduardo A Malavolta
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Jorge H Assunção
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Arnaldo A Ferreira Neto
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Jorge S Silva
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Arnaldo José Hernandez
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
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Assunção JH, Godoy-Santos AL, dos Santos MCLG, Malavolta EA, Gracitelli MEC, Ferreira Neto AA. Matrix Metalloproteases 1 and 3 Promoter Gene Polymorphism Is Associated With Rotator Cuff Tear. Clin Orthop Relat Res 2017; 475:1904-1910. [PMID: 28160256 PMCID: PMC5449328 DOI: 10.1007/s11999-017-5271-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/26/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies suggest that the collagen degeneration and disordered arrangement of collagen fibers in rotator cuff tears are associated with an increase in activity of matrix metalloproteases 1 and 3 (MMP-1 and MMP-3), and that MMP activity may be in part genetically mediated. The degree to which this might be clinically relevant in patients with rotator cuff tears has not been well characterized. QUESTIONS/PURPOSES (1) Is genetic polymorphism of MMP-1 and MMP-3 associated with rotator cuff tears? (2) Are there haplotypes of MMP-1 and MMP-3 correlated with rotator cuff tears? (3) Compared with control subjects, do patients with rotator cuff tears have a higher proportion of relatives with the same disease? METHODS We evaluated 64 patients with full-thickness rotator cuff tears and 64 asymptomatic control subjects. Patients younger 65 years, with nontraumatic tears, were included. The tear or integrity of the rotator cuff tear was evaluated by MRI or ultrasonography in all individuals. The patients and control subjects were paired by age. MMP-1 and MMP-3 genotypes were determined using the PCR-restriction fragment length polymorphism assays. RESULTS Genetic polymorphisms in MMP-1 and MMP-3 are associated with rotator cuff tear, in which individuals with rotator cuff tears have associated genotypes 1G/2G (patients, 32 of 64 [50%], control subjects, 16 of 64 [25%]; odds ratio [OR], 4.8; 95% CI, 2.1-11.0; p < 0.001) and 2G/2G were at great risk (patients, 15 of 64 [23%], control subjects, seven of 64 [11%]; OR, 5.2; 95% CI,1.8-14.9; p < 0.001), and patients with rotator cuff tears were associated with a higher proportion of 2G allele distribution (62 of 128 [48%] versus 30 of 128 [23%]; p < 0.001). Patients with the 5A/5A genotype are at greater risk of rotator cuff tear (patients, 15 of 64 [23%]; control subjects, four of 64 [6%]; OR, 5.5; 95% CI, 1.4-20.9; p = 0.021), and there was higher 5A allele distribution in patients with rotator cuff tears (patients, 68 of 128 [53%]; control subjects, 52 of 128 [41%]; p = 0.045). Individuals with the haplotype 2G/5A were more likely to have rotator cuff tears develop (patients, 42 of 64 [66%]; control subjects, 17 of 64 [27%]; OR, 5.3; 95% CI, 2.5-11.3; p < 0.001). Patients with rotator cuff tears reported, in higher number, the existence of relatives who previously had treatment for rotator cuff tears (19 of 64 [30%] versus four of 64 [6%]; OR, 6.3; 95% CI, 2.0-19.9; p = 0.001). CONCLUSIONS The genetic polymorphism of MMP-1 and MMP-3 is associated with rotator cuff tear. Individuals with haplotype 2G/5A were more susceptible to rotator cuff tears in the population studied. CLINICAL RELEVANCE Knowledge of the genetic markers related to rotator cuff tears can enable identification of susceptible individuals and increase understanding of the pathogenesis of tendon degeneration.
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Affiliation(s)
- Jorge H. Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 333, 3rd Floor, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Alexandre L. Godoy-Santos
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 333, 3rd Floor, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | | | - Eduardo A. Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 333, 3rd Floor, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Mauro E. C. Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 333, 3rd Floor, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Arnaldo A. Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 333, 3rd Floor, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
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Assunção JH, Malavolta EA, Gracitelli MEC, Hiraga DY, da Silva FR, Ferreira Neto AA. Clinical outcomes of arthroscopic rotator cuff repair: correlation between the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores. J Shoulder Elbow Surg 2017; 26:1137-1142. [PMID: 28285831 DOI: 10.1016/j.jse.2017.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are more than 40 outcome scores for evaluating shoulder pain and function. Some studies have correlated the results obtained using different scales, but none has compared the results obtained by the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores. METHODS We performed a retrospective study to evaluate patients who underwent arthroscopic rotator cuff repair with 2 years' follow-up. The patients were evaluated by the UCLA and ASES scores preoperatively and at 6, 12, and 24 months after surgery. The Pearson correlation coefficient (r) was calculated to measure the degree of correlation between the 2 outcome scores. RESULTS We evaluated 143 patients. At 24 months postoperatively, the UCLA and ASES scores were 30.4 ± 5.8 and 81.2 ± 20.8, respectively (P < .001). The UCLA and ASES scores showed a very high correlation (r = 0.91, P < .001). In all the postoperative clinical evaluations, the scores obtained from the 2 scales were highly or very highly correlated (r = 0.87-0.92, P < .001). For the preoperative scores, the correlation was moderate (r = 0.67, P < .001). CONCLUSION The UCLA and ASES scores presented a very high correlation in the evaluation of surgical treatment of rotator cuff tear. In the preoperative period, the correlation was moderate.
