Mario Ronga

Ospedale di Circolo e Fondazione Macchi Varese, Varese, Lombardy, Italy

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Publications (38)50.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This is the medical history of three skeletons from archaeological sites in the province of Varese that are interesting because they show signs of traumatic injury to the skull and postcranial skeleton. Fractures of two of the skeletons were analysed by CT scan and radiological investigations to understand the extent of the damage and to hypothesise the cause. The study of lesions on ancient human remains is important to understand the degree of interpersonal violence within ancient communities and to reconstruct the dynamics of a violent episode.
    Injury 10/2013; · 1.93 Impact Factor
  • P. Cherubino, M. Ronga
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    ABSTRACT: Autologous chondrocyte implantation (ACI) has demonstrated a high rate of clinical success despite a considerable number of complications. The second-generation ACI techniques require three-dimensional scaffolds. Midterm studies have demonstrated comparable results to ACI, yet with a decreased rate of complications. The aim of this review is to define the requisites of a scaffold and to report clinical results and limits of these techniques.
    Archivio di Ortopedia e Reumatologia 01/2013; 124.
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    ABSTRACT: In recent years it has been proposed the use of scaffolds, in different materials, for the regeneration of a meniscal-like tissue to treat partial meniscus defects, in order to avoid the degenerative changes following the meniscectomy. This study reports the results of the clinical use of currently available scaffolds: Menaflex — collagen and Actifit — polyurethane. 21 patients treated with collagen scaffolds with a minimum 10 years’ follow-up and patients 19 treated with polyurethane scaffolds with a minimum 1 year’s follow-up were studied prospectively. The indication for scaffold implantation was an irreparable meniscus lesion or continuous pain after previous partial meniscectomy. The subjects were evaluated clinically and with MRI. In all patients there was a significant clinical improvement during the first months after surgery. In all patients but one the positive results were unchanged at the last follow-up. The MRI study showed a possible chondroprotective effect of the implant and a progressive maturation of the regenerated tissue. The scaffolds for meniscus regeneration can be considered a viable option to manage meniscus defects.
    Archivio di Ortopedia e Reumatologia 12/2012; 123(3).
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    ABSTRACT: Although it is currently the gold standard for the treatment of primary and secondary coxarthrosis, total hip arthroplasty is associated with long-time complications, primarily, polyethylene liner wear, and production of debris that lead to peri-prosthetic osteolysis and resultant aseptic mobilization. (The definition of these osteolytic areas is based on a radiographic classification first described by DeLee and Charnley in 1976.) We introduced a new radiographic classification method, based on the well-known measuring software Roman® v.170 (Cook e Poullain [2002-2005, Institute of Orthopaedics, Oswestry, U.K.]) that is designed to quantify radiologic parameters. Two case studies are also described. This original method can be easily employed, and returns a precise angular classification of the position of the osteolytic area and a computerized calculation of the extent of the osteolytic lesion.
    Surgical technology international 09/2012; XXII.
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    ABSTRACT: The management of distal tibial fractures can be ­difficult, and requires careful preoperative planning. Fracture pattern, soft tissue injury, and bone quality critically influence the selection of fixation technique.1 Several surgical methods have been described for the management of these fractures, including external fixation, intramedullary nailing, and plate fixation. External fixation may result in inaccurate reduction, malunion or nonunion, and pin tract infection.2 Intramedullary nailing is considered the standard method to manage operatively diaphyseal fractures of the tibia, but the distal tibia poses concerns regarding the stability of fixation, the risk of secondary displacement of the fracture on insertion of the nail, breakage of nails and locking screws, and final alignment of the tibia.
    12/2011: pages 163-168;
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    ABSTRACT: To compare morphological, power Doppler, and contrast-enhanced ultrasound (CEUS) features of the Achilles tendon between asymptomatic athletes and athletes who had undergone surgical repair of a previous rupture. Twenty-four athletes were divided in two groups (A and B). Group A included 14 patients with a median age of 32 years (range 27 to 47 years) who had undergone surgical repair for unilateral Achilles tendon rupture. Group B (control group) included 10 subjects with a median age of 34 years (range 27 to 40 years) with no previous or present history of tendinopathy. All patients were evaluated with ultrasound, power Doppler, and CEUS with second-generation contrast agent. We studied the uninjured Achilles tendon in athletes of group A and either the left or the right Achilles tendon of the athletes in group B. CEUS showed a significantly greater ability to detect a greater number of vascular spots within the uninjured tendon of group A compared to group B (<0.05). In athletes who had suffered a tear of an Achilles tendon, CEUS detected small vessels that were not identified by power Doppler ultrasound in the uninjured contralateral Achilles tendon. CEUS is useful to evaluate vascularity not detected by other imaging techniques. Vascularity in the uninjured tendon seems to be increased in patients who had a previous rupture.
