ARNALDO JOSE HERNANDEZ

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Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina

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Autor: FERNANDES, Tiago Lazzaretti ×

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  • article 6 Citação(ões) na Scopus
    3D COMPUTER TOMOGRAPHY FOR MEASUREMENT OF FEMORAL POSITION IN ACL RECONSTRUCTION
    (2015) FERNANDES, Tiago Lazzaretti; MARTINS, Nuno Miguel Morais Fonseca; WATAI, Felipe de Andrade; NETO, Cyro Albuquerque; PEDRINELLI, Andre; HERNANDEZ, Arnaldo Jose
    Objective: To validate intra-and inter-class correlation coefficients of a transparent 3D-TC protocol and investigate relationships between different axial rotations. Methods: Twenty unilateral knee TCs (iSite - Philips) were evaluated by means of a transparent 3D-TC OsiriX Imaging Software (v.3.9.4), 3D MPR protocol. Mathematical model of femoral tunnel projections acquired on vertical and horizontal rotations from -20 to +20 degrees. Height (h'/H) and length (t'/T) of tunnel projections have been analyzed by the Bernard and Hertel's method. Statistics: power of study=80%, ICC, ANOVA, p<0.05 (SPSS-19). Results: Transparent 3D-TC showed high reliability of both intra-observer (h'/H= 0.941; t'/T= 0.928, p<0.001) and inter-observer (h'/H= 0.921; t'/T= 0.890, p<0.001) ICC. ACL Length (t'/T) and Height (h'/H) projections were statistically different on vertical and horizontal rotations: p=0.01 and p<0.001, respectively. Conclusion: This new transparent 3DTC protocol is an accurate and reproducible method that can be applied for ACL femoral tunnel or footprint measurement with high ICC reliability.
  • article 180 Citação(ões) na Scopus
    Macrophage: A Potential Target on Cartilage Regeneration
    (2020) FERNANDES, Tiago Lazzaretti; GOMOLL, Andreas H.; LATTERMANN, Christian; HERNANDEZ, Arnaldo Jose; BUENO, Daniela Franco; AMANO, Mariane Tami
    Cartilage lesions and osteoarthritis (OA) presents an ever-increasing clinical and socioeconomic burden. Synovial inflammation and articular inflammatory environment are the key factor for chondrocytes apoptosis and hypertrophy, ectopic bone formation and OA progression. To effectively treat OA, it is critical to develop a drug that skews inflammation toward a pro-chondrogenic microenvironment. In this narrative and critical review, we aim to see the potential use of immune cells modulation or cell therapy as therapeutic alternatives to OA patients. Macrophages are immune cells that are present in synovial lining, with different roles depending on their subtypes. These cells can polarize to pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes, being the latter associated with wound-healing by the production of ARG-1 and pro-chondrogenic cytokines, such as IL-10, IL-1RA, and TGF-b. Emerging evidence reveals that macrophage shift can be determined by several stimuli, apart from the conventional in vitro IL-4, IL-13, and IL-10. Evidences show the potential of physical exercise to induce type 2 response, favoring M2 polarization. Moreover, macrophages in contact with oxLDL have effect on the production of anabolic mediators as TGF-b. In the same direction, type II collagen, that plays a critical role in development and maturation process of chondrocytes, can also induce M2 macrophages, increasing TGF-b. The mTOR pathway activation in macrophages was shown to be able to polarize macrophages in vitro, though further studies are required. The possibility to use mesenchymal stem cells (MSCs) in cartilage restoration have a more concrete literature, besides, MSCs also have the capability to induce M2 macrophages. In the other direction, M1 polarized macrophages inhibit the proliferation and viability of MSCs and impair their ability to immunosuppress the environment, preventing cartilage repair. Therefore, even though MSCs therapeutic researches advances, other sources of M2 polarization are attractive issues, and further studies will contribute to the possibility to manipulate this polarization and to use it as a therapeutic approach in OA patients.
