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ABSTRACT Objective: To describe a protocol of obtention of mesenchymal stem cells and to report their use as a biological adjuvant in three patients undergoing arthroscopic rotator cuff repair. Methods: Case series of patients who underwent arthroscopic repair of isolated full-thickness supraspinatus tear using mesenchymal stem cells obtained from the bone marrow as a biological adjuvant. All patients were operated on at the same institution, by a surgeon with 13 years of experience. The cells were applied at the end of the procedure, at the tendon-bone interface, at an approximate concentration of 2,000,000 mesenchymal cells/mm3 and a total volume of 5 ml. Results: All patients improved with the procedure, with one excellent and two good results. All cases overcame the minimally important clinical difference. All cases reached tendon healing, without partial or complete re-tears. We observed no complications. Conclusion: Arthroscopic rotator cuff repair with added mesenchymal cells obtained from bone marrow and submitted to a cell expansion process led to good functional results and healing in all cases in the sample, with no complications. Level of Evidence IV, Case Series.

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

ABSTRACT Objective: To evaluate the clinical and radiographic results of the surgical treatment of fractures of the middle third of the clavicle, using the technique of minimally invasive plate osteosynthesis (MIPO) with locking. Methods: Prospective case series, evaluating displaced fractures of the middle third of the clavicle submitted to MIPO with locking, with procedures performed by a single surgeon. Patients were evaluated at 12 months using the University of Los Angeles (UCLA) scale and anteroposterior radiographs of the clavicles with 45° cranial and caudal inclination, as well as reporting complications. Results: In total, 15 patients were evaluated. The median of surgical time was 50 minutes (IQR 35). The UCLA scale had a median of 35 (IQR 2) at 12 months. All patients presented fracture healing. Minor complications occurred in three cases (20%), with two (13.3%) evolving with plate prominence and one (6.7%) with local paresthesia, while major complications occurred in only one case (6.7%), with suture dehiscence requiring surgical re-approach. Conclusion: MIPO with locking is a viable option for the treatment of displaced fractures of the middle third of the clavicle, with excellent results according to the UCLA scale, fracture healing in all cases, and a low rate of complications. Level of Evidence IV, Case Series.

Abstract Objective To evaluate the functional outcome of patients who underwent partial arthroscopic repair of massive rotator cuff tears. Methods Retrospective case series evaluating patients with massive rotator cuff tears who underwent partial arthroscopic repair. The primary outcome was the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) at 24 months. The secondary outcomes were the Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), and the following subdomains: satisfaction, active forward flexion and strength of forward flexion subdomains. Results We evaluated 33 patients. The ASES scale evolved from 39.7 ± 19.6 to 77.6 ± 17.4 (p< 0.001). The UCLA scale evolved from 13.3 ± 5.5 to 27.9 ± 5.6 (p< 0.001). The satisfaction rate was 97%. The number of patients with active forward flexion > 150° increased from 12 (36.4%) to 25 (75.8%) (p= 0.002). The number of patients with normal or good strength of forward flexion increased from 9 (27.3%) to 22 (66.7%) (p = 0.015). Conclusion Partial repair of irreparable rotator cuff tears leads to significant improvement according to the ASES and UCLA scales.

ABSTRACT Objective: To describe the functional results, recurrence rate, postoperative radiographic appearance, and complications of patients undergoing the Latarjet procedure over 24 months. Methods: Retrospective case series, including adult patients with recurrent traumatic anterior glenohumeral dislocation undergoing the Latarjet procedure. We clinically evaluated patients preoperatively by the Rowe score and at six, 12, and 24 months after the procedure. The positioning, consolidation, and resorption of the graft were analyzed by plain radiography. The recurrence rates and other complications were also described. Results: We analyzed 40 patients (41 shoulders). The Rowe score median increased from 25 before surgery to 95 at 24 months after surgery (p < 0.001). We observed graft resorption in three cases (7.3%) and consolidation in 39 (95.1%). Most grafts presented adequate placement. We observed two recurrences (4.8%), one case of dislocation and one of subluxation. Seven patients (17.1%) had a positive apprehension test. The study had no cases of infection, neuropraxia, or graft breakage. Conclusion: Latarjet surgery is a safe and effective procedure in the treatment of recurrent anterior dislocation of the shoulder. This surgery enables a statistically significant improvement according to the Rowe score, with a low number of recurrences. Level of Evidence IV, Case Series.

ABSTRACT Objectives: To describe the clinical and radiographic results of patients with traumatic recurrent anterior shoulder dislocation treated with the Bristow-Latarjet procedure. Methods: Retrospective case series including 44 patients (45 shoulders) who underwent the Bristow-Latarjet procedure. The graft was fixed “standing” in 84% of the shoulders, and “lying” in 16%. Results: The follow-up was 19.25 ± 10.24 months. We obtained 96% of good results, with 2 recurrences presented as subluxation. Graft healing occurred in 62% of cases. The graft was positioned below the glenoid equator in 84% of the cases, and less than 10 mm from its edge in 98%. The external rotation had a limitation of 20.7º ± 15.9º, while the internal rotation was limited in 4.0º ± 9.6º. The limitation of rotation and the position of the graft (“standing” or “lying”) did not correlate with graft healing (p>0.05). Bicortical fixation was positively correlated with healing (p

ABSTRACT Introduction To evaluate the relationship between the genetic polymorphism of matrix metalloproteinases 1 and 13 and posttraumatic elbow stiffness, as well as the association of other risk factors with this condition. Materials and methods We evaluated 20 patients with posttraumatic elbow stiffness and 12 controls with traumatic elbow disorders without contracture. Deoxyribonucleic acid (DNA) was obtained from buccal mucosa epithelial cells of the volunteers. The MMP-1 and MMP-13 genotypes were determined using PCR-restriction fragment length polymorphism assays. Results We did not find any significant differences in the frequency of genotypes and alleles between the test and control groups for the polymorphism of metalloproteinases 1 and 13. We observed that genotypes 1G/2G and 2G/2G of MMP-1 were present in 65% (13/20) of patients with articular stiffness and 50% (6/12) of controls (p = 0.599). Genotypes A/A and A/G of MMP-13 were obtained in 95% (19/20) of patients and 91.6% (11/12) of controls (p = 0.491). Among the prognostic factors for elbow stiffness, only immobilization time correlated positively. The mean immobilization time for cases and controls were 16 ± 10 days and 7 ± 7 days, respectively (p = 0.017). Conclusion The genetic polymorphism of MMP-1 at position -1607 and MMP-13 at position -77 was not associated with post-traumatic elbow stiffness. Level of Evidence III; Prognosis Study; Case-Control Study.