    Journal of Clinical Ultrasound 01/2011; 39(3):141-5. · 0.70 Impact Factor
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    ABSTRACT: The Achilles tendon (AT) is the strongest tendon in the human body, but despite its strength, is the most frequently ruptured tendon in the body. Ruptures usually occur between 2 and 6 cm of its insertion into the superior surface of the calcaneus, a relatively hypovascular area.8,17 The major blood supply to tendons is from the mesotendon, and the largest supply is from the anterior mesentery.2 The tendon is at the greatest risk of rupture when the it is obliquely loaded, the muscle is contracting maximally, and tendon length is short.5 This usually occurs as a result of pushing off with the foot against resistance, and occurs most frequently in males in their fourth decade.
    12/2010: pages 419-424;
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    ABSTRACT: Surgical fixation of distal tibia fractures can be difficult, and requires careful preoperative planning. Fracture pattern, soft tissue injury, and bone quality critically influence the selection of fixation technique.1 Several surgical methods have been described for the treatment of these fractures, including external fixation, intramedullary nailing, and plate fixation. Classical open reduction and internal plate fixation requires extensive soft tissue dissection and periosteal stripping, with high rates of complications, including infection, delayed and non-unions.2,3 Moreover, the surgical dissection required to achieve anatomic reduction evacuates the osteogenic fracture ematoma. Several minimally invasive plate osteosynthesis techniques have been developed, with good results at medium term follow-up.4–6 These techniques aim to reduce surgical trauma and to maintain a more biologically favorable environment for fracture healing.
    12/2010: pages 357-361;
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    ABSTRACT: In this morphological study, we report on the three-dimensional microvascular architecture constituting the toes of a patient affected by diabetic microangiopathy. We applied corrosion casting (CC) technique to the toes of a patient affected by Type 2 diabetes, who underwent surgery for explantation of inferior left limb due to necrotic processes of soft tissues. The toes of a foot traumatically explanted in a motorcycle accident were kept as controls. According to technical protocols, toes were injected with a low-viscosity acrylic resin (Mercox) through the major digital artery, tissues were corroded in KOH solution (8%), and resulting casts processed for SEM observations. Already at low magnification, in diabetic toes, we found an impairment of the linear track-like disposition of the vessels of plantar side, with signs of vascular disruption and obliterations, stopped resin, and leakages. Capillaries under the nail and a lot of vascular villi in eponychium and nail borders were damaged, and vascular regression phenomena acting on them were clearly visible. Resin leakages and impairment of normal vascular architecture were also observed in the root of the nail. This preliminary report represents only the first step for further investigations regarding morphological three-dimensional appearance of diabetic microangiopathy. CC and scanning electron microscopy technique well documented these morphological modifications, highlighting on both structural and ultrastructural features of diabetic toes microvessels. In conclusion, our qualitative data try to better focus on the pathophysiological mechanisms involved in diabetic dermopathy and microangiopathy, proposing CC as useful method to investigate on them.
    The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 10/2010; 293(10):1639-45. · 1.34 Impact Factor
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    ABSTRACT: To define magnetic resonance (MR) arthrography imaging findings of matrix-induced autologous chondrocyte implantation (MACI) grafts of the knee in order to describe implant behaviour and to compare findings with validated clinical scores 30 and 60 months after MACI implant. Thirteen patients were recruited (10 male, 3 female) with a total number of 15 chondral lesions. Each patient underwent an MACI procedure and MR arthrography 30 and 60 months after surgery. MR arthrography was performed using a dedicated coil with a 1.5-Tesla unit. The status of the chondral implant was evaluated with the modified MOCART scoring scale. The lining of the implant, the integration to the border zone, the surface and structure of the repaired tissue were assessed, and the presence of bone marrow oedema and effusion was evaluated. For clinical assessment, the Cincinnati score was used. At 60 months, the abnormality showed worsening in 1 out of 15 cases. Integration showed improvement in 3 out of 15 cases, and worsening in 3 out of 15 cases. Two surfaces of the implant showed further deterioration at 60 months, and 1 afflicted implant fully recovered after the same time interval. Implant contrast enhancement at 30 months was seen in 2 out of 15 cases, 1 of which recovered at 60 months. According to the MOCART score, 4 cases were rated 68.4 out of 75 at 30 months and 65 out of 75 at 60 months. The mean clinical score decreased from 8.6 out of 10 at 30 months to 8.1 out of 10 at 60 months. Magnetic resonance arthrography improved the evaluation of implants and facilitated the characterisation of MACI integration with contiguous tissues. The follow-up showed significant changes in MACI, even at 60 months, allowing for useful long-term MR evaluations.
