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Iannuzzi R, Caravelli S, Pungetti C, Di Ponte M, Zaffagnini S, Mosca M. Orthopaedic and plastic surgery collaboration in resolution of plantar heloma and metatarsalgia using lipofilling: a retrospective evaluation. Musculoskelet Surg 2023; 107:123-126. [PMID: 36637611 DOI: 10.1007/s12306-023-00775-0] [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] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Plantar heloma is a keratotic disorder that can be described as a circumscribed area of thickening with a central core that may penetrate the dermis. Although often considered a minor complaint, longstanding lesions can be debilitating and severely impact on person's quality of life. We present the first retrospective case series at long-term follow-up about the use of plantar lipofilling as a treatment for metatarsalgia caused by plantar heloma. MATERIALS AND METHODS Six patients affected by plantar heloma associated to external metatarsalgia underwent plantar lipofilling. The surgical session was performed as an outpatient procedure. Clinical evaluation was performed using the AOFAS lesser metatarsophalangeal-interphalangeal (MTP-IP) score. RESULTS Mean AOFAS lesser MTP-IP score improved from a preoperative score of 66.6 ± 3.2 points (range 47-77 points) to a post-operative score of 92.8 ± 2.7 points (range 86-95 points); all patients were satisfied with the outcome at the final follow-up. Post-operative clinical examination at final follow-up showed an increase in thickness of the subcutaneous layer and a decrease of dermal layer thanks to the supporting and trophic action of fat cells. CONCLUSIONS Plastic regenerative procedures applicated to a typical foot and ankle surgery field, such as metatarsal overloading, metatarsalgia and forefoot problems, should be encouraged to allow new treatment horizons.
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Affiliation(s)
- R Iannuzzi
- Department of Plastic Surgery, INI Istituto Neurodermatologico Italiano, Grottaferrata, Rome, Italy
| | - S Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - C Pungetti
- Department of Orthopaedics and Traumatology, Ospedale Maggiore "A. Pizzardi", Bologna, Italy
| | - M Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Mosca M, Caravelli S, Vocale E, Fuiano M, Massimi S, Di Ponte M, Censoni D, Grassi A, Ceccarelli F, Zaffagnini S. Hallux valgus associated to osteoarthritis: Clinical-radiological outcomes of modified SERI technique at mid- to long-term follow-up. A retrospective analysis. Foot Ankle Surg 2022; 28:49-55. [PMID: 33574005 DOI: 10.1016/j.fas.2021.01.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/08/2021] [Accepted: 01/23/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Treatment of hallux valgus deformity associated with mild or moderate osteoarthritis (OA) is still a topic of debate. In the literature, there are few studies concerning the management of patients affected by this condition. This study aims to report the experience at mid- to long-term results of an original joint-preserving surgical technique. MATERIALS AND METHODS Patients affected by mild to moderate hallux valgus deformity and associated to grade 1-2 OA and treated with modified Simple-Effective-Rapid-Inexpensive (SERI) technique from 2008 to 2018 were selected. Inclusion criteria were mild or moderate hallux valgus angle (HVA) <40° and an intermetatarsal angle (IMA) <20° and associated grade 1-2 OA of the first metatarso-phalangeal joint (MTPJ). RESULTS 128 feet in 120 consecutive patients, undergone modified SERI procedure, have been retrospectively reviewed at a mean follow-up of 5.1 ± 3.8 years (range 2-11). American Orthopaedics Foot Ankle Society (AOFAS) score that was significantly improved from 44.2 ± 13.2 to 88.2 ± 9.6. Pre-operative average HVA and IMA values decreased respectively from 31.6° ± 3.9° to 9.1° ± 4.4° and from 16.2° ± 3.8° to 7.2° ± 3.1°. The average distal metatarsal articular angle (DMAA) value improved from 28.2° ± 6.5° to 7.1° ± 6°. OA of the first MTPJ highlighted a grade 1 in 46 feet and a grade 2 in 82 feet pre-operatively and a grade 0 in 30 feet, grade 1 in 82 feet, and grade 2 in 16 feet at the final follow-up. CONCLUSIONS The modifications to the SERI technique could extend the indications to patients affected by hallux valgus with mild to moderate OA. The wider case series and the longer follow-up of this study make us believe this technique is very useful for improving the quality of life in these patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - E Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Censoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - F Ceccarelli
- Clinica Ortopedica, Azienda ospedaliero-universitaria Parma, Parma, Italy
| | - S Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Zinno R, Di Paolo S, Ambrosino G, Alesi D, Zaffagnini S, Barone G, Bragonzoni L. Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review. Musculoskelet Surg 2021; 105:235-246. [PMID: 33315156 PMCID: PMC8578080 DOI: 10.1007/s12306-020-00690-8] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Loosening is considered as a main cause of implant failure in total knee replacement (TKR). Among the predictive signs of loosening, migration is the most investigated quantitative parameter. Several studies focused on the migration of the tibial component in TKR, while no reviews have been focused on the migration of the femoral component and its influence on patients' clinical outcomes. The aim of this narrative review was (1) to provide information about of the influence of migration in femoral component of TKR prostheses, (2) to assess how migration may affect patient clinical outcomes and (3) to present alternative solution to the standard cobalt-chrome prostheses. A database search was performed on PubMed Central® according to the PRISMA guidelines for studies about Cobalt-Chrome femoral component migration in people that underwent primary TKR published until May 2020. Overall, 18 articles matched the selection criteria and were included in the study. Few studies investigated the femoral component through the migration, and no clear migration causes emerged. The Roentgen Stereophotogrammetric Analysis has been mostly used to assess the migration for prognostic predictions. An annual migration of 0.10 mm seems compatible with good long-term performance and good clinical and functional outcomes. An alternative solution to cobalt-chrome prostheses is represented by femoral component in PEEK material, although no clinical evaluations have been carried out on humans yet. Further studies are needed to investigate the migration of the femoral component in relation to clinical outcomes and material used.
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Affiliation(s)
- R Zinno
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
| | - S Di Paolo
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy.
| | - G Ambrosino
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - D Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - G Barone
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - L Bragonzoni
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
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Papaleo E, Revelli A, Costa M, Bertoli M, Zaffagnini S, Tomei F, Manno M, Rebecchi A, Villanacci R, Vanni VS, Cantatore F, Ruffa A, Colia D, Sironi M, Tessari T, Parissone F, Romanello I, Reschini M, Dallagiovanna C, Somigliana E. Do we trust scientific evidence? A multicentre retrospective analysis of first IVF/ICSI cycles before and after the OPTIMIST trial. Hum Reprod 2021; 36:1367-1375. [PMID: 33686407 DOI: 10.1093/humrep/deab047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Has the practice of individualizing the recombinant-FSH starting dose been superseded after the largest randomized controlled trial (RCT) in assisted reproduction technology (ART), the OPTIMIST trial? SUMMARY ANSWER The OPTIMIST trial has influenced our ART daily practice to a limited degree, but adherence is still generally poor. WHAT IS KNOWN ALREADY Although the 'one size fits all' approach has been discouraged for decades by most authors, the OPTIMIST study group demonstrated in a large prospective RCT that, in general, dosage individualization does not improve the prospects for live birth, although it may decrease ovarian hyperstimulation syndrome (OHSS) risk in expected high responders. STUDY DESIGN, SIZE, DURATION Retrospective analysis of all first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles from 1st January 2017 to 31st December 2018, before and after the OPTIMIST publication on November 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Two thousand six hundred and seventy-seven patients, between 18 and 42 years old, undergoing their first IVF-ICSI cycle in seven Italian fertility centres, were included. Patients were allocated to three groups according to their ovarian reserve markers: predicted poor ovarian responders (POR), predicted normo-responders (NR) and expected hyper-responders (HRs). MAIN RESULTS AND THE ROLE OF CHANCE Between 2017 and 2018, there was an overall increase in prescription of the standard 150 IU dose proposed by the OPTIMIST trial and a reduction in the use of a starting dose >300 IU. After subgroup analysis, the decrease in doses >300 IU remained significant in the POR and NR sub-groups. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of the study. Physicians need time to adapt to new scientific evidence and a comparison between 2017 and 2019 may have found a greater impact of the Optimist trial, although other changes over the longer time span might have increased confounding. We cannot be sure that the observed changes can be attributed to knowledge of the OPTIMIST trial. WIDER IMPLICATIONS OF THE FINDINGS Clinicians may be slow to adopt recommendations based on RCTs; more attention should be given to how these are disseminated and promoted. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. E.P. reports grants and personal fees from MSD, grants from Ferring, from IBSA, grants and personal fees from Merck, grants from TEVA, grants from Gedeon Richter, outside the submitted work. E.S. reports grants from Ferring, grants and personal fees from Merck-Serono, grants and personal fees from Theramex, outside the submitted work. All other authors do not have conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- E Papaleo
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - A Revelli
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin 10126, Italy
| | - M Costa
- Reproductive Medicine Department, International Evangelic Hospital, Genoa 16122, Italy
| | - M Bertoli
- Reproduction and IVF Unit, C. Poma Hospital, Mantua 46100, Italy
| | - S Zaffagnini
- ART and Fertility Preservation Unit, Maternal Pediatric Department, AOUI Verona, Verona 37126, Italy
| | - F Tomei
- IVF Unit, Azienda Sanitaria Friuli Occidentale, Sacile 33077, PN, Italy
| | - M Manno
- IVF Unit, Azienda Sanitaria Friuli Occidentale, Sacile 33077, PN, Italy
| | - A Rebecchi
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - R Villanacci
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - V S Vanni
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - F Cantatore
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - A Ruffa
- Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin 10126, Italy
| | - D Colia
- Reproductive Medicine Department, International Evangelic Hospital, Genoa 16122, Italy
| | - M Sironi
- Reproduction and IVF Unit, C. Poma Hospital, Mantua 46100, Italy
| | - T Tessari
- Reproduction and IVF Unit, C. Poma Hospital, Mantua 46100, Italy
| | - F Parissone
- ART and Fertility Preservation Unit, Maternal Pediatric Department, AOUI Verona, Verona 37126, Italy
| | - I Romanello
- IVF Unit, Azienda Sanitaria Friuli Occidentale, Sacile 33077, PN, Italy
| | - M Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - C Dallagiovanna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - E Somigliana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy.,Università degli Studi di Milano, Milan 20122, Italy
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Lo Presti M, Costa GG, Vasco C, Agrò G, Poggi A, Neri MP, Zaffagnini S. Küntscher nails with static cement spacer: A simple technique in periprosthetic knee infections with massive bone loss and instability. Knee 2021; 29:580-588. [PMID: 33736904 DOI: 10.1016/j.knee.2021.01.025] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Two-stage revision for periprosthetic knee infection is challenging in cases of massive bone loss and instability. The present study aims to describe our experience with an alternative technique of reinforced cement spacer, usually necessary in these situations, focusing on its advantages and clinical results. METHODS We retrospectively identified all patients who underwent a two-stage revision for periprosthetic knee infection using two intramedullary Küntscher nails as reinforcement from January 2010 to September 2018. From each medical record, we extracted the type of explanted prosthesis, isolated micro-organism, number of cement spacers before index procedure (and related episodes of spacer dislocation) and final treatment. RESULTS Twelve patients were identified, mean age of 64.0 years (range 39-85). In four of them, the reinforced spacer was used twice for persistent infection, with a total of 16 procedures performed and no cases of dislocation. Ten patients were finally treated with reimplantation or arthrodesis with intramedullary nails, whereas an above-knee amputation was necessary for two patients. Infection was eradicated in 10 patients out of 12 (83%) at a mean follow up of 34.3 months (range 10-62). CONCLUSIONS This technique is an effective alternative to traditional spacers in cases of massive bone loss, producing a mechanically stable joint and preserving adequate tissue tensions. The construct is technically easy to perform and, not less importantly, to remove during stage 2. Further studies, with larger groups, are necessary to determine its validity.