Abstract A review involving the six major international orthopedic journals has been published recently. It described the tools used for the evaluation of outcomes in the surgical treatment of recurrent anterior dislocation of the shoulder. There are no studies that exhibit the main outcome tools for this disease in Brazil. The authors evaluated the outcomes of clinical studies involving anterior glenohumeral instability that were published in the last decade in the two leading Brazilian orthopedic journals, Revista Brasileira de Ortopedia and Acta Ortopédica Brasileira. A review of the literature was performed, including all clinical papers published between 2007 and 2016 describing at least one outcome measure before and after surgical intervention. The outcomes were range of motion, muscle strength, physical examination testing, patient satisfaction, return to sports, imaging, complications, and functional outcomes scores. Twelve studies evaluating the clinical outcomes of surgical treatment for anterior shoulder instability were published. Ten studies (83%) were case series (level of evidence IV), 1 (8%) was a case-control study (III), and 1 was a retrospective cohort (III). On average, the number of outcomes assessed was 3.7 ± 1.7. The Rowe score was used in 9 studies (75%), and 7 (58%) papers used the University of California Los Angeles (UCLA) scale. Ten studies (83%) reported complications related to surgical treatment. The complication most frequently reported was recurrent instability, found in 9 studies (75%). The national studies have preferentially used scales considered to be of low reliability, responsiveness, and internal consistency.

Abstract Superior capsular reconstruction is a recently described procedure for the treatment of irreparable supraspinatus tendon tears. Graft options that have been previously described include autogenous fascia lata and decellularized dermal graft. No studies were published with the use of fascia lata allograft. The purpose of this technical note is to describe the surgical technique of superior capsular reconstruction using fascia lata allograft. The procedure is performed by arthroscopic visualization, with the patient positioned in the lateral decubitus position. The authors describe a technique based on the use of a double-pulley knot in the glenoid and greater tuberosity, facilitating the procedure and allowing the graft to be brought into the subacromial space in the definitive position, with the appropriate tension. The allografts are available from this institution's tissue bank, cryopreserved and submitted to microbiological and histopathological evaluation. Superior capsular reconstruction is a promising surgery. The technique described in the present technical note shows a viable arthroscopic alternative, with a smaller number of anchors when compared with other techniques.

ABSTRACT Objective: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. Methods: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. Results: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. Conclusion: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores. Level of Evidence I; Clinical randomized trial

ABSTRACT Objective: To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales. Methods: This cross-sectional study with controls paired by sex and age compared patients with rotator cuff arthropathy with surgical indication for reverse shoulder arthroplasty. The groups were compared according to the SF-12, ASES, and VAS scales. Results: The groups consisted of 38 individuals, 28 women. The SF-12 demonstrated a significant difference in the physical component, with the cases scoring 31.61 ± 6.15 and the controls 49.39 ± 6.37 (p

ABSTRACT Multifocal osteonecrosis is a rare disease; chronic use of corticosteroids is considered the main risk factor. Patients with chronic renal failure can develop aluminum toxicity, which can lead to osteomalacia and encephalopathy. An association between osteonecrosis and aluminum toxicity has been reported among patients with dialytic renal insufficiency. Occupational exposure to aluminum rarely causes lung disease and no cases of bone lesions resulting from exposure to this metal have been reported. In this manuscript, we describe a novel case of a patient with multifocal osteonecrosis associated with chronic occupational exposure to aluminum. Level of Evidence IV, Case Report.

ABSTRACT OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. CONCLUSION: The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.

OBJECTIVE: To identify prognostic factors of postoperative functional outcomes. METHODS: Retrospective case series evaluating patients undergoing rotator cuff repair, analyzed by the UCLA score (pre and 12-month postoperative) and Magnetic Resonance Imaging (preoperative). Patients' intrinsic variables related to the injury and intervention were evaluated. Multivariate linear regression analysis was performed to determine variables impact on postoperative functional assessment. RESULTS: 131 patients were included. The mean UCLA score increased from 13.17 ± 3.77 to 28.73 ± 6.09 (p

OBJECTIVE: To compare the viability of transferring the lower and transverse trapezius to the greater tuberosity using three different techniques. METHODS: Twelve shoulders from six cadavers were used. The primary outcome was to assess the suture viability of the trapezius muscle transfer to the greater tuberosity in the insertion topography of the infraspinatus, with the arm adducted during internal rotation (hand on the abdomen) and maximum scapular retraction. Three transfers were applied to each shoulder: the lower and transverse trapezius distal insertion (Group 1); lower trapezius alone (Group 2); and lower trapezius insertion and origin (Group 3). Accessory nerve integrity was assessed before and after transfers. RESULTS: Sutures were viable in 42% (5/12) and 58% (7/12) on Groups 1 and 3, respectively, with no statistically significant difference (Fisher's test, p=0.558); Group 3 exhibited frequent neurologic injury (11/12). Group 2 was the least successful; the tendon did not reach the greater tuberosity, and no sutures were viable. CONCLUSION: Groups 1 and 3 exhibited the best nongrafting suture viability to the greater tuberosity; however, Group 3 was associated to frequent spinal accessory nerve injury. Level of Evidence IV, Anatomical Study

Objective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r) plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%). Conclusion: The fixation with the Philos(r) plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes.

OBJETIVO: Avaliar a segurança do procedimento de Latarjet artroscópico em cadáveres. MÉTODOS: Doze ombros foram submetidos ao procedimento de Latarjet artroscópico em nosso laboratório de artroscopia, por quatro cirurgiões diferentes. Após a cirurgia os espécimes foram submetidos a exames radiográficos e avaliados por um examinador independente. Dezenove parâmetros foram avaliados, incluindo a fixação do enxerto do coracoide, o posicionamento e a angulação dos parafusos, lesões neurológicas e a integridade dos tendões. RESULTADOS: Quatro dos procedimentos foram considerados satisfatórios, sem diferença entre os cirurgiões. A angulação média dos parafusos foi de 27,2°. A incisão no tendão do subescapular foi, em média, a 17,8mm da sua borda superior. O enxerto coracoide foi corretamente posicionado em relação ao equador da glenoide em 11 casos. Não houve lesão nos nervos axilar ou musculocutâneo. As principais complicações encontradas foram: interposição de tecidos moles, lesão do nervo supraescapular, desvio articular do enxerto, diastase e lesão do tendão conjunto. CONCLUSÃO: O procedimento de Latarjet artroscópico é uma técnica complexa, em que cada etapa deve ser precisa para diminuir o risco de complicações. Nosso estudo demonstrou um alto risco de insucesso do procedimento. Nível de evidência iv, série de casos.

