ALEXANDRE LEME GODOY DOS SANTOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Changes in cartilage, synovial cells and synovial fluid after malleolar fractures: What its importance for post-traumatic ankle osteoarthitis?(2019) GODOY-SANTOS, A.L.; LOPES, D.; GIAROLA, I.; CESAR NETTO, C. de; RAMMELT, S.Background: Despite advances in malleolar fractures treatment, the overall risk to develop posttraumatic ankle osteoarthritis after 20 years is almost 40%, especially bimalleolar Weber type B and C fractures and fractures involving the posterior tibial rim. Methods: We performed a systematic literature review of clinical studies targeting the changes in cartilage, synovial cells and synovial fluid after malleolar fractures. Results: The acute ankle injury initiates a sequence of biological events potentially leading to progressive articular surface damage resulting from inflammatory changes in cartilage, synovial tissue and synovial fluid. Conclusion: A better understanding of the molecular and histological changes induced by acute trauma may potentially lead to novel, targeted treatment of malleolar fractures besides anatomical reduction and adequate stabilization. © 2019
- Extensive Synovial Chondromatosis Involving All Flexor Tendons in the Tarsal Tunnel: A Case Report(2019) PINTER, Zachariah; SHAH, Ashish; CESAR NETTO, Cesar de; SMITH, Walter; O’DALY, Andres; GODOY-SANTOS, Alexandre LemeAbstract Synovial chondromatosis is a rare condition characterized by benign chondrogenic metaplasia of extra-articular synovial tissue. It usually affects a single tendon sheath of the hand or foot. This report describes a rare case with extensive synovial chondromatosis affecting all flexor tendons in the tarsal tunnel, its radiological features, surgical treatment, and clinical outcome. The authors present a unique case of extensive synovial chondromatosis in a 48-year-old male involving the tendon sheaths of the flexor hallucis longus, flexor digitorum longus, and posterior tibialis tendons, at the level of the tarsal tunnel, with extension into the plantar aspect of the foot. The patient initially presentedwith symptoms of tarsal tunnel compression and was found to have a 4-cm mass in the posteromedial aspect of the ankle. The presumptive diagnosis of synovial chondromatosiswasmadebased on radiographic and magnetic resonance imaging evidence. The patient underwent surgical resection of the tumor, aswell as tarsal tunnel releaseandgastrocnemius recession. The diagnosiswas confirmed postoperatively by surgical histopathology. The postoperative course of the patient was uncomplicated and his tarsal tunnel symptoms resolved. This represents a case of extensive synovial chondromatosis involving all flexor tendons in the tarsal tunnel that was correctly diagnosed by clinical and imaging findings, which required early surgical resection to avoid long-term neurovascular complications.
- SOFT-TISSUE INJURY TO THE FOOT AND ANKLE: LITERATURE REVIEW AND STAGED MANAGEMENT PROTOCOL(2019) GODOY-SANTOS, Alexandre Leme; SCHEPERS, Tim; RAMMELT, Stefan; SAKAKI, Marcos Hideyo; MATELUNA, Cristian Ortiz; SPOSETO, Rafael Barban; SYMEONIDIS, Panagiotis; BITAR, Rogerio; DARWISH, Husam; ZWIPP, HansComplex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage associated with neurovascular injury and joint involvement. These injuries are frequently present in the polytraumatized patient and are a predictor of unfavorable clinical outcome. In the initial approach to a patient with complex foot and ankle trauma, the decision between amputation and reconstruction is crucial. The various existing classification systems are of limited effectiveness and should serve as tools to assist and support a clinical decision rather than as determinants of conduct. In the emergency department, one of two treatment options must be adopted: early complete treatment or staged treatment. The former consists of definitive fixation and immediate skin coverage, using either primary closure (suturing) or flaps, and is usually reserved for less complex cases. Staged treatment is divided into initial and definitive. The objectives in the first phase are: prevention of the progression of ischemia, necrosis and infection. The principles of definitive treatment are: proximal-to-distal bone reconstruction, anatomic foot alignment, fusions in severe cartilage lesions or gross instabilities, stable internal fixation and adequate skin coverage.
