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Torre G, Turchetta M, Del Buono A, Pavone V, Papalia R, Mariani PP. Isolated radial tears of the lateral meniscus midbody: a case series of professional athletes treated with outside-in repair. Musculoskelet Surg 2023; 107:447-453. [PMID: 35945416 DOI: 10.1007/s12306-022-00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The main aim of the study is to assess clinical and functional outcomes of arthroscopic outside-in repair of isolated radial tears of the midbody of lateral meniscus in professional athletes and to evaluate the return to the sport activity after surgery. METHODS A retrospective data collection on professional athletes with isolated complete lesion of the midbody of lateral meniscus, treated with arthroscopic outside-in repair was carried out. Outcome measures included functional assessment, Limb Symmetry Index (LSI) and Hamstring Quadriceps Ratio (HQR) and Lysholm score collected before surgery and at 4-month follow-up. Data on return to sport practice and re-injury were also retrieved. RESULTS Fourteen patients satisfied the selection criteria. Full return to professional sport activity (Tegner 10) was registered in the 86% of the cohort at 4 months after the surgery. Functional testing of the athletes showed a return of the LSI and HQR to the pre-surgical condition, demonstrating a full recovery of the functional ability and muscle strength. Similarly, clinical evaluation through Lysholm score showed an improvement, reaching an average of 97.7 points at 4 months follow-up. CONCLUSION A good functional recovery and a high rate of return to play has been observed in a population of professional athletes, at 4 months after outside-in repair.
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Affiliation(s)
- G Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - M Turchetta
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - A Del Buono
- Orthopaedic and Trauma Unit Ospedale Luigi Curto, Polla, Salerno, Italy
| | - V Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - P P Mariani
- Senior Professor, University of Rome Foro Italico, Rome, Italy
- Villa Stuart Sport Clinic - FIFA Medical Centre of Excellence, Rome, Italy
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Wai-kit Chan T, Kong CC, Del Buono A, Maffulli N. Acute augmentation for interstitial insufficiency of the posterior cruciate ligament. A two to five year clinical and radiographic study. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2016.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Hospital Vaio, Fidenza, Italy
| | - N. Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
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3
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Affiliation(s)
- L. Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - M. Buda
- Unit of Orthopaedics and Traumatology, University of Ferrara, Italy
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery Hospital Antonio Cardarelli, Campobasso, Italy
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Affiliation(s)
- A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Italy
| | - F. Oliva
- Department of Orthopaedic and Trauma Surgery, University of Rome Tor Vergata, Rome, Italy
| | - L. Osti
- Unit of Arthroscopy and Sports Trauma Surgery, Hesperia Hospital, Modena, Italy
| | - N. Maffulli
- Head of Department Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, U.K
- Head of Department of Phisical and Rehabilitation Medicine, University of Salerno, Azienda Ospedaliera San Giovanni Di Dio e Ruggi d’Aragona
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Maffulli G, Del Buono A, Richards P, Oliva F, Maffulli N. Conservative, minimally invasive and open surgical repair for management of acute ruptures of the Achilles tendon: a clinical and functional retrospective study. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2017.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- G. Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - P. Richards
- Department of Radiology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - F. Oliva
- Department of Trauma and Orthopaedics, “Tor Vergata” University, Rome, Italy
| | - N. Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, School of Medicine, Salerno, Italy
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Affiliation(s)
- D. Wang
- Department of Medical Statistics, London, UK
| | - A. Bakhai
- Department of Medical Statistics, London, UK
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - N. Maffulli
- Head of Department of Phisical and Rehabilitation Medicine, University of Salerno, Azienda Ospedaliera San Giovanni Di Dio e Ruggi d’Aragona, Salerno, Italy Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
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den Hamer A, Heusinkveld M, Traa W, Oomen P, Oliva F, Del Buono A, Maffulli N. Current techniques for management of transverse displaced olecranon fractures. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2015.13] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. den Hamer
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - M. Heusinkveld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - W. Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - P. Oomen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - F. Oliva
- Department of Orthopaedics, Tor Vergata University, Rome, Italy
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery Hospital Antonio Cardarelli, Campobasso, Italy
| | - N. Maffulli
- Queen Mary University of London, Centre for Sports and Exercise Medicine, Mile End Hospital, Mann Ward, London, England; Department of Musculoskeletal Disorders, University of Sabino School of Medicine and Surgery, Sabino, Italy
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8
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Osti L, Soldati F, Del Buono A, Buda M. Arthroscopic repair of the subscapularis tendon: indications, limits and technical features. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2013.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L. Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - F. Soldati
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - A. Del Buono
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - M. Buda
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
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Caporale M, Gambino G, Larosa F, Del Buono A, Di Segni F. Non-Hodgkin’s lymphoma: unexpected cause of shoulder pain. A systematic review of the literature. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2013.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M.F. Caporale
- Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy
| | - G.F. Gambino
- Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy
| | - F.S. Larosa
- Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Hospital Antonio Cardarelli, Campobasso, Italy
| | - F. Di Segni
- Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy
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McFarland E, Maffulli N, Del Buono A, Murrell G, Garzon-Muvdi J, Petersen S. Impingement is not impingement: the case for calling it “Rotator Cuff Disease”. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2013.11] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E.G. McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA
| | - N. Maffulli
- Department of Physical and Rehabilitation Medicine, University of Salerno School of Medicine and Surgery, Salerno, Italy. Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Italy
| | - G.A.C. Murrell
- Orthopaedic Research Institute, University of South Wales, The St George Hospital, Sydney, Australia
| | - J. Garzon-Muvdi
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA
| | - S.A. Petersen
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA
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Oliva F, Piccirilli E, Bossa M, Giai Via A, Colombo A, Chillemi C, Gasparre G, Pellicciari L, Franceschetti E, Rugiero C, Scialdoni A, Vittadini F, Brancaccio P, Creta D, Del Buono A, Garofalo R, Franceschi F, Frizziero A, Mahmoud A, Merolla G, Nicoletti S, Spoliti M, Osti L, Padulo J, Portinaro N, Tajana G, Castagna A, Foti C, Masiero S, Porcellini G, Tarantino U, Maffulli N. I.S.Mu.L.T - Rotator Cuff Tears Guidelines. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2015.01] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F. Oliva
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - E. Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - M. Bossa
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome “Tor Vergata”, Italy
| | - A. Giai Via
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - A. Colombo
- UO Pediatric Orthopaedics, Humanitas Research Hospital, Milano, Italy
| | - C. Chillemi
- Department of Orthopaedic and Traumatology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - G. Gasparre
