EDUARDO ANGELI MALAVOLTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
15 resultados
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- Outcome assessment in the treatment of rotator cuff tear: what is utilized in Brazil?(2017) ASSUNÇÃO, Jorge Henrique; MALAVOLTA, Eduardo Angeli; DOMINGUES, Vitor Rodrigues; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoABSTRACT 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.
- Correlation between the UCLA and Constant-Murley scores in rotator cuff repairs and proximal humeral fractures osteosynthesis(2018) MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; SIMÕES, Pedro Antonio Araújo; SHIDO, Danilo Kenji; FERREIRA NETO, Arnaldo AmadoABSTRACT 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.
- Osteoid osteoma of the glenoid: Arthroscopic treatment(2015) MALAVOLTA, E. A.; ASSUNCAO, J. H.; REBOLLEDO, D. C. S.; GRACITELLI, M. E. C.; CORREIA, L. F. M.; FERREIRA NETO, A. A.; CAMARGO, O. P. deOsteoid 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.
article 1 Citação(ões) na Scopus ANTERIOR INSTABILITY OF THE SHOULDER. RETROSPECTIVE STUDY ON 159 CASES(2011) FERREIRA NETO, Arnaldo Amado; CAMANHO, Gilberto Luis; FELIX, Alessandro Monterroso; BENEGAS, Eduardo; BITAR, Alexandre Carneiro; RAMADAN, Lucas Busnardo; MALAVOLTA, Eduardo AngeliObjective: 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<0.05). Of the 35 patients with anterior glenoid bone lesion, 8 had recorrence, while of the 124 patients without fractures, 8 had recorrence (p<0.05). Of the 113 patients with first-time traumatic dislocations, 12 developed limitation of external rotation, while in 46 atraumatic cases none developed limitation (p<0.05). Of the patients with SLAP lesion, 11 developed pain, while in the cases without this lesion, only 3 presented pain (p<0.05). Conclusion: There were more recurrences (deveria ser plural e recurrences, nao recurrence) in cases of anterior glenoid bone lesion. Post-operative pain was more frequent when the lesion type was SLAP Limitation of external rotation is associated to traumatic instability.- Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital(2018) ASSUNÇÃO, Jorge Henrique; NOFFS, Guilherme Guelfi; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; LIMA, Ana Lucia Munhoz; FERREIRA NETO, Arnaldo AmadoABSTRACT 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.
- MULTIFOCAL OSTEONECROSIS SECONDARY TO OCCUPATIONAL EXPOSURE TO ALUMINUM(2017) ASSUNCAO, Jorge Henrique; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; FILIPPI, Renee Zon; FERREIRA NETO, Arnaldo AmadoMultifocal 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.
- 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.
- Early versus late repair of rotator cuff tears in rats(2018) CAVINATTO, Leonardo; MALAVOLTA, Eduardo Angeli; PEREIRA, Cesar Augusto Martins; MIRANDA-RODRIGUES, Manuela; SILVA, Luiza Campos Moreira; GOUVEIA, Cecilia Helena; NETTO, Cesar de Cesar; MATTAR, Rames Junior; FEREIRA NETO, Arnaldo AmadoBackground: In the event of a traumatic rotator cuff tear, patients are routinely advised that early surgical intervention produces an optimal repair, despite a lack of direct evidence to support this recommendation. To address this knowledge gap, massive rotator cuff tears in rats were assessed by biomechanical and bone morphometric analyses after early or late repair. Methods: Combined supraspinatus and infraspinatus tendon tears of the left shoulder were created in 21 adult Wistar rats, which were divided into 2 groups. The tendons of the injured shoulder in the animals in group I were surgically repaired 8 weeks after the injury. Under the same anesthesia, the same injury was created on the right shoulder, which was immediately repaired. The rats from group I were euthanized 8 weeks after the repairs. No repair was performed in the rats from group II, which were euthanized 8 weeks after the injury. Tissues from both groups were harvested and biomechanically tested for supraspinatus tendon and bone morphometry analysis of the humeral head. Results: All biomechanical properties were significantly increased in the early repair group compared with the late repair group. No significant differences were observed in bone morphometry of the humeral head when early and late repair groups were compared. Conclusion: Early surgical repair of a massive rotator cuff tear leads to improved biomechanical properties of the tissue after healing. Proximal humerus bone morphometry was unaffected by surgical repair timing.
- Rotator cuff repair in the Brazilian Unified Health System: Brazilian trends from 2003 to 2015(2017) MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; BERALDO, Rodrigo Alves; PINTO, Gustavo de Mello Ribeiro; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoABSTRACT 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.
- Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis(2014) BENEGAS, Eduardo; FERREIRA NETO, Arnaldo Amado; GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; ASSUNCAO, Jorge Henrique; PRADA, Flavia De Santis; BOLLIGER NETO, Raul; MATTAR JR., RamesBackground: Minimally invasive plate osteosynthesis for humeral shaft fractures has been described recently, but there are no randomized studies comparing the clinical results for shoulder function between this technique and locking intramedullary nailing. Methods: A prospective randomized study was performed. Forty-one humeral shaft fractures (40 patients) were randomized to be treated with a minimally invasive plate (n = 21) or a locking intramedullary nail (n = 19). Clinical and radiographic outcome assessments were conducted at 1 year postoperatively. Shoulder function was the primary outcome, as measured by the University of California, Los Angeles Shoulder Scale. Elbow function was measured by the Broberg-Morrey score, and fracture consolidation and complications were the main secondary outcomes. Results: At 1 year postoperatively, no significant difference was found with regard to shoulder function according to the University of California, Los Angeles scale between the minimally invasive plate and locking intramedullary nail (31.4 points vs 31.2 points, P = .98). There was also no difference in elbow function (94.8 points vs 94.1 points, P = .96). Complications were similar between the groups, without significant differences regarding infection (P > .99), symptomatic shoulder stiffness (P = .488), and neurapraxia of the lateral cutaneous nerve of the forearm (P = .475). Fracture union was achieved in all but 1 patient (2.4%) in the intramedullary nail group within 1 year after the surgical procedure. Conclusion: There is no significant difference in shoulder function between antegrade intramedullary nailing and minimally invasive plate osteosynthesis for the treatment of displaced humeral shaft fractures, despite the limited power of our study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.