  • article 6 Citação(ões) na Scopus
    Isokinetic muscle strength and knee function associated with double femoral pin fixation and fixation with interference screw in anterior cruciate ligament reconstruction
    (2012) FERNANDES, Tiago Lazzaretti; PROTTA, Thiago Rocha; FREGNI, Felipe; BOLLIGER NETO, Raul; PEDRINELLI, Andre; CAMANHO, Gilberto Luis; HERNANDEZ, Arnaldo Jose
    Intensive scheduling in sports requires athletes to resume physical activity shortly after injury. The purpose of this study was to investigate early isokinetic muscle strength and knee function on bone-patellar tendon-bone (BPTB) ACL reconstruction with double femoral pin fixation or interference screw technique. A prospective study was conducted from 2008 to 2009, with 48 athletes who received femoral BPTB fixation with interference screw (n = 26) or double pin (n = 22). Clinical (IKDC objective score and hop test) and isokinetic muscle strength (peak torque (PT), PT/body weight and flexion/extension rate (F/E) in 60 and 240A degrees/s) were analyzed at 6 months of follow-up. Analysis at baseline showed no differences between groups before surgery related to age, gender, associated injury, Tegner or Lysholm score; thus showing that groups were similar. During follow-up, however, there were significant differences between the two groups in some of the isokinetic muscle strength: PT/BW 60A degrees/s (Double Pin = 200% +/- A 13% vs. Interference Screw = 253% +/- A 16%*, *P = 0.01); F/E 60A degrees/s (Double Pin = 89% +/- A 29%* vs. Interference Screw = 74% +/- A 12%, *P = 0.04). No statistical differences between groups were observed on IKDC objective score, hop test and complications. The significant muscle strength outcome of the interference screw group found in this study gives initial evidence that this fixation technique is useful for athletes that may need accelerated rehabilitation. Early return to sports ability signaled by isokinetic muscle strength is of clinical relevance as it is one of the main goals for athletes' rehabilitation. III.
  • article 2 Citação(ões) na Scopus
    BILATERAL LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: CASE REPORT AND REVIEW
    (2018) FERNANDES, Tiago Lazzaretti; VIDEIRA, Livia Dau; SASAKI, Sandra Umeda; NATALINO, Renato Jose Mendonca; ALMEIDA, Adriano Marques de; PEDRINELLI, Andre; HERNANDEZ, Arnaldo Jose
    Objectives: Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. Methods: The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. Results: Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28-year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1-and T2-weighted images. These were associated with hemosiderin pigmentation. Conclusion: The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site.
  • article 4 Citação(ões) na Scopus
    Is 12 months enough to reach function after athletes? ACL reconstruction: a prospective longitudinal study
    (2022) FELIX, Ellen Cristina Rodrigues; ALONSO, Angelica Castilho; BRECH, Guilherme Carlos; FERNANDES, Tiago Lazzaretti; ALMEIDA, Adriano Marques de; LUNA, Natalia Mariana Silva; SOARES-JUNIOR, Jose Maria; BARACAT, Edmund Chada; HERNANDEZ, Arnaldo Jose; GREVE, Julia Maria D'Andrea
    Context: Anterior Cruciate Ligament (ACL) injury is disabling in several sports because it causes knee instability and functional deficit. Usually, surgical treatments produce the best functional outcomes, however, sometimes they are not always able to fully restore stability and function.Objective: The objective of this study was to evaluate postural balance, muscle strength, and functional perfor-mance of young athletes with an ACL injury before and after ACL reconstruction. Design: This was a longitudinal observational prospective study. Method: 74 athletes, 60 men, and 14 women, aged between 16 and 45, divided into two groups: the Group-Lesion of ACL with 34 athletes (24.1 years) and the Group-Control with 40 athletes without ACL lesion (27.7 years old). All volunteers performed posturography, isokinetic dynamometry, and the Hop-Test. The ACL-Group was evalu-ated before and 12 months after the reconstruction and the control group was evaluated once.Results: The Postoperative ACL Group presented greater limb symmetry, 0.96 (+/- 0.12), than the preoperative ACL Group, 0.87 (+/- 0.17), p < 0.01 in the Hop-Test. In the posturography, the displacement area was smaller in the postoperative ACL Group, 19.85 (+/- 5.74), compared to the preoperative ACL Group, 24.20 (+/- 8.97), p < 0.01. In isokinetic dynamometry the torque peak was greater in the postoperative ACL Group, 0.91 (+/- 0.14), than in the preoperative ACL Group, 0.74 (+/- 0.15), p < 0.01.Conclusion: The functional outcomes increased in ACL reconstruction athletes after 12 months, but not at the same level as in the Control Group. The result indicates an incomplete functional recovery, adaptive changes in postural control after injury, reconstruction, and return to sport.
  • article 5 Citação(ões) na Scopus
    Muscle Injury: Pathophysiology, Diagnosis, and Treatment
    (2022) SANTANNA, João Paulo Cortez; PEDRINELLI, André; HERNANDEZ, Arnaldo José; FERNANDES, Tiago Lazzaretti
    Abstract Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.