OBJECTIVE: Profile analysis of articles from scientific journals is rare in our country. The aim of this study was to perform an analysis of publications of the Revista Brasileira de Ortopedia (RBO), to specify the designs of the studies and their level of evidence. METHODS: All articles published in RBO from January 2006 to December 2010 were classified according to the design of the study. The clinical studies were further stratified according to the level of evidence, in agreement with the norm of the journal. The studies classified as randomized and controlled clinical trials (RCTs) had their quality assessed by the system proposed by Jadad. RESULTS: In this period, there were 376 articles published in RBO. Clinical studies represented most of the papers, with 60.64% of the total. Case series represented 61.4% of the clinical studies. Thirteen RCTs were published, accounting for 3.46% of the total, and 5.7% of the clinical studies. The analysis of the quality of the RCTs showed that 5 (38.46%) were considered high quality, while 8 (61.54%) were of low quality. Among the studies in which the level of evidence does not apply (non-clinical), non-systematic reviews (46 articles) and basic research (40 articles) have prevailed, representing 12.23% and 10.64% respectively of the total. CONCLUSIONS: Case series were the most prevalent (37.23%) studies published in RBO between 2006 and 2010, while RCTs accounted for 3.46% of the articles. The majority of RCTs (61.54%) were considered low quality, and only 1.32% of the clinical studies were classified as level I evidence.

OBJETIVOS: Avaliar a correlação entre os parâmetros radiográficos e as avaliações funcionais de pacientes com osteoartrose do ombro submetidos à artroplastia do ombro e descrever os resultados funcionais deste procedimento em nosso serviço. MÉTODOS: Foram avaliados 21 pacientes (22 ombros) que realizaram artroplastias do ombro entre 1998 e 2010 e que apresentassem tempo mínimo de seguimento de 12 meses. A avaliação clínica foi realizada através das escalas de Constant-Murley, UCLA, EVA e da medida do arco de movimento ativo. Aferimos parâmetros radiográficos pré-operatórios (distância entre o topo da cabeça e o úmero e o acrômio, migração superior, inclinação do colo,"offset" medial, subluxação do úmero, erosão da glenóide) e pós-operatórios (inclinação da haste, migração dos componentes e sinais de soltura). RESULTADOS: Os pacientes apresentaram melhora significativa em todos os parâmetros avaliados: flexão (p=0,0083), abdução (p=0,0266), rotação externa (p=0,0062), Constant-Murley (p=0,0001), UCLA (pOBJECTIVES: to evaluate the correlation between radiographic parameters and functional assessments of patients with osteoarthritis of the shoulder who underwent shoulder arthroplasty and describe the functional outcomes of this procedure in our institution. METHODS: we evaluated 21 patients (22 shoulders) who underwent shoulder arthroplasty between 1998 and 2010 with a minimum follow-up of 12 months. clinical evaluation was performed using the constantmurley scale, ucla, vas and measuring the arc of active motion. we analysed preoperative radiographic parameters (distance from the top of the head and the humerus and the acromion, superior migration, neck angulation, medial "offset", subluxation, glenoid cavity erosion) and postoperatively we evaluated rod inclination, migration of components and loosening. RESULTS: patients showed significant improvement in all parameters: flexion (p = 0.0083), abduction (p = 0.0266), external rotation (p = 0.0062), constantmurley (p = 0.0001 ), ucla (p < 0.0001) and vas (p = 0.0002). the superior migration of the humerus showed a significant correlation with ucla and constant-murley scores (p = 0.0480 and p = 0.0110, respectively). the other radiographic parameters had no correlation with the clinical outcomes. CONCLUSION: the superior migration of the humerus is related to a worsening of clinical scores. Level of Evidence IV, Case Series.

OBJETIVO: Avaliar os resultados funcionais e o índice de rerrotura do reparo do manguito rotador por via artroscópica associado ao uso do PRP. MÉTODOS: Série de casos prospectiva, avaliando os resultados do reparo artroscópico do manguito rotador em fileira simples associada ao uso do PRP. Foram incluídas apenas roturas isoladas do supraespinal, com retração inferior a 3cm. O PRP utilizado foi obtido pelo método de aférese, e aplicado em sua forma ativada, com a adição de trombina autóloga, na consistência líquida. A avaliação pós-operatória foi realizada de maneira padronizada, aos 12 meses de seguimento. Foram utilizadas as escalas de Constant-Murley, UCLA e EVA, além da análise da incidência de rerroturas através da ressonância magnética. RESULTADOS: Foram avaliados 14 pacientes (14 ombros). A escala de Constant-Murley evoluiu em média de 45,64 ± 12,29 no pré-operatório para 80,78 ± 13,22 no pós-operatório (p < 0,001). A escala de UCLA sofreu um incremento de 13,78 ± 5,66 para 31, 43 ± 3,9 (p < 0,001). A dor dos pacientes apresentou uma melhora significativa de acordo com a EVA (p = 0,0013), decrescendo de uma mediana de 7,5 (p25% = 6, p75% = 8) para 0,5 (p25% = 0, p75% = 3). Nenhum dos pacientes apresentou rerrotura completa. Em três pacientes (21,4%) foi observada uma rerrotura parcial, sem transfixação. Apenas um paciente evoluiu com complicação (capsulite adesiva). CONCLUSÃO: Os pacientes submetidos ao reparo do manguito rotador por via artroscópica associado ao uso do PRP apresentaram uma melhora funcional significativa e nenhuma rerrotura completa.OBJECTIVE: To evaluate shoulder functional results and the re tear rate of arthroscopic repair of the rotator cuff augmented with platelet-rich plasma (PRP). METHODS: Prospective case series with single-row arthroscopic repair of the rotator cuff augmented with PRP. Only cases of isolated supraspinatus tears with retraction of less than 3 cm were included in this series. The PRP used was obtained by apheresis. It was applied on liquid consistency in its activated form, with the addition of autologous thrombin. Patients were evaluated after 12 months of the surgical procedure. The Constant-Murley, UCLA and VAS scales were used, and the retear rate was assessed using magnetic resonance imaging (MRI). RESULTS: Fourteen patients were evaluated (14 shoulders). The mean Constant-Murley score was 45.64 ± 12.29 before the operation and evolved to 80.78 ± 13.22 after the operation (p < 0.001). The UCLA score increased from 13.78 ± 5.66 to 31.43 ± 3.9 (p < 0.001). The patients' pain level decreased from a median of 7.5 (p25% = 6, p75% = 8) to 0.5 (p25% = 0, p75% = 3) (p = 0.0013) according to the VAS score. None of the patients presented complete retear. Three patients (21.4%) showed partial retear, without transfixation. Only one patient developed complica tions (adhesive capsulitis). CONCLUSION: Patients submitted to arthroscopic rotator cuff repair augmented with PRP showed significant functional improvement and none of them had com plete retearing.