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Affiliation(s)
- M Lo Presti
- 2nd Orthopaedic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - C Vasco
- 2nd Orthopaedic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - G Agrò
- 2nd Orthopaedic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - A Poggi
- 2nd Orthopaedic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - M P Neri
- 2nd Orthopaedic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Zaffagnini
- 2nd Orthopaedic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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Alesi D, Meena A, Fratini S, Rinaldi VG, Cammisa E, Lullini G, Vaccari V, Zaffagnini S, Marcheggiani Muccioli GM. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg 2021; 106:1-8. [PMID: 33587251 PMCID: PMC8881420 DOI: 10.1007/s12306-021-00695-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/02/2021] [Indexed: 10/31/2022]
Abstract
Total knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, one should aware with the technical aspects of surgical exposure, bone cuts of the distal femur and proximal tibia, medial and lateral ligament balancing, flexion and extension gap balancing, creating an appropriate tibiofemoral joint line, balancing the patellofemoral joint, preserving peroneal nerve function, and selection of the implant regarding constraint. Restoration of neutral mechanical axis and correct ligament balance are important factors for stability and longevity of the prosthesis and for good functional outcome. Thus, our review aims to provide step by step comprehensive knowledge about different surgical techniques for the correction of severe valgus deformity in total knee arthroplasty.
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Affiliation(s)
- D Alesi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - A Meena
- VMMC and Safdarjung Hospital, Central Institute of Orthopedics, New Delhi, 110029, India
| | - S Fratini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - V G Rinaldi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - E Cammisa
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - G Lullini
- UO Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy
| | - V Vaccari
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - G M Marcheggiani Muccioli
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
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Cucurnia I, Pudda A, Madonna V, Berruto M, Zaffagnini S. Patient-reported outcomes of intra-articular hyaluronic acid for osteoarthritis of the knee: a prospective and multicentric case series. Musculoskelet Surg 2021; 106:303-310. [PMID: 33486612 DOI: 10.1007/s12306-021-00698-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the present study, patients with symptomatic knee osteoarthritis (OA) were treated with single intra-articular injection of a high molecular weight, non-cross-linked hyaluronic acid (HA), highly concentrated (2%) and associated with sorbitol (4%). The aims of this study were to (1) evaluate clinical outcome after 6 months, (2) evaluate clinical outcomes after 12 months and (3) evaluate clinical outcomes according to OA grade. Hypothesis of the study was that a single intra-articular injection of this HA associated with sorbitol leads to a significant clinical improvement within 6 months in patients with early or moderate knee OA. MATERIALS AND METHODS A total of 77 patients were enrolled in this prospective multicentric study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was recorded at baseline and at months 1, 3, 6 and 12 following the intra-articular injection. Moreover, a stratified analysis of all WOMAC items following the OA grade was performed for both groups of patients, one with low (grade I-II according to Kellgren-Lawrence classification) and another with moderate OA grade (grade III according to Kellgren-Lawrence) and the differences between groups were evaluated. RESULTS Seventy-three patients completed the 12 months follow-up. Pain, stiffness, functional limitation and total scores were significantly reduced at 1, 3 and 6 months (p < 0.05), but not at 12 months. Stratified analysis of all subscores according to OA grade showed that pain, functional limitation and total score decreased at 1, 3, 6 and 12 months (p < 0.05) in both groups. Stiffness was the only item that decreased significantly at 1, 3 and 6 months but not at 12 months in both groups. All subscore values were significantly lower in the group of patients with low OA grade compared to the one with moderate OA grade. No adverse events were reported. CONCLUSION At 6 months after a single intra-articular injection of a high molecular weight, non-cross-linked HA associated with sorbitol, WOMAC scores decreased significantly. Clinical benefits were observed both in patients with low and in those with moderate OA grade, with better results in the first group.
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Affiliation(s)
- I Cucurnia
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy.
| | - A Pudda
- Clinica Ortopedica e Traumatologica, Ospedale di Bolzano, 39100, Bolzano, Italy
| | - V Madonna
- Clinica Ortopedica, Istituto Humanitas Castelli, 24128, Bergamo, Italy
| | - M Berruto
- Chirurgia Articolare del Ginocchio, ASST Ospedale Gaetano Pini-CTO, 20122, Milano, Italy
| | - S Zaffagnini
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy
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Golinelli D, Rosa S, Rucci P, Tedesco D, Grassi A, Amabile M, Cosentino M, Maietti E, Zaffagnini S, Fantini MP. Patient-reported outcomes in patients undergoing elective arthroplasty: the PaRIS-IOR study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.929] [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: 11/13/2022] Open
Abstract
Abstract
Background
The number of hip and knee arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched the PaRIS Initiative for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the Initiative (PaRIS-IOR study), because it hosts the Registry of Orthopedic Prosthetic Implants (RIPO). The objective of PaRIS-IOR study is to investigate the characteristics and temporal trend of PROMs in relation to the type of surgical intervention and patient profile. Here we report the preliminary results of the first study year.
Methods
The PaRIS-IOR is a prospective, single site, cohort study started on January 1st 2019 that consists of the administration of Euro Quality 5 Dimensions (EQ-5D), Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score Physical function Short-form (HOOS-PS, KOOS-PS) questionnaires to patients on the list for elective arthroplasty. Questionnaires data are linked with those routinely collected by the RIPO and regional administrative data, in order to track patients' medical history.
Results
The study population consists of 1,413 patients. Patients undergoing knee arthroplasty (n = 393) were older (68.4 vs 60.2 years; p < 0.001), and had a higher prevalence of obesity (41.6 vs 22.6%; p < 0.001) than patients undergoing hip arthroplasty (n = 1020). Female and obese patients reported a worse perceived health status both in the EQ-5D (p < 0.001) and in the HOOS-PS and KOOS-PS (p < 0.001). Among patients who underwent knee surgery, the younger ones reported a poorer perceived health in the general and the specific questionnaires.
Conclusions
The PaRIS-IOR study has potential important implications in targeting the factors affecting patient-reported functional outcomes and quality of life after joint arthroplasty.
Key messages
The PaRIS-IOR study underscores the poorer perception of health status in female and obese patients undergoing arthroplasty and in younger patients undergoing knee surgery. The routine adoption of PROMs may support surgeons in the management of patients undergoing hip and knee arthroplasty and policy-makers in improving healthcare quality in orthopedics.
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Affiliation(s)
- D Golinelli
- Department of Biomedical and Neuromotor Sciences., University of Bologna, Bologna, Italy
| | - S Rosa
- Department of Biomedical and Neuromotor Sciences., University of Bologna, Bologna, Italy
| | - P Rucci
- Department of Biomedical and Neuromotor Sciences., University of Bologna, Bologna, Italy
| | - D Tedesco
- Direzione Sanitaria, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Amabile
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Cosentino
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Maietti
- Department of Biomedical and Neuromotor Sciences., University of Bologna, Bologna, Italy
| | - S Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences., University of Bologna, Bologna, Italy
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9
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Massimi S, Caravelli S, Fuiano M, Pungetti C, Mosca M, Zaffagnini S. Management of high-grade hallux rigidus: a narrative review of the literature. Musculoskelet Surg 2020; 104:237-243. [PMID: 32030657 DOI: 10.1007/s12306-020-00646-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/02/2019] [Accepted: 02/02/2020] [Indexed: 01/13/2023]
Abstract
Hallux rigidus is a disease characterized by an osteoarthritic degeneration of the first metatarsophalangeal joint. Aetiology of hallux rigidus is not clear in the literature. History of trauma is considered one of the most common causes of unilateral hallux rigidus. Also, repetitive microtraumas or inflammatory and metabolic causes such as gout, rheumatoid arthritis and seronegative arthropathy can cause degeneration of the joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified main operative procedures to treat of hallux rigidus. This may provide current information for med-school students, researchers and physicians. A comprehensive literature search using PubMed database has been performed. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. High-grade hallux rigidus represents a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.
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Affiliation(s)
- S Massimi
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Caravelli
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - M Fuiano
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - C Pungetti
- Department of Orthopaedic Surgery, Ospedale Maggiore "Pizzardi", Bologna, Italy
| | - M Mosca
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Zaffagnini
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
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10
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Grassi A, Signorelli C, Lucidi GA, Raggi F, Macchiarola L, Roberti Di Sarsina T, Marcheggiani Muccioli GM, Filardo G, Zaffagnini S. Corrigendum to "ACL reconstruction with lateral plasty reduces translational and rotatory laxity compared to anatomical single bundle and non-anatomical double bundle surgery: An in vivo kinematic evaluation with navigation system." [Clin. Biomech. (Bristol, Avon) 2019 Oct; 69:1-8. doi:10.1016/j.clinbiomech.2019.06.012. Epub 2019 Jun 14]. Clin Biomech (Bristol, Avon) 2020; 72:211. [PMID: 32127218 DOI: 10.1016/j.clinbiomech.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A Grassi
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy.
| | - C Signorelli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy.
| | - G A Lucidi
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy.
| | - F Raggi
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - L Macchiarola
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - T Roberti Di Sarsina
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - G M Marcheggiani Muccioli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - G Filardo
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di NanoBiotecnologie (NaBi), Via Di Barbiano 1/10, 40136 Bologna, BO, Italy.
| | - S Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy.
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11
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Marcheggiani Muccioli GM, Fratini S, Roberti Di Sarsina T, Di Paolo S, Ingrassia T, Grassi A, Cardinale U, Cammisa E, Bragonzoni L, Zaffagnini S. Two different posterior-stabilized mobile-bearing TKA designs: navigator evaluation of intraoperative kinematic differences. Musculoskelet Surg 2020; 105:173-181. [PMID: 31993972 DOI: 10.1007/s12306-020-00643-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to compare two types of posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasties (TKAs). The hypothesis was that no major differences were going to be found among the two TKA designs. METHODS Two cohorts of patients who were divided according to implant design (Cohort A, new design gradually reducing radius PS MB TKA; Cohort B, traditional dual-radius PS MB TKA) were analyzed by means of intraoperative navigation. All operations were guided by a non-image-based navigation system that recorded relative femoral and tibial positions in native and implanted knees during the following kinematic tests: passive range of motion (PROM), varus-valgus stress test at 0° and 30° (VV0, VV30) and anterior/posterior drawer test at 90° of flexion (AP90). RESULTS There were no significative differences in kinematic tests between the two implants. Cohort A, however, showed a different post-implant trend for VV0 and VV30 that were lower than the pre-implant ones, as expected, while for Cohort B, the trend is opposite. However, the gradually reducing radius prosthesis (Cohort A) showed a trend of improving stability (29% compared to the preoperative status) in mid-flexion (VV30) which the traditional dual-radius design (Cohort B) would not. Moreover, we found no differences among postoperative results of the two TKA designs. CONCLUSION Despite design variations, no difference has been found among the prostheses in terms of PROM, rotations and translations. Both design kinematics did not show paradoxical external rotations, but an increase in femoral translation in mid-flexion without affecting the functioning of the prosthesis. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - S Fratini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - T Roberti Di Sarsina
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - T Ingrassia
- Dipartimento di Ingegneria, Università di Palermo, Palermo, Italy
| | - A Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - U Cardinale
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Cammisa
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Bragonzoni
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - S Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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12
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Vetri V, Dragnevski K, Tkaczyk M, Zingales M, Marchiori G, Lopomo NF, Zaffagnini S, Bondi A, Kennedy JA, Murray DW, Barrera O. Advanced microscopy analysis of the micro-nanoscale architecture of human menisci. Sci Rep 2019; 9:18732. [PMID: 31822796 PMCID: PMC6904744 DOI: 10.1038/s41598-019-55243-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/13/2019] [Indexed: 12/05/2022] Open
Abstract
The complex inhomogeneous architecture of the human meniscal tissue at the micro and nano scale in the absence of artefacts introduced by sample treatments has not yet been fully revealed. The knowledge of the internal structure organization is essential to understand the mechanical functionality of the meniscus and its relationship with the tissue’s complex structure. In this work, we investigated human meniscal tissue structure using up-to-date non-invasive imaging techniques, based on multiphoton fluorescence and quantitative second harmonic generation microscopy complemented with Environmental Scanning Electron Microscopy measurements. Observations on 50 meniscal samples extracted from 6 human menisci (3 lateral and 3 medial) revealed fundamental features of structural morphology and allowed us to quantitatively describe the 3D organisation of elastin and collagen fibres bundles. 3D regular waves of collagen bundles are arranged in “honeycomb-like” cells that are comprised of pores surrounded by the collagen and elastin network at the micro-scale. This type of arrangement propagates from macro to the nanoscale.
