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Saccomanno MF, Lisai A, Romano AM, Vitullo A, Pannone A, Spoliti M, Di Giunta ACC, Castricini R, Giordano MC. High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach. Knee Surg Sports Traumatol Arthrosc 2023; 31:4594-4600. [PMID: 37522951 DOI: 10.1007/s00167-023-07501-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To develop a consensus on diagnosis and treatment of rotator cuff tears. The study focused on selected areas: imaging, prognostic factors, treatment options, surgical techniques. METHODS Panel was composed of all members of the shoulder committee of the Italian Society of Arthroscopy, Knee, Upper arm, Sport, Cartilage and Orthopedic techniques (SIAGASCOT). Four rounds were performed. The first round consisted of gathering questions which were then divided into seven blocks referring to: imaging, patient-related prognostic factors, treatment options, surgical steps, reparative techniques, surgical predictive factors, advanced techniques. Subsequent rounds consisted of condensation by means of online questionnaire and debates. Consensus was defined as two-thirds agreement on one answer. Descriptive statistic was used to summarize the data. RESULTS Forty-one shoulder experts were involved. Fifty-six statements were finally formulated. A consensus could be achieved on 51. Experts agreed that preoperative magnetic resonance imaging is strongly recommended because it allows a careful evaluation of tear characteristics, while the role of US remains debatable. Controversial patient-related factors such as age, comorbidities, smoking and stiffness do not contraindicate the repair. From a surgical standpoint, the experts highlighted that pseudo-paralysis is not a contraindication to rotator cuff repair. Consensus on specific surgical steps was also achieved: capsular release should be performed only in stiff shoulders; footprint preparation is mandatory, while debridement of tendon edges is not essential. If necessary, a rotator interval release could be performed without interrupting the continuity between subscapularis and supraspinatus tendon; posterior delamination should be always included in the repair. Advanced techniques such as tendon transfers should be selected based on the main clinical deficit, while the superior capsule reconstruction plays a role only in combination with a functional repair. CONCLUSION A consensus was achieved almost on every topic of controversy explored. Particularly, MRI was deemed necessary to determine tear characteristics, while radiographs remain important for differential diagnosis; age should not be considered a contraindication to surgery; pseudo-paralysis does not represent a contraindication to arthroscopic rotator cuff repair, but superior capsule reconstruction plays a role only in combination with a functional repair. Latissimus dorsi transfer plays a role when the main functional deficit is in elevation, while the lower trapezius transfer plays a role when the main functional deficit is the external-rotation. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Maristella F Saccomanno
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | | | | | | | | | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department Emergency and Acceptance, San Camillo Forlanini Hospital, Rome, Italy
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Fischetti M, Romano AM, Albano D, Di Salvatore MG, Sconfienza LM, Zappia M. Imaging of Anatomical Variants of the Long Head Biceps Tendon. Semin Musculoskelet Radiol 2023; 27:153-162. [PMID: 37011616 DOI: 10.1055/s-0043-1761210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Anatomical variants of the long head of biceps (LHB) tendon are widely discussed in the literature. As one of the few intra-articular tendons, magnetic resonance arthroscopy can quickly evaluate the proximal part of LHB morphology. It provides good assessment of both intra-articular and extra-articular portions of the tendons. In-depth knowledge about imaging of the anatomical LHB variants discussed in this article is useful preoperatively for orthopaedists and also helps avoid potential diagnostic misinterpretations.
