[Show abstract][Hide abstract] ABSTRACT: In the last year, we have performed a new technique for combined medial collateral ligament (MCL) and posterior oblique ligament (POL) reconstruction in chronic setting of anterior cruciate ligament and MCL complex deficiency. Autogenous semitendinosus tendon with the tibial attachment preserved has been used for the medial/posteromedial compartment reconstruction. We describe the operative technique.
Between January and December 2014, 12 consecutive patients with multiligamentous injuries underwent concomitant MCL/POL using a novel technique. The usefulness of the novel technique is the semitendinosus sling on the semimembranosus tendon and the POL fixation with the knee in full extension.
An ideal anteroposterior and rotational stability avoiding the medial compartment over constraint was achieved, in the immediate after surgery, due to the sequence of the bundle fixations and to the semitendinosus sling below the semimembranosus tendon.
This technique is easily reproducible and useful and restores the medial stability immediately after surgery.
[Show abstract][Hide abstract] ABSTRACT: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR).
a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed.
the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears.
painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion.
level I, validating cohort study with good reference standards.
[Show abstract][Hide abstract] ABSTRACT: There is a distinct need for minimally invasive surgical options for the treatment of knee osteoarthritis. This manuscript describes a minimally invasive implant that reduces the load carried by the medial compartment of the knee joint during the stance phase of gait. Implantation is achieved without resection of bone, muscle, or ligaments and without violation of the joint capsule. The procedure is completely reversible should the need arise, allowing for simple device removal without comprising future surgical options. The surgical techniques for implant and explant are explained in detail.
Techniques in Orthopaedics 07/2014; DOI:10.1097/BTO.0000000000000084
[Show abstract][Hide abstract] ABSTRACT: Ankle tendinopathies in athletes are a major problem given the consider- able diffusion of sport in non-professionals. Recreational athletes are more affected be- cause of an improper athletic training. The most common tendon injuries affect Achilles tendon, posterior tibial tendon and peroneal tendons. The treatment of these condi- tions is not easy: diagnosis requires a good knowledge of the conditions that may pro- vide the biomechanical substrate for the onset of tendinopathy. This means being able to conduct not only a good clinical investigation but also be able to analyze the play- ing habits and the type of training that is leading the patient. Moreover, despite the huge variety of therapeutic strategies available nowadays, there is a serious lack of sci- entific evidence. This treaty aims to analyze causes and types of tendinopathy enshrin- ing the available therapeutic pathways
[Show abstract][Hide abstract] ABSTRACT: Iatrogenic vascular injuries to the knee in orthopedic surgery are a major concern for surgeons and a major problem for patients. They are fortunately rare, but it is equally difficult to process. The first decisions taken as soon as you confirm the diagnosis are the most important for the pa-tient's recovery. We did a review of the cases in our center where they are present simultaneously in the Department of Orthopaedic Surgery and Vascular Surgery.
[Show abstract][Hide abstract] ABSTRACT: The menisci are semi-lunar wedge-shaped structures that play critical roles in load distribution, shock absorption, and joint congruity in the knee. Meniscal tears are common knee injuries that subsequently lead to degenerative arthritis, attributed primarily to the changes in stress distribution in the knee. In such cases there is a need to protect the articular cartilage by either repairing or replacing the menisci. While traditionally, meniscal replacement involves implantation of allografts, problems related to availability, size matching, cost and risk of disease transmission limit their use. Another potential treatment option is that of biodegradable scaffolds, which are based principally on tissue engineering concepts. The variability in body response to biodegradable implants and the quality of the tissue formed still pose a problem in this respect, particularly in light of the intense loading conditions in the knee. Moreover, the aforementioned repair and regenerative approaches are generally limited to younger patients. Therefore, the goal of this study was, to develop a synthetic meniscal implant which can replace the injured meniscus, restore its function, and relieve pain.
[Show abstract][Hide abstract] ABSTRACT: Le lesioni legamentose multiple di ginocchio sono una patologia complessa che costituisce una vera e propria sfida per lo specialista ortopedico sia da un punto di vista diagnostico che terapeutico. La scarsità in letteratura di studi significativi rende ad oggi non univoca la scelta dell’approccio terapeutico, le indicazioni ed il timing del trattamento chirurgico, le tecniche di riparazione/ricostruzione più adeguate per ciascun caso.
[Show abstract][Hide abstract] ABSTRACT: Total knee arthroplasty can be considered as a reliable surgical procedure with a good long-term clinical result. However, implant failure due to particle induced aseptic loosening as well as the aspect of hypersensitivity to metal ions still remains an emerging issue.
The purpose of this prospective international multi-centre study was to evaluate the clinical and radiological outcomes and the reliability of the unconstrained Multigen Plus Total Knee System with a new BIOLOX® delta ceramic femoral component. Cemented total knee arthroplasty was performed on 108 patients (110 knees) at seven hospitals in three countries. Clinical and radiological evaluations were performed preoperatively, and after 3, 12 and 24 months postoperatively using the HSS-, WOMAC-, SF-36-score and standardised X-rays.
