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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- Comparative CT with stress manoeuvres for diagnosing distal isolated tibiofibular syndesmotic injury in acute ankle sprain: a protocol for an accuracy- test prospective study(2020) RODRIGUES, Joao Carlos; SANTOS, Alexandre Leme Godoy; PRADO, Marcelo Pires; ALLOZA, Jose Felipe Marion; MASAGAO, Renato Amaral; ROSEMBERG, Laercio Alberto; BARROS, Durval do Carmo Santos; CASTRO, Adham do Amaral e; DEMANGE, Marco Kawamura; LENZA, Mario; FERRETTI, MarioIntroduction Although several imaging options are available for diagnosing syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. This study aims to investigate which strategy among an existing CT index test and two new add-on CT index tests with stress manoeuvres more accurately diagnoses syndesmotic instability. The secondary objective is to investigate the participants' disability outcomes by applying the Foot and Ankle Ability Measure questionnaire. Methods and analyses This study of a diagnostic accuracy test will consecutively select individuals older than 18 years with a clinical diagnosis of a suspected acute syndesmotic injury. Three strategies of the CT index test (one in the neutral position and two with stress) will examine the accuracy using MRI as the reference standard. The external rotation and dorsiflexion of the ankle will guide the stress manoeuvres. A comparison of measurements between the injured syndesmosis and the uninjured contralateral side of the same individual will investigate the syndesmotic instability, by evaluating the rotational and translational relationships between the fibula and tibia. Sensitivity, specificity, area under the receiver operating characteristic curve and likelihood analyses will compare the diagnostic accuracies of the strategies. Ethics and dissemination The Internal Review Board and the Einstein Ethics Committee approved this study (registered number 62100016.5.0000.0071). All participants will receive an oral description of the study's aim, and the choice to participate will be free and voluntary. Participants will be enrolled after they sign the written informed consent form, including the terms of confidentiality. The results will be presented at national and international conferences and published in peer-reviewed journals and social media.
- EPIDEMIOLOGIC STUDY OF ANKLE FRACTURES IN A TERTIARY HOSPITAL(2014) SAKAKI, Marcos Hideyo; MATSUMURA, Bruno Akio Rodrigues; DOTTA, Thiago De Angelis Guerra; PONTIN, Pedro Augusto; SANTOS, Alexandre Leme Godoy dos; FERNANDES, Tulio DinizObjectives: To evaluate the epidemiology of ankle fractures surgically treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Universidade de Sao Paulo. Methods: Medical records of patients admitted with foot and ankle fractures between 2006 and 2011 were revised. Seventy three ankle fractures that underwent surgical treatment were identified. The parameters analyzed included age, gender, injured side, AO and Gustilo & Anderson classification, associated injuries, exposure, need to urgent treatment, time to definitive treatment and early post-operative complications. Study design: retrospective epidemiological study. Results: Male gender was predominant among subjects and the mean age was 27.5 years old. Thirty nine fractures resulted from traffic accidents and type B fracture according to AO classification was the most common. Twenty one were open fractures and 22 patients had associated injuries. The average time to definitive treatment was 6.5 days. Early post-operative complications were found in 21.3% of patients. Conclusions: Ankle fractures treated in a tertiary hospital of a large city in Brazil affect young people victims of high-energy accidents and present significant rates of associated injuries and post-operative complications.
- 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.
- HALLUX RIGIDUS: PROSPECTIVE STUDY OF JOINT REPLACEMENT WITH HEMIARTHROPLASTY(2013) SANTOS, Alexandre Leme Godoy dos; DUARTE, Fernando Aires; SEITO, Carlos Augusto Itiu; ORTIZ, Rafael Trevisan; SAKAKI, Marcos Hideyo; FERNANDES, Tulio DinizObjective: To report the results of medium-term follow-up after deploying Arthrosurface-HemiCap (R) in patients with diagnosis of Hallux Rigidus (HR). Method: Eleven patients underwent partial Arthroplasty of the first metatarsal-phalangeal joint. Six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) scales for hallux, Visual Analogical Scale (VAS) - analog functional pain - and range of motion in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. Results: The results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. The comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. Conclusion: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hallux rigidus II and III, with significant improvement of the evaluated parameters for the studied population.