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Affiliation(s)
| | | | | | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Musculoskeletal Radiology Unit, Varelli Institute, Napoli, Italy
- Radiology Unit, Campolongo Hospital, Eboli (SA), Italy
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Corona K, Cerciello S, Ciolli G, Proietti L, D’Ambrosi R, Braile A, Toro G, Romano AM, Ascione F. Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis. J Clin Med 2021; 10:jcm10143014. [PMID: 34300180 PMCID: PMC8307830 DOI: 10.3390/jcm10143014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated. The purpose of the present meta-analysis was to compare the outcomes of the primary lateralized RSAs with and without subscapularis repair in terms of range of motion, clinical outcomes, dislocations, and complications rate. Materials and Methods: A systematic literature search in MEDLINE (Pubmed), Embase, and the Cochrane Central Register of Controlled Trials database was carried up to December 2020. A data extraction form was developed to collect select data from the included studies. The methodological quality was assessed using a Methodological Index for Nonrandomized Studies (MINORS) score. Statistical analysis was performed with Review Manager (Version 5.4, The Cochrane Collaboration). Results: A total of four comparative studies involving 978 patients were included. In the pooled analysis, the reinsertion of the subscapularis yielded better functional outcomes in terms of the constant (P < 0.00001) and ASES (P = 0.002) scores. The forward elevation, external rotation at 0°, internal rotation, and dislocation rates were comparable between the two groups (P = n.s.), while statistically increased abduction was observed in those patients who did not have their subscapularis repaired (P < 0.00001). Conclusion: The results of the present findings suggest that it seems reasonable to reinsert the subscapularis whenever it is present, in good tissue conditions, and with no evidence of fatty degeneration of its muscle belly. Level of evidence: Level III meta-analysis
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Affiliation(s)
- Katia Corona
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Giovanni Paolo II, 86100 Campobasso, Italy
- Correspondence:
| | - Simone Cerciello
- Department of Orthopaedics, Agostino Gemelli University Hospital Foundation IRCCS, Catholic University, 00168 Rome, Italy; (S.C.); (G.C.)
- Casa di Cura Villa Betania, 00165 Rome, Italy;
- Marrelli Hospital, 88900 Crotone, Italy
| | - Gianluca Ciolli
- Department of Orthopaedics, Agostino Gemelli University Hospital Foundation IRCCS, Catholic University, 00168 Rome, Italy; (S.C.); (G.C.)
| | | | | | - Adriano Braile
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University “Campana Luigi Vanvitelli”, 81100 Napoli, Italy; (A.B.); (G.T.)
| | - Giuseppe Toro
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University “Campana Luigi Vanvitelli”, 81100 Napoli, Italy; (A.B.); (G.T.)
| | - Alfonso Maria Romano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Napoli, Italy; (A.M.R.); (F.A.)
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84127 Salerno, Italy
| | - Francesco Ascione
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Napoli, Italy; (A.M.R.); (F.A.)
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84127 Salerno, Italy
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Zappia M, Ascione F, Romano AM, Di Pietto F, Nastrucci G, Collina A, Brunese L. Comma sign of subscapularis tear: diagnostic performance and magnetic resonance imaging appearance. J Shoulder Elbow Surg 2021; 30:1107-1116. [PMID: 32835804 DOI: 10.1016/j.jse.2020.07.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The main aim of this study was to evaluate the performance of magnetic resonance imaging (MRI) and interobserver agreement in the identification of the comma sign. The second objective was to look for a correlation between the comma sign and the detachment of the superficial fascia of the subscapularis. MATERIALS AND METHODS Two radiologists, blinded to the arthroscopic findings, retrospectively assessed the magnetic resonance images of 110 shoulders and were asked to assess the presence of the comma sign and the intact subscapularis fascia. The inter-reader agreement and the MRI performance values for detection of the comma sign were calculated. In addition, the association between the intact superficial subscapularis fascia and the comma sign was evaluated. RESULTS The agreement between the 2 radiologists was perfect. The following values were obtained: sensitivity, 90.9%; specificity, 98.8%; positive predictive value, 95.2%; negative predictive value, 97.7%; and accuracy, 97.2%. No association between the comma sign and subscapularis fascia lesions was found. CONCLUSION MRI appears to be a reliable method for preoperative assessment of the comma sign. The comma sign appears not to be formed by the detached subscapularis fascia.