    Skeletal Radiology 05/2010; 40(1):47-56. · 1.74 Impact Factor
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    ABSTRACT: Tendon is a poorly vascularized and highly specialized connective tissue containing few scattered cells that play an important role in the musculoskeletal apparatus by resisting mechanical stress. Because of the slow rate of the metabolism of its molecular components, the tendon gradually loses its mechanical properties and may rupture upon an array of physical activities. In this report, we discuss the molecular changes involved in the extracellular matrix-tendon interactions leading to tissue degeneration and rupture.
    Frontiers in bioscience (Elite edition) 01/2010; 2:1-12.
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    ABSTRACT: Minimally invasive surgical techniques for pathologies of the Achilles tendon (AT) hold the promise to decrease perioperative morbidity, allow faster recovery times, shorten hospital stays, and improve functional outcomes when compared with open procedures, which can lead to difficulty with wound healing because of the tenuous blood supply and increased chance of wound breakdown and infection. This article presents recent advances in the field of minimally invasive AT surgery for tendinopathy, acute ruptures, and chronic tears. All of the techniques described in this article are inexpensive and do not require highly specialized equipment and training. Future randomized controlled trials are required to address the issue of the comparison between open versus minimally invasive AT surgery.
    Orthopedic Clinics of North America 10/2009; 40(4):491-8, viii-ix. · 1.25 Impact Factor
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    ABSTRACT: This study investigated at medium term follow-up the clinical outcomes and any progression of knee osteoarthritis in a population of patients that underwent arthroscopic placement of a collagen meniscus implant. Thirty-four patients underwent arthroscopic placement of a collagen meniscus implant for a symptomatic deficiency of medial meniscal tissue. Follow-up evaluation included Lysholm II score and Tegner activity scores and MR arthrography of the knee at 2 and 5 years after surgery. Plain radiographs were also obtained at 5 years. Six patients were excluded. In eight cases arthroscopic second look evaluation was performed. Lysholm and Tegner activity scores at 2 and 5 years after surgery improved significantly compared to the preoperative score. These patients showed good to excellent clinical results after 5 years from a CMI placement. The chondral surfaces of the medial compartment had not degenerated further since placement of the CMI. MR signal had continued to mature between 2 and 5 years after implant, progressively decreasing signal intensity but in any case comparable to the low signal of a normal meniscus. In most of cases the CMI-new tissue complex had a slight reduction in size, compared to a normal medial meniscus, but the new tissue had no apparent negative effects.
    The Knee 10/2009; 17(3):224-9. · 2.01 Impact Factor
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    ABSTRACT: The management of distal tibia fractures can be challenging because of the scarcity of soft tissue, their subcutaneous nature, and poor vascularity. Classic open reduction and internal plate fixation require extensive soft tissue dissection and periosteal stripping, with high rates of complications. Minimally invasive plating techniques reduce iatrogenic soft tissue injury and damage to bone vascularity and preserve the osteogenic fracture hematoma. Locking plates (LPs) have the biomechanical properties of internal and external fixators, with superior holding power because of fixed angular stability through the head of locking screws, independent of friction fit. In this review, the rationale for the use of LPs and a description of the technique of minimally invasive LP osteosynthesis of distal tibia fractures are presented.
    Orthopedic Clinics of North America 10/2009; 40(4):499-504, ix. · 1.25 Impact Factor
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    ABSTRACT: Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 08/2009; 468(4):975-82. · 2.79 Impact Factor
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    ABSTRACT: Percutaneous repair of Achilles tendon (AT) ruptures reportedly reduces the risk of rerupture compared to nonoperative treatment and reduces the risk of wound infection compared to open surgery. We retrospectively reviewed the postoperative Achilles tendon total rupture score (ATRS), and the maximum calf circumference in 35 patients over 65 years of age who sustained an acute tear of the AT and underwent percutaneous repair of the AT. There were 26 men and nine women with a mean age at operation of 73.4 +/- 8.7 years (range, 65-86 years). Of the 35 recruited patients, we report on 27 patients for whom we have a full data set. The minimum followup was 49 months (mean, 88 months; range, 49-110 months). The ATRS had a postoperative average rating of 69.4 +/- 14 (range, 56-93). All patients were able to bear weight fully on the affected limb by the eighth postoperative week. The data suggest that percutaneous repair of the AT is a suitable option for patients older than 65, producing similar outcomes when compared to percutaneous repair in younger patients of previous reports. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 07/2009; 468(4):1039-46. · 2.79 Impact Factor
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    ABSTRACT: Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in noncollagenous matrix. Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy.
