EDUARDO ANGELI MALAVOLTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
21 resultados
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Agora exibindo 1 - 10 de 21
- Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon(2015) MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; GUGLIELMETTI, Cesar L. B.; SOUZA, Felipe F. de; GRACITELLI, Mauro E. C.; FERREIRA NETO, Arnaldo A.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 1.5 T 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 30 mm, 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.
- Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome(2021) ALAITI, Rafael Krasic; CANEIRO, J. P.; GASPARIN, Juliana T.; CHAVES, Thais Cristina; MALAVOLTA, Eduardo A.; GRACITELLI, Mauro E. C.; MEULDERS, Ann; COSTA, Marcelo Fernandes daSupplemental Digital Content is Available in the Text. Neither the number nor severity of rotator cuff tendons reported as abnormal was associated with the pain occurrence across clinically relevant arm movements. Introduction:People with chronic shoulder pain commonly report pain during arm movements in daily-life activities. Pain related to movement is commonly viewed as an accurate representation of tissue damage. Thus, when a person reports pain across a variety of movements, this is often understood as indicative of greater damage.Objectives:We aimed to investigate if movement-related pain that occurs across a wider variety of movements was associated with the number or severity of rotator cuff tendons reported as abnormal on a magnetic resonance imaging (MRI). To answer this question, this study was designed in 3 phases.Methods:We recruited 130 individuals with chronic shoulder pain diagnosed with subacromial pain syndrome. First, a list of daily functional activities commonly reported as painful by people with chronic shoulder pain was generated from 3 well-established outcome measures with 30 individuals and a measurement tool was developed with data from further 100 individuals, which demonstrated to have acceptable content validity, construct validity, internal consistency, interrater reliability, and structural validity. Multiple linear regression was then used to evaluate the hypotheses of the study. A direct acyclic graph was used to select variables for linear regression modelling.Results:There was no association between movement-related pain occurrence across movements and the MRI findings.Conclusion:Our study provides evidence that neither the number of rotator cuff tendons reported as abnormal nor the severity of each tendon imaging finding were associated with pain occurrence across movements and activities commonly perceived as painful by people with chronic shoulder pain.
- Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial(2016) GRACITELLI, Mauro E. C.; MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; KOJIMA, Kodi E.; REIS, Paulo R. dos; SILVA, Jorge S.; FERREIRA NETO, Arnaldo A.; HERNANDEZ, Arnaldo J.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. Level of evidence: Level I; Randomized controlled trial; Treatment study (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees.
- Response to letter to the editor concerning ""The rotation of the humeral head does not alter radiographic evaluation of the head-shaft angle""(2016) MALAVOLTA, Eduardo A.; GRACITELLI, Mauro E. C.; ASSUNCAO, Jorge H.; FERREIRA NETO, Arnaldo A.
article 1 Citação(ões) na Scopus Fracture of the clavicle and second rib: an indirect injury from tricep dips(2016) MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; GRACITELLI, Mauro E. C.; LOBO, Frederico L.; FERREIRA NETO, Arnaldo A.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 later. To our knowledge, this is the first study describing the association of these fractures triggered by a single event of muscle. contraction.- Intraobserver and interobserver agreement in the classification and treatment of proximal humeral fractures(2017) GRACITELLI, Mauro E. C.; DOTTA, Thiago A. G.; ASSUNCAO, Jorge H.; MALAVOLTA, Eduardo A.; ANDRADE-SILVA, Fernando B.; KOJIMA, Kodi E.; FERREIRA NETO, Arnaldo A.Background: There is controversy surrounding the reliability of radiographic measurements and existing classifications for proximal humeral fractures. Methods: Ten orthopedists, divided into 2 groups by length of experience, evaluated radiographs in 3 views from 40 proximal humeral fractures. We evaluated 11 radiographic criteria (including the Neer and pathomorphologic classifications, head-shaft angle, displacement of the humeral shaft, and lesser and greater tuberosities) and treatment indication. We also analyzed the criteria that most influenced the choice of treatment. Results: Interobserver reliability was substantial for the presence of fracture of the greater tuberosity (kappa = 0.749) and medial metaphyseal comminution (kappa = 0.627) and moderate for the pathomorphologic classification (kappa = 0.504), displacement of the greater tuberosity (kappa = 0.422), and treatment decision (kappa = 0.565). Intraobserver reliability was substantial for treatment indication (kappa = 0.620) and presence of displacement of the fracture of the greater tuberosity (kappa = 0.627 and 0.611) and moderate for the Neer (kappa = 0.490) and pathomorphologic (kappa = 0.607) classifications. The results were influenced by the observer's experience. The surgical indication was influenced by the pathomorphologic classification in 50% of the evaluators (odds ratio, 4.85; range, 3.30-8.65). Conclusion: The pathomorphologic classification has higher reliability than the Neer classification and was the factor that most influenced the surgical decision. The determination of the presence of fracture and displacement of the greater tuberosity and medial metaphyseal comminution is reliable with the use of simple radiographs, and the results were influenced by the observer's experience. Level of evidence: Basic Science Study; Validation of Classification System (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
- Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation(2020) GUGLIELMETTI, Cesar L. B.; GRACITELLI, Mauro E. C.; ASSUNCAO, Jorge H.; ANDRADE-SILVA, Fernando B.; PESSA, Mariana M. Nicolosi; LUZO, Maria Candida; NETO, Arnaldo A. Ferreira; MALAVOLTA, Eduardo A.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 degrees in the surgical group and 88 degrees in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17 degrees and 27% in the conservative group and 41 degrees 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.