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Affiliation(s)
- Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy; Department of Radiology, Campolongo Hospital, Eboli, Italy; Musculoskeletal Radiology Unit, Varelli Institute, Naples, Italy.
| | - Francesco Ascione
- Department of Shoulder Surgery, Campolongo Hospital, Eboli, Italy; Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Alfonso Maria Romano
- Department of Shoulder Surgery, Campolongo Hospital, Eboli, Italy; Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | | | | | - Anna Collina
- Department of Radiology, Campolongo Hospital, Eboli, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Romano AM, Ascione T, Casillo P, Nastrucci G, Susanna M, Di Giunta A, Ascione F. An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment. J Clin Med 2020; 9:E3683. [PMID: 33207849 PMCID: PMC7696467 DOI: 10.3390/jcm9113683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
Periprosthetic joint infections of the shoulder (PJIS) are the major cause for revision within the first two post-operative years, and are challenging both to diagnose and treat. Success depends on early identification of microorganisms, appropriate surgical procedures and efficient antibiotic administration. The peculiar microbiology of the shoulder may render the criteria for hip/knee PJI management inappropriate. In addition, later cases with clinically subtle signs often present diagnostic challenges. In recent years, specific issues of PJIS have been managed through the use of new instruments, such as MicroDTTect in pathogen detection and Bioactive Glass and tantalum cones in humeral bone loss. In the literature to date, no reports have been found that discuss the application in shoulder revisions and infections. The early identification of the microorganisms that cause infection may help improve both treatment strategies and the efficacy of therapy. MicroDTTect proved to be more efficient than swab collection for bacterial identification in orthopedic surgery, thus reducing analysis costs. The increasing number of shoulder arthroplasties is associated with an increase in the number of revisions. In cases of massive metaphyseal humeral bone loss, several techniques have been described; no reports have been reported regarding tantalum in humeral bone loss management. In some cases the tantalum cones required adaptation for femoral diaphysis in the augmentation of the humerus metaphysis and bone loss management improvement. Obtaining stable osseointegration of prosthetic implants is one of the greatest issues in orthopedic surgery, and even more crucial in revisions. Bioactive glasses demonstrated good regenerative and osseointegration properties, and an excellent candidate as a bone graft, scaffold and antibiotics deliverer. The Bioactive glasses were used to increase prosthesis-bone interface stability and fill bone defects in PJIS revision surgeries, contributing to the prevention of re-infection. Longer-term follow-up will be necessary to determine if construction durability is improved in the long term.
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Affiliation(s)
- Alfonso Maria Romano
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
- Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Napoli, Italy
| | - Tiziana Ascione
- Department of Infectious Diseases, A. Cardarelli Hospital, 80131 Napoli, Italy;
| | - Pasquale Casillo
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
| | - Guglielmo Nastrucci
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
| | - Massimiliano Susanna
- Orthopedic and Traumatology Unit, San Donà di Piave Hospital, 30027 Venezia, Italy;
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico “G.B. Morgagni”, 95125 Catania, Italy;
| | - Francesco Ascione
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
- Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Napoli, Italy
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Romano AM, Braile A, Casillo P, Nastrucci G, Susanna M, Di Giunta A, Ascione F. Onlay Uncemented Lateralized Reverse Shoulder Arthroplasty for Fracture Sequelae Type 1 with Valgus/Varus Malunion: Deltoid Lengthening and Outcomes. J Clin Med 2020; 9:jcm9103190. [PMID: 33019637 PMCID: PMC7599608 DOI: 10.3390/jcm9103190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022] Open
Abstract
