Nicola Maffulli

Nicola Maffulli
Università degli Studi di Salerno | UNISA · Department of Medicine and Surgery

MD, MS, PhD, FRCP, FRCS(Orth), FFSEM

About

1,909
Publications
988,287
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
67,885
Citations
Introduction
Nicola Maffulli currently works at the Department of Medicine and Surgery, Università degli Studi di Salernom where he is the Professor and Chair of Trauma and Orthopaedic Surgery. Nicola udnertakes research in Orthopedic Surgery and Sports Medicine. A broadly trained orthopaedic surgeon, his major areas of expertise are knee surgery and foot and ankle surgery. Nicola has produced major contributions in the physiopathology of tendon ailments, and has undertaken a large number of randomised controlled trials in trauma and orthopaedic surgery. Given his training, Prof Maffulli has a large gamut of expertise, ranging from exercise physiology, gene expression in musculoskeletal conditions and tissue engineereing and mesenchimal stem cell therapy.
Additional affiliations
January 2013 - present
Università degli Studi di Salerno
Position
  • Professor of Trauma and Orthopaedics
December 2008 - January 2013
Queen Mary, University of London
Position
  • Centre Lead and Professor
December 2008 - January 2013
Barts Health NHS Trust
Position
  • Consultant

Publications

Publications (1,909)
Article
Objective. High-density surface electromyography (HD-sEMG) allows the reliable identification of individual motor unit (MU) action potentials. Despite the accuracy in decomposition, there is a large variability in the number of identified MUs across individuals and exerted forces. Here we present a systematic investigation of the anatomical and neu...
Article
Full-text available
Background: The Mayo Elbow Performance Score (MEPS) is a rating system consisting of four dimensions to evaluate elbow performance. It is a common tool for assessment of elbow impairments worldwide. We determined the validity and reliability of its German version (MEPS-G) after cross-cultural adaptation. Methods: Six investigators examined 57 pat...
Article
Full-text available
Background Musculoskeletal ailments impact the lives of millions of people, and at times necessitate surgery followed by physiotherapy, drug treatments, or immobilization. Regenerative musculoskeletal medicine has undergone enormous progress over the last few decades. Sources of tissues used for regenerative medicine purposes can be grouped into au...
Article
Background: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in ten languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish, Portuguese). From other languages under validation, the Portuguese version completed data acquisition and underwent further va...
Article
Background: The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated. Purpose: To determine the effect of...
Article
Full-text available
The hamstring muscle group is the most frequently injured muscle group in non-contact muscle injuries in sports involving high-speed running. A total of 84% of hamstring injuries affect the biceps femoris (BF) muscle. Clinical assessments and magnetic resonance imaging (MRI) are routinely used for diagnosis and plan management. MRI-negative scans f...
Article
Full-text available
This study describes measurements between the coracoid, glenoid, and humerus; characterizes coracoid shape, rotator cuff fatty infiltration, and quantitatively evaluates coracoid impingement and its association with anterosuperior rotator cuff tears (ASCT). 193 shoulder magnetic resonance imaging (MRI) scans demonstrating: rotator cuff tear; isolat...
Article
Introduction Ankle fractures in sport are common. Their optimal management is unclear, as is when patients can return to their sports activities. This systematic review provides a contemporary assessment of the literature on return to sports following acute traumatic ankle fractures managed both operatively and non-operatively. Sources of data We...
Article
Full-text available
Background Overuse injuries are common in sporting children and adolescents. These injuries are a particular concern when they involve the epiphyseal–physeal–metaphyseal (EPM) complex given their potential to disturb skeletal growth. Specifically, the limits of mechanical tolerance of the EPM complex to repetitive stress may be exceeded by the inte...
Article
Full-text available
Stress injuries involving the epiphyseal–physeal–metaphyseal complex affecting the extremities of child and adolescent athletes were first described in the early 1950s. Initially observed in Little League baseball players, these injuries are now known to affect skeletally immature athletes in a variety of sports that involve high-impact repetitive...
Article
Full-text available
(1) Background: Conclusions of meta-analyses of clinical studies may substantially influence opinions of prospective patients and stakeholders in healthcare. Nineteen meta-analyses of clinical studies on the management of primary knee osteoarthritis (pkOA) with stem cells, published between January 2020 and July 2021, came to inconsistent conclusio...
Article
Full-text available
Background Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current evidence is mainly based on case reports and case series, and no guidelines are available. The present study investigated the current surgical management and related outcome...