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - L. Pellicciari
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome “Tor Vergata”, Italy
| | - E. Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - C. Rugiero
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - A. Scialdoni
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - F. Vittadini
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - P. Brancaccio
- Service of Sports Medicine, II University of Naples, Italy
| | - D. Creta
- Physical Therapy and Rehabilitation Service, Private Hospital “Madre Fortunata Toniolo”, Bologna, Italy
| | - A. Del Buono
- Orthopaedics and Traumatology, Ospedale Sant’Anna, Sanfermo della Battaglia, Como, Italy
| | - R. Garofalo
- Shoulder Service, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - F. Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - A. Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - A. Mahmoud
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome “Tor Vergata”, Italy
| | - G. Merolla
- Shoulder and Elbow Unit Biomechanics Laboratory “M. Simoncelli” D. Cervesi Hospital, Cattolica, Italy
| | - S. Nicoletti
- Department of Orthopaedics and Traumatology, San Jacopo Hospital, Italy
| | - M. Spoliti
- Department of Orthopaedics and Traumatology, San Camillo Hospital, Rome, Italy
| | - L. Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - J. Padulo
- Sport Science, University e-Campus, Novedrate, Italy; Tunisian Research Laboratory “Sports Performance Optimization”, National Center of Medicine and Science in Sport, Tunis, Tunisia
| | - N. Portinaro
- UO Pediatric Orthopaedics, Humanitas Research Hospital, Milano, Italy
| | - G. Tajana
- Hystology ed Embriology, University of Salerno, Italy
| | - A. Castagna
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Rozzano, Milano, Italy
| | - C. Foti
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome “Tor Vergata”, Italy
| | - S. Masiero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - G. Porcellini
- Shoulder and Elbow Unit Biomechanics Laboratory “M. Simoncelli” D. Cervesi Hospital, Cattolica, Italy
| | - U. Tarantino
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - N. Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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12
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Affiliation(s)
- L. Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - F. Soldati
- Unit of Orthopaedics and Traumatology, University of Ferrara, Italy
| | - L. Massari
- Unit of Orthopaedics and Traumatology, University of Ferrara, Italy
| | - A. Del Buono
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
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13
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Maffulli N, Del Buono A, Oliva F. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: surgical technique. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2017.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- N. Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, London, UK
| | - A. Del Buono
- Department of Orthopedic and Trauma Surgery, Fidenza Hospital, Fidenza, Italy
| | - F. Oliva
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Rome, Italy
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Affiliation(s)
- L. Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - M. Buda
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery Hospital Sant’Anna, Como, Italy
| | - R. Osti
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
| | - L. Massari
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
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Maffulli N, Oliva F, Frizziero A, Nanni G, Barazzuol M, Giai Via A, Ramponi C, Brancaccio P, Lisitano G, Rizzo D, Freschi M, Galletti S, Melegati G, Pasta G, Testa V, Valent A, Del Buono A. ISMuLT skeletal muscles injuries Guidelines. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2013.02] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- N. Maffulli
- Head of Department of Physical and Rehabilitation Medicine, University of Salerno, Azienda Ospedaliera San Giovanni Di Dio e Ruggi d’Aragona, Salerno, Italy Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - F. Oliva
- Department of Orthopaedics and Traumatology, University of Rome ‘Tor Vergata’ School of Medicine, Rome, Italy
| | - A. Frizziero
- Department of Orthopaedic Rehabilitation, University of Padova School of Medicine, Italy
| | - G. Nanni
- Isokinetic Medical Group, Head of the Medical Staff of Bologna Football Club 1909, Bologna, Italy
| | - M. Barazzuol
- Department of Orthopaedic Rehabilitation, University of Padova School of Medicine, Italy
| | - A. Giai Via
- Department of Orthopaedics and Traumatology, University of Rome ‘Tor Vergata’ School of Medicine, Rome, Italy
| | - C. Ramponi
- Sport Physical Therapist, Kinè Physiotherapic Center, Conegliano, Italy
| | - P. Brancaccio
- Sports Medicine Unit, II University of Naples, Italy
| | - G. Lisitano
- Head of Kinecenter Rehabilitation Center, Messina, Italy
| | - D. Rizzo
- Isokinetic Medical Group, Medical Staff of Bologna Football Club 1909 Youth Department, Bologna, Italy
| | - M. Freschi
- Isokinetic Medical Group, Medical Staff of AC Milan, Italy
| | - S. Galletti
- Muscoloskeletal Interventional Sonographic Unit, Casa di Cura Toniolo, Bologna, Italy
| | - G. Melegati
- Rehabilitation I Unit, Center for Sports Rehabilitation, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - G. Pasta
- Head of Radiology Unit Parma Football Club, Italy
| | - V. Testa
- Olympic Center, Sports Medicine Unit, Angri, Salerno, Italy
| | - A. Valent
- Head of the Rehabilitation Unit “Riacef Clinic” Spezzano, Modena, Italy
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery Hospital Antonio Cardarelli, Campobasso, Italy
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Capuano N, Del Buono A, Maffulli N. Tissue preserving total hip arthroplasty using superior capsulotomy. Oper Orthop Traumatol 2015; 27:334-41. [PMID: 25900826 DOI: 10.1007/s00064-013-0242-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/11/2013] [Accepted: 02/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goals of a tissue-preserving minimally invasive approach to the hip are to allow early short-term recovery, achieve hip joint stability, minimize muscle strength loss from surgery, spare the peri-articular soft tissues, and allow unrestricted motion in the long term. INDICATIONS Hip arthroplasty in patients with no pre-existing hardware, with a sufficient space between the acetabular rim and greater trochanter; management of subcapital femoral fractures in older patients. CONTRAINDICATIONS Protrusio acetabuli. Joint stiffness. This is the main concern when undertaking the superior capsulotomy. Stiffness may result from bone causes, including ankylosis, large osteophytes, bone bridges etc., extra-articular retraction of surrounding soft tissues with capsular contracture of both ligaments and muscles, or a combination of bony and soft tissues causes, resulting in limited adduction. Indeed, maximal adduction is necessary to increase the distance between the apex of the greater trochanter and the superior acetabular edge. In the approach described in the present article, the real limitation is the impossibility to introduce a straight stem through the trochanteric fossa without weakening the trochantericarea. If adduction is restricted, excessive lateralization of the femoral stem would result in postoperative pain and discomfort, especially as we advocate immediate full weight bearing. Even though patients fare better when the trochanteric area is intact, many types of stem such as the GTS (Biomet), or stem Microplasty (Biomet) or even stem Parva (Adler Ortho) may pressurize the internal bone of the trochanteric structures. Therefore, these stems may be implanted in maximal hip adduction. This is the case in coxa profunda or coxa vara, which require more invasive and destabilizing surgical approaches. SURGICAL TECHNIQUE Lateral position, 5-8 cm incision from the tip of the greater trochanter, identification and transaction of piriformis tendon. Anterior mobilization of the gluteus minimus and exposure of the trochanteric fossa. Removal of the superior portion (bone block) of the head and neck, and preparation of the femoral canal. Preparation of the acetabulum. Complete muscle relaxion is helpful to proceed to satisfactory trial reduction. POSTOPERATIVE MANAGEMENT Patients may progress to motion and weight bearing without restriction. RESULTS From April 2009 to December 2010, the first author operated on 463 patients, 275 for osteoarthrosis of the hip, and 188 for subcapital fractures of the femoral neck. Thereof, 375 (75 %) patients could walk with full weight within 6 h from the operation, and climb stairs 24 h later with low loss of blood, and rapid recovery.