OBJETIVO: Descrever a experiência inicial de quatro serviços ortopédicos com a artroplastia total do cotovelo (ATC) Bi-Contact® relatando os resultados e complicações do procedimento. MÉTODOS: Estudo retrospectivo, através da análise de prontuários, de pacientes submetidos à ATC primária com modelo de prótese desenvolvido junto ao IOT-HCFMUSP. Foram avaliados 46 cotovelos (45 pacientes) operados de 2000 a 2009 em quatro serviços ortopédicos. RESULTADOS: A maioria dos pacientes era do sexo feminino (74%) e a mediana da idade foi de 62,5 anos. Os diagnósticos encontrados foram sequela de trauma (47,83%), artrite reumatóide (32,61%), osteoartrose primária (8,7%), fraturas agudas (6,52%) e ossificação heterotópica (2,17%). A mediana do tempo de acompanhamento foi de 2,08 anos (0,25-9). O procedimento melhorou significativamente a dor e o arco de movimento. Foi evidenciada a presença de pelo menos uma complicação em 69,57% dos casos, sendo as principais infecção (28,26%), necessidade de revisão (28,26%), fratura intraoperatória (15,22%) e soltura asséptica (15,22%). CONCLUSÃO: A ATC do tipo Bi-Contact® propiciou uma melhora significativa na dor e no arco de movimento na presente série. O índice de complicação é alto, sendo as mais frequentes infecção, soltura asséptica e fratura intraoperatória.OBJECTIVE: To describe the initial experience of four orthopedic clinics from using Bi-Contact® total elbow arthroplasty (TEA), reporting the results and complications of the procedure. METHODS: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. RESULTS: The majority of the patients were female (74%), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83%), rheumatoid arthritis (32.61%), primary osteoarthrosis (8.7%), acute fractures (6.52%) and heterotopic ossification (2.17%). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57% of the cases, and the main ones were infection (28.26%), need for revision (28.26%), intraoperative fracture (15.22%) and aseptic loosening (15.22%). CONCLUSION: Bi-Contact® TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture.

OBJETIVO: Apresentar os resultados clínicos e radiográficos de uma série de casos com diagnóstico de Luxação Acromioclavicular (LAC) Aguda, tratados através da fixação coracoclavicular com âncoras por via artroscópica. MÉTODO: Vinte pacientes apresentando LAC com menos de 30 dias de evolução foram operados pela técnica da estabilização coracoclavicular com âncoras por via artroscópica. Duas âncoras metálicas com dois fios cada, foram inseridas no coracóide. Os fios foram amarrados sobre a clavícula passando por túneis transósseos claviculares. Para a avaliação radiográfica, foi utilizada a medida comparativa da distância coracoclavicular com o lado contralateral e a avaliação funcional através dos escores de Constant e UCLA o seguimento foi de seis meses. RESULTADO: Dos vinte casos inicialmente selecionados, seis necessitaram de novo procedimento cirúrgico e foram excluídos do estudo. Dos quatorze pacientes restantes, apenas dois mantiveram redução da articulação acromioclavicular, enquanto os demais apresentaram algum grau de desvio no decorrer da evolução. Desconsiderando os pacientes excluídos, os escores de Constant e UCLA tiveram média 94,79 (82-100) e, 32,64 (26-35), respectivamente. CONCLUSÃO: A técnica apresentou um alto índice de perda da redução ao longo da evolução de seis meses. A avaliação funcional apresentou resultado satisfatório com escore médio elevado de Evidência: Nível de Evidência: Nível III, estudo retrospectivo.OBJECTIVE: To present the clinical and radiographic results of a case series of patients with acute acromioclavicular dislocation (AAD) treated by arthroscopic coracoclavicular fixation with suture anchors. METHOD: Twenty patients with AAD with less than 30 days since the injury were submitted to a coracoclavicular stabilization procedure using 2 suture anchors placed at the base of the coracoid process. Each suture anchor was connected to 2 strands of No.2 nonabsorbable-braided sutures, which were passed through the holes drilled in the clavicle and tied to the upper surface of the clavicle. The coracoclavicular distance was measured and compared to the opposite side using radiographic evaluation. Constant and UCLA scores were used to determine clinical and functional evaluation after 6 months. RESULTS: Of the initial twenty cases, six were submitted to a new surgical procedure and were excluded from the study. Of the fourteen patients remaining, only two maintained the initial reduction, while the remainder presented some degree of reduction loss. The Constant and UCLA score averages were 94.79 (82-100) and 32.64 (26-35) respectively. CONCLUSION: The technique had a high incidence of reduction loss after 6 months of follow up. The clinical and functional evaluation was satisfactory, with a high average score. Level of Evidence: Level III, retrospective study.

OBJETIVO: Análise dos resultados de 159 pacientes com instabilidade anterior do ombro submetidos ao tratamento artroscópico de janeiro de 2001 a dezembro de 2005. MÉTODOS: Estudo retrospectivo de prontuários com dados completos. RESULTADOS: Em 108 pacientes notou-se a lesão de Bankart e em 62 pacientes a lesão do tipo SLAP estava presente. Utilizou-se em média 2,7 âncoras. Apresentaram complicações 42 casos; 14 tinham dor aos esforços, 12 tinham algum grau de diminuição da rotação externa, 16 apresentaram recidiva. Os pacientes que evoluíram com complicações utilizaram em média 2,5 âncoras, enquanto naqueles sem complicações a média foi de 2,8 (pOBJECTIVE: To analyze the results of 159 patients with anterior instability of the shoulder submitted to arthroscopic treatment from January 2001 to December 2005. METHODS: Retrospective study of complete patient records. RESULTS: In 108 patients the Bankart lesion was found, while in 62 patients, SLAP type lesions were found. An average of 2.7 anchors was used. 42 cases presented complications; 14 had pain on effort, 12 had some degree of reduction of external rotation, and 16 had recorrence. The patients who developed complications used an average of 2.5 anchors, while those without complications used an average of 2.8 anchors (p

Os ensaios clínicos controlados e randomizados (ECCR) são considerados o padrão ouro da medicina baseada em evidências na atualidade, sendo importantes para direcionar a conduta médica através de observações científicas consistentes. Passos como seleção dos pacientes, randomização e cegamento são fundamentais na realização de um ECCR e apresentam algumas dificuldades extras nos ensaios que envolvem procedimentos cirúrgicos, como é comum na Ortopedia. O objetivo deste artigo é destacar e discutir algumas dificuldades e eventuais limitações dos ECCR na área cirúrgica.Randomized controlled clinical trials (RCTs) are considered to be the gold standard for evidence-based medicine nowadays, and are important for directing medical practice through consistent scientific observations. Steps such as patient selection, randomization and blinding are fundamental for conducting an RCT, but some additional difficulties are presented in trials that involve surgical procedures, as in common in orthopedics. The aim of this article was to highlight and discuss some difficulties and possible limitations on RCTs within the field of surgery.