    Sports medicine and arthroscopy review 07/2009; 17(2):112-26. · 1.16 Impact Factor
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    ABSTRACT: The Achilles tendon (AT) is the most frequently ruptured tendon in the human body, but the etiology of AT ruptures is still not completely understood. Percutaneous repair and conservative management are viable alternatives to open surgery, which carries higher complication rates and is the most costly of the 3 management options. Individual patients will have different needs due to their age, occupation, or level of sporting activity. If the studies reporting a rising incidence of AT rupture are accurate, the field of AT surgery will become an increasingly important one for orthopedic surgeons. A major problem in the evaluation of the outcome of management of AT ruptures has been the lack of a universally accepted scoring system for the evaluation of results of management of AT rupture. The AT Total Rupture Score is a self-administered instrument with high clinical utility, and it can be used for measuring the outcome, related to symptoms and physical activity, after treatment in patients with a total AT rupture. Future developments may include the use of adhesives in tendon surgery. An understanding of the role, which cytokines play in tendon healing may also lead to the advent of new treatments, possibly based on gene therapy. However, such novel interventions are unlikely to be in routine clinical use for some time.
    Sports medicine and arthroscopy review 07/2009; 17(2):127-38. · 1.16 Impact Factor
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    ABSTRACT: Recurrent patellar dislocations are common injuries in children and adolescents. The subjective and functional results of soft tissue surgical management in a population that was skeletally immature at the time of surgery have not been reported. The 3-in-1 procedure is an effective treatment for recurrent patellar dislocation in skeletally immature patients. Case series; Level of evidence, 4. Twenty-five skeletally immature patients (age at operation, 13.5 +/- 3.8 years) who were practicing sports and suffering from recurrent unilateral patellar dislocation were included in the study and followed until skeletal maturation. Clinical evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. The average follow-up was 3.8 years (range, 2.5-6 years). The mean modified Cincinnati score increased from 51.7 +/- 12.6 preoperatively to 94.3 +/- 10.8 (P < .02), while the mean Kujala scores increased from 52.4 +/- 12.7 preoperatively to 93.8 +/- 14.2 (P < .02). The Insall-Salvati index remained essentially unchanged, being 1.04 +/- 0.2 preoperatively and 1.02 +/- 0.3 at latest follow-up. Significant differences were found between the operated and the contralateral limb in the various isokinetic strength variables at all angular velocities measured at the latest follow-up (.05 < P < .0042). The 3-in-1 procedure is a safe, reliable management option for recurrent patellar dislocation in skeletally immature patients. Side-to-side differences in isokinetic strength and in anthropometric indices persist despite subjective success of the procedure.
    The American journal of sports medicine 06/2009; 37(9):1814-20. · 3.61 Impact Factor
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    ABSTRACT: Several medial patellofemoral ligament reconstruction procedures have been proposed to manage recurrent patellar dislocation. Reconstruction of the medial patellofemoral ligament using a hamstring graft with a 2 transverse patellar tunnels technique is an effective treatment for recurrent patellar dislocation in patients without any evident predisposing factors. Case series; Level of evidence, 4. Twenty-eight patients with chronic patellar instability without any anatomic predisposing factors, experiencing recurrent unilateral patellar dislocation, were included in the study. Evaluation included the modified Cincinnati and the Kujala scores, anthropometry, plain radiography, and isokinetic dynamometry. The average follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score increased from 52 preoperatively to 89 (P = .001). The mean Kujala scores increased from 45 preoperatively to 83 (P = .03). The muscle volume of the thigh of the operated limb increased with time, but remained less well developed than the nonoperated limb (P = .04). The mean Insall-Salvati index was 1.1 (range, 0.9-1.2) preoperatively and remained within normal range (1.1 [range, 0.9 to 1.2]) (P = .07), at latest follow-up. Significant isokinetic strength differences were found between the operated and the contralateral limbs (.05 < P < .006), even at the latest follow-up. Three patients experienced a new patellar dislocation. Medial patellofemoral ligament reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.
    The American journal of sports medicine 06/2009; 37(9):1735-42. · 3.61 Impact Factor

Publication Stats

552 Citations
50.35 Total Impact Points

Institutions

  • 2012
    • Ospedale di Circolo e Fondazione Macchi Varese
      Varese, Lombardy, Italy
  • 2003–2012
    • University of Insubria
      Varese, Lombardy, Italy
  • 2008–2010
    • Università degli Studi dell'Insubria
      • Department of Clinical and Experimental Medicine
      Varese, Lombardy, Italy
  • 2009
    • University Hospital Of North Staffordshire NHS Trust
      Stoke-upon-Trent, England, United Kingdom
    • University of Rome Tor Vergata
      Roma, Latium, Italy
    • Queen Mary, University of London
      • Centre for Sports and Exercise Medicine
      London, ENG, United Kingdom