- Talar Body Reconstruction for Nonunions and Malunions(2018) SAKAKI, Marcos Hideyo; MACEDO, Rodrigo Sousa; SANTOS, Alexandre Leme Godoy Dos; ORTIZ, Rafael Trevisan; SPOSETO, Rafael Barban; FERNANDES, Tulio DinizBackground: Talar body and neck nonunions and malunions may undergo a reconstructive surgery when joint cartilage is still viable, and no talar collapse or infection has occurred. This is a rare condition and the studies supporting the procedure have small number of cases. The objective of the present study is to report a case series of six patients who underwent talar reconstructions. Materials and Methods: Six patients with talar malunions or nonunions who underwent surgical treatment were reviewed in this retrospective study. There were three nonunions and two malunions of the talar body and one malunion of the talar neck. Clinical evaluation included all the parameters used in the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale. Arthritic degeneration of the ankle joint was assessed according to a modified Bargon scale. Results: The mean followup was 86 months (range 24-282 months). There were no cases of postoperative avascular necrosis of the talus. Four of the six patients in our series required a subtalar fusion as part of the reconstruction procedure. The average preoperative AOFAS hindfoot score was 34, and at the time of the last evaluation, it was 74. The mean preoperative score on the modified Bargon scale for the tibiotalar joint was 1.17. At the last followup, it rose to 1.33. Three different deformities of the talus were identified (a) flattening of the talus (b) extra-articular step and (c) intraarticular step. Conclusion: Reconstruction of talar nonunions and malunions improved function in selected patients with a low risk of complications. Three different anatomical patterns of talar nonunions and malunions were identified.
- Anatomic Evaluation of Percutaneous Achilles Tendon Lengthening(2018) PHILLIPS, Sierra; SHAH, Ashish; STAGGERS, Jackson Rucker; PINTO, Martim; GODOY-SANTOS, Alexandre Leme; NARANJE, Sameer; NETTO, Cesar de CesarBackground: The objective of the study was to evaluate the accuracy of percutaneous Achilles tendon lengthening (TAL) using a triple hemisection technique and the improvement in ankle dorsiflexion. Methods: Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of the Achilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Following forced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper. Results: The overall relative width of the percutaneous cut was 51.3% 16.3% of the Achilles tendon diameter, 44.3% 13.6% for the proximal cut, 50.3% +/- 15.6% for the intermediate cut, and 59.3% +/- 18.4% for the distal cut. Tendon excursion averaged 13.0 +/- 3.8 mm for the proximal cuts, 12.5 +/- 4.7 mm for the intermediate cuts, and 8.2 +/- 3.7 mm for the distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion data analysis. The mean range of motion for ankle dorsiflexion was 8.1 +/- 3.9 degrees preprocedure and 27.6 +/- 5.3 degrees postprocedure. The dorsiflexion angle significantly increased (P < .0001) at an average of 19.5 +/- 5.0 degrees following TAL. Conclusion: Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accurate technique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures are possible complications. Clinical Relevance: Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.
- Primary Arthrodesis for High-Energy Lisfranc Injuries(2020) GODOY-SANTOS, Alexandre Leme; NETTO, Cesar de CesarThe reported incidence of Lisfranc injuries is 9.2/100.000 person-years; two-thirds of the injuries are nondisplaced. Tarsometatarsal injuries range from minor sprains and isolated ligamentous injuries to grossly unstable and multiligamentous lesions. High-energy injuries are usually linked with mechanical energy dissipation through the soft tissues. Operative treatment options include open reduction and internal fixation, open reduction with hybrid internal and external fixation, closed reduction with percutaneous internal or external fixation, and primary arthrodesis. Treatment goals are to obtain a painless, plantigrade, and stable foot. Anatomic reduction is a key factor for improved outcomes and decreased rates of post-traumatic arthritis.
- Advanced Imaging in the Chronic Lateral Ankle Instability: An Algorithmic Approach(2023) CASTRO, Adham do Amaral e; GODOY-SANTOS, Alexandre Leme; TANEJA, Atul K.A flowchart summarizing the best imaging methods to use in each clinical scenario of CLAI is presented in Fig. 12, based on the most recent literature and authors' experience.
- 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.