OBJETIVO: Avaliar o resultado clínico da técnica de "remplissage" associada ao reparo da lesão de Bankart (BK) para o tratamento da luxação anterior recidivante do ombro. MÉTODOS: Nove pacientes (10 ombros), com seguimento médio de 13,7 meses, apresentaram luxação traumática anterior recidivante do ombro. Todos tinham lesão de BK associada à lesão de Hill e Sachs (HS), com sinal do "encaixe". O defeito das lesões de HS foi medido e apresentava em média 17,3% (7,7% a 26,7%) de perda óssea em relação ao diâmetro da cabeça do úmero. Todos foram submetidos ao reparo artroscópico da lesão de BK associado ao preenchimento ("remplissage") da lesão de HS pela tenodese do infraespinal. RESULTADOS: O escore de Rowe variou de 22,5 (10 a 45) no período pré-operatório para 80,5 (5 a 100) no período pós operatório (p < 0,001). O escore da UCLA variou de 18,0 (8 a 29) para 31,1 (21 a 31) (p < 0,001). As medidas das rotações externa e interna, em 90º de abdução no período pós-operatório, foram 63,5º (45º a 90º) e 73º (50º a 92º), respectivamente. Dois pacientes apresentaram recidiva (um com luxação e outro com subluxações). Nenhum paciente apresentou dor na topografia do tendão infraespinal no período pós-operatório. CONCLUSÃO: A técnica de "remplissage" por artroscopia demonstrou, a curto prazo, melhora dos escores funcionais e baixo índice de complicações no tratamento da instabilidade glenoumeral associada às lesões de Hill-Sachs.OBJECTIVE: To evaluate the clinical result from the filling ("remplissage") technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. METHODS: Nine patients (10 shoulders), with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the "engaging" sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3% (7.7% to 26.7%) in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. RESULTS: The Rowe score ranged from 22.5 (10 to 45) before the operation to 80.5 (5 to 100) after the operation (p < 0.001). The UCLA score ranged from 18.0 (8 to 29) to 31.1 (21 to 31) (p < 0.001). The measurements of external and internal rotation at abduction of 90º after the operation were 63.5º (45º to 90º) and 73º (50º to 92º) respectively. Two patients presented recurrence (one with dislocation and the other with subluxation). None of the patients presented pain in the region of the infraspinatus tendon after the operation. CONCLUSION: Over the short term, the filling ("remplissage") arthroscopic technique produced improvements in functional scores and a low complication rate when used for treating glenohumeral instability associated with Hill-Sachs lesions.

OBJETIVO: Apresentar os resultados radiográficos e funcionais de pacientes submetidos ao tratamento da luxação acromioclavicular crônica com reconstrução dos ligamentos coracoclaviculares com enxerto de tendão semitendíneo. MÉTODO: Quinze pacientes, entre abril de 2007 e junho de 2008, foram submetidos a reconstrução dos ligamentos coracoclaviculares com enxerto tendíneo. Dois pacientes foram excluídos do estudo por seguimento inadequado. Treze pacientes foram seguidos clinicamente e radiograficamente, em média, por 16 meses (12-26 meses). Os pacientes foram submetidos a avaliação clinica pré e pós-operatória, utilizando os escores Constant e UCLA. Radiografias pré e pós-operatórias foram comparadas. RESULTADOS: Neste grupo de 13 pacientes com seguimento mínimo de um ano, o escore Constant variou de 60,9 (26-88) na avaliação pré-operatória para 87 (60-98) na última avaliação no período pós-operatório. O escore UCLA foi de 16,8 (11-27) no pré operatório para 33 (29-35) na avaliação pós-operatória (p=0,001). No controle radiográfico com um ano de pós-operatório, encontramos 12 pacientes (92%) com a distância coracoclavicular igual comparando o ombro operado ao contralateral. Todos os ombros operados apresentavam-se sem translação na direção antero-posterior no perfil axilar. CONCLUSÃO: O resultado funcional e radiográfico foi muito satisfatório nos pacientes submetidos à reconstrução das luxações acromioclaviculares crônicas, com baixo indice de recidiva. Nivel de Evidência IV, série de casos.OBJECTIVE: The aim of this study is to present the radiographic and functional results of patients undergoing treatment for chronic acromioclavicular dislocation with coracoclavicular ligament reconstruction using tendon graft. METHOD: Between 2007 and 2008, fifteen patients with chronic Rockwood type III through V acromioclavicular joint dislocations underwent reconstruction of the coracoclavicular ligaments using semitendinosus tendon graft. Two patients were excluded due to inadequate follow up. Thirteen patients were followed up clinically and radiographically after a mean of 16 months (range 12-26 months). Clinical evaluation was performed using the UCLA and Constant scores. Preoperative and postoperative radiographs were compared. RESULTS: In this group of 13 patients followed up for at least one year, the Constant score ranged from 60.9 (26-88) in the preoperative evaluation to 87 (60-98) at the last evaluation during the postoperative period (p< .001). The mean UCLA score improved from 16.8 points (11-27) to 33 (29-35) points. (p=0.001). After 1 year of follow-up, the postoperative radiographic control showed twelve patients (92%) with equal coracoclavicular distance between the affected and unaffected shoulders. No anteroposterior translation in the axial view was present in any of the shoulders operated on. CONCLUSION: The functional and radiographic results were very satisfactory in patients undergoing reconstruction of chronic acromioclavicular dislocations, with a low recurrence rate. Level of Evidence: Level IV, case series.

As fraturas da diáfise do úmero (FDU) representam 3% das fraturas do aparelho locomotor; o terço médio da diáfise direita é o mais acometido. Seu tratamento é, na sua maioria, realizado por meio de métodos não cirúrgicos, mas as indicações cirúrgicas nas FDU são adotadas em situações cada vez mais frequentes. A diversidade de opiniões torna difícil o consenso sobre qual o tipo de osteossíntese, qual a técnica cirúrgica, a quantidade e a qualidade dos materiais de síntese a serem utilizados. Temos a impressão de que o melhor método para o tratamento cirúrgico das FDU está longe de ter um consenso entre os especialistas. Acreditamos que os métodos menos invasivos e que privilegiam a estabilidade relativa são os mais adequados, pois complicações mais temidas são menos frequentes.Humeral shaft fractures (HSF) represent 3% of fractures of the locomotor apparatus, the mid-third section of the shaft being the most commonly affected. In the majority of cases, it is treated by non-surgical methods, but surgical indications in HSF are increasingly being adopted. The diversity of opinions makes it difficult to reach a consensus regarding to the type of osteosynthesis, surgical technique, and quantity and quality of the synthesis materials to be used. It would appear that specialists are far from reaching a consensus as to the best method for the surgical treatment of HSF. We believe that less invasive methods, which favor relative stability, are the most appropriate methods, as the most feared complications are less frequent.

