Browsing by Author "Cesar, Cesar DE"

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    ItemOpen Access
    FOOT ALIGNMENT IN SYMPTOMATIC NATIONAL FOOTBALL LEAGUE (NFL) ATHLETES: A WEIGHTBEARING CT ANALYSIS.
    (Acta ortopedica brasileira, 2021-05) Bernasconi, Alessio; Cesar, Cesar DE; Roberts, Lauren; Lintz, François; Godoy-Santos, Alexandre Leme; O'Malley, Martin Joseph

    Objective

    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 (Inftal-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° vs 0.8° 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° vs 18.3°, 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. Level of Evidence III, Retrospective comparative study.
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    HALLUX PROXIMAL PHALANX FRACTURE IN ADULTS: AN OVERLOOKED DIAGNOSIS.
    (Acta ortopedica brasileira, 2020-11) Godoy-Santos, Alexandre Leme; Giordano, Vincenzo; Cesar, Cesar DE; Sposeto, Rafael Barban; Bitar, RogÉrio Carneiro; Wajnsztejn, AndrÉ; Sakaki, Marcos Hideyo; Fernandes, TÚlio Diniz

    Objectives

    To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options.

    Methods

    we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020.

    Results

    There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures.

    Conclusion

    The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.
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    ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS.
    (Acta ortopedica brasileira, 2017-09) Shah, Ashish; Naranje, Sameer; Araoye, Ibukunoluwa; Elattar, Osama; Godoy-Santos, Alexandre Leme; Cesar, Cesar DE

    Objectives

    The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes.

    Methods

    We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically.

    Results

    There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56).

    Conclusion

    Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.
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    WEIGHT-BEARING COMPUTED TOMOGRAPHY OF THE FOOT AND ANKLE: AN UPDATE AND FUTURE DIRECTIONS.
    (Acta ortopedica brasileira, 2018-03) Godoy-Santos, Alexandre Leme; Cesar, Cesar DE; WEIGHT-BEARING CT INTERNATIONAL STUDY GROUP
    Spatial understanding of osteoarticular deformities of the foot and ankle is vital to correct diagnosis and therapeutic decision making. Poor reproducibility in conventional standing radiography in three orthogonal views has driven the development of weight-bearing computed tomography (WBCT) technology over the last decade. We analyzed the available literature on WBCT imaging in patients with foot and ankle disorders by performing a literature review of relevant clinical studies in multiple databases including PubMed, MedLine, and Scopus from January 1999 to October 2017. WBCT imaging allows correct evaluation of foot and ankle anatomy with the patient in a standing position, providing images with high spatial resolution, short image acquisition time, low dose of radiation, and costs which are similar to other available imaging technologies. This diagnostic tool can be used for decision making in the treatment of deformities of the ankle, hindfoot, midfoot, and forefoot. Level of Evidence III; Systematic review of level III studies.