The mean preoperative HSS-Score amounted to 55.5 ± 11.5 points and improved significantly in all postoperative evaluations (85.7 ± 11.7 points at 24 months). Furthermore, improvements in WOMAC- and SF-36-score were evaluated as significant at all points of evaluation. Radiolucent lines around the femoral ceramic component at 24 months were found in four cases. Progression of radiolucent lines was not seen and no implant loosening was observed. During the 24 month follow-up eight patients underwent subsequent surgery due to reasons unrelated to the implant material.
The observed clinical and radiological results are encouraging for a long-term survival of the ceramic femoral component. Therefore, ceramic implants could be a promising solution not only for patients with allergies against metallic implant materials, but also for the osteoarthritic knee joint. Long-term follow-up is necessary to draw conclusions regarding the superiority of the ceramic knee implants concerning in vivo wear and long-term survivorship.
The Open Orthopaedics Journal 04/2012; 6:172-8. DOI:10.2174/1874325001206010172
[Show abstract][Hide abstract] ABSTRACT: We describe a case of dorsal-lumbar vertebral tuberculosis (Pott's disease) first treated with antibiotic therapy, bed rest, and cast. After 2 months of treatment patient's symptoms worsened. Minimally invasive posterior vertebral stabilization was carried out, with excellent clinic and radiographic results.
Journal of Orthopaedics and Traumatology 02/2012; 14(2). DOI:10.1007/s10195-012-0184-0
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: The posterolateral corner (PLC) is more likely to be injured in combination with the posterior cruciate ligament (PCL) or the anterior cruciate ligament than in isolation. This leads to instability of the knee and loss of function. We hypothesised that combined PCL and PLC reconstruction would restore sufficient stability to allow improvement in patient symptoms and function. METHODS: 19 patients who underwent arthroscopic-assisted single-bundle PCL and PLC reconstruction by a single surgeon were analysed retrospectively. The PLC reconstruction was a modified Larson reconstruction of the lateral collateral ligament and the popliteofibular ligament. The IKDC and Tegner scores were used to assess outcome. Dial test and varus laxity were used to assess improvements in clinical laxity. Posterior laxity was tested using the KT-1000. RESULTS: The mean follow-up was 38 months (±(2× standard deviations), ±12.3). There were no postoperative complications. All patients had less than 5 mm posterior step-off. 17 of 19 patients had negative dial and varus stress tests. Measured range of motion was reduced by a mean of 10°, but patients did not report any daily activities restrictions. Tegner scores improved from a median pre-operative value of 2 (range 1-4) to 6 (4-9) at final follow-up. The mean postoperative IKDC score was 86 (±11). CONCLUSIONS: Subjectively, the knee stability achieved allowed daily activities. However, there were remaining abnormalities in range of motion, posterior drawer and rotational laxity, suggesting that normal knee laxity was not restored. LEVEL OF EVIDENCE: IV.
[Show abstract][Hide abstract] ABSTRACT: Aging is responsible for degenerative changes in all cartilage elements, thus impairing its properties and healing potential. Most studies on surgical procedures for cartilage focus on young patients because these procedures are generally not considered suitable for older patients.
To analyze the clinical outcome of cartilage lesion treatment using second-generation autologous chondrocyte implantation (ACI) techniques in patients more than 40 years old with no clear signs of osteoarthritis, to understand their real potential in relation to aging, the failure rate, and complications in older patients.
Case series; Level of evidence, 4.
Sixty-one patients with grade III to IV cartilaginous lesions of the condyles with no clear signs of osteoarthritis and a minimum age of 40 years were treated with second-generation ACI and prospectively evaluated at 5 years' follow-up. Twenty-two patients were treated with arthroscopic Hyalograft C implantation, and 39 underwent the open Chondro-Gide MACI procedure.
A significant improvement in both subjective and objective evaluations was observed. The International Knee Documentation Committee (IKDC) subjective score improved from 36.8 ± 8.4 to 68.1 ± 21.8 at the final evaluation. The failure rate was 20%. A faster improvement was observed in the group treated with the arthroscopic Hyalograft C technique, whereas similar scores were found at the 24-month follow-up and final evaluation.
A clinical improvement was found in patients more than 40 years old, who in most cases benefited from second-generation ACI with good results lasting at medium-term follow-up. However, the results were inferior with respect to those previously found for younger populations, and the failure rate at medium-term follow-up was also higher. These findings were consistent in the 2 treatment groups. The only difference was the faster recovery when the arthroscopic approach was used.