Preprint
Full-text available
Objective High-density surface electromyography (HD-sEMG) allows the reliable identification of individual motor unit (MU) action potentials. Despite the accuracy in decomposition, there is a large variability in the number of identified MUs across individuals and exerted forces. Here we present a systematic investigation of the anatomical and neur...
Preprint
Background: Conclusions of meta-analyses of clinical studies may substantially influence opinions of perspective patients and stakeholders in health care. Nineteen meta-analyses of clinical studies on the management of primary knee osteoarthritis (pkOA) with stem cells, published between January 2020 and July 2021, came to inconsistent conclusions...
Article
Study design Study of diagnostic accuracy/assessment scale. Background Proximal hamstring tendinopathy (PHT) usually causes disability, deep pain in the proximal insertion of the tendon, and limitations in daily life and sports practice. Scales that assess PHT pain and disability may assist practitioners in their clinical decision-making processes...
Article
Full-text available
Background: Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds. Sources of data: PubMed, EMBASE, Web o...
Article
Full-text available
Background Recently, the management of musculoskeletal disorders with the patients' own stem cells, isolated from the walls of small blood vessels, which can be found in great numbers in the adipose tissue, has received considerable attention. On the other hand, there are still misconceptions about these adipose-derived regenerative cells (ADRCs) t...
Article
Full-text available
Background: Morton's neuroma (MN) is a common cause of forefoot pain. After failure of conservative management, surgical procedures include neurectomy or neuroma preserving procedures; resection of deep transverse intermetatarsal ligament only (DTIML), dorsal neurolysis, dorsal nerve transposition (DNT). Objectives: This retrospective study eval...
Chapter
Given this new understanding of the physiopathology of LE, treatment approaches have shifted toward novel biological therapies to restore tendon biology through reactivation of a healing response that may stimulate local tendon repair and/or regeneration, rather than just treating inflammation and pain. The developing treatment strategies include l...
Article
Full-text available
Background Radial extracorporeal shock wave therapy (rESWT) is an attractive, non-invasive therapy option to manage fracture nonunions of superficial bones, with a reported success rate of approximately 75%. Using zebra mussels ( Dreissena polymorpha ), we recently demonstrated that induction of biomineralization after exposure to focused extracorp...
Article
Full-text available
Background Platelet-rich plasma (PRP) is widely used in the management of lateral elbow tendinopathy (LET) despite conflicting evidence on its effectiveness. With high levels of user experience, this study aimed to assess consensus amongst experts on its clinical use. Methods A three-round international Delphi study was conducted. Participants wer...
Chapter
Soft tissue overuse injuries including patellar tendinopathy are common among athletes who perform repetitive activities that including sprinting or jumping. They occur along a continuum of severity from mild inflammation to complete tendon rupture and affect three anatomic sites: the proximal patellar tendon, the inferior pole of the patella, and...
Article
Background An all-arthroscopic rotator cuff repair (ASR) may result in less postoperative pain and better functional outcomes than the mini-open (MOR) approach. This meta-analysis provides an updated assessment of the current literature which compares the clinical outcomes of mini-open versus all arthroscopic rotator cuff repair techniques. Materi...
Preprint
Full-text available
Background: Recently, the management of musculoskeletal disorders with the patients' own stem cells, isolated from the walls of small blood vessels, which can be found in great numbers in the adipose tissue, has received considerable attention. On the other hand, there are still misconceptions about these adipose-derived regenerative cells (ADRCs)...
Article
Full-text available
Objective The aim of the present study was to determine the influence of resident involvement on acute complication rates in revision total hip arthroplasty (THA). Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 1,743 revision THAs were identified from 2008 to 2012; 949 of them...
Preprint
Recently, the management of musculoskeletal disorders with the patients' own stem cells, isolated from the walls of small blood vessels, which can be found in great numbers in the adipose tissue, has received considerable attention. The use of these autologous, unmodified stem cells can be seamlessly integrated into modern orthopedic treatment conc...
Preprint
Background Radial extracorporeal shock wave therapy (rESWT) is an attractive, non-invasive therapy option to manage fracture nonunions of superficial bones, with a reported success rate of approximately 75%. Using zebra mussels (Dreissena polymorpha), we recently demonstrated that induction of biomineralization after exposure to focused extracorpor...
Article
Full-text available
Musculoskeletal ailments affect millions of people around the world and place a high burden on healthcare. Traditional treatment modalities are limited and do not address underlying pathologies. Mesenchymal stem cells (MSCs) have emerged as an exciting therapeutic alternative and Wharton’s jelly-derived mesenchymal stem cells (WJSCs) are some of th...