The successful treatment of proximal humeral fractures remains challenging for shoulder surgeons, and failure rates are high, regardless of initial treatment. This study aimed to analyze the clinical and radiographic midterm results of onlay lateralized cementless stem reverse shoulder arthroplasty (RSA) in patients with valgus/varus malunion proximal humerus fracture sequelae without metaphyseal osteotomy. We retrospectively studied 35 cases with the diagnosis of fracture sequelae of the proximal part of the humerus with valgus/varus malunion. The mean duration of follow-up was 4.6 years (range, 2 to 7 years), and the mean time between fracture and arthroplasty was 6 years (1 to 32 years). Seventeen patients (48.6%) had initially been treated nonoperatively. The Constant score (CS), active range of motion, and radiographs of the affected shoulders, as well as the acromion to greater tuberosity (AGT) distance and deltoid length (DL), were analyzed before surgery and at their latest follow-up. A total of thirty-three patients (94.3%) rated their outcome as very good or good. Mean CS, forward flexion, and external rotation improved significantly (p < 0.0001), as did internal rotation and pain (p < 0.05). AGT distance significantly increased postoperatively from 14.7 to 43.3 mm, as did DL from 143 to 170 mm (p < 0.05). There was no correlation between the outcomes and valgus/varus deformity, previous surgeries, or AGT distance/DL. A total of four complications occurred (11.4%): two dislocations were detected (5.7%) and successfully revised with a longer cemented stem. Onlay lateralized uncemented stem RSA improves clinical outcomes and decreases complications when treating valgus/varus malunion fracture sequelae, avoiding intraoperative technical challenges, such as tuberosities osteotomy conscious of bone loss and proper deltoid tensioning.
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Affiliation(s)
- Alfonso Maria Romano
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84025 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Naples, Italy
| | - Adriano Braile
- Dipartimento Multidisciplinare di Specialità Medico-Chirurgiche ed Odontoiatriche, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Pasquale Casillo
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84025 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
| | - Guglielmo Nastrucci
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84025 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
| | - Massimiliano Susanna
- Orthopedic and Traumatology Unit, San Donà di Piave Hospital, 30027 Venice, Italy;
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico ‘G.B. Morgagni’, 95100 Catania, Italy;
| | - Francesco Ascione
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84025 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Naples, Italy
- Correspondence: ; Tel.: +39-347-611-9973
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Ascione F, Braile A, Romano AM, di Giunta A, Masciangelo M, Senorsky EH, Samuelsson K, Marzano N. Experience-optimised fast track improves outcomes and decreases complications in total knee arthroplasty. Knee 2020; 27:500-508. [PMID: 31883758 DOI: 10.1016/j.knee.2019.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/07/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to describe an advanced total knee arthroplasty (TKA) fast-track programme and determine discharge parameters during hospitalisation, as well as patient satisfaction, outcomes and complications within the first 12 months after surgery. METHODS This prospective study was based on patients selected consecutively for primary elective TKA, undergoing surgery between 2014 and 2017 in an established fast-track setting. Hospitalisation-related parameters were collected: demographics, body mass index (BMI), surgical time, ischaemia time, haemoglobin values, blood transfusions, length of stay, weight-bearing and stair-climbing time, opioid administration, preoperative and discharge loss of extension and maximum active flexion of the knee, visual analogue scale (VAS), 12-month follow-up satisfaction rate and range of motion, any complications, hospital re-admission and re-operation within the first 12 months. Differences were determined using t-tests. RESULTS A total of 704 total knee replacements implanted in 481 patients were included in the study and 223 patients had a bilateral TKA. Their mean age was 69.8 years (range 57-88 years). At the 12-month follow-up, 623 patients (88.5%) reported being satisfied or very satisfied and 15 (2.1%) were dissatisfied with their TKA, mean active flexion and loss of extension were 104.4° and 2.3°, respectively. A total of 15 complications occurred (two percent): five painful knees, three knee stiffness, three haematomas, two infections, one hospital re-admission and one deep venous thrombosis. No cases of pulmonary embolism and death related to surgery were reported. CONCLUSION The study reports on an advanced fast-track programme for TKA with a low incidence of surgery- and hospitalisation-related issues and complications and without any severe adverse events during the first year. On average, the fast-track programme had a short length of stay, an early recovery of weight-bearing, knee mobility, pain control and a high satisfaction rate, accompanied with an acceptable 12 month range of motion.