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Affiliation(s)
- Jorge H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mauro E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Dalton Y Hiraga
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Flavio R da Silva
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Arnaldo A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Malavolta EA, Assunção JH, Gracitelli ME, Lobo FL, Ferreira Neto AA. Fracture of the clavicle and second rib: an indirect injury from tricep dips. J Sports Med Phys Fitness 2016; 56:909-912. [PMID: 27377364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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 months later. To our knowledge, this is the first study describing the association of these fractures triggered by a single event of muscle contraction.
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Affiliation(s)
- Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil -
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Gracitelli MEC, Malavolta EA, Assunção JH, Kojima KE, dos Reis PR, Silva JS, Ferreira Neto AA, Hernandez AJ. Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial. J Shoulder Elbow Surg 2016; 25:695-703. [PMID: 27085296 DOI: 10.1016/j.jse.2016.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/01/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Mauro E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil.
| | - Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Jorge H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Kodi E Kojima
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Paulo R dos Reis
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Jorge S Silva
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Arnaldo A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Arnaldo J Hernandez
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
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Malavolta EA, Assunção JH, Gracitelli MEC, Ferreira Neto AA. Comments on: Evaluation of platelet-rich plasma and fibrin matrix to assist in healing and repair of rotator cuff injuries: a systematic review and meta-analysis. Clin Rehabil 2016; 30:726-7. [DOI: 10.1177/0269215516645433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Jorge H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Mauro EC Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Arnaldo A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
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11
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Malavolta EA, Assunção JH, Pagotto RA, Avelino RL, Gracitelli MEC, Pereira CAM, Jacomo AL, Ferreira Neto AA. The rotation of the humeral head does not alter radiographic evaluation of the head-shaft angle. J Shoulder Elbow Surg 2016; 25:543-7. [PMID: 26700557 DOI: 10.1016/j.jse.2015.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/21/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The head-shaft angle is used to plan osteotomies and arthroplasties and to assess the radiographic outcomes of surgical treatment for proximal humerus fractures. There are no published data showing whether different degrees of arm rotation interfere with the evaluation of this angle. METHODS Eighteen humeri from adult cadavers were used. Radiographs were taken with the specimens initially placed in a true anteroposterior position and then subsequently positioned with internal and external rotations of 10°, 20°, and 30°. All radiographs were evaluated by 3 shoulder and elbow surgeons at 2 different times 3 months apart. The head-shaft angle was measured using a picture archiving and communication system. RESULTS For the humerus in the neutral position, the head-shaft angle was 137° ± 4°. With the anatomic specimen positioned with increasing external and internal rotations, there was a maximum difference of 2° compared with the value observed in the neutral position, which was not a significant difference (P = .911). Measurements of the head-shaft angle showed a good interobserver correlation coefficient, with a value of 0.788 (0.728-0.839) for all measurements. The intraobserver correlation coefficient ranged from moderate to excellent (0.536-0.938). CONCLUSION The head-shaft angle did not change significantly with varying degrees of humeral rotation. The interobserver correlation coefficient showed good reliability, and the intraobserver correlation was moderate to excellent.
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Affiliation(s)
- Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Jorge H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil.
| | - Raphaella A Pagotto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Rafael L Avelino
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Mauro E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Cesar A M Pereira
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Alfredo L Jacomo
- Department of Anatomy, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Arnaldo A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
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Malavolta EA, Assunção JH, Rebolledo DCS, Gracitelli MEC, Correia LFM, Ferreira Neto AA, de Camargo OP. Osteoid osteoma of the glenoid: Arthroscopic treatment. Orthop Traumatol Surg Res 2015; 101:977-80. [PMID: 26545941 DOI: 10.1016/j.otsr.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 08/10/2015] [Accepted: 08/28/2015] [Indexed: 02/02/2023]
Abstract
Osteoid 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.