Chapter
G. A. J. Robertson, N. Maffulli (eds.), Fractures in Sport, https://doi.org/10.1007/978-3-030-72036-0
Article
Background: Winged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper extremity’s function and poor performance in daily activities. Sources of data: A systematic review and meta-analysis were performed following the PRISMA guidelines. Two independ...
Article
Full-text available
Background Lumbopelvic control (LPC) has recently been associated with function, kinesiology, and load distribution on the limb. However, poor LPC has not been studied as a risk factor for lower limb injury in sports requiring frequent jump landings. The present study investigated the effects of LPC on landing mechanics and lower limb muscle activi...
Article
Full-text available
Background Musculoskeletal conditions are highly prevalent, and knee OA is most common. Current treatment modalities have limitations and either fail to solve the underlying pathophysiology or are highly invasive. To address these limitations, attention has focused on the use of biologics. The efficacy of these devices is attributed to presence of...
Chapter
Internal snapping hip is a common clinical condition and is usually asymptomatic, but in few cases, mostly in athletes and professionals who participate in activities requiring extreme ranges of hip motion, the snap may become painful (internal snapping hip syndrome—ISHS). Traditionally, the ISHS pathogenesis was described as a snapping of the tend...
Article
Introduction Hip fractures in the elderly impact negatively on functional dependence, and carry great social costs and morbidity. We assessed the decline in muscle mass and functional outcomes following hip fracture surgery . Material and methods Thirty patients with a hip fracture (mean age: 80.8 years) were assessed using dual-energy X-ray absor...
Article
Full-text available
Objective: By analyzing our cases of posterior cruciate ligament (PCL) tibial avulsion fracture, we noted that a U-shaped image was present in the anteroposterior plain radiographs view of the affected knee, even in cases where the profile view of the knee had been inconclusive as to tibial PCL avulsion fracture, a "hidden" fracture. Therefore, we...
Chapter
This chapter presents a case scenario of a 41‐year‐old male runner who presents with swelling 2.5 cm in diameter, 4 cm proximal to the insertion of the Achilles tendon. Several management options have been proposed to allow recovery of patients with Achilles tendinopathy (AT). Extracorporeal shockwave therapy (ESWT) may be a good option in these pa...
Article
Background Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. Methods Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and th...
Article
Full-text available
How to cite this article: Saxena A, Maffulli N. RE: Darwish et al. “Ethibond Suture Granuloma Formation Following Repair of Acute Achilles Tendon Ruptures”. J Foot Ankle Surg (Asia Pacific) 2021;8(2):91.
Article
Objective: To cross-culturally adapt and validate the Victorian Institute of Sports Assessment - Hamstrings (VISA-H) scale into Spanish. Design: Clinical measurement study (psychometric analysis). Setting: Sports clubs and physiotherapy clinics. Participants: The Spanish version of the VISA-H (VISA-H-Sp) scale was administered to 101 subject...
Article
Full-text available
Background Osteoarthritis (OA) is the most common joint disorder in the United States of America (USA) with a fast-rising prevalence. Current treatment modalities are limited, and total knee replacement surgeries have shown disadvantages, especially for grade II/III OA. The interest in the use of biologics, including umbilical cord (UC)-derived Wha...
Article
Background The aetiopathogenesis of tendinopathy is uncertain, but inflammation may play a role in the early phase of tendinopathy and in tendon healing response. We investigated the most up-to-date evidence about the association between obesity, high-fat diet and tendinopathy, focusing on the role of adipokines, inflammatory pathways and molecular...
Chapter
In all areas of Medicine, physicians must be aware of patients’ voice and opinions because patients’ observations about their treatment play an essential role in developing and refining a management plan. This chapter aims to discuss PROM in Sports Medicine, starting by its definition, contributions in Orthopedics, the lack of PROM in Sports Medici...
Chapter
The origin of wrestling as a sport can be traced back to the Sumerians 5000 years ago. In ancient Egypt drawings in the tomb of Beni-Hassan show 400 pairs of wrestlers [1]. For the Greeks, wrestling trained men for war, and drawings of Greek wrestling style resemble contemporary Freestyle wrestling [1]. In 708 BC, wrestling was incorporated as a ma...
Chapter
Soft tissue ankle equinus and anterior/posterior translation of the talus are commonly encountered malalignment situations seen with end-stage ankle arthritis. These malalignments are important to recognize and correct at the time of primary total ankle replacement. The decision to perform an Achilles tendon lengthening or a gastrocnemius-soleus le...
Article
Background The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish). From other languages under validation, the Persian version finished data acquisition and underwent further validation...