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Affiliation(s)
- N Capuano
- Department of Orthopaedics and Traumatology, San Luca Hospital, Vallo Della Lucania, Italy
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Abstract
We hypothesised that a minimally invasive peroneus brevis tendon transfer would be effective for the management of a chronic rupture of the Achilles tendon. In 17 patients (three women, 14 men) who underwent minimally invasive transfer and tenodesis of the peroneus brevis to the calcaneum, at a mean follow-up of 4.6 years (2 to 7) the modified Achilles tendon total rupture score (ATRS) was recorded and the maximum circumference of the calf of the operated and contralateral limbs was measured. The strength of isometric plantar flexion of the gastrocsoleus complex and of eversion of the ankle were measured bilaterally. Functional outcomes were classified according to the four-point Boyden scale. At the latest review, the mean maximum circumference of the calf of the operated limb was not significantly different from the pre-operative mean value, (41.4 cm, 32 to 50 vs 40.6 cm, 33 to 46; p = 0.45), and not significantly less than that of the contralateral limb (43.1 cm, 35 to 52; p = 0.16). The mean peak torque (244.6 N, 125 to 367) and the strength of eversion of the operated ankle (149.1 N, 65 to 240) were significantly lower (p < 0.01) than those of the contralateral limb (mean peak torque 289, 145 to 419; strength of eversion: 175.2, 71 to 280). The mean ATRS significantly improved from 58 pre-operatively (35 to 68) to 91 (75 to 97; 95% confidence interval 85.3 to 93.2) at the time of final review. Of 13 patients who practised sport at the time of injury, ten still undertook recreational activities. This procedure may be safely performed, is minimally invasive, and allows most patients to return to pre-injury sport and daily activities. Cite this article: Bone Joint J 2015;97-B:353–7.
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Affiliation(s)
- N. Maffulli
- University of Salerno, School
of Medicine and Surgery, Salerno, Italy
| | - F. Oliva
- University of Rome ‘Tor Vergata’ School
of Medicine, Viale Oxford 81, Rome, Italy
| | - V. Costa
- Campus Biomedico University , Via
Alvaro del Portillo, 200, 00128
Trigoria, Rome, Italy
| | - A. Del Buono
- Campus Biomedico University, Via
Alvaro del Portillo, 200, 00128
Trigoria, Rome, Italy
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18
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Osti L, Del Buono A, Maffulli N. Anterior Medial Meniscal Root Tears: A Novel Arthroscopic All Inside Repair. Transl Med UniSa 2014; 12:41-6. [PMID: 26535186 PMCID: PMC4592042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Management of tears of the anterior and posterior roots of the meniscus is still controversial. We wish to propose a simple technique of suture anchor to repair tears of the anterior root of the medial meniscus. METHODS Twelve patients, active males, underwent arthroscopic repair of the anterior meniscal horn between 2009 and 2011. All were assessed postoperatively at an average follow-up of 1 year after the index operation. RESULTS At the last appointment, the average Lysholm scores was improved from a pre-operative average value of 48±17 to a postoperative value of 91±7 (P<0.001); five patients (45.3%) were scored as excellent (≥95), and 7 (54.6%) as good (85-94). At the last appointment, 8 of 9 active patients practiced sport at the same preoperative level, 1 (8.5%) had changed to lower level of activity. No technique related complications were evident.