- Should it Stay or Should it Go? Thinking Critically About Posterior Tibial Tendon Excision in Flatfoot Correction(2019) DUNHAM, Alexandra M.; NETTO, Cesar de Cesar; GODOY-SANTOS, Alexandre L.; SCHON, Lew C.Stage II adult acquired flatfoot deformity is characterized by painful, progressive collapse long thought to be driven by posterior tibialis tendon (PTT) deficiency or insufficiency. In this article, we discuss the history of our understanding the role of the PTT in the development of adult acquired flatfoot deformity, and considerations in tendon excision in flatfoot correction. We argue that routine excision of the PTT should be rethought and instead the tendon should be critically assessed in each case and debridement with repair should be attempted when appropriate. Technique for flexor digitorum longus transfer is detailed as well as preoperative evaluation, imaging, nonoperative treatment, and adjuvants including biologics.
- Radiographic Assessment of First Tarsometatarsal Joint Shape and Orientation(2019) KOURY, Kimberly; STAGGERS, Jackson R.; PINTO, Martim C.; GODOY-SANTOS, Alexandre L.; SMYTH, Niall A.; SHAH, Ashish B.; NETTO, Cesar de CesarBackground: Hypermobility within the first tarsometatarsal (TMT) joint is a predisposing factor for hallux valgus. The purpose of this study was to assess whether the shape and angulation of the first TMT joint are affected by the positioning of the foot in radiographs. Methods: Ten adult above-knee fresh-frozen cadaveric specimens were placed into a radiolucent apparatus that allowed controlled angulation of each foot at 0, 5, 10, 15, and 20 degrees in dorsiflexion, plantarflexion, inversion, and eversion. For each specimen, the first TMT joint angle (1TMTJA), shape of the distal articular surface of the medial cuneiform (flat or curved), and image quality of the first TMT joint were measured. Results: The mean value for 1TMTJA was 22.9 degrees (95% confidence interval [CI] 21.9-24). Individual anatomical variations of the specimens as well as the different angulations due to foot positioning significantly influenced the 1TMTJA (both P < .001). Joints that were found to have a flat configuration showed significantly increased 1TMTJA on average when compared to the ones with curved articular surface, 25.9 (95% CI 24.4-27.4) and 20.8 degrees (95% CI 19.5-22.0) (P < .001), respectively. Image quality for visualization of the first TMT joint was progressively better for increased angles of dorsiflexion and inversion. Conclusion: The shape and angulation of the first TMT joint on radiographic evaluation are affected by the positioning of the foot.
- The use of bioactive glass S53P4 in the treatment of an infected Charcot foot: a case report(2019) GODOY-SANTOS, Alexandre L.; ROSEMBERG, Laercio A.; CESAR-NETTO, Cesar de; ARMSTRONG, David G.Objective: To report a case of successful limb-salvage staged treatment in the treatment of an infected diabetic Charcot foot. Case summary: A 45-year-old male with long-term, uncontrolled type 2 diabetes, six months' history of progressive deformity on the right foot and 45 days of purulent drainage in the lateral aspect of the foot. Patient was diagnosed with an infected Charcot foot with extensive midfoot bone involvement as shown by radiographic and MRI images. We used a multidisciplinary approach to treatment with early antibiotic therapy, tight glycaemic control and staged surgical treatment. Initial treatment was adequate irrigation and debridement, bone-void filling with bioactive glass, external fixation and provisional negative pressure wound therapy (NPWT). Later progressed to total contact casting and progressive protect weight bearing. At final follow-up, patient was full weight-bearing in stiff soled footwear, with no clinical signs of infection, no gross alteration of gait pattern and demonstrating complete bone healing and integration of the bioactive glass. Conclusion: The bioactive glass S53P4 was successfully used in the limb-salvage staged treatment of a patient with an infected Charcot foot. Here, full integration with the surrounding bone and its supportive action in the combat of bone infection was demonstrated.