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Affiliation(s)
- E A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil
| | - J H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil.
| | - D C S Rebolledo
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil
| | - M E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil
| | - L F M Correia
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil
| | - A A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil
| | - O P de Camargo
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Universidade de São Paulo - USP, Rua Dr. Ovídio Pires de Campos 333, 3rd floor, 05403-010 Cerqueira Cesar São Paulo/SP, Brazil
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13
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Malavolta EA, Assunção JH, Guglielmetti CLB, de Souza FF, Gracitelli MEC, Ferreira Neto AA. Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon. Eur J Radiol 2015; 84:2250-4. [PMID: 26256048 DOI: 10.1016/j.ejrad.2015.07.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022]
Abstract
OBJETIVES To evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of disorders of the long head of the biceps tendon (LHBT). The secondary objective was to investigate predictive factors for tears and instability. METHODS This retrospective case series involved patients undergoing shoulder arthroscopy due to rotator cuff injury. MRI was performed in a 1.5T scanner and was evaluated by a musculoskeletal radiologist. The findings were compared with those of arthroscopic inspection. RESULTS A total of 90 shoulders were analyzed. Regarding tears, there was 67% sensitivity and 98% specificity. Regarding instabilities, the values were 53% and 72%, respectively. Tears and fatty degeneration of the infraspinatus are predictive factors for tears of the LHBT. Tears of the subscapularis and infraspinatus, retraction of the supraspinatus and infraspinatus equal to or greater than 30mm, and fatty degeneration of the infraspinatus and subscapularis are predictive factors for instability. CONCLUSION Compared to arthroscopy, the shoulder MRI has a sensitivity of 67% and a specificity of 98% for the detection of complete tears of the LHBT. For instability, the values are 53% and 72%, respectively.
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Affiliation(s)
- Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Jorge H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil.
| | - Cesar L B Guglielmetti
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Felipe F de Souza
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Mauro E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
| | - Arnaldo A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo/SP, Brazil
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Negri JH, Malavolta EA, Assunção JH, Gracitelli MEC, Pereira CAM, Bolliger Neto R, Croci AT, Ferreira Neto AA. Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers. Orthop Traumatol Surg Res 2014; 100:727-31. [PMID: 25261174 DOI: 10.1016/j.otsr.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/05/2014] [Accepted: 07/31/2014] [Indexed: 02/02/2023]
Abstract
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. Determining the 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. LEVEL OF EVIDENCE IV, basic science, biomechanics, cadaver model.
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Affiliation(s)
- J H Negri
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - E A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - J H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil.
| | - M E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - C A M Pereira
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - R Bolliger Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - A T Croci
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - A A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
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Ferreira Neto AA, Assunção JH, Ferreira Filho AA, Malavolta EA, Gracitelli MEC. Comments on: "Centering osteotomy for treatment of posterior shoulder dislocation in obstetrical palsy" by PR Vilaça, MK Uezami, A Zoppi Filho published in Orthop Tramatol Surg Res 2012; 98: 199-205. Orthop Traumatol Surg Res 2013; 99:755-6. [PMID: 23988423 DOI: 10.1016/j.otsr.2013.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/26/2013] [Indexed: 02/02/2023]
Affiliation(s)
- A A Ferreira Neto
- Shoulder and Elbow Group, University of São Paulo, São Paulo, Brazil
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Mion D, Pierin AMG, Bambirra AP, Assunção JH, Monteiro JM, Chinen RY, Coser RB, Aikawa VN, Cação FM, Hausen M, Vilibor MF, Aikawa NE, Konno SN, Coser RB. Hypertension in employees of a University General Hospital. ACTA ACUST UNITED AC 2004; 59:329-36. [PMID: 15654485 DOI: 10.1590/s0041-87812004000600004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE: To find out the prevalence of hypertension in employees of the Hospital and relate it to social demographic variables. METHODS: Blood pressure measurement was performed with a mercury sphygmomanometer, using an appropriate cuff size for arm circumference, weight, and height in a population sample of 864 individuals out of the 9,905 employees of a University General Hospital stratified by gender, age, and job position. RESULTS: Hypertension prevalence was 26% (62% of these reported being aware of their hypertension and 38% were unaware but had systolic/diastolic blood pressures of >140 and/or >90 mm Hg at the moment of the measurement). Of those who were aware of having hypertension, 51% were found to be hypertensive at the moment of the measurement. The prevalence was found to be 17%, 23%, and 29% (P <.05) in physicians, nursing staff, and "others", respectively. The univariate analysis showed a significant odds ratio for the male gender, age >50 years, work unit being the Institute of Radiology and the Administration Building, educational level <elementary school, length of work >10 years, and body mass index >30 kg/m². The multivariate logistic regression model revealed a statistically significant association of hypertension with the following variables: gender, age, skin color, family income, and body mass index. CONCLUSIONS: Hypertension prevalence was high, mainly in those who were not physicians or members of the nursing staff. High-risk groups (obese, non-white, men, low family income) should be better advised of prevention and early diagnosis of hypertension by means of special programs.
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Affiliation(s)
- Decio Mion
- Hypertension Unit, Hospital das Clínicas, Faculty of Medicine, University of São PauloSão Paulo, SP, Brazil.
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