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Affiliation(s)
- L. Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - A. Del Buono
- Department of Orthopaedics and Traumatology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia (Como), Italy
| | - N. Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy;,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.,Corresponding author
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Coppola C, Del Buono A, Maffulli N. Teriparatide in Fracture Non-Unions. Transl Med UniSa 2014; 12:47-53. [PMID: 26535187 PMCID: PMC4592043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The use of teriparatide in the management of fracture disorders is poorly documented. This study aims to show that teriparatide administration may improve the healing process in patients with nonunions after open fixation of traumatic fractures of the lower limb. METHODS Four patients received Teriparatide for management of non-unions after open fixation of traumatic fractures of the lower limb. RESULTS Teriparatide administration resulted in adequate bone callus over the site of nonunion in all the patients, and clinical and radiographic evidence of sound union. CONCLUSIONS The efficacy of teriparatide in delayed or non unions is still unclear. It may induce an angiogenetic response which counteracts the features responsible for development of non-union. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- C. Coppola
- Department of Orthopaedic and Trauma Surgery, Hospital “S. Maria di Loreto Nuovo”, Naples, Italy
| | - A. Del Buono
- Department of Orthopaedics and Traumatology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia (Como), Italy
| | - N. Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy ; Centre for Sports and Exercise Medicine,Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.,Corresponding author
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20
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Maffulli N, Del Buono A, Loppini M, Denaro V. Ipsilateral free semitendinosus tendon graft with interference screw fixation for minimally invasive reconstruction of chronic tears of the Achilles tendon. Oper Orthop Traumatol 2014; 26:513-9. [PMID: 25261286 DOI: 10.1007/s00064-012-0228-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/21/2012] [Accepted: 10/29/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Minimally invasive ipsilateral semitendinosus reconstruction of large chronic tears aims to be advantageous for the patient in terms of plantar flexion recovery, anthropometric measures, fast return to daily and sport activity, is safe, with low donor site co-morbidities, low risks of wound complications and neurovascular injuries. INDICATIONS Tendon gaps greater than 6 cm and in cases of revision surgery (rerupture). CONTRAINDICATIONS Diabetes, vascular diseases, previous anterior cruciate ligament (ACL) reconstruction using ipsilateral semitendinosus tendon graft. SURGICAL TECHNIQUE The semitendinosus tendon is harvested through an incision in the medial aspect of the popliteal fossa, and the proximal stump is exposed and mobilized through an incision performed 2 cm proximal and medial to the palpable tendon gap. We repeat the same steps distally, approaching the distal stump of the tendon through a 2.5 cm longitudinal incision made 2 cm distal and just anterior to the lateral margin of the distal stump. Through the distal incision, we expose the Kager's space and the postero-superior corner of the osteotomized calcaneum. We drill a bone tunnel into the calcaneum from dorsal to plantar using a cannulated headed reamer. The semitendinosus tendon graft is passed into the proximal stump through a medial-to-lateral small incision, its two ends are moved distally, and finally it is pulled down and shuttled through the bone tunnel. The construct is fixed to the calcaneum using an interference screw. POSTOPERATIVE MANAGEMENT Immobilization in a below the knee plaster cast with the foot in plantar flexion for 2 weeks, weight bearing on the metatarsal heads as tolerated, use elbow crutches, and keep the knee flexed. At 2 weeks, plaster removed, and rehabilitative exercises started, walker cast allowed. RESULTS Between 2008 and 2010, the procedure was performed on 28 consecutive patients (21 men and 7 women, median age 46 years). At the 2-year follow-up, average ATRS scores significantly improved (p < 0.0001) compared to average preoperative scores with good to excellent outcomes for 26 out of 28 patients (93 %); the maximum calf circumference also improved considerably whereby no clinical or functional relevance compared to the contralateral side observed. Of the 28 patients 16 (57 %) could practice sport at the same preinjury level, whereby 1 patient experienced persistent pain over the distal wound, which ameliorated after desensitization therapy.
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Affiliation(s)
- N Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, E1 4DG, London, UK,
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Turmo-Garuz A, Rodas G, Balius R, Til L, Miguel-Perez M, Pedret C, Del Buono A, Maffulli N. Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle? Musculoskelet Surg 2013; 98:121-6. [PMID: 24222527 DOI: 10.1007/s12306-013-0305-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/04/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of the study is to explain the cause-effect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. METHODS Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. RESULTS An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. CONCLUSIONS Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.
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Affiliation(s)
- A Turmo-Garuz
- High Performance Center (CAR de Sant Cugat Consorci Sanitari de Terrassa), Barcelona, Spain
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22
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Proietti M, Del Buono A, Pagliaro G, Del Buono R, Di Rienzo C. The intestinal permeability syndrome, celiac disease, gluten sensitivity, autistic spectrum, mycotoxins and immunological tolerance. Mediterranean Journal of Nutrition and Metabolism 2013. [DOI: 10.3233/s12349-013-0125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Proietti
- Italian Association of Toxic Elements Studys, Rome, Italy. e-mail:
| | - A. Del Buono
- Academy of Micronutrition “L. Pauling”, Caserta, Italy
| | - G. Pagliaro
- Department of Biochemistry, Biology and Genetics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy. e-mail:
| | | | - C. Di Rienzo
- Italian Association of Toxic Elements Studys, Rome, Italy. e-mail:
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23
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Shaikh Z, Perry M, Morrissey D, Ahmad M, Del Buono A, Maffulli N. Achilles Tendinopathy in Club Runners. Int J Sports Med 2012. [DOI: 10.1055/s-0032-1313785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Z. Shaikh
- Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, United Kingdom
| | - M. Perry
- Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, United Kingdom
| | - D. Morrissey
- Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, United Kingdom
| | - M. Ahmad
- Barts and The London School of Medicine and Dentistry, Radiology, Queen Mary University of London, United Kingdom
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery, University Campus Bio Medico, Rome, Italy
| | - N. Maffulli
- Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, United Kingdom
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24
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Ortiz C, Wagner E, Mocoçain P, Labarca G, Keller A, Del Buono A, Maffulli N. Biomechanical comparison of four methods of repair of the Achilles tendon. ACTA ACUST UNITED AC 2012; 94:663-7. [DOI: 10.1302/0301-620x.94b5.27642] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We tested four types of surgical repair for load to failure and distraction in a bovine model of Achilles tendon repair. A total of 20 fresh bovine Achilles tendons were divided transversely 4 cm proximal to the calcaneal insertion and randomly repaired using the Dresden technique, a Krackow suture, a triple-strand Dresden technique or a modified oblique Dresden technique, all using a Fiberwire suture. Each tendon was loaded to failure. The force applied when a 5 mm gap was formed, peak load to failure, and mechanism of failure were recorded. The resistance to distraction was significantly greater for the triple technique (mean 246.1 N (205 to 309) to initial gapping) than for the Dresden (mean 180 N (152 to 208); p = 0.012) and the Krackow repairs (mean 101 N (78 to 112; p < 0.001). Peak load to failure was significantly greater for the triple-strand repair (mean 675 N (453 to 749)) than for the Dresden (mean 327.8 N (238 to 406); p < 0.001), Krackow (mean 223.6 N (210 to 252); p < 0.001) and oblique repairs (mean 437.2 N (372 to 526); p < 0.001). Failure of the tendon was the mechanism of failure for all specimens except for the tendons sutured using the Krackow technique, where the failure occurred at the knot. The triple-strand technique significantly increased the tensile strength (p = 0.0001) and gap resistance (p = 0.01) of bovine tendon repairs, and might have advantages in human application for accelerated post-operative rehabilitation.