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Affiliation(s)
- V Vetri
- Università degli Studi di Palermo, Palermo, Italy
| | | | | | - M Zingales
- Università degli Studi di Palermo, Palermo, Italy
| | - G Marchiori
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | - N F Lopomo
- Università degli Studi of Brescia, Brescia, Italy
| | - S Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | - A Bondi
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | | | | | - O Barrera
- University of Oxford, Oxford, UK. .,University of Luxembourg, Luxembourg, Luxembourg. .,Oxford Brookes University, Oxford, UK.
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13
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Zaffagnini S, Vannini F, Di Martino A, Andriolo L, Sessa A, Perdisa F, Balboni F, Filardo G. Low rate of return to pre-injury sport level in athletes after cartilage surgery: a 10-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2019; 27:2502-2510. [PMID: 30374578 DOI: 10.1007/s00167-018-5255-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/22/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Although articular surface is frequently damaged in athletes, results in terms of return to sport and level of activity after cartilage surgery remain rather unpredictable and poorly documented. The aim of this study is to evaluate the clinical outcome in terms of rate and level of return to sport in a group of competitive athletes who underwent matrix-assisted autologous chondrocyte transplantation (MACT), as well as the impact on their athletic career. METHODS Thirty-one male patients (mean age 22.6 ± 6.3 years) p racticing sport at competitive level, affected by focal chondral/osteochondral lesions of the distal femur, were enrolled and treated with arthroscopic hyaluronan-based MACT. Patients were evaluated prospectively at 1-year intervals with the IKDC subjective, Tegner, and EuroQol VAS scores during their pre-operative visit and subsequent follow-ups for up to 10 years. Return to sport in terms of level, time and maintenance of the activity level was documented, together with surgical or clinical failures. RESULTS A marked improvement in all scores was found: IKDC increased from 40.3 ± 13.4 to 81.7 ± 14.4 (p < 0.0005) at 12 months; a further improvement was observed at 2 years (89.5 ± 11.3; p = 0.008), then results were stable for up to 10 years (87.3 ± 13.6). The analysis of return to sport documented that 64.5% of patients were able to return at a competitive level, and 58.1% performed at the same pre-injury level, with activity rates decreasing over time. The rate of patients returning to competitive level was 84% in those without previous surgery (vs. 33% who had undergone previous surgery), 87% for those with traumatic lesions (vs. 33% and 50% for degenerative and OCD lesions, respectively), and 92.3% in younger patients (age < 20 years). Among these factors, multivariate analysis demonstrated that previous surgery was the single most influencing factor for returning to the same sport level (p = 0.010). CONCLUSIONS These long-term results showed that chondrocyte-based regenerative approach has some limitations in terms of sport-related outcomes. The level of high functional knee restoration needed for such high-demanding activity level can be challenging to achieve, especially in patients with a more compromised joint homeostasis. Return to sport rate varies significantly according to specific patient and lesion characteristics and best results are obtained in young patients with traumatic lesions without previous surgery, which should be considered when treating athletes affected by cartilage lesions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Vannini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Di Martino
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - L Andriolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - A Sessa
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Perdisa
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Balboni
- Laboratorio NABI, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Marchiori G, Parrilli A, Sancisi N, Berni M, Conconi M, Luzi L, Cassiolas G, Zaffagnini S, Lopomo N. Integration of micro-CT and uniaxial loading to analyse the evolution of 3D microstructure under increasing strain: application to the Anterior Cruciate Ligament. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.matpr.2018.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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15
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Caravelli S, Mosca M, Massimi S, Pungetti C, Russo A, Fuiano M, Catanese G, Zaffagnini S. A comprehensive and narrative review of historical aspects and management of low-grade hallux rigidus: conservative and surgical possibilities. Musculoskelet Surg 2018; 102:201-211. [PMID: 29392615 DOI: 10.1007/s12306-018-0530-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/05/2018] [Accepted: 01/16/2018] [Indexed: 06/07/2023]
Abstract
Hallux rigidus, Latin for Stiff Toe, is characterized by an osteoarthritic degeneration of the articular surfaces of the first metatarsophalangeal joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified operative procedures and the more up to date knowledge about non-operative and surgical treatment of hallux rigidus. This may provide current information for physicians, medschool attendants and researchers. A comprehensive literature search using PubMed database has been performed, up to April 1, 2017. Several different types of treatment are described in the literature for low-grade hallux rigidus. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. Hallux rigidus is a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment for low-grade forms should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.
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Affiliation(s)
- S Caravelli
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy.
| | - M Mosca
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy
| | - S Massimi
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy
| | - C Pungetti
- Department of Orthopaedic Surgery, Ospedale Maggiore "Pizzardi", Bologna, Italy
| | - A Russo
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy
| | - M Fuiano
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy
| | - G Catanese
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy
| | - S Zaffagnini
- Rizzoli Orthopaedic Institute, 2nd Clinic of Orthopaedics and Traumatology, Bologna, Italy
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16
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Cassiolas G, Berni M, Marchiori G, Bontempi M, Bragonzoni L, Valente G, Grassi A, Zaffagnini S, Visani A, Lopomo NF. How cartilage status can be related to joint loads in anterior cruciate ligament reconstruction: a preliminary analysis including MRI t2 mapping and joint biomechanics. J BIOL REG HOMEOS AG 2018; 32:35-40. [PMID: 30644279] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The knee is the largest and most complex joint in the human body. Traumatic events, such as anterior cruciate ligament (ACL) tear, can lead to an alteration of joint tissues homeostasis. Literature reports an evident correlation between abnormal joint biomechanics and the status of articular tissues. These alterations, due to a sub-optimal ACL reconstruction, may result in an increasing risk of developing degenerative pathologies, such as osteoarthritis. Thus, the identification of the optimal surgical technique is a highly demanding issue in ACL reconstruction. The aim of this study was to analyze the correlation between joint cartilage conditions and knee biomechanics in ACL reconstructions, by integrating MRI T2 mapping investigations, radiostereophotogrammetry-based gait analysis and subject-specific musculoskeletal modelling.
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Affiliation(s)
- G Cassiolas
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Berni
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Marchiori
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Bontempi
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Bragonzoni
- Alma mater studiorum, Università di Bologna, Bologna
| | - G Valente
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Visani
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - N F Lopomo
- Università degli Studi di Brescia, Brescia, Italy
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17
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Caravelli S, Mosca M, Massimi S, Costa GG, Lo Presti M, Fuiano M, Grassi A, Zaffagnini S. Percutaneous treatment of hallux valgus: What's the evidence? A systematic review. Musculoskelet Surg 2018; 102:111-117. [PMID: 29081030 DOI: 10.1007/s12306-017-0512-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 06/07/2023]
Abstract
Hallux and first MTP joint have a fundamental role in the transfer of the weight-bearing load during the normal ambulation. The aim of this paper is to review and analyze the available literature about the percutaneous surgical management of the hallux valgus to highlight its strengths and weakness, also comparing with other minimal invasive techniques. A systematic search of PubMed and Google Scholar databases has been performed, covering the period between 1981 and 2016. Various combinations of the keyword terms "PDO," "hallux valgus," "bunion," "percutaneous," "surgery," "non-invasive," "minimal invasive," "burr," "osteotomy," "distal," "linear," "saw" have been used.Four papers, published from 2005 to 2015, fulfilled the inclusion criteria. A total of 464 hallux valgus has been treated with a properly percutaneous distal first metatarsal osteotomy. Mean AOFAS score, retrieved from the 4 studies included in our review, has been recorded. There are different aspects that the foot and ankle non-experienced surgeon has to consider about percutaneous surgery: limitation of the tools, radioexposure, lack of direct visual control of the osteotomy and higher costs and patient risk due to surgical time.
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Affiliation(s)
- S Caravelli
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - M Mosca
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Massimi
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G G Costa
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Lo Presti
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Fuiano
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Zaffagnini
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
INTRODUCTION Traditional prosthetic solutions expose the amputee to numerous problems that limit his ability to safely perform the normal activities of daily life. In order to eliminate the problems related to the use of the traditional prosthesis with socket, a new technique was developed for fixing the prosthesis to the amputees based on the principle of osseointegration. The aim of this paper is to study and analyze the stress distribution on the interface between a trans-humeral osseointegrated prosthetic implant and the residual bone, identifying the most stressed areas and thus foreseeing possible failure phenomena of the entire prosthetic system and, after, to compare the stress distribution on three different prosthetic designs that differ from each other for some geometric characteristics. MATERIALS AND METHODS A healthy individual mimics two fall scenarios of which the trans-humeral amputees can most likely be victims: Static fall and Dynamic fall. A force platform (P-6000, BTS Bioengineering) is required for load data acquisition. The CAD model of the trans-humeral osseointegrated implant was created following the guidelines of the OPRA implant. The bone model was created starting from the CAT scan of a left humerus. The FEM simulation was conducted throught a linear analysis. RESULTS Both during static fall and dynamic fall, similar trends have been observed for the reaction force Fz, the torque moment Tz, the bending moments Mx and My. From the analysis of the von Mises stress distribution it was found that the stress distribution is more homogeneous in the case where the thread of the fixture is made by a triangular profile with height of the thread equal to 0.5 mm. However, it can be seen that, when passing from a thread with height of 0.5 mm to a 1 mm, there is a slight decrease in the stress on the whole contact zone between the fixture and the humerus. The same improvement can also be seen in the case of trapezoidal threading. CONCLUSION By modifying the height and/or by varying the thread profile, are obtained slightly better results with respect to the case with a 0.5 mm height triangular thread.
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Affiliation(s)
| | | | - S Zaffagnini
- University of Bologna, Italy; II Clinic Rizzoli Orthopaedic Institute, Bologna, Italy
| | - M Bontempi
- University of Bologna, Italy; Laboratory of Biomechanics and Technology Innovation, Rizzoli Orthopaedic Institute, Italy
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Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Roberti Di Sarsina T, Macchiarola L, Mosca M, Neri MP, Marcacci M. Anterior cruciate ligament revision with Achilles tendon allograft in young athletes. Orthop Traumatol Surg Res 2018; 104:209-215. [PMID: 29032309 DOI: 10.1016/j.otsr.2017.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/26/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Return to sport after revision ACL reconstruction is a controversial topic, several studies reported the results of different techniques and graft in sportsman, presenting an incredibly wide range of return to the same pre-injury activity level, from 0% to 100%. The purpose of this study was to evaluate the clinical outcomes and return to sport rate in young athletes after non anatomic double-bundle revision ACL reconstruction with Achilles allograft. HYPOTHESIS The present revision technique was effective in terms of stability, return to sport and functional outcomes. MATERIAL AND METHODS All the athletes undergone Revision ACL reconstruction with non-irradiated Achilles tendon allograft with a non-anatomical double-bundle technique were included in the study. A split Achilles tendon allograft was used to reproduce the anteromedial (AM) bundle using the over-the-top position, while the posterolateral (PL) bundle was reconstructed through a femoral tunnel located in the anatomical PL footprint. Sport activity, knee function with Lysholm score, knee laxity and re-injury or re-operations were evaluated. RESULTS Twenty-six athletes (23 males, three females) with a mean age of 23.4±3.6 years were evaluated at a mean follow-up of 6.0±1.6 years. Overall 69% of patients returned to sport both at elite (44%) or county level (56%) after a mean 6.7±1.5 (3-9 range) months. The mean Lysholm score showed a significant improvement from 64.4±8.1 at pre-operative status to 83.8±11.3 at final follow-up (P<.0001). Seven patients (30%) were rated as excellent, nine (39%) as good, five (22%) as fair and 2 (9%) as poor. Three patients (12%) experienced a further graft rupture after a mean 2.6 years, (3.5 months-48 months range) and two had >5mm side-to-side difference at KT-1000. Therefore, the overall survival rate at mean six years follow-up was 81%. CONCLUSION The ACL revision with a double-bundle technique using Achilles tendon allograft was successful in 81% of athletes at six years mean follow-up. TYPE OF STUDY AND LEVEL OF EVIDENCE Retrospective case series, level IV.
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Affiliation(s)
- S Zaffagnini
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - A Grassi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
| | - G M Marcheggiani Muccioli
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - T Roberti Di Sarsina
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - L Macchiarola
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - M Mosca
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - M P Neri
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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20
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Rocca M, Giavaresi G, Aldini NN, Fini M, Marcacci M, Zaffagnini S, Giardino R. pO2 Measurement in an Experimental Model of Patellar Tendon Autograft Pro-Anterior Cruciate Ligament. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thirty-four sheep were submitted to surgery substituting the native ACL with the central third of the patellar tendon, ten enter this study. The purpose was to find a possible relationship between tissue pO2 and healing processes considering also the biomechanical and histomorphological aspects of the grafts. Four of them were sacrificed under general anaesthesia after 6 months, and six after 1 year in order to perform tissue pO2 measurement and an analysis of microvessel density on specimens of the normal ACL and the graft. Our data showed higher pO2 values of the autografts after 6 months. After 1 year the data was comparable to those of native ACL. This was confirmed by a microvessel count of the histological specimens and the data was in relationship to biomechanical and histomorphological analysis. Tissue pO2 can be observed and recorded in “in vivo” ACL, and patellar tendon used as graft, with no injury to their integrity. The monitoring system might be considered as an experimental tool for indirect controls of the anterior cruciate substitutes.
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Affiliation(s)
- M. Rocca
- Surgical Pathophysiology, Medical School, University of Bologna, and Department of Experimental Surgery
| | - G. Giavaresi
- Surgical Pathophysiology, Medical School, University of Bologna, and Department of Experimental Surgery
| | - N. Nicoli Aldini
- Surgical Pathophysiology, Medical School, University of Bologna, and Department of Experimental Surgery
| | - M. Fini
- Surgical Pathophysiology, Medical School, University of Bologna, and Department of Experimental Surgery
| | - M. Marcacci
- Laboratory of Biomechanics, Rizzoli Orthopaedic Institute, Bologna - Italy
| | - S. Zaffagnini
- Laboratory of Biomechanics, Rizzoli Orthopaedic Institute, Bologna - Italy
| | - R. Giardino
- Surgical Pathophysiology, Medical School, University of Bologna, and Department of Experimental Surgery
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21
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Musahl V, Zaffagnini S, LaPrade R, Hirschmann MT, Karlsson J. Erratum to: The challenge of treating complex knee instability. Knee Surg Sports Traumatol Arthrosc 2017; 25:3987. [PMID: 27535676 DOI: 10.1007/s00167-016-4267-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- V Musahl
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - S Zaffagnini
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, BO, Italy
- Dipartimento Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - R LaPrade
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M T Hirschmann
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Karlsson
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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22
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Bonanzinga T, Signorelli C, Grassi A, Lopomo N, Jain M, Mosca M, Iacono F, Marcacci M, Zaffagnini S. Erratum to: Kinematics of ACL and anterolateral ligament. Part II: anterolateral and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:3991. [PMID: 28382406 DOI: 10.1007/s00167-017-4533-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Bonanzinga
- Humanitas Clinical and Research Center, Milano, MI, Italy.,Dipartimento Scienze Biomediche e Neuromotorie, Università di Bologna, DIBINEM, Bologna, BO, Italy
| | - C Signorelli
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, Bologna, BO, Italy.
| | - A Grassi
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, Bologna, BO, Italy.,Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, BO, Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria, PA, Italy
| | - N Lopomo
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, Bologna, BO, Italy.,Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia, BS, Italy
| | - M Jain
- Mohit Hospital, Borivali East, Mumbai, India
| | - M Mosca
- Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, BO, Italy
| | - F Iacono
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, Bologna, BO, Italy.,Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, BO, Italy
| | - M Marcacci
- Dipartimento Scienze Biomediche e Neuromotorie, Università di Bologna, DIBINEM, Bologna, BO, Italy.,Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, Bologna, BO, Italy.,Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, BO, Italy
| | - S Zaffagnini
- Dipartimento Scienze Biomediche e Neuromotorie, Università di Bologna, DIBINEM, Bologna, BO, Italy.,Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, Bologna, BO, Italy.,Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, BO, Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria, PA, Italy
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23
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Gokeler A, Welling W, Benjaminse A, Lemmink K, Seil R, Zaffagnini S. A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: A case control study. Orthop Traumatol Surg Res 2017; 103:947-951. [PMID: 28428033 DOI: 10.1016/j.otsr.2017.02.015] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [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: 01/25/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Given that bilateral deficits are present after ACLR, this may result in a falsely high limb symmetry index (LSI), since LSI is calculated as a ratio between the values of the limbs. HYPOTHESIS Athletes after ACLR would achieve LSI>90% for the hop test. Secondly, athletes after ACLR demonstrate decreased jump distance on the single hop for distance (SLH) and triple leg hop for distance (TLH) and decreased number of hops for the side hop (SH) for both involved and uninvolved limbs compared to normative data of sex, age and type of sports matched healthy athletes. MATERIALS AND METHODS Fifty-two patients (38 males mean age 23.9±3.5years; 14 females mean age 21.7±3.5 years) who had undergone an ACLR participated in this study. Patients performed the 3 hop tests at a mean time of 7 months after ACLR. Hop distance, number of side hops and LSI were compared with normative data of 188 healthy athletes. RESULTS The differences between the involved limb and the uninvolved limb were significant in all hop tests (SLH P=0.003, TLH P=0.003, SH P=0.018). For females, only significant between limb differences were found in the SLH (P=0.049). For both the SLH and the TLH, significant differences were found between the involved limb and the normative data (males; SLH P<0.001, TLH P<0.001; females; SLH P<0.001, TLH P=0.006) and between the uninvolved limb and the normative data for both males and females (males; SLH P<0.001, TLH P<0.001; females; SLH P=0.003, TLH P=0.038). For the SH, only significant differences were found between the involved limb and the normative values in males (P=0.033). CONCLUSION Athletes who have undergone an ACLR demonstrate bilateral deficits on hop tests in comparison to age and sex matched normative data of healthy controls. Using the LSI may underestimate performance deficits and should therefore be analyzed with caution when used as a criterion for RTS after ACLR. LEVEL OF EVIDENCE III, case control study.
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Affiliation(s)
- A Gokeler
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - W Welling
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Medisch Centrum Zuid, Groningen, The Netherlands
| | - A Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Hanze University Applied Science, School of Sport Studies, Groningen, The Netherlands
| | - K Lemmink
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - S Zaffagnini
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
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24
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Grassi A, Nitri M, Moulton SG, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Zaffagnini S. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? a meta-analysis of 32 studies. Bone Joint J 2017; 99-B:714-723. [PMID: 28566389 DOI: 10.1302/0301-620x.99b6.bjj-2016-0929.r2] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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: 09/19/2016] [Accepted: 02/16/2017] [Indexed: 01/02/2023]
Abstract
AIMS Our aim was to perform a meta-analysis of the outcomes of revision anterior cruciate ligament (ACL) reconstruction, comparing the use of different types of graft. MATERIALS AND METHODS A search was performed of Medline and Pubmed using the terms "Anterior Cruciate Ligament" and "ACL" combined with "revision", "re-operation" and "failure". Only studies that reported the outcome at a minimum follow-up of two years were included. Two authors reviewed the papers, and outcomes were subdivided into autograft and allograft. Autograft was subdivided into hamstring (HS) and bone-patellar tendon-bone (BPTB). Subjective and objective outcome measures were analysed and odds ratios with confidence intervals were calculated. RESULTS A total of 32 studies met the inclusion criteria. Five studies used HS autografts, eight reported using BPTB autografts, two used quadriceps tendon autografts and eight used various types. Seven studies reported using allografts, while the two remaining used both BPTB autografts and allografts. Overall, 1192 patients with a mean age of 28.7 years (22.5 to 39) and a mean follow-up of 5.4 years (2.0 to 9.6) were treated with autografts, while 269 patients with a mean age of 28.4 years (25 to 34.6) and a mean follow-up of 4.0 years (2.3 to 6.0) were treated with allografts. Regarding allografts, irradiation with 2.5 mrad was used in two studies while the graft was not irradiated in the seven remaining studies. Reconstructions following the use of autografts had better outcomes than those using allograft with respect to laxity, measured by KT-1000/2000 (MEDmetric Corporation) and the rates of complications and re-operations. Those following the use of allografts had better mean Lysholm and Tegner activity scores compared with autografts. If irradiated allografts were excluded from the analysis, outcomes no longer differed between the use of autografts and allografts. Comparing the types of autograft, all outcomes were similar except for HS grafts which had better International Knee Documentation Committee scores compared with BPTB grafts. CONCLUSION Autografts had better outcomes than allografts in revision ACL reconstruction, with lower post-operative laxity and rates of complications and re-operations. However, after excluding irradiated allografts, outcomes were similar between autografts and allografts. Overall, the choice of graft at revision ACL reconstruction should be on an individual basis considering, for instance, the preferred technique of the surgeon, whether a combined reconstruction is required, the type of graft that was previously used, whether the tunnels are enlarged and the availability of allograft. Cite this article: Bone Joint J 2017;99-B:714-23.
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Affiliation(s)
- A Grassi
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
| | - M Nitri
- Orthopedic Institute Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - S G Moulton
- Oregon Health & Science University, 3181 SW, Sam Jackson Park Rd, Portland, Oregon, USA
| | | | - A Bondi
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
| | - M Romagnoli
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
| | - S Zaffagnini
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
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25
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De Fine M, Romagnoli M, Toscano A, Bondi A, Nanni M, Zaffagnini S. Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2017; 103:349-355. [PMID: 28159679 DOI: 10.1016/j.otsr.2016.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 10/17/2016] [Revised: 12/16/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED Benefits of femoral offset restoration during total hip arthroplasty should be the reduction of bearing surfaces wear, implant loosening and dislocation rates. Modular neck stems ensure offset customization but fretting corrosion and catastrophic failures are well-documented complications. Since clinical evidences are needed to substantiate the effectiveness of femoral offset restoration and promote modular neck choice, we systematically reviewed the literature to ascertain whether femoral offset itself has a proven clinical influence: (1) on bearing surfaces wear, (2) implant loosening, (3) and dislocation rates. A systematic literature screening was conducted to find papers dealing with the influence of femoral offset on wear, dislocation and loosening, including articles with conventional radiographic femoral offset assessment and with comparative design. Observational studies, case reports, instructional course lectures, cadaveric and animal studies as well as biomechanical studies, letters to the editor, surgical techniques or technical notes were all excluded. No limits about publication date were supplied but only papers in English were taken into account. Data were extracted into an anonymous spreadsheet. Offset values, dislocation rates, wear rates, follow-up and surgical approaches were all detailed. Ten manuscripts were finally selected. A statistically significant correlation between femoral offset restoration and the reduction of conventional ultrahigh-molecular-weight polyethylene wear was found in two out of three papers investigating this issue, but no correlations were found between femoral offset and dislocation rates or implant loosening. Femoral offset modification influences ultrahigh-molecular-weight polyethylene liners wear, but no correlation was found with dislocation rates or implant loosening. Advantages on wear can be counterbalanced by the use of hard bearing surfaces or highly cross-linked polyethylene liners, besides the availability of larger femoral heads improving implant stability further reduces the importance of femoral offset restoration by means of modularity. We believe that efforts in restoring femoral offset during total hip arthroplasty do not translate into tangible clinical profits and consequently, we do not advise the routinely usage of modular neck stems in total hip arthroplasty. LEVEL OF EVIDENCE level III, systematic review of case-control studies.
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Affiliation(s)
- M De Fine
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy.
| | - M Romagnoli
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - A Toscano
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - A Bondi
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - M Nanni
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - S Zaffagnini
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
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26
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Bonanzinga T, Signorelli C, Grassi A, Lopomo N, Bragonzoni L, Zaffagnini S, Marcacci M. Kinematics of ACL and anterolateral ligament. Part I: Combined lesion. Knee Surg Sports Traumatol Arthrosc 2017; 25:1055-1061. [PMID: 27631644 DOI: 10.1007/s00167-016-4259-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 03/01/2016] [Accepted: 07/29/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To quantify the influence of ALL lesions on static and dynamic laxity in ACL-deficient knee. METHODS The study was performed in 10 fresh-frozen knees. The joints were analysed in the following conditions: intact, ACL resection and ACL + ALL resection. Testing parameters were defined as: anterior displacement at 30° and 90° of flexion (AP30, AP90) applying a manual-maximum load; internal rotation at 30° and 90° of flexion (INT30, INT90) applying a 5 N m torque and internal rotation and acceleration during manual pivot-shift (PS) test. Kinematics was acquired by a navigation system; a testing rig and a torquemeter were used to control the limb position and the applied torque. Paired Student's t test was conducted to assess statistical difference, and significance was set at P < 0.05. RESULTS The ALL resection determined a significant increase in terms of internal rotation (INT30 P = 0.02, INT90 P = 0.03), while AP30 (P n.s) and AP90 (P n.s) were not affected. ALL resection produced a significant increase in terms of acceleration during PS test (P < 0.01), but no significant change in PS internal rotation was observed. CONCLUSION The ALL plays a significant role in controlling static internal rotation and acceleration during PS test. On the other hand, ALL resection did not produce any significant change in terms of anterior displacement. A trend was seen for the internal rotation during the pivot-shift test to increase after ALL resection was higher when compared to the intact and isolated ACL lesion states; however, the differences were not significant. The results highlight the clinical relevance of this structure that should be assessed before an ACL reconstruction in order to avoid residual laxity.
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Affiliation(s)
- T Bonanzinga
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy. .,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.
| | - C Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - A Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - N Lopomo
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia, BS, Italy
| | - L Bragonzoni
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - S Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - M Marcacci
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
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27
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Filardo G, Kon E, Perdisa F, Sessa A, Di Martino A, Busacca M, Zaffagnini S, Marcacci M. Polyurethane-based cell-free scaffold for the treatment of painful partial meniscus loss. Knee Surg Sports Traumatol Arthrosc 2017; 25:459-467. [PMID: 27395355 DOI: 10.1007/s00167-016-4219-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 02/16/2016] [Accepted: 06/14/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to document, at mid-term follow-up, the clinical and MRI outcome of a polyurethane-based cell-free scaffold implanted to treat painful partial meniscus loss. METHODS Eighteen consecutive patients were enrolled and treated with arthroscopic polyurethane meniscal scaffold implantation and, in case of other comorbidities, with concurrent surgical procedures: 16 patients (9 men and 7 women, mean age 45 ± 13 years, mean BMI 25 ± 3, 12 medial and 4 lateral implants) were prospectively evaluated with the subjective and objective IKDC and the Tegner scores at 24, 36, 48, 60, and 72 months of follow-up. Eleven patients were also evaluated by 1.5-T MRI at the final follow-up. RESULTS The IKDC subjective score showed a significant improvement from baseline to 24 months (45.6 ± 17.5 and 75.3 ± 14.8, respectively; p = 0.02) and subsequent stable results over time for up to 72 months (final score 75.0 ± 16.8). The Tegner score improvement between pre-operative status and final follow-up was also significant (p = 0.039). Nevertheless, the final score remained significantly lower than the pre-injury sports activity level (p = 0.027). High-resolution MRIs documented the presence of abnormal findings in terms of morphology, signal intensity, and interface between the implant and the native meniscus. Implant extrusion and bone oedema at the treated compartment were also observed in most of the cases, even though no correlation was found between imaging findings and clinical outcome. CONCLUSIONS The present study reports satisfactory clinical outcomes at mid-term follow-up after polyurethane-based meniscal cell-free scaffold implantation. The treatment was effective both in cases of isolated partial meniscal lesions and in complex cases requiring the combination with other surgical procedures. On the other hand, a high rate of altered MRI aspects was documented. However, no correlation was found between the altered imaging parameters and the overall positive clinical findings, thus supporting the use of this procedure to treat painful partial meniscus loss. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- G Filardo
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.,Bologna University, Bologna, Italy
| | - E Kon
- Bologna University, Bologna, Italy.,Laboratory of NanoBiotechnology (NABI), Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - F Perdisa
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - A Sessa
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
| | - A Di Martino
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - M Busacca
- Diagnostic and Interventional Radiology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - S Zaffagnini
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.,Bologna University, Bologna, Italy
| | - M Marcacci
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.,Bologna University, Bologna, Italy
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28
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Bontempi M, Cardinale U, Bragonzoni L, Macchiarola L, Grassi A, Signorelli C, Marcheggiani Muccioli G, Zaffagnini S. Total knee replacement: intraoperative and postoperative kinematic assessment. Acta Biomed 2017. [PMID: 28657561 PMCID: PMC6179007 DOI: 10.23750/abm.v88i2-s.6509] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIM The main goals of the total knee arthroplasty (TKA) is to reduce the perceived pain and restore knee mobility and function in case of osteoarthritic knees joints. Literature shows how the three major causes of TKA failures are related to wear, loosening and instability and this is due to a problem of imbalance and malalignment. Intraoperative and postoperative kinematics analysis could be of benefit for improving surgery outcome. The aim of the present paper is to give an overview of the two set-up with the highest accuracy for intraoperative and postoperative TKA kinematics evaluation, currently in use at Istituto Ortopedico Rizzoli. Introperative and Postoperative Evaluation: For intraoperative evaluation it has been presented a navigation system with a specifically developed software, while for the postoperative it has been presented the roentgen stereophotogrammetric analysis (RSA). The navigation system consists in a laptop connected with an optoelectronic localizer (Polaris, Northern Digital Inc, Canada). Two reference arrays with passive optical markers and a marked probe are used to localize the knee joint in the 3D space and track the joint kinematics. The RSA is a radiographic technique used in orthopaedic field for measuring micromotion at bone/prosthesis interface or for joint kinematics evaluation. The RSA uses two X-ray sources synchronized with two digital flat-panels. CONCLUSIONS The present paper shows that using the navigation system allows the surgeon to easily perform kinematic and alignment evaluation during TKA surgery while the RSA allows a quantitative evaluation of the joint kinematics during the recovery time.
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Affiliation(s)
- M. Bontempi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna (BO), Italy,Dipartimento di Scienze Biomediche e Neuromotorie – DIBINEM, Università di Bologna (BO), Italy
| | - U. Cardinale
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna (BO), Italy,Dipartimento di Scienze Biomediche e Neuromotorie – DIBINEM, Università di Bologna (BO), Italy
| | - L. Bragonzoni
- Dipartimento di Scienze Biomediche e Neuromotorie – DIBINEM, Università di Bologna (BO), Italy
| | - L. Macchiarola
- Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - A. Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna (BO), Italy,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - C. Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - G.M. Marcheggiani Muccioli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna (BO), Italy,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - S. Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna (BO), Italy,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy,Correspondence: Prof. Stefano Zaffagnini Istituto Ortopedico Rizzoli Laboratorio di Biomeccanica e Innovazione Tecnologica Via Di Barbiano 1/10 40136 Bologna (BO), Italy Tel. 0039 051 6366507 Fax 0039 051 583789 E-mail:
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29
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Kon E, Muttini A, Arcangeli E, Delcogliano M, Filardo G, Nicoli Aldini N, Pressato D, Quarto R, Zaffagnini S, Marcacci M. Erratum: Novel nanostructured scaffold for osteochondral regeneration: pilot study in horses. J Tissue Eng Regen Med 2016; 10:981. [DOI: 10.1002/term.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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30
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Signorelli C, Filardo G, Bonanzinga T, Grassi A, Zaffagnini S, Marcacci M. ACL rupture and joint laxity progression: a quantitative in vivo analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:3605-3611. [PMID: 27273022 DOI: 10.1007/s00167-016-4158-2] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/27/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE Benefits of an early reconstruction and the optimal time lapse between injury and surgery to reduce the effects of altered kinematics in ACL-deficient knees are still controversial. AIM The aim of this study was to clarify, through a quantitative in vivo evaluation, the effects of the time lapse between ACL injury and surgery in terms of changes in the pre-operative knee laxity. METHODS An in vivo study was performed on 99 patients who underwent ACL surgery. Just before the graft fixation, six laxity tests were performed for all the subjects at manual-maximum load: anterior-posterior displacement and internal-external rotation at 30° and 90° of knee flexion (AP30, AP90, IE30, IE90) as well as varus-valgus rotation (VV0, VV30) at 0° and 30° of flexion. Kinematics data were acquired by a navigation system. The Spearman rank correlation was used to assess correlation between rank and continuous data. Significance was set at P = 0.05. RESULTS The analysis highlighted a significant influence of the injury-to-surgery time lapse on VV0 and AP90 compared with pre-operative laxity levels. Meniscus status also significantly affected the pre-operative laxity in the VV0 (Spearman's ρ = 0.203, P = 0.038; GLM with meniscal correction partial η = 0.27, P = 0.007) and AP90 (Spearman's ρ = 0.329, P = 0.001; GLM with meniscal correction partial η = 0.318, P = 0.017) tests. CONCLUSION The main finding of this study is that patients with ACL rupture and a higher injury-to-surgery time present higher values of knee laxity involving AP90 displacement and VV30 rotation. Clinical relevance of the study is that ACL-deficient joint laxity, involving anterior-posterior displacement at 90° of knee flexion and varus-valgus rotation at 0° of flexion, is significantly affected by the lapse of injury-to-surgery time. This highlights the importance of considering the effects of delaying surgery when managing patients with such deficiency.
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Affiliation(s)
- C Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.
| | - G Filardo
- Laboratorio Nano-Biotechnology NaBi, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - T Bonanzinga
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - A Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Univeristà di Bologna, Bologna, Italy
| | - M Marcacci
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Univeristà di Bologna, Bologna, Italy
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31
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Zaffagnini S, Signorelli C, Bonanzinga T, Roberti Di Sarsina T, Grassi A, Budeyri A, Marcheggiani Muccioli GM, Raggi F, Bragonzoni L, Lopomo N, Marcacci M. Technical variables of ACL surgical reconstruction: effect on post-operative static laxity and clinical implication. Knee Surg Sports Traumatol Arthrosc 2016; 24:3496-3506. [PMID: 27628740 DOI: 10.1007/s00167-016-4320-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/21/2016] [Accepted: 09/02/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The hypothesis was that an alteration of different surgical variables of ACL reconstruction would produce significant changes in post-operative static laxity of knee joint. METHODS Joint laxity was acquired by a surgical navigation system for 17 patients just after graft fixation during single-bundle reconstruction with extra-articular lateral tenodesis. The analysed laxity parameters were: internal/external rotation at 30° (IE30) and 90° (IE90) of flexion, varus/valgus rotation at 0° (VV0) and 30° (VV30) of flexion and anterior/posterior displacement at 30° (AP30) and 90° (AP90) of flexion. As surgical variables, the angles between the tibial tunnel and the three planes were defined as well as the lengths of the tunnel and the relationship between native footprints and tunnels. The same analysis was performed for the femoral side. All surgical variables were combined in a multivariate analysis to assess for predictive factors between them and post-operative laxities values. To quantify the performance of each multivariate model, the correlation ratio (η 2) and the corresponding P value (*P < 0.050) have been evaluated. RESULTS Multivariate analysis underlined statistically significant models for the estimation of: AP30 (η 2 = 0.987; P = 0.014), IE30 (η 2 = 0.995; P = 0.005), IE90 (η 2 = 0.568; P = 0.010), VV0 (η 2 = 0.932; P = 0.003). The parameters that greatly affected the identified models were the orientation of the tibial tunnel with respect to the three anatomical planes. The estimation of AP30, IE30 and IE90 got lower value as the orientation of the tibial tunnel with respect to transverse plane decreases. Considering the orientation to sagittal ([Formula: see text]) and coronal ([Formula: see text]) plane, we found that their reduction provoked a decrease in the estimation of AP30, IE30 and IE90 (except [Formula: see text] that did not appear in the estimation of AP30). The estimation of VV0 got an increase of [Formula: see text], and [Formula: see text] which led to a laxity reduction. CONCLUSION The main finding of the present in vivo study was the possibility to determine significant effects on post-operative static laxity level of different surgical variables of ACL reconstruction. In particular, the present study defined the conditions that minimize the different aspects of post-operative laxity at time-zero after surgery.
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Affiliation(s)
- S Zaffagnini
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy. .,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy. .,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy. .,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy.
| | - C Signorelli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy
| | - T Bonanzinga
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - T Roberti Di Sarsina
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - A Grassi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy
| | - A Budeyri
- Orthopaedics and Traumatology, SANKO University, Gaziantep, Turkey
| | - G M Marcheggiani Muccioli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
| | - F Raggi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - L Bragonzoni
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
| | - N Lopomo
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia (BS), Italy
| | - M Marcacci
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
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32
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Zaffagnini S, Deep K, Confalonieri N. Future perspective of CAS in orthopaedics. Knee Surg Sports Traumatol Arthrosc 2016; 24:3379-3380. [PMID: 27405578 DOI: 10.1007/s00167-016-4239-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- S Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, BO, Italy. .,Clinica Ortopedica e Trumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.
| | - K Deep
- Department of Orthopaedics, Golden Jubilee National Hospital, Glasgow, UK
| | - N Confalonieri
- Reparto di Ortopedia e Traumatologia, Ospedale C.T.O, Milano, MI, Italy
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33
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Zaffagnini S, Signorelli C, Bonanzinga T, Grassi A, Galán H, Akkawi I, Bragonzoni L, Cataldi F, Marcacci M. Does meniscus removal affect ACL-deficient knee laxity? An in vivo study. Knee Surg Sports Traumatol Arthrosc 2016; 24:3599-3604. [PMID: 27371290 DOI: 10.1007/s00167-016-4222-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 07/30/2015] [Accepted: 06/16/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of the present study was to determine, in vivo, the effect of different types of meniscectomy on an ACL-deficient knee. METHODS Using a computer-assisted navigation system, 56 consecutive patients (45 men and 11 women) were subjected to a biomechanical testing with Lachman test (AP30), drawer test (AP90), internal/external rotation test, varus/valgus rotation test and pivot-shift test. The patients were divided into three groups according to the status of the medial meniscus. Group BH, 8 patients with bucket-handle tear of medial meniscus underwent a subtotal meniscectomy; Group PHB, 19 patients with posterior horn body of medial meniscus tear underwent a partial meniscectomy; and Group CG with isolated ACL rupture, as a control group, with 29 patients. RESULTS A significant difference in anterior tibial translation was seen at 30 grades and in 90 grades between BH and PHB groups compared to the CG. In response to pivot-shift test, no significant differences in terms of AREA and POSTERIOR ACC were found among the three groups (n.s). Concerning the anterior displacement of the pivot shift a statistically significant differences among the three tested groups was found. CONCLUSION The present study shows that meniscal defects significantly affect the kinematics of an ACL-deficient knee in terms of anterior tibial translation under static and dynamic testing.
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Affiliation(s)
- S Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - C Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.
| | - T Bonanzinga
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - A Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - H Galán
- Instituto Dr. Jaime Slullitel, Rosario, Santa Fe, Argentina
| | - I Akkawi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - L Bragonzoni
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - F Cataldi
- Anestesia e terapia intensiva post operatoria e del dolore, Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - M Marcacci
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
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Signorelli C, Bonanzinga T, Grassi A, Lopomo N, Zaffagnini S, Marcacci M. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis. Comput Methods Biomech Biomed Engin 2016; 19:1610-7. [PMID: 27123692 DOI: 10.1080/10255842.2016.1176152] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome.
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Affiliation(s)
- C Signorelli
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy
| | - T Bonanzinga
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - A Grassi
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - N Lopomo
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,c Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia , Brescia , Italy
| | - S Zaffagnini
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - M Marcacci
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
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35
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Musahl V, Zaffagnini S, LaPrade R, Hirschmann MT, Karlsson J. The challenge of treating complex knee instability. Knee Surg Sports Traumatol Arthrosc 2015; 23:2769-70. [PMID: 26037547 DOI: 10.1007/s00167-015-3665-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- V Musahl
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy.
| | - S Zaffagnini
- Università di Bologna, Dipartimento Scienze Biomediche e Neuromotorie, Bologna (BO), Italy
| | - R LaPrade
- Università di Bologna, Dipartimento Scienze Biomediche e Neuromotorie, Bologna (BO), Italy
| | - M T Hirschmann
- Università di Bologna, Dipartimento Scienze Biomediche e Neuromotorie, Bologna (BO), Italy
| | - J Karlsson
- Università di Bologna, Dipartimento Scienze Biomediche e Neuromotorie, Bologna (BO), Italy
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36
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Bruni D, Bragonzoni L, Bontempi M, Iacono F, Neri MP, Bignozzi S, Zaffagnini S, Marcacci M. DOES TOTAL KNEE REPLACEMENT MODIFY FLEXION AXIS OF THE KNEE ON FRONTAL AND AXIAL PLANE REGARDLESS FROM LIMB ALIGNMENT? J BIOL REG HOMEOS AG 2015; 29:121-129. [PMID: 26652498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The optimal reference for rotational positioning of femoral component in total knee replacement (TKR) is debated. Navigation has been suggested for intra-op acquisition of patients specific kinematics and functional flexion axis (FFA). The main purpose of the present study is to prospectively investigate whether pre-operative FFA in patients with osteoarthritis (OA) and varus alignment changes after TKR and whether a correlation exists between post-op FFA and pre-op alignment. A navigated TKR was performed in 108 patients using a specific software to acquire passive joint kinematics before and after TKR. The knee was cycled through three passive range of motions (PROM), from 0° to 120°. FFA was computed using the mean helical axis algorithm. The angle between FFA and surgical TEA was determined on frontal (αf) and axial (αa) plane. The pre- and post-op hip-knee-ankle angle (HKA) was determined. Post-op FFA was different from pre-op FFA only on frontal plane. No significant difference was found on axial plane. No correlation was found between HKA-pre and αA-pre. A significant correlation was found between HKA-pre and αFpre. The study concluded that TKR modifies FFA only on frontal plane. No difference was found on axial plane. Pre-op FFA is in a more varus position respect to TEA. The position of FFA on frontal plane is dependent on limb alignment. The present study has demonstrated TKR modifies the position of FFA only on frontal plane. The position of FFA on axial plane is not dependent on the amount of varus deformity and is not influenced by TKR. Level of evidence, IV, case series.
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Affiliation(s)
- D Bruni
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - L Bragonzoni
- Biomedical and Neuromotor Sciences - DIBINEM - The Alma Mater Studiorum, University of Bologna, Italy
| | - M Bontempi
- Biomechanics Laboratory, Codivilla-Putti Research Center, Bologna, Italy
| | - F Iacono
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - M P Neri
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - S Zaffagnini
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - M Marcacci
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy; Biomechanics and Technologic Innovation Laboratory and Nanobiotechnology Laboratory, Codivilla-Putti Research Center, Bologna University, Italy
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Cinti F, Signorelli C, Lopomo N, Baracchi M, Del Magno S, Foglia A, Zaffagnini S, Pisoni L. Two different approaches for novel extracapsular cranial cruciate ligament reconstruction: an in vitro kinematics study. J Small Anim Pract 2015; 56:398-406. [DOI: 10.1111/jsap.12348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 12/27/2022]
Affiliation(s)
- F. Cinti
- Centro Veterinario Luni Mare; Ortonovo (SP) Italy
- Dipartimento di Scienze Mediche Veterinarie; Università di Bologna; Ozzano dell'Emilia (BO) Italy
| | - C. Signorelli
- Istituto Ortopedico Rizzoli; Laboratorio di Biomeccanica e Innovazione Tecnologica; Bologna (BO) Italy
| | - N. Lopomo
- Istituto Ortopedico Rizzoli; Laboratorio di Biomeccanica e Innovazione Tecnologica; Bologna (BO) Italy
- Istituto Ortopedico Rizzoli; Laboratorio di NanoBiotecnologie-NaBi; Bologna (BO) Italy
| | - M. Baracchi
- Istituto Ortopedico Rizzoli; Laboratorio di Biomeccanica e Innovazione Tecnologica; Bologna (BO) Italy
| | - S. Del Magno
- Dipartimento di Scienze Mediche Veterinarie; Università di Bologna; Ozzano dell'Emilia (BO) Italy
| | - A. Foglia
- Dipartimento di Scienze Mediche Veterinarie; Università di Bologna; Ozzano dell'Emilia (BO) Italy
| | - S. Zaffagnini
- Istituto Ortopedico Rizzoli; Laboratorio di Biomeccanica e Innovazione Tecnologica; Bologna (BO) Italy
| | - L. Pisoni
- Dipartimento di Scienze Mediche Veterinarie; Università di Bologna; Ozzano dell'Emilia (BO) Italy
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Zaffagnini S, Fink C, Grassi A, Marcheggiani Muccioli G, Marcacci M. Meniskusimplantate. Arthroskopie 2015. [DOI: 10.1007/s00142-014-0837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Iacono F, Raspugli GF, Bruni D, Filardo G, Zaffagnini S, Luetzow WF, Lo Presti M, Akkawi I, Marcheggiani Muccioli GM, Marcacci M. The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre. Knee Surg Sports Traumatol Arthrosc 2014; 22:3034-8. [PMID: 24362919 DOI: 10.1007/s00167-013-2809-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/30/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The restoration of the normal joint line (JL) is important both in primary and revision total knee arthroplasty (TKA). However, the assessment of the femoro-tibial JL is still controversial. A strong correlation between femoral width (FW) and distance from adductor tubercle (AT) to JL was found on radiographs, with a ratio of 0.54. The hypothesis was that this ratio was applicable also in the surgical theatre by using measurements obtained intra-operatively with a caliper. METHODS Femoral width, AT to JL distance and the RATIO between AT to JL distance and FW of 40 patients who underwent TKA were measured on radiograph and intra-operatively. Bland-Altman agreement tests with repeated measurements and linear regression analysis were used. The ratio was used to estimate the distance between JL and AT. RESULTS The AT to JL distance/FW ratio calculated with linear regression resulted 0.54 for radiographic measurements and 0.53 for intra-operative measurements. There was no difference (0.009 ± 0.03) between the calculated ratios on radiographic and intra-operative measurements, and the correlation between intra-operative and radiographic measurements was 0.5 (p = 0.0016). CONCLUSIONS This study shows that the validity of the radiographic method which uses an AT to JL distance/FW ratio to determine the level of the JL is confirmed also when using intra-operatively acquired measurements. Thus, this ratio represents a reliable tool to determine the JL level even in challenging prosthetic revision cases when the anatomical JL is missing. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- F Iacono
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy,
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Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Tsapralis K, Ricci M, Bragonzoni L, Della Villa S, Marcacci M. Return to sport after anterior cruciate ligament reconstruction in professional soccer players. Knee 2014; 21:731-5. [PMID: 24593869 DOI: 10.1016/j.knee.2014.02.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [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: 09/19/2013] [Revised: 01/12/2014] [Accepted: 02/03/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND To investigate time to return to sport and rate of professional sport activity in a homogenous group of competitive soccer players 4 years after anterior cruciate ligament (ACL) reconstruction and rehabilitation. METHODS Twenty-one male professional soccer players (mean age 22.9±5.4 years) underwent non-anatomical double-bundle autologous hamstring ACL reconstruction and followed the same rehabilitative protocol. Clinical evaluation was performed preoperatively and at 3, 6 and 12-month follow-up. Data regarding return to train and official match, sport activity, complications and revision surgeries were collected at 4-year follow-up. RESULTS Laxity test (KT-2000) and total KOOS mean score resulted in a significant improvement from the preoperative status to the 12-month follow-up (p<0.0001). The KOOS mean value showed a significant progressive improvement from the preoperative status to 6-month follow-up (p=0.0010) as well, while values collected at 6 and 12-month follow-up were comparable (p=0.2349). Returned to official matches 186±53 days after surgery. After 12 months, 95% came back to the same activity level performed before injury. Four years after ACL reconstruction, 15 patients (71%) were still playing competitive soccer. One patient (5%) underwent ACL failure and subsequent revision. CONCLUSIONS The ACL reconstruction with the presented technique followed by patient-tailored rehabilitation, allowed 95% and 62% professional male soccer players to return to the same sport activity 1 year and 4 years after surgery respectively. However, 71% were still able to play competitive soccer at final follow-up. Clinical scores were restored after 6 months. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- S Zaffagnini
- II Clinica Ortopedica e Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- II Clinica Ortopedica e Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G M Marcheggiani Muccioli
- II Clinica Ortopedica e Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - K Tsapralis
- Isokinetic FIFA Medical Centre of Excellence, Bologna, Italy
| | - M Ricci
- Isokinetic FIFA Medical Centre of Excellence, Bologna, Italy
| | - L Bragonzoni
- II Clinica Ortopedica e Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Della Villa
- Isokinetic FIFA Medical Centre of Excellence, Bologna, Italy
| | - M Marcacci
- II Clinica Ortopedica e Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Bouyarmane H, Beaufils P, Pujol N, Bellemans J, Roberts S, Spalding T, Zaffagnini S, Marcacci M, Verdonk P, Womack M, Verdonk R. Polyurethane scaffold in lateral meniscus segmental defects: clinical outcomes at 24 months follow-up. Orthop Traumatol Surg Res 2014; 100:153-7. [PMID: 24332925 DOI: 10.1016/j.otsr.2013.10.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 09/09/2013] [Accepted: 10/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Segmental tissue loss in the lateral meniscus is associated with pain and increased risk of osteoarthritis even when indications have been carefully considered. HYPOTHESIS Repairing the defect using a novel biodegradable scaffold will reduce pain and restore the knee function. METHODS In this prospective multicenter study, a total of 54 patients (37 males/17 females; mean age: 28 years [16-50]) were enrolled. All patients presented with postmeniscectomy syndrome and segmental lateral meniscus loss, and were treated with a polyurethane biodegradable scaffold (Actifit(®), Orteq) implanted arthroscopically. Clinical outcomes were assessed at 6, 12 and 24 months using Visual Analogue Scale (VAS), International Knee Documentation Committee Score (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS VAS decreased from 5.5 at baseline to 3.6 at 6 months, 3.4 at 12 months and 2.9 at 24 months. IKDC improved from 47.0 at baseline to 60.2, 67.0 and 67.0 at 6, 12 and 24 months. All KOOS subscores improved between baseline and 24 months. DISCUSSION Clinical results of this study demonstrate clinically and statistically significant improvements of pain and function scores (VAS, IKDC, and all KOOS subscales except sport), at the 6 months follow-up and on all clinical outcomes at the 2-year follow-up. The Actifit(®) scaffold is safe and effective in treating lateral meniscus defects. LEVEL OF EVIDENCE IV continuous prospective multicenter study.
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Affiliation(s)
- H Bouyarmane
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Université Versailles-Saint Quentin, rue de Versailles, 78150 Le Chesnay, France; Orthopaedic Surgery Center, 71, boulevard d'Anfa, Casablanca 20060, Morocco
| | - P Beaufils
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Université Versailles-Saint Quentin, rue de Versailles, 78150 Le Chesnay, France.
| | - N Pujol
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Université Versailles-Saint Quentin, rue de Versailles, 78150 Le Chesnay, France
| | - J Bellemans
- Catholic University Hospitals, Langdorp, Belgium
| | - S Roberts
- Orthopaedic Hospital, Oswestry, United Kingdom
| | - T Spalding
- University Hospitals, Coventry, United Kingdom
| | | | - M Marcacci
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P Verdonk
- Antwerpen Orthopaedic center, Antwerp, Belgium
| | - M Womack
- Orteq Sports Medicine, London, United Kingdom
| | - R Verdonk
- Ghent University Hospital, Ghent, Belgium
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Filardo G, Kon E, Perdisa F, Di Matteo B, Di Martino A, Iacono F, Zaffagnini S, Balboni F, Vaccari V, Marcacci M. Osteochondral scaffold reconstruction for complex knee lesions: a comparative evaluation. Knee 2013; 20:570-6. [PMID: 23810647 DOI: 10.1016/j.knee.2013.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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: 11/19/2012] [Revised: 04/04/2013] [Accepted: 05/24/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The primary aim of the present study is to evaluate the results obtained in challenging knee lesions with the implant of an osteochondral scaffold and concomitant treatment of all comorbidities. The secondary aim is to compare the results obtained with those found when a chondral scaffold was applied. MATERIALS AND METHODS Patients affected by complex lesions of the knee articular surface were included. "Complex cases" were defined according to the following criteria: previous clinical history of intra-articular fracture, lesion located at the tibial plateau, concurrent knee axial realignment procedure, concurrent meniscal scaffold or allograft implantation, and multiple articular surface lesions treated. Thirty-three patients were treated with the implantation of an osteochondral scaffold. The results of a homogeneous group of 23 patients previously treated and prospectively evaluated after implantation of a chondral scaffold were analyzed and compared. RESULTS IKDC subjective score improved significantly from pre-operative (40.4±14.1) to 12months' follow-up (69.6±17.0; p<0.0005) with a further improvement at the final evaluation at 24months (75.5±15.0; p=0.038). The same positive trend was confirmed by the VAS and Tegner scores. At final follow-up the group treated with the osteochondral scaffold presented a better subjective IKDC score with respect to the group treated with the chondral scaffold (p=0.034). CONCLUSIONS A regenerative procedure to address the entire osteochondral unit, together with the treatment of all comorbidities, might offer good results also in complex cases otherwise doomed to non-biological resurfacing. LEVEL OF EVIDENCE III Comparative study.
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Affiliation(s)
- G Filardo
- Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
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Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, Bonanzinga T, Iacono F, Filardo G. Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc 2013; 21:2509-17. [PMID: 23370980 DOI: 10.1007/s00167-013-2388-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/07/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE Although traditionally not indicated for the treatment of osteoarthritis (OA), regenerative procedures are becoming a focus of increased interest due to their potential to provide pain relief and alter the progression of degenerative diseases. The purpose of this study was to assess whether a combined biomechanical and biological approach could offer good results in unicompartmental OA, thus delaying the need for unicompartmental arthroplasty in patients too young or refusing metal resurfacing. METHODS Forty-three patients (mean age = 40.1 ± 11 years, 33 men and 10 women, mean BMI = 25 ± 3) affected by unicompartmental OA (Kellegren-Lawrence score = 3) in stable joints were enrolled and treated consecutively. Fifteen patients were treated with osteotomy and osteochondral biomimetic scaffold implant (3 of them also with meniscal substitution), 11 with osteotomy and meniscal scaffold implant, 9 with osteotomy and meniscal allograft implant, and 8 with both cartilage and meniscal reconstruction, depending on the specific joint compartment main requirements. Clinical evaluation was performed at 3-year (2-4) median follow-up using the following scoring systems: IKDC subjective and objective, VAS for pain, and Tegner scores. Failures, adverse events, and complications were also reported. RESULTS The IKDC subjective score improved from 47.3 to 79.6 at the final evaluation (p < 0.0005), VAS improved from 6.1 to 2.3 (p < 0.0005), and also sport activity level evaluated with the Tegner score showed a significant improvement, from 2 (1-5) to 4 (3-10; p < 0.0005), even if without achieving the pre-injury level (6, p = 0.001). A further subanalysis confirmed the positive outcome obtained in all the treatment subgroups and showed a higher clinical improvement in patients under the age of 40 years (IKDC subjective 84.4 ± 13.2 vs 76.5 ± 17.3; p = 0.03). CONCLUSION This integrated biological and biomechanical approach produced a marked improvement at short-medium follow-up in patients affected by unicompartmental OA. Even though a good outcome was achieved at all ages, patients under the age of 40 years presented a greater clinical and subjective improvement. Longer follow-up studies are needed to show results over time and confirm this approach as an effective alternative to unicompartmental implants.
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Affiliation(s)
- M Marcacci
- II Orthopaedic Clinic and Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano n. 1/10, 40136, Bologna, Italy,
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Signorelli C, Bonanzinga T, Lopomo N, Marcheggiani Muccioli GM, Bignozzi S, Filardo G, Zaffagnini S, Marcacci M. Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction? Scand J Med Sci Sports 2013; 23:e219-24. [PMID: 23438253 DOI: 10.1111/sms.12059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 11/30/2022]
Abstract
The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique.
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Affiliation(s)
- C Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Marcheggiani Muccioli GM, Grassi A, Setti S, Filardo G, Zambelli L, Bonanzinga T, Rimondi E, Busacca M, Zaffagnini S. Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: pulsed electromagnetic fields therapy. Eur J Radiol 2012; 82:530-7. [PMID: 23219192 DOI: 10.1016/j.ejrad.2012.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/05/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND HYPOTHESIS pulsed electromagnetic fields treatment might improve symptoms in the early stage of spontaneous osteonecrosis of the knee. METHODS Twenty-eight patients (19M/9F, age 49.8±16.4 years) suffering from symptomatic (pain) Koshino stage I spontaneous osteonecrosis of the knee, confirmed by magnetic resonance imaging (MRI) were treated with local pulsed electromagnetic fields therapy (6 h daily for 90 days). Clinical evaluation: baseline, 6- and 24-month follow-up by VAS for pain, knee society score (KSS), Tegner and EQ-5D scales. MRI evaluation: baseline and 6-month follow-up, measuring bone marrow lesion's areas and grading these lesions by WORMS score. Failures: patients undergoing knee arthroplasty. RESULTS Pain significantly reduced at 6 months (from 73.2±20.7 to 29.6±21.3, p<0.0001), which remained almost unchanged at final follow-up (27.0±25.1). KSS significantly increased in first 6 months (from 34.0±13.3 to 76.1±15.9, p<0.0001) and was slightly reduced at final follow-up (72.5±13.5, p=0.0044). Tegner median level increased from baseline to 6-month follow-up (1(1-1) and 3(3-4), respectively, p<0.0001) and remained stable. EQ-5D improved significantly throughout the 24 months (0.32±0.33, baseline; 0.74±0.23, 6-month follow-up (p<0.0001); 0.86±0.15, 24-month follow-up (p=0.0071)). MRI evaluation: significant reduction of total WORMS mean score (p<0.0001) and mean femoral bone marrow lesion's area (p<0.05). This area reduction was present in 85% and was correlated to WORMS grading both for femur, tibia and total joint (p<0.05). Four failures (14.3%) at 24-month follow-up. CONCLUSIONS Pulsed electromagnetic fields stimulation significantly reduced knee pain and necrosis area in Koshino stage I spontaneous osteonecrosis of the knee already in the first 6 months, preserving 86% of knees from prosthetic surgery at 24-month follow-up. No correlation was found between MRI and clinical scores. LEVEL OF EVIDENCE Level IV; case series.
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Affiliation(s)
- G M Marcheggiani Muccioli
- Isituto Ortopedico Rizzoli, University of Bologna, III Orthopaedic and Traumatologic Clinic and Biomechanics Laboratory Via di Barbiano, 1/10, 40136 Bologna (BO), Italy.
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Colombet P, Jenny JY, Menetrey J, Plaweski S, Zaffagnini S. Current concept in rotational laxity control and evaluation in ACL reconstruction. Orthop Traumatol Surg Res 2012; 98:S201-10. [PMID: 23153665 DOI: 10.1016/j.otsr.2012.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
Rotation combined with translation; compose the three-dimensional motion of the knee subluxation in anterior cruciate ligament deficient knee. The worldwide scientists were focused initially on the translation part of this complex 3D motion, but since the beginning of the century there was a large interest on knee rotational laxity study. Lot of paper reported new devices and results with an explosion since the beginning of the decade. The purpose of this review is to provide an extensive critical analysis of the literature and clarify the knowledge on this topic. We will start with a dismemberment of different rotational laxities reported: the rotation coupled with translation in 2D tests such as Lachman test and anterior drawer test; the rotational envelope considering the maximum internal external rotation; and the "active rotation" occurring in 3D Pivot-shift (PS) test. Then we will analyze the knee kinematics and the role of different anterior cruciate ligament (ACL) bundle on rotation. A review of different mechanical and radiological devices used to assess the different rotations on ACL deficient knees will be presented. Two groups will be analyzed, dynamic and static conditions of tests. Navigation will be described precisely; it was the starter of this recent interest in rotation studies. Opto electronic and electromagnetic navigation systems will be presented and analyzed. We will conclude with the last generation of rotational laxity assessment devices, using accelerometers, which are very promising.
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Affiliation(s)
- P Colombet
- Clinique du sport, 9, rue Jean-Moulin, 33700 Mérignac, France.
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Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, Puddu G, Rodkey WG, Verdonk P, Verdonk R, Zaffagnini S, Marcacci M. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc 2012; 20:468-86. [PMID: 22068267 DOI: 10.1007/s00167-011-1714-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/06/2011] [Indexed: 11/24/2022]
Abstract
UNLABELLED Young patients with early osteoarthritis (OA) represent a challenging population due to a combination of high functional demands and limited treatment options. Conservative measures such as injection and physical therapy can provide short-term pain relief but are only palliative in nature. Joint replacement, a successful procedure in the older population, is controversial in younger patients, who are less satisfied and experience higher failure rates. Therefore, while traditionally not indicated for the treatment of OA, cartilage repair has become a focus of increased interest due to its potential to provide pain relief and alter the progression of degenerative disease, with the hope of delaying or obviating the need for joint replacement. The field of cartilage repair is seeing the rapid development of new technologies that promise greater ease of application, less demanding rehabilitation and better outcomes. Concurrent procedures such as meniscal transplantation and osteotomy, however, remain of crucial importance to provide a normalized biomechanical environment for these new technologies. LEVEL OF EVIDENCE Systematic review, Level II.
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Affiliation(s)
- A H Gomoll
- Cartilage Repair Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Gomoll AH, Filardo G, de Girolamo L, Espregueira-Mendes J, Marcacci M, Rodkey WG, Steadman JR, Zaffagnini S, Kon E. Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc 2012; 20:450-66. [PMID: 22113219 DOI: 10.1007/s00167-011-1780-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/08/2011] [Indexed: 01/30/2023]
Abstract
Young patients with early osteoarthritis (OA) represent a challenging population due to a combination of high functional demands and limited treatment options. Conservative measures such as injection and physical therapy can provide short-term pain relief but are only palliative in nature. Joint replacement, a successful procedure in the older population, is controversial in younger patients, who are less satisfied and experience higher failure rates. Therefore, while traditionally not indicated for the treatment of OA, cartilage repair has become a focus of increased interest due to its potential to provide pain relief and alter the progression of degenerative disease, with the hope of delaying or obviating the need for joint replacement. This review of cartilage repair techniques will discuss currently available procedures, specifically pertaining to experiences in the setting of early OA. Level of evidence IV.
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Affiliation(s)
- A H Gomoll
- Cartilage Repair Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Zaffagnini S, Bonanzinga T, Marcheggiani Muccioli GM, Giordano G, Bruni D, Bignozzi S, Lopomo N, Marcacci M. Does chronic medial collateral ligament laxity influence the outcome of anterior cruciate ligament reconstruction?: a prospective evaluation with a minimum three-year follow-up. ACTA ACUST UNITED AC 2011; 93:1060-4. [PMID: 21768629 DOI: 10.1302/0301-620x.93b8.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We have shown in a previous study that patients with combined lesions of the anterior cruciate (ACL) and medial collateral ligaments (MCL) had similar anteroposterior (AP) but greater valgus laxity at 30° after reconstruction of the ACL when compared with patients who had undergone reconstruction of an isolated ACL injury. The present study investigated the same cohort of patients after a minimum of three years to evaluate whether the residual valgus laxity led to a poorer clinical outcome. Each patient had undergone an arthroscopic double-bundle ACL reconstruction using a semitendinosus-gracilis graft. In the combined ACL/MCL injury group, the grade II medial collateral ligament injury was not treated. At follow-up, AP laxity was measured using a KT-2000 arthrometer, while valgus laxity was evaluated with Telos valgus stress radiographs and compared with the uninjured knee. We evaluated clinical outcome scores, muscle girth and time to return to activities for the two groups. Valgus stress radiographs showed statistically significant greater mean medial joint opening in the reconstructed compared with the uninjured knees (1.7 mm (SD 0.9) versus 0.9 mm (SD 0.7), respectively, p = 0.013), while no statistically significant difference was found between the AP laxity and the other clinical parameters. Our results show that the residual valgus laxity does not affect AP laxity significantly at a minimum follow up of three years, suggesting that no additional surgical procedure is needed for the medial collateral ligament in combined lesions.
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Affiliation(s)
- S Zaffagnini
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
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Kon E, Muttini A, Arcangeli E, Delcogliano M, Filardo G, Nicoli Aldini N, Pressato D, Quarto R, Zaffagnini S, Marcacci M. Novel nanostructured scaffold for osteochondral regeneration: pilot study in horses. J Tissue Eng Regen Med 2010; 4:300-8. [PMID: 20049745 DOI: 10.1002/term.243] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present in vivo preliminary experiment is aimed at testing mechanical and biological behaviour of a new nano-structured composite multilayer biomimetic scaffold for the treatment of chondral and osteochondral defects. The three-dimensional biomimetic scaffold (Fin-Ceramica Faenza S.p.A., Faenza-Italy) was obtained by nucleating collagen fibrils with hydroxyapatite nanoparticles, in two configurations, bi- and tri-layered, to reproduce, respectively, chondral and osteochondral anatomy. Chondral defects (lateral condyle) and deep osteochondral defects (medial condyle) were made in the distal epiphysis of the third metacarpal bone of both forelimbs of two adult horses and treated respectively with the chondral and osteochondral grafts. Both animals were euthanised six months follow up. The images obtained at the second look arthroscopy evaluation, performed two months after surgery, demonstrated good filling of the chondral and osteo-chondral defects without any inflammatory reaction around and inside the lesions. At the histological analysis the growth of trabecular bone in the osteochondral lesion was evident. Only in one case, the whole thickness of the osteochondral lesion was filled by fibrocartilaginous tissue. The formation of a tidemark line was evident at the interface with the newly formed bone. Newly formed fibrocartilaginous tissue was present in the area of the chondral defect. Initial alignment of the collagen fibres was recognisable with polarised light in both groups. The results of the present pilot study showed that this novel osteochondral and chondral scaffold may act as a suitable matrix to facilitate orderly regeneration of bone and hyaline-like cartilage.
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Affiliation(s)
- E Kon
- Rizzoli Orthopaedic Instituite, Bologna, Italy
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