OBJETIVO: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico por via artroscópica em pacientes com tendinite calcária do manguito rotador. MÉTODO: Foi realizado um estudo retrospectivo com análise de 20 pacientes que foram submetidos ao tratamento artroscópico da tendinite calcária do ombro, de março de 1999 a novembro de 2005. Seis pacientes foram excluídos devido à perda do seguimento. Com seguimento médio de 41,4 meses, oito pacientes (57%) eram do sexo feminino e seis (43%) do masculino; sendo o lado direito acometido em 10 (71%) e o esquerdo em quatro (29%). Nove casos (64%) apresentavam calcificação no tendão supraespinal, dois (14%) no infraespinal e três (21%) envolvendo os dois tendões. RESULTADOS: Em todos os casos, realizou-se a ressecção dos depósitos de cálcio através da perfuração com agulha (Jelco® nº 14) e curetagem (minicureta). Dois ombros (14%) foram submetidos à descompressão subacromial; um, (7%) à exérese distal da clavícula; e, em três, (21%) houve a necessidade de se fazer sutura tendão-tendão. Nenhum paciente foi submetido à reinserção tendão-osso. Pela escala da UCLA, a média da pontuação foi de 33 pontos (26-35), indicando que a maioria teve resultados bons. Na avaliação final radiográfica, nenhum paciente apresentava sinais de calcificações. CONCLUSÃO: O tratamento artroscópico da tendinite calcária do ombro permite a exérese da calcificação com segurança, obtendo-se resultados bons com relação à dor e à função do ombro.OBJECTIVE: To evaluate the clinical and radiographic results of arthroscopic treatment of the rotator cuff in patients with Calcifying Tendinitis. METHOD: A retrospective study of twenty patients submitted to arthroscopic treatment for rotator cuff Calcifying Tendinitis from March 1999 to November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57%) were female and six (43%) male. The right side was affected in 10 (71%) and the left in four (29%) cases. Nine cases (64%) had calcification in the tendon above the supraspinatus, two (14%) in the infraspinatus, and three (21%) involved the two tendons. RESULTS: In all cases, the resection of calcium deposits was performed with a needle (Jelco® No. 14) in combination with curettage (mini-curette). Two shoulders (14%) were submitted to sub-acromial decompression, and one (7%) to excision of the distal clavicle. A suture tendon-tendon was performed in three shoulders (21%). Transosseous suture was not necessary for any patient. According to UCLA scale, an average of 33 points (26-35) was obtained, indicating that a majority of patients had good results. In the final radiographic evaluation, no patients showed signs of calcification. CONCLUSION: Arthroscopic treatment of calcifying tendinitis of the rotator cuff safely allows for the excision of the calcification, leading to good results in relation to shoulder pain and function.

OBJETIVO: comparar a rigidez de três diferentes montagens de placa em ponte com a da haste intramedular bloqueada, em tíbias de cadáveres com fratura tipo C. MATERIAIS E MÉTODOS: vinte tíbias humanas captadas de cadáveres, submetidas à fratura do tipo C; quinze fixadas com placas em ponte, divididas em 03 grupos, de acordo com o tamanho das placas (10, 14 e 18 furos) e 05 fixadas com hastes intramedulares bloqueadas. Todas as tíbias foram expostas a cargas progressivas e semelhantes. Foram medidos os deslocamentos de ambos fragmentos (proximal e distal), nos planos sagital, coronal e axial do espaço, conforme incremento gradual de carga. RESULTADOS: tíbias fixadas com placas em ponte de 18 furos apresentam um comportamento biomecânico semelhante às fixadas com haste intramedular bloqueada. CONCLUSÕES: Em fraturas do tipo C em tíbias há maior mobilidade do segmento ósseo distal no plano coronal, quando a fratura é fixada com placas em ponte de 14 e 18 furos que quando fixada com haste intramedular bloqueada sem fresagem. Apesar dessa maior mobilidade, os movimentos relativos entre os fragmentos fraturários nos GHB e GP18 tendem a ser semelhantes entre si.OBJECTIVE: To compare the stiffness of three different assemblies of bridging plates with intramedullary locking nails in cadaveric models of tibial fractures type C. MATERIALS AND METHODS: Twenty cadaveric tibias subjected to type C fractures; fifteen were fixed with the bridging plate technique and divided into three groups, according to the plate size (10, 14 and 18 holes), and five were fixed with intramedullary nail. All the tibias were exposed to similar and progressive loads. Dislocation of both fragments (proximal and distal) was measured on three planes (sagittal, coronal and axial), as the load was increased. RESULTS: tibias fixed with the 18 hole bridging plate have the same biomechanical behavior of tibias fixed with intramedullary locking nails. CONCLUSIONS: In type C tibial fractures, there is more mobility at the distal segment on the coronal plane when the fracture is fixed with 14 and 18 holes bridging plates as compared to fractures fixed with non-reamed intramedullary locking nails. Even with this mobility, the relative movements between the fragments at GHB and GP18 seem to be similar.

A grande maioria das fraturas de diáfise de úmero são de tratamento conservador. As indicações absolutas(ie lesão vascular) e relativas(ie paralisia nervosa primária) para tratamento cirúrgico estão bem estabelecidas na literatura. Os dois principais métodos utilizados para tal, a placa de auto-compressão e a haste intramedular travada possuem estudos comparando-os.No entanto não existem trabalhos comparando a haste intramedular com a placa em ponte e é a este fim que o presente estudo destina-se.The treatment of the great majority of humeral shaft fractures is conservative. Absolute indications (i.e., vascular injury) and relative indications (i.e., primary nervous palsy) for surgical treatment are well established by literature. The two most used methods for that purpose - the self - compression plate and the locked intramedullary nail - have already been comparatively studied. However, there are no studies comparing intramedullary nails to the bridging plate, therefore, this is the objective of the present study.

As fraturas da patela são prevalentes na faixa etária de 20 a 50 anos e representam 1% das fraturas. São classificadas através de 2 aspectos principais: característica do traço de fratura e presença de exposição óssea, o que dirige a escolha do tratamento dentro das diversas técnicas propostas. Este trabalho objetivou estudar a incidência dos padrões de fraturas patelares e analisar os resultados funcionais encontrados com as diferentes modalidades de tratamento no IOT-HC-FMUSP. Levantou-se 103 prontuários de pacientes com fratura de patela tratados no IOT no período de 1988 - 1999 com seguimento mínimo de 5 anos. A média etária foi de 39,4 anos, 68% do sexo masculino, 51,5% de acometimento do lado direito e 2,9% de bilateralidade. Prevaleceram fraturas transversas (36%); 30% de exposição óssea; técnicas mais utilizadas patelectomia parcial (46,6%), banda de tensão (20,4%), imobilização gessada (17,5%), cerclagem (4,8%) e patelectomia total (2,9%); notou-se 57,1% de excelentes e bons resultados com banda de tensão AO e 44,4% nas patelectomias parciais. Concluiu-se que o resultado funcional final do tratamento da fratura de patela é multifatorial; o tipo de fratura, o modo de tratamento - conservador ou cirúrgico, a idade e o mecanismo de trauma não influenciam, isoladamente, o sucesso da terapêutica.Patellar fractures are prevalent within the age group of 20 - 50 years old and account for 1% of total fractures. They are classified according to 2 major aspects: fracture trace characteristic and bone exposure presence, which drives treatment selection towards the various proposed techniques. This study aimed to investigate the incidence of patellar fractures patterns and to analyze the functional outcomes found with the different treatment modalities at the IOT-HC-FMUSP. One hundred and three files of patellar fracture patients treated at IOT during the period of 1988 - 1999 with a minimum follow-up time of 5 years were gathered. Mean age was 39.4 years old, being 68% males, 51.5% with right side affected, and 2.9% bilateral. Transverse fractures were prevalent (36%); 30% with bone exposure; the most used techniques were: partial patellectomy (46.6%), tension band (20.4%), plastered immobilization (17.5%), cerclage (4.8%), and total patellectomy (2.9%). Outcomes were considered as excellent or good in 57.1% for tension band AO, and in 44.4% for partial patellectomies. It was concluded that the end functional outcome in the patellar fracture treatment is multifactorial; the kind of fracture, the treatment approach (conservative or surgical), age, and the mechanism of trauma, alone, do not influence therapy success.

