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
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Surgical management of displaced talus neck fractures: single vs double approach, screw fixation alone vs screw and plating fixation-systematic review and meta-analysis(2021) GIORDANO, Vincenzo; LIBERAL, Bauer Ramos; RIVAS, Daniela; SOUTO, Danilo Baia; YAZEJI, Henrique; SOUZA, Felipe Serrao; GODOY-SANTOS, Alexandre; AMARAL, Ney PecegueiroPurpose: To provide a direct comparison between two important aspects related to talar neck fractures management - surgical approaches and fixation strategies. Data sources: A systematic review and meta-analysis was performed using PubMed, SciELO, and gray literature databases. The keyword ""talus fracture"" and the combined terms ""talus neck fracture AND surgical approach"" and ""talus neck fracture AND fixation strategy"" were used. Study selection: Study selection, data extraction, and the risk of bias assessment were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Searches were limited to human studies and the English and Portuguese. Inclusion criteria were articles in full text that reported on any aspect of surgical approach and fixation strategy for talus neck fractures. Exclusion criteria were skeletally immature patients, mean follow-up of less than 12 months, studies that did not use the Hawkins classification system, primary treatment of arthrodesis, studies published before year 2000, and studies published in languages other than English and Portuguese. Data extraction: Basic information was collected including journal, author(s), year published, level of evidence, number of fractures, and follow-up. Specific information was collected including fracture classification, surgical approach, fixation strategy, complication rate, type of complication(s), and outcome measurement(s). Data synthesis: Fixed-effects model was used for meta-analysis. The choice for surgical approach(es) and fixation strategy was stratified based on fracture classification. Complication rate, type of complication(s), and outcome measurement(s) were calculated for all studies and delineated by fracture classification. Conclusion: There is a significant correlation between poor scores and poor fracture reduction, but not with the modified Hawkins classification, surgical approach, and fixation strategy. The presence of an open talus neck fracture-dislocation jeopardizes the functional outcome, increasing the risk of complications. The overall avascular necrosis and post-traumatic osteoarthritis event rate was 0.279 and 0.400, respectively. Both complications were highly correlated to higher energy fracture patterns and to the use of combined approaches, but not to fixation strategy.
- Progressive collapsing foot deformity: How should we translate it into Neo-Latin languages?(2021) BERNASCONI, Alessio; VACAS, Elena; GODOY-SANTOS, Alexandre Leme; LINTZ, Francois
- FOOT ALIGNMENT IN SYMPTOMATIC NATIONAL FOOTBALL LEAGUE (NFL) ATHLETES: A WEIGHTBEARING CT ANALYSIS(2021) BERNASCONI, Alessio; NETTO, Cesar de Cesar; ROBERTS, Lauren; LINTZ, Francois; GODOY-SANTOS, Alexandre Leme; O'MALLEY, Martin JosephObjective: Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group. Methods: 41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (lnftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance. Results: NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9 degrees vs 0.8 degrees in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15 degrees vs 18.3 degrees, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls. Conclusion: In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players.
- What Are the Updates on Epidemiology of Progressive Collapsing Foot Deformity?(2021) GODOY-SANTOS, Alexandre Leme; SCHMIDT, Eli L.; CHAPARRO, Felipe
- Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm(2021) GIORDANO, Vincenzo; BONI, Guilherme; GODOY-SANTOS, Alexandre Leme; PIRES, Robinson Esteves; FUKUYAMA, Junji Miller; KOCH, Hilton A.; V, Peter GiannoudisPurpose Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. Patients and methods Sixty-nine consecutive patients were managed with fibular IM fixation for closed malleolar fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union. Results The mean AOFAS for Group I was 99.35 +/- 1.95 points and that for Group II was 89.30 +/- 16.98 points. There were no significant differences between the fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05). Conclusion In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.
- Congenital Clubfoot - Is the Ponseti Method the Definitive Solution?(2021) CORDEIRO, Felippi Guizardi; MACEDO, Rodrigo Sousa; MASSA, Bruno Sérgio Ferreira; GRANGEIRO, Patricia Moreno; GODOY-SANTOS, Alexandre Leme; FERNANDES, Túlio DinizAbstract Congenital clubfoot is one of the most common deformities at birth. The inadequacy or absence of treatment causes serious limitations for people with this condition. The initial treatment using the Ponseti method ensures functional results superior to other treatment modalities previously proposed. However, recurrences and neglected feet are still a challenge today. An understanding of the pathophysiology of the disease, as well as of the anatomy and local biomechanics and a thorough clinical and radiological evaluation of patients are essential to understanding the limits of the method and choosing the best treatment.
- Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update(2021) GODOY-SANTOS, Alexandre Leme; BERNASCONI, Alessio; BORDALO-RODRIGUES, Marcelo; LINTZ, François; LôBO, Carlos Felipe Teixeira; NETTO, Cesar de CesarAbstract Cone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.
- Ankle Osteoarthritis(2021) GODOY-SANTOS, Alexandre Leme; FONSECA, Lucas Furtado; CESAR NETTO, Cesar de; GIORDANO, Vincenzo; VALDERRABANO, Victor; RAMMELT, StefanAbstract Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing posttraumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.
- Biomechanical evaluation in runners with Achilles tendinopathy (vol 76, e2803, 2021)(2021) GODOY-SANTOS, Alexandre Leme; ANDERE, N. F. B.; GODOY-SANTOS, A. L.; MOCHIZUKI, L.; RODRIGUES, M. B.; FERNANDES, T. D.; SOARES-JUNIOR, J. M.
- Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity(2021) AUCH, Elijah; MANSUR, Nacime Salomao Barbachan; ALVES, Thiago Alexandre; CYCHOSZ, Christopher; LINTZ, Francois; GODOY-SANTOS, Alexandre Leme; BAUMFELD, Daniel Soares; CESAR NETTO, Cesar deBackground: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm(2)). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% (P < .001) in FAO and 10.4 mm(2) (P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a thorn of 0.22 (P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm(2). Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm(2). A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening.