Walter Pascale

Istituto Ortopedico Galeazzi, Milano, Lombardy, Italy

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Publications (8)14.4 Total impact

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    ABSTRACT: Purpose To evaluate the long-term functional results of arthroscopic abrasion arthroplasty for the treatment of full-thickness cartilage lesions of the medial femoral condyle. Methods Between 1990 and 1996, 75 consecutive patients with isolated chondral lesions of the medial femoral condyle were treated with arthroscopic chondral abrasion. A retrospective analysis of the clinical results of this cohort was performed. The patients were evaluated according to the Knee Society Score questionnaire preoperatively, at 10 years postoperatively, and at final long-term follow-up at a mean of 20 years. At final follow-up, they were also assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index. Patients were divided according to the lesion size and by age, and the Kaplan-Meier survivorship function (with second operation taken as an endpoint) for the various groups was calculated. Results At a mean of final follow-up of 20 years (range, 16.94 to 23.94 years), a positive functional outcome (Knee Society Score ¥70 points or no reoperation) was recorded in 67.9% of the patients. Twenty-year survivorship in this cohort was 71.4% (95% confidence interval, 0.5690 to 0.8590). The survivorship was 89.5% for patients younger than 50 years and 55.7% for patients aged 50 years or older. The functional results for patients with lesions smaller than 4 cm2 were significantly better than those for patients with lesions of 4 cm2 or greater (P =.031). There were no statistical differences between patients with and without associated lesions at the time of surgery. Conclusions Our hypothesis that there would be survivorship greater than 86% was disproved. However, arthroscopic abrasion arthroplasty can be a valid treatment for medial femoral condylar full-thickness defects of the knee, even in the long-term, particularly for younger patients and those with smaller lesions. Level of Evidence Level IV, therapeutic case series.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2014; 31(3). DOI:10.1016/j.arthro.2014.10.007 · 3.21 Impact Factor
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    ABSTRACT: Background The aim of this study was to investigate the involvement of the nitric oxide (NO) pathway in osteoarthritis (OA). Material/Methods The study groups consisted of 32 patients with knee OA and 31 healthy controls. In peripheral venous blood samples (from the OA patients and the controls) and in synovial fluid samples (from the OA patients), the concentrations of L-arginine (ARN), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) were evaluated. In plasma samples, thiobarbituric acid reactive substances (TBARS) were also measured. Results Plasma ARN concentrations were lower in the OA patients than in controls (53.55±16.37 vs. 70.20±25.68 μmol/l) (P<0.05), while plasma ADMA concentrations were similar. Accordingly, the ARN/ADMA ratio was lower in the OA patients than in the control group (80.85±29.58 vs. 110.51±30.48, P<0.05). Plasma SDMA and TBARS concentrations were higher in the OA patients than in controls (0.69±0.15 vs. 0.60±0.10 μmol/l, P<0.05 and 1.21±0.29 vs. 0.55±0.12, respectively) (P<0.001). In the OA patients, ADMA concentrations were significantly higher in the synovial fluid than in plasma (0.75±0.09 vs. 0.69±0.14 μmol/l, P<0.05), as were ARN concentrations (76.96±16.73 vs. 53.55±16.73 μmol/l) (P<0.00001). Conclusions These results indicate a poor availability of NO in the synovial fluid of the OA patients, which may contribute to the progression of OA. The decreased ARN/ADMA ratio and the increased SDMA and TBARS in the plasma of the OA patients suggest an impairment of endothelial function in these subjects.
    Medical science monitor: international medical journal of experimental and clinical research 11/2013; 19:1057-62. DOI:10.12659/MSM.889275 · 1.43 Impact Factor
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    ABSTRACT: Appropriate limb length (LL) and femoral offset (OS) after total hip arthroplasty (THA) are crucial for a successful and lasting outcome. However, intraoperative assessment is difficult. Computed navigation is effective but the use of radiation and of invasive bone references is cause of concern. Imageless, pinless navigation systems have been shown to be accurate in experimental studies. However, almost no clinical validation has been performed. We used a minimally-invasive computer-navigated system (MICNS) in conjunction with an imageless measurement technique for implanting 60 consecutive THAs. Head/neck trial components of different size were applied, and the differences in LL and femoral OS measurements were recorded and compared to the implant manufacturer's specifications, corrected for the anatomical variations of each patient. The imageless MICNS revealed a valid and accurate intra-operative tool for measuring LL and femoral OS in vivo.
    The Journal of arthroplasty 10/2013; 29(5). DOI:10.1016/j.arth.2013.09.038 · 2.67 Impact Factor
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    ABSTRACT: Coexistence of degenerative arthritis and calcium pyrophosphate dihydrate (CPPD) crystals (or radiological chondrocalcinosis) with osteoarthritis (OA) of the knees is frequent at the time of arthroplasty. Several studies suggest more rapid clinical and radiographic progression with CPPD than with OA alone. However, it is unclear whether chondrocalcinosis predisposes to higher risks of progression of arthritis in other compartments. QUESTION/PURPOSES: We questioned whether chondrocalcinosis influences clinical scores, degeneration of other compartments, rupture of the ACL, survivorship, reason for revision, or timing of failures in case of UKA. We retrospectively reviewed 206 patients (234 knees) who had UKAs between 1990 and 2000. Of these 234 knees, 85 had chondrocalcinosis at the time of surgery and 63 of the knees subsequently had radiographic evidence of chondrocalcinosis observed during followup. We evaluated patients with The Knee Society rating system and compared function and radiographic progression in the other compartments of patients without and with chondrocalcinosis. The use of conventional NSAIDs, radiographic progression of OA in the opposite femorotibial compartment of the knee, failure of the ACL, and aseptic loosening did not occur more frequently among patients with chondrocalcinosis. The 15-year cumulative survival rates were 90% and 87% for the knees without and with chondrocalcinosis, respectively, using revision to TKA as the end point. Our findings show chondrocalcinosis does not influence progression and therefore is not a contraindication to UKA.