OBJETIVO: Avaliar as taxas de publicação do Congresso Brasileiro de Ortopedia (CBOT) de 2007. MÉTODOS: Avaliação do número de trabalhos enviados pelas diferentes sub-especialidades ortopédicas e pelos estados brasileiros. Em seguida, realização de uma busca nas bases de dados Lilacs e Pubmed com o intuito de encontrar quais trabalhos geraram artigos publicados na literatura nacional e internacional. RESULTADOS: São Paulo e a região Sudeste foram os responsáveis pelo maior número de apresentações no Congresso (54,1% e 68,3% respectivamente). A sub-especialidade com maior número de trabalhos foi Ombro e Cotovelo (13,8%). Do total de 653 trabalhos no congresso, 174 (26,6%) foram publicados. Apresentações orais obtiveram uma taxa de publicação 3,58 vezes maior que pôsteres. CONCLUSÕES: A taxa de publicação do CBOT encontra-se abaixo dos 30%. Muitos dos trabalhos apresentados no CBOT não passam pelo crivo de revistas científicas e as apresentações deste congresso não devem ser a única forma de atualização científica dos congressistas. Epidemiológico Descritivo.

Descreve-se neste artigo um padrão de lesão descrito na literatura apenas duas vezes, num total de quatro casos, denominado Segond reverso por apresentar achados clínicos e radiológicos exatamente opostos aos da clássica lesão de Segond. Semelhantemente aos casos previamente descritos, apresentou fratura avulsão do planalto tibial medial, na inserção do ligamento colateral medial profundo, associada a lesão do ligamento cruzado posterior. Assim como em um dos casos prévios, foi constatada lesão do ligamento cruzado anterior. Entretanto, diferiu dos anteriormente relatados por não apresentar lesão do menisco medial.This article reports an injury pattern described only twice in literature, totaling four cases, and referred to as reverse Segond injury for its clinical and radiological findings are precisely opposite to those observed in the classical Segond injury. Similarly to the previously described cases, our case reported avulsion fracture of the medial tibial plateau at the insertion of the deep tibial collateral ligament, associated to posterior cruciate ligament injury. Similarly to one of the previous cases, anterior cruciate ligament injury was found in our case, although it differs from the previous ones because it does not show medial meniscal injury.

ABSTRACT OBJECTIVE: To evaluate the clinical and radiological results and the impact on quality of life of the reverse shoulder arthroplasty. METHODS: Retrospective case series evaluating 13 patients undergoing reverse shoulder arthroplasty with at least two years of clinical follow-up. Clinical evaluation was performed before and after surgery with the ASES and VAS scales and hand-mouth, hand-neck, and hand-head functional tests. Quality of life was measured with the SF-12 questionnaire. The rate of complications and radiographic postoperative findings were recorded. RESULTS: The patients improved from 23.1 ± 15 to 82.7 ± 15 according to ASES scale (p < 0.001). The physical component of the SF-12 increased from 31.7 ± 6.9 to 47.1 ± 8.6 (p < 0.001), while the emotional increased from 48 ± 12.3 to 55.5 ± 7.5 (p = 0.061). The pain reduced from 7.9 to 1 according to the VAS (p = 0.002). The performance on the hand-mouth, hand-neck, and hand-head functional tests showed significant improvement (p = 0.039, p < 0.001 and p < 0.001, respectively). Complications occurred in 15% of patients and notching, in 31%. CONCLUSION: Reverse shoulder arthroplasty led to a significant clinical improvement according to the ASES and VAS scales. The quality of life has improved according to the physical aspect of the SF-12, and showed a trend of improvement in the emotional aspect. The complication rate was 15%, and notching occurred in 31%.

ABSTRACT This review evaluated the outcomes used in clinical studies involving rotator cuff tear published in the last decade in the two leading Brazilian orthopedic journals. A literature review was performed using the journals Revista Brasileira de Ortopedia and Acta Ortopédica Brasileira. It included all original clinical articles describing at least one outcome measured before or after any clinical or surgical intervention related to rotator cuff tear, published between 2006 and 2015. The authors evaluated range of motion, muscle strength, patient satisfaction, and tendon integrity and functional outcomes scores. There were 25 clinical studies published about rotator cuff in the two principal Brazilian orthopedic journals in the last decade, 20 case series (80%), one case-control (4%), and four cohorts (16%). Objective measures such as muscle strength, patient satisfaction, and evaluation of tendon integrity were little used. Range of motion measurements were performed in 52% of the articles. Evaluations of muscle strength and patient satisfaction were reported by 28% and 16% of the studies, respectively. Only 28% of the articles evaluated tendon integrity after surgery. Of these, 16% did so by magnetic resonance imaging and 12% by , ultrasonography. The most used scale was the UCLA, present in 92% of the articles, while the Constant-Murley appeared in 20%. Scales deemed reliable, with high internal consistency and good responsiveness, were rarely used.

ABSTRACT Objective: The aim of this study was to evaluate whether Asian ethnicity is a risk factor for the development of adhesive capsulitis. The secondary aim was to describe the distribution of cases of capsulitis by age group. Methods: A cross-sectional study comparing the rate of adhesive capsulitis in individuals of Asian ethnicity with that of other ethnicities. We excluded patients with fractures and those with symptoms not involving the shoulder. The odds ratio was adjusted for confounding factors by binary logistic regression. Results: A total of 1331 patient records were evaluated and after applying the selection criteria, 814 patients remained. We found 134 cases of adhesive capsulitis (15.6%). The peak of incidence was at 60-64 years in the patients of Asian ethnicity and at 55-59 years in the other patients. The unadjusted odds ratio was 4.2 (CI 95%, 2.4-7.4), while the odds ratio adjusted for sex and diabetes mellitus was 3.6 (CI 95%, 2.0-6.5). Conclusion: Patients of Asian ethnicity showed an independent risk factor for the development of adhesive capsulitis, with an adjusted odds ratio of 3.6. Adhesive capsulitis was more common between 55 and 64 years.