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Affiliation(s)
- C. Ortiz
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - E. Wagner
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - P. Mocoçain
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - G. Labarca
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - A. Keller
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - A. Del Buono
- Campus Biomedico, University of Rome, Department
of Orthopaedic and Trauma Surgery, Via Álvaro
del Portillo 21, 00128 Rome, Italy
| | - N. Maffulli
- Centre for Sports and Exercise Medicine,
Barts and The London School of Medicine and Dentistry, Mile
End Hospital, 275 Bancroft Road, London
E1 4DG, UK
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Abstract
Ultrasound (US) changes within the Achilles tendon are present in asymptomatic Achilles individuals. We assessed the association of US signs with symptoms of Achilles tendinopathy in a study group of club level running athletes and in a control group of athletes training at least 2 times per week. The Achilles tendon was assessed in its entirety on longitudinal US scans, at the musculotendinous junction (MTJ), the calcaneal insertion site, and at a midtendon point. 25 middle distance runners, 19 males and 6 females, aged from 18 to 58, were enrolled in each group. When compared to control athletes, club level runners presented significantly increased tendon thickness (p=0.046) at the musculo-tendinous junction, and increased tendon thickness, with no statistical significance, at the other landmarks points. Although club level runners were significantly more symptomatic and predisposed to develop signs of tendinopathy than control athletes (p=<0.001), ultrasound abnormalities were not significantly associated with local symptoms complained at the US investigation time. Prospective studies on asymptomatic athletes are needed to define the predictive value of US signs of Achilles tendinopathy in the development of symptoms in the long-term.
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Affiliation(s)
- Z Shaikh
- Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, London, United Kingdom
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Maffulli N, Del Buono A, Testa V, Capasso G, Oliva F, Denaro V. Safety and outcome of surgical debridement of insertional Achilles tendinopathy using a transverse (Cincinnati) incision. J Bone Joint Surg Br 2012. [PMID: 22058302 DOI: 10.1302/0301-620x.93b10.27379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This is a prospective analysis on 30 physically active individuals with a mean age of 48.9 years (35 to 64) with chronic insertional tendinopathy of the tendo Achillis. Using a transverse incision, the tendon was debrided and an osteotomy of the posterosuperior corner of the calcaneus was performed in all patients. At a minimum post-operative follow-up of three years, the Victorian Institute of Sports Assessment scale-Achilles tendon scores were significantly improved compared to the baseline status. In two patients a superficial infection of the wound developed which resolved on antibiotics. There were no other wound complications, no nerve related complications, and no secondary avulsions of the tendo Achillis. In all, 26 patients had returned to their pre-injury level of activity and the remaining four modified their sporting activity. At the last appointment, the mean pain threshold and the mean post-operative tenderness were also significantly improved from the baseline (p < 0.001). In patients with insertional tendo Achillis a transverse incision allows a wide exposure and adequate debridement of the tendo Achillis insertion, less soft-tissue injury from aggressive retraction and a safe osteotomy of the posterosuperior corner of the calcaneum.
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Affiliation(s)
- N Maffulli
- Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.
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Abstract
Platelet-rich plasma (PRP) is increasingly used in the management of tendon injury in sports, supposedly accelerating the process of healing, tissue regeneration, and return to play. However, the scientific clinical evidence to support its use is scanty, and more level I studies need to be performed to justify its widespread use.
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Affiliation(s)
- A Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Italy
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28
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Maffulli N, Del Buono A, Testa V, Capasso G, Oliva F, Denaro V. Safety and outcome of surgical debridement of insertional Achilles tendinopathy using a transverse (Cincinnati) incision. ACTA ACUST UNITED AC 2011; 93:1503-7. [DOI: 10.1302/0301-620x.93b11.27379] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This is a prospective analysis on 30 physically active individuals with a mean age of 48.9 years (35 to 64) with chronic insertional tendinopathy of the tendo Achillis. Using a transverse incision, the tendon was debrided and an osteotomy of the posterosuperior corner of the calcaneus was performed in all patients. At a minimum post-operative follow-up of three years, the Victorian Institute of Sports Assessment scale – Achilles tendon scores were significantly improved compared to the baseline status. In two patients a superficial infection of the wound developed which resolved on antibiotics. There were no other wound complications, no nerve related complications, and no secondary avulsions of the tendo Achillis. In all, 26 patients had returned to their pre-injury level of activity and the remaining four modified their sporting activity. At the last appointment, the mean pain threshold and the mean post-operative tenderness were also significantly improved from the baseline (p < 0.001). In patients with insertional tendo Achillis a transverse incision allows a wide exposure and adequate debridement of the tendo Achillis insertion, less soft-tissue injury from aggressive retraction and a safe osteotomy of the posterosuperior corner of the calcaneum.
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Affiliation(s)
- N. Maffulli
- Centre for Sports and Exercise Medicine,
Mile End Hospital, 275 Bancroft Road, London
E1 4DG, UK
| | - A. Del Buono
- Department of Orthopaedic and Trauma Surgery,
Campus Biomedico University of Rome, Via
Alvaro del Portillo 200, 00128 Rome, Italy
| | - V. Testa
- Department of Sports Traumatology, Olympic
Centre, Via dei Goti, 1-84012
Angri, Italy
| | - G. Capasso
- Department of Orthopaedics and Traumatology, Second
University of Napoli, Via Luigi De Crecchio, 4-80138
Napoli, Italy
| | - F. Oliva
- Department of Orthopaedic and Trauma Surgery,
University of Rome, Tor Vergata 1, 00155
Rome, Italy
| | - V. Denaro
- Department of Orthopaedic and Trauma Surgery,
Campus Biomedico University of Rome, Via
Alvaro del Portillo 200, 00128 Rome, Italy
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Giombini A, Dragoni S, Di Cesare A, Di Cesare M, Del Buono A, Maffulli N. Asymptomatic Achilles, patellar, and quadriceps tendinopathy: a longitudinal clinical and ultrasonographic study in elite fencers. Scand J Med Sci Sports 2011; 23:311-6. [PMID: 22092963 DOI: 10.1111/j.1600-0838.2011.01400.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2011] [Indexed: 10/15/2022]
Abstract
Lower limb tendon changes detected at imaging are common among asymptomatic athletes. We aimed to prospectively assess the clinical status, tendon structure, and vascularity of lower limb tendons of elite fencers, and predict the risk of developing symptoms over time. Clinical examination, changes at ultrasonography (US), and Power Doppler (PD) flow of both the Achilles, patellar, and quadriceps tendon were assessed in 37 elite fencers in January 2007 and 3 years after. Two hundred and twenty-two tendons were examined. At the last appointment, patellar tendons diagnosed as abnormal at baseline were more likely to develop symptoms than those normal at baseline (P < 0.05, Fisher's exact test), while US and PD abnormalities on Achilles and quadriceps tendons were no predictive for development of symptoms over years. A very low percentage of tendons diagnosed as normal at baseline (1.45%) showed US abnormalities at 3-year follow-up. In asymptomatic elite fencers, structural changes are relatively common at US and PD assessment of Achilles, quadriceps, and patellar tendons. It seems unlikely that additional PD investigations provide further information or change prognosis in patients with US diagnosis of tendinopathy.