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Affiliation(s)
- Francesco Ascione
- Department of Shoulder Surgery, Campolongo Hospital, Salerno, Italy; Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Napoli, Italy
| | - Adriano Braile
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Napoli, Italy.
| | - Alfonso Maria Romano
- Department of Shoulder Surgery, Campolongo Hospital, Salerno, Italy; Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Napoli, Italy
| | - Angelo di Giunta
- Orthopaedic Division of Policlinico 'G.B. Morgagni', Catania, Italy
| | - Marco Masciangelo
- Orthopedics and Sport Medicine Unit, Casa di Cura 'Sileno e Anna Rizzola', San Donà di Piave, Venezia, Italy
| | - Eric Hamrin Senorsky
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nicola Marzano
- Orthopedics and Sport Medicine Unit, Casa di Cura 'Sileno e Anna Rizzola', San Donà di Piave, Venezia, Italy
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Romano AM, Oliva F, Nastrucci G, Casillo P, Di Giunta A, Susanna M, Ascione F. Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups. Muscles Ligaments Tendons J 2017; 7:263-270. [PMID: 29264337 DOI: 10.11138/mltj/2017.7.2.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Rehabilitation after Reverse Shoulder Arthroplasty (RSA) is still object of discussion with no based evidence guidelines. The aim of this study was to test a personalized rehabilitation protocol for three different patients groups according to clinical and intraoperative parameters that can affect final outcomes after RSA. Patients and methods We retrospectively evaluated a consecutive series of 112 patients who underwent to RSA between 2013 and 2015. The average follow-up was 29.2 months. A preoperative and postoperative clinical and radiographic assessment was performed. According to clinical, radiographic and intraoperative parameters, we selected three groups dedicating each one a specific level of post surgical care. Results A statistically significant improvement was achieved from preoperative evaluation, regarding all analysed parameters. Notable improvements were reported in high care group: elevation improved of 63.9° despite of Group A 55.5° and Group B 54.5° and it resulted statistically significant (p< 0.05). Costant Score increased of 35.9%, despite of Group A and Group B respectively 40.6% and 34.8% (p> 0.05). Conclusion Our study shows that a personalized rehabilitation protocol can be effective improving clinical outcomes and decreasing complications rate, particularly in difficult management patients. Level of Evidence Therapeutic Level IV.
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Affiliation(s)
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Pasquale Casillo
- I Orthopedic and Traumatology Unit, Università della Campania "L. Vanvitelli", Napoli, Italy
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico "G.B. Morgagni", Catania, Italy
| | | | - Francesco Ascione
- I Orthopedic and Traumatology Unit, Università della Campania "L. Vanvitelli", Napoli, Italy
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Giardella A, Ascione F, Mocchi M, Berlusconi M, Romano AM, Oliva F, Maradei L. Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients. Muscles Ligaments Tendons J 2017; 7:271-278. [PMID: 29264338 DOI: 10.11138/mltj/2017.7.2.271] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation.The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly. Materials and methods The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proximal humeral three- and four- parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2.The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control. Results We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudoarthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required. Conclusion Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA compared with ORIF, confirming that rTSA is one of the best treatment in proximal humeral fractures in the elderly patients, which rotator cuff status frequently is poor and degenerating. The few radiological complications do not seem to have influence on active ROM and Constant Score, both the first and the second group of patients. Level of evidence Level IV, Case Series, Surgical.