Article
Introduction: SARS-CoV-2 induces a cytokine storm and can cause inflammation, fibrosis and apoptosis in the lungs, leading to acute respiratory distress syndrome (ARDS). ARDS is the leading reason for the mortality and morbidity the associated to COVID-19, and the cytokine storm is a prominent etiological factor. Mesenchymal stem cell-derived extr...
Article
Full-text available
Methods. Following isokinetic assessment to estimate the hamstrings to quadriceps dynamic ratio (H:Q), the participants were divided in two groups (Group 1 (N = 10): athletes with a H:Q ratio range 55-70% and no side to side difference of the ratios more than 6 units; and Group 2 (N = 8) athletes with a H:Q ratio outside of the 55-70% range and/or...
Article
Full-text available
Background and Study Aim: In Olympic judo, athletes are not allowed to kick, punch, or strike, or use any equipment or weapons. The athlete must subdue the opponent only by gripping the uniform and using techniques to lift and throw the competitor or pin them down to the mat. The purpose of the research is to know about type of injuries judo athlet...
Article
Full-text available
Background: Patellar tendinopathy is common. The success of traditional management, including isometric or eccentric exercises combined with shockwave therapy and even surgery, is limited. Therefore, it is important to determine whether biological treatments such as ultrasound-guided intratendinous and peritendinous injections of autologous expand...
Article
Full-text available
Intra-articular injections of platelet-rich plasma (PRP) and other novel blood-derived products developed specifically for osteoarthritis (OA) can provide pain relief and potential benefits in disease progression. Meta-analyses show the clinical superiority of PRP compared with other intra-articular injections, but results are modest and the effect...
Article
Full-text available
We report on the outcome of acute Achilles tendon ruptures by a single surgeon using open and percutaneous techniques was performed. This prospective study included 186 patients with 188 ruptured Achilles tendons. A traditional open technique was primarily performed on patients from January 2001 to December 2011. From January 2012 to January 2018,...
Article
Full-text available
Objectives Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing. Methods The management methods and outcomes of treatment are classically based on relatively small...
Article
Full-text available
Background Osteoarthritis (OA) is the most common joint disorder in the USA, and knee OA has the highest prevalence. Inflammation and decrease in vascularization are key factors in the degeneration of articular cartilage and the associated pain and decrease in function. To combat this process, the use of biologics including umbilical cord-derived W...
Article
Full-text available
Sports injuries and secondary joint problems, mainly of the knee, are common, especially in sports associated with high impact activities and/or torsional loading. The consequences can be career ending in elite athletes and reduce exercise activities in recreational people. Various cell products can be injected intra-articularly. First, fresh cellu...
Preprint
Full-text available
Background: Lumbopelvic control has recently been associated with function, kinesiology, and limb loading. However, poor lumbopelvic control has not been studied as a risk factor for lower limb injury in sports with frequent jump landings. The present study aimed to investigate the effects of lumbopelvic control on landing mechanics and lower limb...
Article
Full-text available
Background: The present study assesses the frequency of injury in Europe's top-level judokas, during top-level competitions, and defines risk factors. Methods: The members of the EJU Medical Commission collected injury data over the period of 2005 to 2020 using the EJU Injury Registration Form at Europe's top judoka tournaments. Results: Over...
Article
Full-text available
Background Professional soccer players are often evaluated with asymptomatic lesions of the ankle and foot, and such abnormalities may eventually become clinically relevant. Purpose To ascertain the prevalence of foot and ankle abnormalities in elite professional adult soccer players. Study Design Case series; Level of evidence, 4. Methods Profe...
Article
Full-text available
Introduction: Concussion is traumatic brain injury with associated tissue damage commonly produced by an indirect or direct head or facial trauma that can negatively impact an athletes' career and personal life. In this context, the importance on how to deal with a concussion has received attention from worldwide literature and has become a topic...
Article
The validation of a 4-domain PROM tailored to orthopedic sports medicine was performed through item generation, item scaling, validity and reliability testing, statistical analysis, as well as item reduction. Conbrach's alpha was used to verify item homogeneity, i. e. their accuracy or consistency. This PROM showed acceptable statistical accuracy a...
Article
Background and purpose of the study Arthroscopic debridement, the most commonly applied surgical technique for focal cartilage lesions in the knee, is not included in most treatment algorithms because of discouraging results in the management of osteoarthritis of the knee. The present systematic review evaluates the outcome of arthroscopic cartilag...
Article
Full-text available
Background: The present study investigated the impact of competitive soccer on the short-term changes in isometric strength of the adductor muscle group during the competitive season. Methods: In this cohort study we evaluated the association between a serum marker of muscle damage [creatine phosphokinase (CPK)] and isometric strength of the add...