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Affiliation(s)
- A Giombini
- Department of Health Sciences, University of Molise, Molise, Italy
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Abstract
Overuse tendinopathies are a common cause of pain and disability in athletes. According to histological findings, it is a “failed healing response” to overuse tendon injury. In obesity, macrophages and mast cells migrate to adipose tissue, and the resulting decreased availability of immune circulating cells should be responsible for less effective immune responses to acute tendon injury. In diabetic patients, free glucose molecules attach to collagen, alter collagen solubility, increase resistance to enzymatic degradation, and impair cross linking, contributing to the subsequent development of chronic tendinopathy secondary to a failed healing response to a tendon insult. Prolonged systemic, low-grade inflammation and impaired insulin sensitivity act as a risk factor for a “failed healing response” after an acute tendon insult, and predispose to the development of chronic overuse tendinopathies. Further studies may reveal novel therapeutic treatment approaches.
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Affiliation(s)
- A. Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy
| | - L. Battery
- Department of Orthopaedic Surgery, Catholic University of Rome, Largo Francesco Vito 1, Rome, Italy
| | - V. Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy
| | - G. Maccauro
- Department of Orthopaedic Surgery, Catholic University of Rome, Largo Francesco Vito 1, Rome, Italy
| | - N. Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
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31
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Morisco F, Mazziotti G, Rotondi M, Tuccillo C, Iasevoli P, Del Buono A, Sorvillo F, Amato G, Marmo R, Caporaso N, Carella C. Interferon-related thyroid autoimmunity and long-term clinical outcome of chronic hepatitis C. Dig Liver Dis 2001; 33:247-53. [PMID: 11407670 DOI: 10.1016/s1590-8658(01)80715-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A high incidence of thyroid autoantibodies and/or disorders was observed in subjects with hepatitis C virus-related chronic hepatitis during interferon-alpha therapy. AIM To evaluate whether thyroid autoimmunity and dysfunction, induced by interferon-alpha therapy, could be viewed as predictors for treatment response and as valid prognostic markers of liver disease progression. PATIENTS A total of 136 subjects (96 males/40 females; median age 48 years; range 23-64) affected by biopsy-proven chronic hepatitis C (33.1% with compensated liver cirrhosis). METHODS All subjects were treated with interferon-alpha therapy at 6 MU 3 times weekly for 12 months and then followed up for an average period of 60 months (range 12-108). Routine laboratory tests, virological assessment, liver ultrasound, thyroid function tests (serum free-triiodothyronine, free-thyroxine, serum thyrotropin), and autoimmunity were performed for all subjects. RESULTS Percentage of thyroid autoimmunity and thyroid dysfunction in long-term responders was not significantly different compared to that in non-responders (47.0% and 11.8% vs 35.3% and 5.9%, respectively; non significant). The multivariate model demonstrated that the absence of cirrhosis was the only factor significantly related to successful response to therapy (odds ratio: 14.9; 95% confidence interval: 1.9-115.0 for chronic hepatitis C vs presence of cirrhosis). Moreover, the occurrence of thyroid autoimmunity during interferon therapy was similar both in patients with or without worsening of liver disease (33.3% and 39.8%, respectively; p = not significant). No subject with on-going liver disease developed thyroid dysfunction during treatment, as opposed to the 10/118 (8.4%) with a better course of liver disease; however, this difference was not statistically significant. The multivariate model showed that age was the only covariate significantly associated with unfavourable outcome of liver disease (odds ratio: 18.6; 95% confidence interval: 2.3-151.9, for those over 48 years vs younger patients). CONCLUSIONS There is no evidence that the immune mechanism involved in the pathogenesis of thyroid autoimmune phenomena is the same as that regulating the therapeutic clearance of HCV or modulating the unfavourable course of HCV-related chronic hepatitis. However, our study confirmed that liver disease seems to progress more slowly in younger subjects.
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Affiliation(s)
- F Morisco
- Dept. of Food Sciences, Federico II, University of Naples, Portici, Italy
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32
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Rotondi M, Amato G, Biondi B, Mazziotti G, Del Buono A, Rotonda Nicchio M, Balzano S, Bellastella A, Glinoer D, Carella C. Parity as a thyroid size-determining factor in areas with moderate iodine deficiency. J Clin Endocrinol Metab 2000; 85:4534-7. [PMID: 11134104 DOI: 10.1210/jcem.85.12.7002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Among the factors that may influence thyroid size, pregnancy and its goitrogenic effect have been widely investigated, but thyroid volume and pregnancy have never been compared retrospectively, and there are no data on the possible relationship between thyroid size and parity. The purpose of this work was to evaluate the effects of pregnancy on thyroid volume in a moderate iodine deficiency area, to assess the possibility of a relationship between thyroid size and parity status in healthy females. A group of 208 nongoitrous healthy women underwent thyroid volume estimation by ultrasound examination. All subjects were euthyroid and negative for thyroid autoantibodies. They were assigned to different groups, according to the number of completed pregnancies. Five groups were formed (0, 1, 2, 3, 4 or more term pregnancies). Mean thyroid volume increased progressively among the groups: group 0 (14.8 +/- 0.7 mL); group I (16.0 +/- 0.9 mL); group II (17.1 +/- 0.6 mL); group III (18.2 +/- 0.6 mL); group IV (20.3 +/- 0.9 mL). The increment in thyroid volume was statistically significant between group 0 and groups III (P: < 0.01) and IV (P: < 0.001), and also between group I and group IV (P: < 0. 05). No independent effect of body weight and age on thyroid volume was seen. Our results indicate that, in an area with moderate iodine deficiency, the goitrogenic effect of pregnancy is not fully reversible. Moreover, the statistically significant increase in thyroid volume, observed in relation to parity, is the first clinical demonstration of a cumulative goitrogenic effect of successive pregnancies, providing a strong argument to increase the iodine supply during pregnancy, even in conditions with moderate iodine deficiency.