The American Journal of Sports Medicine 05/2011; 39(8):1668-75. DOI:10.1177/0363546511404675 · 4.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction Total knee arthroplasty (TKA) is one the most successful
procedures in orthopaedic surgery, with good outcomes in
pain reduction and function recovery. However, the increase in life
expectancy and in patients’ needs have led to develop new designs
and materials. The introduction of alternative materials, as ceramic, is
important because allows the reduction of polyethylene wear, one of
the most important causes of mobilisation, and represents a solution
for the growing problem of metals hypersensitivity. The goal of this
prospective study is to evaluate clinical and radiographic outcomes of
a total knee prosthesis with an innovative femoral ceramic
Materials and methods 108 patients (110 knees) underwent a total
knee arthroplasty with a ceramic BIOLOX� delta femoral component
(Multigen Plus Ceramic Knee, Limacorporate SpA, Villanova
di San Daniele, Udine) in 7 European centres. The average age of
the patients was 67.7 ± 5.9 years. They were female in 81 cases
(73.6%) and male in 29 (26.4%) and had an average height and
weight respectively of 165.9 ± 7.7 cm e 79.0 ± 11.7 kg (BMI
28.7 ± 3.5). They mainly suffered from primary osteoarthritis
(93%), osteonecrosis (4%), rheumatoid arthritis (2%) and, lastly,
secondary osteoarthritis (1%). Clinical evaluation was performed
preoperatively, at 3, 12, 24 and 60 months using the Hospital for
Special Surgery Score (HSS), WOMAC score e SF-36 questionnaire.
Radiographic evaluation was planned at the same time points
using the immediate postoperative as baseline. The statistical analysis
was performed with the Friedman (FR) and Wilcoxon (WI)
tests, with p-value\0.05.
Results The minimum follow-up was 12 months. The average HHS
value significantly improved from 55.5 ± 11.5 in the pre-operative to
77.2 ± 10.3 and 85.6 ± 8.9, respectively after 3 and 12 months (WI
test p = 0.001). Significant improvements were identified in all
domains, especially pain and ROM (WI test: pain p\0.001, function
p\0.001, muscular strength p\0.001, deformity p\0.001).Radiolucent lines have been identified in 3 cases, but without signs of
progression. No implant-related complications, signs of mobilisation
and failures occured.
Conclusions Short-term clinical and radiographic outcomes in the use
of the ceramic in knee femoral component arthroplasty are very
promising. A long-term follow-up is necessary to confirm the results
and evaluate the survivorship rate of the implants.
[Show abstract][Hide abstract] ABSTRACT: Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique.
We retrospectively evaluated a case series of patients who received isolated PLC reconstruction between March 2005 and January 2007. Ten patients were surgically treated for isolated injuries and were available for follow-up; average patient age was 27.4 years (range 16-47 years). All patients were treated following the fibular-based technique: double femoral tunnel was performed in six patients, while in the remaining four patients, the reconstruction of the PLC was performed with a single femoral tunnel. Six patients had semitendinosus allograft and four had semitendinosus autograft. All patients had the same evaluation and the same rehabilitation protocol.
Mean follow-up was 27.5 months (range 18-40 months). Mean range of motion (ROM) was 143.5 degrees for flexion (range 135-150 degrees) and 0.5 degrees for extension (range 0-3 degrees). Three patients showed 1+ on varus stress test, while on Dial test another three patients showed 10 degrees reduction of external rotation compared with contralateral knee. The average Lysholm score was 94 points (range 83-100), and the mean International Knee Documentation Committee (IKDC) subjective result was 88.48 (range 74-96.5). Based on Lysholm score, the results were excellent in eight knees and good in two knees. On IKDC evaluation, two patients were grade A and eight were grade B. No significant difference in clinical results was observed between single and double femoral tunnel.
Fibular-based technique showed good results in terms of clinical outcome, restoring varus and rotation stability of knees in treatment of chronic isolated PLC injury.
Journal of Orthopaedics and Traumatology 03/2010; 11(2):73-9. DOI:10.1007/s10195-010-0088-9
[Show abstract][Hide abstract] ABSTRACT: Patellofemoral problems are probably the most common knee complaints in adolescents and adults. The vague and general term “chondromalacia patellae” has been widely used in the past to describe retro-patellar pain and instability. The term patellofemoral malalignment (PFM) was introduced in 1979 by Insall  and since then, it indicates a wide range of pathological conditions from abnormal tracking of the patella on the trochlea with unbalanced transmitted loads on the cartilage, to acute and recurrent dislocation of the patella, which explains the anterior knee pain and patellar instability. This theory has influenced the development of several surgical procedures to correct the malalignment. At present only a small percentage of patients with patellofemoral pain are candidates for surgical correction of the malalignment . According to Dejour et al. [11, 12], patellofemoral disorders can be classified into three major categories. Objective patellar instability is defined as true patellar dislocation or subluxation when trochlear dysplasia is present, potential patellar instability includes trochlear dysplasia when true patellar dislocation or subluxation has never occurred, and the third group covers patello-femoral pain syndrome.
[Show abstract][Hide abstract] ABSTRACT: Metal sensitivity can be considered an emerging issue in TKA (Hallab, 2001). Wear of the polyethylene liner has been addressed
with better design of the components, improvement of the material itself and improved surgical techniques (Gioe, 2004; Fehring,
2004, Tsukamoto, 2006). However, for the increasing number of young active people candidate for a variety of reasons to surgery,
the issue of wear still remain of paramount importance.