    Clinical Orthopaedics and Related Research 12/2011; 470(7):1973-9. DOI:10.1007/s11999-011-2211-5 · 2.77 Impact Factor
  • Walter Pascale · Simone Luraghi · Laura Perico · Valerio Pascale ·
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    ABSTRACT: The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). Final assessment was conducted 5 years postoperatively, including clinical response measured by the International Knee Documentation Committee (IKDC), Lysholm score, and patient satisfaction score. All patients were blinded to the treatment received and followed the same rehabilitation protocol. A statistically significant improvement between pre- and postoperative values was observed for Lysholm and IKDC scores in both groups, without any statistically significant difference between them. Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036).Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures.
    Orthopedics 07/2011; 34(7):e251-5. DOI:10.3928/01477447-20110526-06 · 0.96 Impact Factor
  • Mohit Bhandari · Walter Pascale · Sheila Sprague · Valerio Pascale ·
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    ABSTRACT: Since its introduction in 1996, the Genesis II Total Knee System has produced good clinical results in patients undergoing primary total knee replacement. A systematic review of the literature-the first of its kind for this device-was undertaken to collect data on the Genesis II in order to provide a better understanding of its medium- to long-term performance. Of 124 Genesis II-related studies published in the literature, 11 met the eligibility criteria and were included in the final analysis. The included studies had a mean follow-up length of 38.1 months. Data from 1201 knees were available for review. Patients were an average of 70.5 years of age and predominantly female (63%). Findings indicated that the revision rate with this implant is low with up to 11.9 years of follow-up, with 14 revisions in total. The survival rate ranged from 100% at 1 and 2 years to 96.0% at 11.9 years. The mean Knee Society knee score improved 51.0 points from preoperative to postoperative evaluation. In conclusion, the Genesis II exhibited good clinical performance with up to 11 years follow-up, with an encouraging rate of survival and improvement in function. Additional studies with larger sample sizes and longer follow-up periods are needed to better understand the long-term performance of this implant.
    The Knee 04/2011; 19(1):8-13. DOI:10.1016/j.knee.2011.02.003 · 1.94 Impact Factor
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    ABSTRACT: Asymmetric dimethylarginine (ADMA), a methyl derivate of the amino acid arginine, is produced by the physiological degradation of methylated proteins. ADMA is the major endogenous inhibitor of nitric oxide synthase (NOS), the enzyme which synthesizes nitric oxide (NO), a molecule endowed with important anti-atherosclerotic properties. Increased plasma ADMA concentrations cause impaired NO synthesis leading to endothelial dysfunction and atherosclerotic vascular disease. Increased plasma ADMA levels mainly occur following inhibition of the enzyme responsible for ADMA catabolism, dimethylarginine dimethylaminohydrolase (DDAH), by oxidative stress triggered by several cardiovascular risk factors. This paper reviews the effects on cardiovascular function produced by ADMA administration to experimental animals and humans. In addition, a number of clinical conditions associated with increased plasma ADMA concentrations are considered. Then the growing body of literature indicating that plasma ADMA levels have a predictive value for major cardiovascular events in prospective studies is discussed. Finally, an analysis is provided of the published data concerning the possibility to modulate plasma ADMA levels using drugs belonging to different pharmacological classes.
    Medical science monitor: international medical journal of experimental and clinical research 05/2009; 15(4):RA91-101. · 1.43 Impact Factor
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    Valerio Pascale · Walter Pascale ·
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    ABSTRACT: Total knee replacement (TKR) infection represents only a small percentage of all the potential complications in joint replacement, but one that can lead to disastrous consequences. Two-stage revision, which has been proven to be the most effective technique in eradicating infection, includes prosthesis removal, positioning of an antibiotic-loaded spacer, and systemic antimicrobial therapy for at least 6 weeks. It has been suggested that there is better performance in terms of range of motion, pain, extensor mechanism shortening, and spacer-related bone loss if articulating spacers are used instead of fixed spacers. In this paper, we describe our results in two-stage revision of infected total knee arthroplasty with a minimum follow-up of 12 months on 14 patients treated by antibiotic-loaded custom-made articulating spacer as described by Villanueva et al. (Acta Orthop 77(2):329-332, 2006). The mean flexion achieved after the second stage of the revision was 120 degrees , ranging from 97 degrees to 130 degrees. The mean Hospital for Special Surgery score was 84. At 1 year after surgery, none of the knees showed any evidence of recurrence of the infection. Articulating spacers are a suitable alternative to fixed spacers with good range of motion after reimplantation and effectiveness against total knee replacement deep infections.
    HSS Journal 10/2007; 3(2):159-63. DOI:10.1007/s11420-007-9048-1