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Affiliation(s)
- M Rotondi
- Institute of Endocrinology, II University of Naples, Naples, Italy
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33
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Rotondi M, Amato G, Del Buono A, Mazziotti G, Manganella G, Biondi B, Sinisi AM, Santini L, Bellastella A, Carella C. Postintervention serum TSH levels may be useful to differentiate patients who should undergo levothyroxine suppressive therapy after thyroid surgery for multinodular goiter in a region with moderate iodine deficiency. Thyroid 2000; 10:1081-5. [PMID: 11201853 DOI: 10.1089/thy.2000.10.1081] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies have raised doubts about the efficacy of the postoperative use of levothyroxine (LT4) suppressive doses in patients who underwent thyroid surgery for multinodular goiter. The purpose of this retrospective study was to examine the efficacy of different doses of LT4 in preventing postsurgical recurrences of simple multinodular goiter and to identify a marker that could be useful in discriminating patients with a higher risk of developing recurrence. Two hundred thirty-two patients (57 male, 175 female) operated for nontoxic multinodular goiter were divided into two groups: (I) patients with normal postsurgery thyrotropin (TSH) levels (0.25 to 4.5 mU/L) and (II) patients with elevated postsurgery TSH levels (>4.5 mU/L). All patients were subjected to replacement (1.3 microg LT4/kg/day) or suppressive (1.7 microg LT4/kg/day) doses of LT4, and they were followed for a median period of 6 years (range 2 to 12). No statistical difference was found for sex, age, and postsurgery serum TSH between patients submitted to suppressive and replacement therapy. The ultrasound (US) detection of new postsurgery nodules of at least 0.5 cm maximum diameter was considered a recurrence of disease and was found in 10% of the cases studied. Patients with normal postsurgery serum TSH showed a high recurrence rate (30.4%) when submitted to lower daily doses of LT4. In patients with elevated postsurgery serum TSH, the rate of nodular goiter recurrence did not vary with different types of LT4 therapy. In conclusion, our results suggest that the postsurgical serum TSH is useful for prediction of nodular goiter recurrence, as it reflects the amount of residual functioning thyroid tissue in the cervical area. It may also be indicative of patients who might benefit from LT4 suppressive therapy.
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Affiliation(s)
- M Rotondi
- Institute of Endocrinology, II University of Naples, Italy
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Rotondi M, Caccavale C, Di Serio C, Del Buono A, Sorvillo F, Glinoer D, Bellastella A, Carella C. Successful outcome of pregnancy in a thyroidectomized-parathyroidectomized young woman affected by severe hypothyroidism. Thyroid 1999; 9:1037-40. [PMID: 10560961 DOI: 10.1089/thy.1999.9.1037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Severe hypothyroidism was discovered in a young woman in her 29th week of pregnancy. Previously, at the age of 12 years, she had undergone thyroid surgery for Graves' disease that resulted in persistent hypothyroidism and hypoparathyroidism. After surgical excision, the patient started levothyroxine replacement therapy and had regular control of thyroid function with normal findings throughout the years. The dose of levothyroxine had not been adjusted when the pregnancy started, and at the 29th week of gestation the patient had a thyrotropin (TSH) of 72.4 microU/mL. Ultrasound studies were performed in order to monitor fetal development. The fetal parameters analyzed before the adjustment of levothyroxine therapy showed growth retardation of various degrees. All analyzed fetal parameters (biparietal diameter, cranial and abdominal circumference, humerus and femur length) improved during the last 6 weeks of gestation, showing a good correlation with the newly achieved euthyroid state of the mother. The infant was clinically euthyroid at birth and was found normal at all evaluations of the neonatal hypothyroidism screening program (1, 5, 30 days).
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Affiliation(s)
- M Rotondi
- Institute of Endocrinology, II University of Naples, Italy
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Carella C, Rotondi M, Del Buono A, Sinisi AM, Del Basso De Caro ML, Mone CM, Vizioli L, Sorvillo F, Mazziotti G, Bellastella A. Diabetes insipidus and increased serum levels of leptin and lactate-dehydrogenase (LDH) in an adolescent boy with a primary intracranial germinoma. Case report and an endocrinological revaluation of literature. J Endocrinol Invest 1999; 22:558-61. [PMID: 10475155 DOI: 10.1007/bf03343609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 16-year-old boy presented with a four-month history of polyuria-polydipsia and a diplopia which had reverted after treatment. The neuroimaging studies performed had been strongly suggestive of an optic nerve glioma, while endocrinological investigation (beta-hCG 420 IU/L) has lead to the correct diagnosis later confirmed at the immunohystochemical analysis performed at biopsy. The high serum level of hCG was unaffected by bromocriptine nor octreotide, while the PRL level (80.0 microg/L) was reduced only by bromocriptine. Among the several tumor markers which may be secreted by such lesions, ours is the first reported case of an elevation of serum LDH for a primary intracranial germinoma. Moreover, the elevated value of serum leptin reported by us might be due to the insensitivity of the hypothalamic structures to endogenous leptin.
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Affiliation(s)
- C Carella
- Istituto di Endocrinologia, II University of Napoli, Italy
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Rotondi M, Oliviero A, Profice P, Mone CM, Biondi B, Del Buono A, Mazziotti G, Sinisi AM, Bellastella A, Carella C. Occurrence of thyroid autoimmunity and dysfunction throughout a nine-month follow-up in patients undergoing interferon-beta therapy for multiple sclerosis. J Endocrinol Invest 1998; 21:748-52. [PMID: 9972674 DOI: 10.1007/bf03348040] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thyroid autoimmunity and dysfunction are a well known side effect of IFN alpha therapy for viral hepatitis and tumors, while the IFN beta effects on the thyroid gland in neurological patients have not been studied. The aim of this longitudinal study was to look for the appearance of thyroid autoimmunity as well as for the occurrence of overt thyroid disease in the patients affected by multiple sclerosis (MS) treated with IFN beta 1b. Eight patients (4 males, 4 females) undergoing r-IFN beta 1b treatment (8 M.U. every other day for 9 months) for relapsing remitting multiple sclerosis entered the study. We have analyzed thyroid function parameters and auto antibody levels before and after 1, 2, 3, 6 and 9 months of therapy. None of them referred to familiar thyroid pathology or presented clinically overt thyroid disease except for one patient (case 4) who showed TPO-Ab pretreatment positivity and another (case 8) who was in therapy with Levothyroxine 100 microg/die for multinodular goiter. The number of patients with appearance of thyroid antibodies has slowly increased, until the third month of therapy with 3 patients out of 7 positive for TPO-Ab. The only case of overt thyroid dysfunction reported by us appeared after nine months of therapy and consisted of a hypothyroidism. Our data suggest that short-term interferon beta treatment is able to induce thyroid autoimmunity (42.8%) and dysfunction (12.5%).