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Affiliation(s)
- Antonio Giardella
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Francesco Ascione
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Mattia Mocchi
- Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Marco Berlusconi
- Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Alfonso Maria Romano
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Leonardo Maradei
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
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Asís SE, Bruno AM, Martínez AR, Sevilla MV, Gaozza CH, Romano AM, Coussio JD, Ciccia G. Diarylsemicarbazones: synthesis, antineoplastic activity and topoisomerase I inhibition assay. Farmaco 1999; 54:517-23. [PMID: 10510848 DOI: 10.1016/s0014-827x(99)00050-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A series of diarylsemicarbazones was synthesized and tested against human neoplastic cell lines. The more active members have a l-naphthyl ring at the carbamidic nitrogen, and chloro, dimethylamino or nitro group substituents at the benzylidene moiety. None of these showed affinity to DNA. One of the more active compounds was tested as a topoisomerase I inhibitor and showed a potent effect. SAR studies demonstrated linear correlation between lypophilicity and activity on the most sensitive lines and a definite conformational shape for antineoplastic action.
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Affiliation(s)
- S E Asís
- Departamento de Química Orgánica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
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Scotto di Uccio F, Russo S, Romano AM, Cautela G, Scotto di Uccio V. [An unusual episode of angina]. Minerva Cardioangiol 1999; 47:71-4. [PMID: 10389447] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors report the case of a 77-year-old woman suffering from ischemic cardiopathy, arterial hypertension and NID diabetes mellitus who was hospitalised for diabetic retinopathy. Following the topical administration of a drop of phenylephrine in the right eye, in preparation for fluoroangiography, she suffered an attack of angina pectoris. This event was clearly identified by a ECG carried out at the time which highlighted the sublevelling of the ST tract in the precordial derivations V2-V5, and by ecocardiographic imaging that showed septo-apical, anterior-apical and anterior-median transient segmentary hypokinesia. This case underlines the need for prudence and emphasises the need to regard patients suffering from ischemic cardiopathy as high-risk when undergoing diagnostic tests, in particular if these involve the use of vasoactive drugs.
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Bosi F, Silini E, Luisetti M, Romano AM, Prati U, Silvestri M, Tinelli C, Samloff IM, Fiocca R. Aspartic proteinases in normal lung and interstitial pulmonary diseases. Am J Respir Cell Mol Biol 1993; 8:626-32. [PMID: 8323747 DOI: 10.1165/ajrcmb/8.6.626] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Two aspartic proteinases, pepsinogen II (PgII) and cathepsin E (CathE), were identified immunocytochemically in lung epithelia. In normal lung, type II pneumocytes were characterized by PgII immunoreactivity of variable intensity, while bronchiolar Clara cells reacted with CathE antibodies. With the exception of small groups of nonciliated bronchial cells overlying lymphoid follicles, no other CathE-immunoreactive cell was found in the lung. Immunoblots of crude protein extracts of lung tissue using PgII and CathE antibodies showed reactivity with single molecular species co-migrating with analogous bands obtained from gastric mucosa (molecular weight, 40,500 for PgII and 42,000 to 44,000 for CathE). In 75 cases of non-neoplastic lung disease, a highly significant correlation was found between the severity of histopathologic lesions and expression of both PgII (P < 0.001) and CathE (P < 0.001). Epithelial hyperplasia contributed more than inflammation and fibrosis to this relationship. Proteinase overexpression was not specific to any particular disease and was found in both focal and diffuse lesions. Segregation of PgII and CathE in different cells was lost in hyperplastic epithelium, where coexpression of both proteinases by the same cell was frequently observed. The location of both proteinases in distal airways and their enhanced expression in the proliferative, hyperplastic phase of several non-neoplastic pneumopathies suggest their possible involvement in the process of parenchymal remodeling that occurs in fibrosing lung diseases.
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Affiliation(s)
- F Bosi
- Department of Pathology, University of Pavia, Italy
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Nastasi G, Sala L, Romano AM, Nucera D, Anselmetti L, Castoldi O, Crema F, Pasotti D. [Results of treatment with 5-fluorouracil and folinic acid in patients with carcinoma of the large intestine]. Medicina (Firenze) 1988; 8:175-8. [PMID: 2852292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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