  • article 23 Citação(ões) na Scopus
    The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports
    (2014) FERNANDES, Tiago Lazzaretti; FREGNI, Felipe; WEAVER, Kayleen; PEDRINELLI, Andre; CAMANHO, Gilberto Luis; HERNANDEZ, Arnaldo Jose
    The purpose of this study was to radiographically investigate the influence of femoral tunnel placement in ACL reconstruction on early outcomes and return to sports due to anatomic and nonanatomic positioning. A prospective study was conducted from 2008 to 2010, with 86 athletes who underwent ACL reconstruction between anteromedial (AM) footprint and high AM position. Knee functional outcomes (IKDC objective and subjective, Tegner score, and Lysholm scale) return to sports and complications were analyzed at 6- and 12-month follow-up. At follow-up, it was observed that tunnel projection along Blumensaat's line was correlated with functional outcomes on Tegner scale (at 6 and 12 months) and IKDC subjective (at 12 months). There was a significant difference in mean tunnel projection along Blumensaat's line when analyzing return to sports (73 +/- A 1.4 and 79 +/- A 1.7 %, respectively, for projections on return vs. no return to sports, p = 0.02) and complications (73 +/- A 1.3 vs. 78 +/- A 1.6 %, respectively, for projections on no complications vs. complications, p = 0.03). No differences were stated on coronal view. These correlations between tunnel positioning on functional outcomes could not be explained by demographic or baseline characteristics. The clinical relevance of this study is that tunnel positioning along AM footprint and high AM position represented by tunnel projection along Blumensaat's line is associated with early return to sports on previous Tegner level and better functional outcome in athletes. III.
  • article 35 Citação(ões) na Scopus
    EPIDEMIOLOGY OF SPORTS INJURIES ON COLLEGIATE ATHLETES AT A SINGLE CENTER
    (2014) ROSA, Bruno Berbert; ASPERTI, Andre Marangoni; HELITO, Camilo Partezani; DEMANGE, Marco Kawamura; FERNANDES, Tiago Lazzaretti; HERNANDEZ, Arnaldo Jose
    Objective: To evaluate the incidence of sports injuries in college athletes from the same institution from 1993 to 2013. Methods: Athletes from 13 modalities were interviewed about the presence and type of injury, type of treatment and time of withdrawal, based on the questionnaire ""Injury Surveillance System"" (ISS). Data were analyzed with graphs and tables of injury prevalence by gender, age, site of injury and modality. We also analyzed the average time of withdrawal of athletes, returning to sports practice and new lesions. Results: It was observed that 49.91% of the athletes showed some type of injury, with similar incidence between genders; the most frequent injuries were the anterior cruciate ligament (ACL) and the ankle sprain; the average withdrawal time was 11 weeks. ACL was the injury with greater impact on college sports career, especially given the time of withdrawal. Conclusion: The most frequent injury, ACL, occurred most frequently in indoor sports such as handball and volleyball and had the highest number of cases treated with surgery and a longer average withdrawal time. More studies are needed to create a larger database in order to schedule preventive measures for amateur athletes.
  • article 0 Citação(ões) na Scopus
    ANTEROMEDIAL OR CENTRAL ANATOMIC ACL RECONSTRUCTION? A CADAVERIC HIP-TO-TOE STUDY
    (2023) FERNANDES, Tiago Lazzaretti; SOUZA, Michel Oliveira; NETO, Cyro Albuquerque; ARAUJO, Paulo Henrique; PEDRINELLI, Andre; HERNANDEZ, Arnaldo Jose
    Objective: To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods: Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results: The Central REC group showed a smaller degree of internal rotation (0.6 & DEG; & PLUSMN; 0.3 & DEG; vs. 1.8 & DEG; & PLUSMN; 0.3 & DEG;, respectively, P < 0.05) and no difference in anterior translation (4.7 mm & PLUSMN; 0.4 mm vs. 4.5 mm & PLUSMN; 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion: The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.
  • article 1 Citação(ões) na Scopus
    Description of an evaluation system for knee kinematics in ligament lesions, by means of optical tracking and 3D tomography,
    (2014) FERNANDES, Tiago Lazzaretti; RIBEIRO, Douglas Badillo; ROCHA, Diogo Cristo da; ALBUQUERQUE, Cyro; MARTINS PEREIRA, César Augusto; PEDRINELLI, André; HERNANDEZ, Arnaldo José
    Objective: To describe and demonstrate the viability of a method for evaluating knee kine matics, by means of a continuous passive motion (CPM) machine, before and after anterio cruciate ligament (ACL) injury. Methods: This study was conducted on a knee from a cadaver, in a mechanical pivot-shif simulator, with evaluations using optical tracking, and also using computed tomography. Results: This study demonstrated the viability of a protocol for measuring the rotation an translation of the knee, using reproducible and objective tools (error<0.2mm). The mech anized provocation system of the pivot-shift test was independent of the examiner an always allowed the same angular velocity and traction of 20 N throughout the movement. Conclusion: The clinical relevance of this method lies in making inferences about the in viv behavior of a knee with an ACL injury and providing greater methodological quality in futur studies for measuring surgical techniques with grafts in relatively close positions.