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Affiliation(s)
- M Rotondi
- Institute of Endocrinology, II University of Napoli, Italy
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Mone CM, Nigro V, Rotondi M, Del Buono A, Mazziotti G, Riondino M, Sinisi AM, Ghizzoni L, Phillips JA, Bellastella A, Carella C. An improved polymerase chain reaction (PCR) protocol for unambigous detection of growth hormone gene deletions. J Pediatr Endocrinol Metab 1998; 11:563-8. [PMID: 9777578 DOI: 10.1515/jpem.1998.11.4.563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
hGH-1 gene deletions are detected by simultaneous PCR amplification along the two homologous DNA sequences flanking the hGH-1 gene on both sides and are differentiated by SmaI restriction enzyme digestion. We have observed that among the SmaI digested PCR products from normal homozygous subjects, from those heterozygous for the 7.6 kb deletion and from those heterozygous for a 6.7 kb deletion, along with the expected fragments there is an unexpected 1470 bp fragment. This fragment arises from the co-amplification of a third homologous sequence located downstream from the hGH-1 gene and it confuses differentiation between normal homozygous and heterozygous for 7.6 kb subjects from the 6.7 kb heterozygous subjects. To overcome this problem we have improved PCR conditions using a different reverse primer. These changes avoid the interaction of the primers with the third homologous sequence located downstream from the hGH-1 gene and prevent the appearance of this additional band that complicates the interpretation of the results. We conclude that the new reverse primer sequence avoids the amplification of the downstream hGH-1 gene sequence and the production of the 1474 bp band after SmaI endonuclease enzyme digestion and makes it possible to differentiate homozygous normal subjects and those who are heterozygous for a 7.6 kb deletion from those who are heterozygous for a 6.7 kb deletion.
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Affiliation(s)
- C M Mone
- Institute of Endocrinology, Second University of Naples, Italy
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Paolisso G, Ammendola S, Del Buono A, Gambardella A, Riondino M, Tagliamonte MR, Rizzo MR, Carella C, Varricchio M. Serum levels of insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 in healthy centenarians: relationship with plasma leptin and lipid concentrations, insulin action, and cognitive function. J Clin Endocrinol Metab 1997; 82:2204-9. [PMID: 9215295 DOI: 10.1210/jcem.82.7.4087] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It has been demonstrated that healthy centenarians have more favorable anthropometric characteristics and insulin-mediated glucose uptake than aged subjects. The plasma insulin-like-growth factor I (IGF-I) concentration may account for such differences. Three groups of subjects were studied: 1) adults (< 50 yr; n = 30), 2) aged subjects (75-99 yr; n = 30), 3) centenarians (> 100 yr; n = 19). In all subjects, fasting plasma IGF-I, IGF-binding protein-3 (IGFBP-3), leptin, and lipid concentrations were determined; body composition was assessed by bioimpedance analysis; and insulin-mediated glucose up-take was evaluated by euglycemic hyperinsulinemic glucose clamp. IGF-I declined with advancing age, but no differences between aged subjects and centenarians were found. IGFBP-3 showed a trend similar to IGF-I, but lower values were present in centenarians than in aged subjects. Nevertheless, centenarians had a plasma IGF-I/IGFBP-3 molar ratio greater than that in aged subjects. Centenarians had also a whole body glucose disposal (WBGD) greater than that in aged subjects, but similar to that in adults. Mini Mental State Examination (27 +/- 2.1 vs. 18.3 +/- 3.1; P < 0.02) and Instrumental Activities Daily Living (26 +/- 2.6 vs. 8.4 +/- 4.1; P < 0.001) scores were significantly different in aged subjects and centenarians, respectively. In centenarians, the plasma IGF-I/IGFBP-3 molar ratio correlated with the body mass index (r = -0.55; P < 0.009); the amount of body fat (r = -0.62; P < 0.003); fat-free mass (r = 0.56; P < 0.008); fasting plasma leptin (r = -0.63; P < 0.004), triglycerides (r = -0.58; P < 0.01), free fatty acid (r = -0.64; P < 0.005), and low density lipoprotein cholesterol (r = -0.59; P < 0.009) concentrations; Mini Mental State Examination (r = 0.53; P < 0.0.03); and WBGD (r = 0.64; P < 0.005). All correlations were independent of daily fat and carbohydrate intake and WBGD (P < 0.05 for all). No significant correlations between the plasma IGF-I/IGFBP-3 molar ratio and plasma total (r = 0.31; P = NS) and high density lipoprotein cholesterol (r = 0.34; P = NS) concentrations were present. The correlation between the plasma IGF-I/IGFBP-3 molar ratio and WBGD persisted after adjustment for body fat, fasting plasma insulin concentration, daily carbohydrate and fat intake, and daily physical activity (r = 0.55; P < 0.009), but not after further adjustment for plasma free fatty acid concentration (r = 0.30; P = 0.17). In conclusion, healthy centenarians have plasma IGF-I/IGFBP-3 molar ratio greater than aged subjects. A more elevated plasma IGF-I/IGFBP-3 molar ratio might improve insulin action and plasma lipid concentration in centenarians.
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Affiliation(s)
- G Paolisso
- Department of Geriatric Medicine and Metabolic Diseases, II University of Naples, Italy
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Costa A, Suyama K, Lalanne CM, Lauwers L, Chauvel P, Del Buono A. [Development and use of an automatic conversational system for the calculation of dose in teleradiotherapy (author's transl)]. J Radiol Electrol Med Nucl 1976; 57:455-8. [PMID: 994093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The authors describe the equipment and methods of calculation used for a system of automatic conversational dosimetry with a mini-computer. They present the dialogue of the physician with the calculator and indicate the conditions they required of such a system: i.e. rapidity of response, simplicity of use, verification of data, precision, adaptability. Testing involved 800 dosimetric cases including 300 cases of routine clinical dosimetry.
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