- Serial structural MRI evaluation of arthroscopy rotator cuff repair: does Sugaya's classification correlate with the postoperative clinical outcomes?(2016) MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge Henrique; RAMOS, Frederico F.; FERREIRA, Thiago C.; GRACITELLI, Mauro E. C.; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo A.Sugaya's classification is the most commonly used for postoperative evaluation of rotator cuff repairs. However, the correlation between this classification and clinical outcomes after supraspinatus tendon repair were not performed with serial MRI examinations in standardized time intervals. This prospective case series involved 54 patients undergoing repair of the supraspinatus tendon tear. Magnetic resonance imaging (MRI, 1.5 T) was used to determine the Sugaya's classifications at 3, 6, and 12 months, and these data were correlated with the visual analog scale for pain (VAS), Constant and University of California at Los Angeles (UCLA) assessments. Patients with types I, II, and a parts per thousand yenIII of Sugaya's classification experienced pain of 1.27 +/- 1.95, 1.00 +/- 1.40, and 3.43 +/- 3.36, respectively (p = 0.010), according to the VAS. The Constant and UCLA scales did not differ significantly. Type II predominated, though their percentage decreased over time (from 77.8 to 66.7 %), whereas type I became more frequent (from 1.9 to 20.4 %). The pain was more intense in patients classified as types III, IV, or V of Sugaya's classification. The postoperative appearance of the supraspinatus tendon was not correlated with the Constant and UCLA scales. The occurrence of type II, the most prevalent, decreased over time, whereas the occurrence of type I increased; these differences were not significant. Level de evidence: prospective cohort evaluation-level III.
- Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair(2022) MALAVOLTA, Eduardo A.; YAMAMOTO, Gustavo J.; BUSSIUS, Daniel T.; ASSUNCAO, Jorge H.; ANDRADE-SILVA, Fernando B.; GRACITELLI, Mauro E. C.; FERREIRA NETO, Arnaldo A.Background/Hypothesis: Minimal clinically important difference (MCID) is a vital tool in the analysis of clinical results. It allows the determination of clinical relevance of statistical data. Our hypothesis was that specific differences between preoperative and postoperative scores would be able to accurately predict patient perception of improvement and satisfaction as reflected by anchor and distribution-based questions. Methods: Retrospective cohort with patients that underwent rotator cuff repair. We evaluated the University of California at Los Angeles Shoulder Rating Scale (UCLA) and the American Shoulder and Elbow Surgeons Assessment Form (ASES) before and 12-months after surgery. Anchor-based, distribution-based and minimum detectable change (MDC) approaches were utilized. Results: We evaluated 289 shoulders. The MCID for the UCLA scale was 4.5 points using the anchor method, 2.5 by the distribution method and 3.6 by MDC. Patients with a baseline score > 20 presented a lower MCID (1.5, 1.1 and 1.7, respectively). For the ASES score, the MCID was 6.1 by the anchor method, 10.5 based on the distribution method and 26.3 by MDC. In the group of patients above the 60 point cutoff, the obtained values were 2.4, 4.9 and 13.6, respectively. Conclusion: The mean MCID value for the UCLA shoulder score is 3.5 points, ranging from 2.5 points (distribution method) to 4.5 points (anchor method). The mean MCID value for the ASES score was 15.2 points, ranging from 6.1 (anchor method) to 26.3 (MDC). Patients groups presenting with higher preoperative scores showed lower MCID values. This fact needs to be considered in postoperative comparisons between treatment groups. Level of evidence: Basic Science Study, Validation of Outcomes Instruments/Classification Systems.
- Humeral stress fracture in a female CrossFit athlete: a case report (vol 20, 150, 2019)(2019) GODOY, Ivan R. B.; MALAVOLTA, Eduardo A.; LUNDBERG, Jan Stefan; SILVA, Jader J. da; SKAF, AbdallaIt has been brought to our attention that the article [1] in reference [7] Smith MM, Sommer AJ, Starkoff BE, Devor ST. Crossfit-based high-intensity power training improves maximal aerobic fitness and body composition. J Strength Cond Res. 2013;27(11):3159-72 was retracted in October 2017. At the time of the submission of the manuscript the authors were not aware of the retraction and legal implications related to this reference. Therefore, the authors do not support the findings of the retracted article such as that CrossFit has an apparent disproportionate musculoskeletal injury risk, especially for novice participants. The overall conclusions of the case report are not affected by this erratum.
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