- Posterior quadratus lumborum block for primary total hip arthroplasty analgesia: a comparative study(2019) KUKREJA, Promil; MACBETH, Lisa; POTTER, William; BUDDEMEYER, Katherine; DEBELL, Henry; ELSHARKAWY, Hesham; KALAGARA, Hari; WAJNSZTEJN, Andre; PIRES, Eduardo Araujo; GODOY-SANTOS, Alexandre Leme; SHAH, AshishObjective: To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Methods: The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Results: For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg +/- 37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL +/- 58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. Conclusion: Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay.
- Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity(2019) NETTO, Cesar de Cesar; GODOY-SANTOS, Alexandre Leme; SAITO, Guilherme H.; LINTZ, Francois; SIEGLER, Sorin; O'MALLEY, Martin J.; DELAND, Jonathan T.; ELLIS, Scott J.Background: Progressive peritalar subluxation (PTS) is part of adult acquired flatfoot deformity (AAFD). We investigated the use of the middle facet as an indicator of PTS using standing, weight-bearing computed tomography (CT) images. We hypothesized that weight-bearing CT would be an accurate method of measuring increased subluxation (""uncoverage"") and incongruence of the middle-facet among patients with AAFD. Methods: We included 30 patients with stage-II AAFD (20 female and 10 male; mean age, 57.4 years [range, 24 to 78 years]) and 30 matched controls (20 female and 10 male; mean age, 51.8 years [range, 19 to 81 years]) who underwent standing, weight-bearing CT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the middle facet at the midpoint of its longitudinal length, using coronal-plane, weight-bearing, cone-beam CT images. Intraobserver and interobserver reliabilities were assessed using intraclass correlation coefficients (ICCs). Comparisons were performed using independent t tests or Wilcoxon tests. P values of <0.05 were considered significant. Results: Substantial to almost perfect intraobserver and interobserver reliability was observed for both measurements. We found that the middle facet demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% confidence interval [CI], 38.5% to 52.1%) compared with 4.8% (95% CI, 3.2% to 6.4%) in controls (p < 0.0001). A significant difference was also found for the incongruence angle, with a mean value of 17.3 degrees (95% CI, 14.7 degrees to 19.9 degrees) in the AAFD group and 0.3 degrees (95% CI, 0.1 degrees to 0.5 degrees) in controls (p < 0.0001). A joint incongruence angle of >8.4 degrees was found to be diagnostic for symptomatic stage-II AAFD. Conclusions: We investigated the use of the middle facet of the subtalar joint as a marker for PTS in patients with AAFD. We confirmed that standing, weight-bearing CT images allowed accurate measurements and that significant differences were found in the percentage of joint uncoverage and the incongruence angle compared with controls.
- The Flatfoot in Collapse Needs Stability and That is Why I Fuse It(2019) SPOSETO, Rafael B.; SAKAKI, Marcos H.; FERNANDES, Tulio D.; GODOY-SANTOS, Alexandre L.The pathophysiology and treatment of the adult-acquired flatfoot is still quite controversial. Soft tissue reconstruction and tendon transfer surgery combined with corrective osteotomy for flexible deformities are well established in the literature. However, patients with signs of hindfoot osteoarthritis, rheumatological or neurological diseases, and obesity can benefit from surgical correction with arthrodesis because of greater outcome predictability. Various types of arthrodesis, including isolated, triple, double, or segmental procedures, have been described to treat this deformity. We will discuss the events leading to the progressive collapse of the medial arch and distinguish between patients who could benefit from reconstruction with arthrodesis from those who cannot, as well as the indications for these technical options. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
- Short-term Changes After Corticosteroid Injections Into the Normal Tendons of Rabbits: A Controlled Randomized Study(2019) DINHANE, Kandir Genesio Innocenti; GODOY-SANTOS, Alexandre Leme; FABRO, Alexandre Todorovic; MORETTO, Maria Regina; DEPRA, Igor; YOSHIDA, Winston BonettiBackground: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopaedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Purpose: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Study Design: Controlled laboratory study. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group-in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group-in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, animals were euthanized and tendons were harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load x elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group had a significant reduction in MMP2 expression as compared with the control groups (P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased duration of follow-up, various doses, and multiple injections and in tendinopat