ABSTRACT Objective: To evaluate supraspinatus tendon integrity with ultrasound (US) in patients submitted to proximal humeral fracture (PHF) fixation with a locking intramedullary nail., Methods: Thirty-one patients with PHF treated with curvilinear locking intramedullary nail, aged between 50 and 85 years, were assessed by US at six months postoperatively and clinically at six and 12 months postoperatively. The primary aim was supraspinatus tendon integrity, evaluated by US at six months postoperatively. Secondary aims included the Constant-Murley, DASH score, and visual analog pain scores, as well as complications and reoperation rates. Results: Full-thickness rotator cuff ruptures were observed in four patients (13%), supraspinatus ruptures in three cases (10%), and subscapularis ruptures in one case (3%). Partial ruptures were diagnosed in 10 cases (32%). The results using the Constant-Murley score at 12 months were 71.3 ± 15.2 points for the entire series, with 73.2 ± 16.1 points for patients without rotator cuff ruptures and 68.7 ± 14.1 points for those with partial or complete ruptures, without a statistically significant difference (p= 0.336). Complications, exclusively for rotator cuff ruptures, were observed in nine patients (29%). Conclusion: A high rate of rotator cuff ruptures was demonstrated, with partial ruptures in 32% of cases and full-thickness ruptures in 13%. However, clinical results are satisfactory, and are not influenced by the presence of rotator cuff ruptures.

ABSTRACT Objective: To evaluate the correlation between the UCLA and Constant-Murley scores in the surgical treatment of rotator cuff tears and proximal humeral fractures (PHF). Methods: Retrospective study evaluating patients submitted to arthroscopic rotator cuff repair and surgical treatment of PHF with 2-year follow-up. Patients were evaluated by the UCLA and Constant-Murley scores in the preoperative period for the rotator cuff repairs, and 3, 6, 12 and 24 months after surgery for both diagnoses. Pearson's correlation coefficient (r) was calculated to measure the degree of correlation between the two clinical scales. Results: We evaluated 109 patients: 54 with rotator cuff tear and 55 with PHF. Twenty-four months after surgical treatment, the scores according to the UCLA and Constant-Murley scores were 32.6 ± 4.0 and 85.0 ± 12.0 for the rotator cuff tears and 30.3 ± 5.3 and 73.8 ± 13.9 for the PHF, demonstrating significant improvements in both, in relation to the initial evaluation (p < 0.001). The scales demonstrated high correlation (r = 0.88, p < 0.001). The scores obtained in the two scales showed high or very high correlation in all the postoperative clinical evaluations (r = 0.79-0.91, p < 0.001). The correlation was high in the preoperative evaluation (r = 0.73, p < 0.001). Conclusion: The UCLA and Constant-Murley scores presented high or very high correlation in the evaluation of surgical treatment of rotator cuff tears and PHF. The correlation in the preoperative evaluation was high.

ABSTRACT OBJECTIVE: To assess the historical trend of rotator cuff repairs in Brazil between 2003 and 2015, using the database of the Brazilian Unified Health System's (Sistema Único de Saúde [SUS]) Department of Informatics (DataSUS). METHODS: Historical series using DataSUS. Surgeries performed between 2003 and 2015 were included and data relating to cuff tear repair were assessed, including decompression procedures were included. The numerator was the total number of rotator cuff repair and the denominator, the total population of the assessed locality. Population data were based on information from the Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTS: During the period, 50,207 surgeries were performed. The rate was presented as number of procedures per 100,000 inhabitants, and increased from 0.83 to 2.81, a growth of 238%. In 2015, the South region had the highest rate, 6.32, followed by the Southeast, 3.62, while the North had the lowest rate, 0.13. The growing trend can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast. CONCLUSION: The rate of rotator cuff repairs in Brazil performed through the SUS increased from 0.83 to 2.81 between 2003 and 2015, representing a growth of 238%, but remains lower than that of developed countries. A trend of growth can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast.

ABSTRACT Objective: To describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment. Methods: A retrospective case series was studied with patients treated between 2004 and 2014. The patients' clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated. Results: Twenty-seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors. Conclusions: Septic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. S. aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.

Abstract Objective To evaluate the prevalence of family history of rotator cuff tear and the presence of tendinopathy in other joints in patients with rotator cuff tears and to compare them with paired controls. To estimate the odds ratio for rotator cuff tear for these two risk factors. Methods We performed a case-control study comparing patients submitted to treatment for rotator cuff tear with asymptomatic controls. All cases and controls were evaluated by imaging exams and matched by age (±2 years) and gender. We conducted an interview using a standardized questionnaire, and collected data on various risk factors. Results We evaluated 144 patients, 72 per group. Patients with rotator cuff tears reported a higher number of consanguineous relatives who underwent treatment for the same disease and tendon injuries in other joints compared to the controls (p= 0.005 and p= 0.045 respectively). Individuals with a family history of treatment for rotator cuff tear or with tendinopathies in other joints were more likely to present a rotator cuff tear, with odds ratios of 3.3 (95% confidence interval [95%CI] = 1.4–7.7) and 2.7 (95%CI = 1.1–6.9) respectively. Conclusions Patients with rotator cuff tear have a higher prevalence of family members with the same disease and tendinopathies or tendon injuries in other joints. The presence of consanguineous relatives with treatment for rotator cuff and tendinopathies in other joints are risk factors for the presence of rotator cuff tears.

Abstract Objective To evaluate the influence of the supraspinal tear pattern on the pre- and postoperative functional evaluations. Methods A retrospective cohort study comparing patients with supraspinatus crescent-shaped tears versus L- or U-shaped tears. We included patients undergoing complete supraspinatus arthroscopic repair. We did not include patients with subscapularis or infraspinatus repair, those submitted to open surgery, or those in whom only partial repair was achieved. The clinical scales used were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) and the Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), which were applied 1 week before and 24 months after the procedure. Results We analyzed 167 shoulders (from 163 patients). In the preoperative period, the ASES scale was significantly higher in the crescent-shaped pattern (43.5 ± 17.6 versus 37.7 ± 13.8; p = 0.034). The UCLA scale followed the same pattern (15.2 ± 4.6 versus 13.5 ± 3.6; p = 0.028). In the postoperative period, however, there was no significant difference. According to the ASES scale, crescent-shaped tears scored 83.7 ± 18.7 points, and L- or U-shaped tears scored 82.9 ± 20.1 (p = 0.887). The values were 30.9 ± 4.9 and 30.5 ± 5.6 (p = 0.773) respectively, by the UCLA scale. Conclusion Crescent-shaped and L- or U-shaped supraspinatus tears have similar postoperative functional results. In the preoperative period, the functional results are superior in crescent-shaped tears.