
Nicola MaffulliUniversità degli Studi di Roma Sapienza · Trauma and Orthopaedic Surgery
Nicola Maffulli
MD, MS, PhD, FRCP, FRCS(Orth), FFSEM
About
2,342
Publications
1,340,225
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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.
Publications
Publications (2,342)
Background
Osteoporosis (OP) is a metabolic bone disease producing reduction in bone mass with consequent bone fragility. Circular ribonucleic acid (CircRNA) is a form of RNA that forms a loop structure rather than a linear one. CircRNA can be used for therapeutic purposes, including molecular targets or to test new therapies.
Sources of data
A sy...
Radial extracorporeal shock wave therapy (rESWT) is an established modality in the management of Achilles tendinopathy. A recent study published in Clinical Rehabilitation reported that the addition of rESWT to exercise and education did not lead to improvements in pain, function or other outcomes compared to the addition of sham rESWT at 6 or 12 w...
Background
Proper positioning of a total hip arthroplasty (THA) plays a crucial role in the success and long-term survivorship of the implant. Cup positioning within the Lewinnek Safe Zone (LSZ) does not, however, avoid implant dislocation. Thus, the concept of a functional cup position has been introduced. The purpose of this study was to assess t...
Objectives: This study tested the hypothesis that radial extracorporeal shock wave therapy combined with a specific rehabilitation program (rESWT + RP) is more effective than sham rESWT + RP in athletes with acute hamstring muscle complex (HMC) injury type 3b.
Methods: This was a prospective, randomized, sham-controlled, single center trial with pu...
Purpose: Tears of the pectoralis major (PM) rupture are uncommon and are associated with sport. Early diagnosis is essential to obtain a satisfactory functional outcome. Ruptures can be full or partial and can present as acute or chronic injuries. Most commonly, ruptures are located at the level of the humeral insertion of the PM, followed by ruptu...
We read with great attention, and fully enjoyed, the work by Foti G [...]
Purpose
The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots.
Methods
All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group...
The advent of bioprinting has enabled the creation of precise three‐dimensional (3D) cell cultures suitable for biomimetic in vitro models. In this study, we developed a novel protocol for 3D printing methacrylated collagen (ColMa, or PhotoCol®) combined with tendon stem/progenitor cells (hTSPCs) derived from human tendon explants. Although pure Co...
Purpose
The use of a fixed theoretical-proportional-factor (TPF15) is one of the indirect highest-oxygen-consumptions (HOC) assessment methods, but it may not accurately reflect the physiological differences across various sports (cycling-triathlon-running-football-multisport). The aim of this study is to evaluate the variability of TPF across diff...
Introduction
Fractures of the distal radius are common in pediatric population, with considerable variation in the management of pediatric wrist fractures across different countries. It is crucial to consider the different approaches to conservative management and surgical intervention. The decision on the appropriate treatment method often depends...
Introduction
Heterotopic ossifications (HO) are common after total hip arthroplasty (THA). The invasiveness of surgical approaches plays a relevant role in HO development. The aims of this study were to assess the development of HO 6 months after THA through direct lateral approach (DLA) or direct anterior approach (DAA) without a dedicated orthopa...
A limited understanding of tendon cell biology in healthy and pathological conditions has impeded the development of effective treatments, necessitating in vitro biomimetic models for studying tendon events. We established a dynamic culture using fibrin scaffolds, bioengineered with tendon stem/progenitor cells (hTSPCs) from healthy or diseased hum...
Background
Bacterial infection after hardware implantation in orthopedic and trauma surgery is devastating, resulting in increased hospital costs and stays, multiple revision surgeries, and prolonged use of antibiotics. The present study aims to determine whether a symbiotic relationship between the human organism and bacteria in hardware implantat...
Transcranial direct current stimulation (tDCS) can increase cortical excitability of a targeted brain area. This study aimed to investigate the effect of adding anodal-tDCS (a-tDCS) to neuromuscular training (NMT) on the dynamic knee valgus (DKV) and feedforward activity (FFA) of knee muscles. Thirty-four Taekwondo athletes with DKV, were randomly...
Hand tendinopathies represent a pathological condition associated with significant disability. However, due to this high heterogeneity of the treatments and their efficacy, there is still a lack of consensus on the infiltrative therapy of the hand. This systematic review aimed to investigate the efficacy of injection techniques in the treatment of...
Background
Kickboxing is a popular striking combat sport, and K-1 is a type of kickboxing. Direct head blows can cause significant long-term injury and affect brain wave activity.
Objectives
We aim to compare the changes in brain wave activities of fighters during a K-1 kickboxing contest to those in a control group, who were striking a punching b...
Joint pain is a common complaint owing to its origin in inflammatory and degenerative joint diseases. Recent research has helped narrow down inadequate angiogenesis as one of the causes. Angioembolization has emerged as a treatment option for this condition when it is refractory to conservative treatment. This review describes angioembolization by...
Although lumbar synovial cysts (LSCs) are frequently described in the literature, they are a relatively uncommon cause of low back and radicular leg pain. Furthermore, their spontaneous resolution is an even rarer event. The standard treatment of the lumbar synovial cyst is surgical excision. Spontaneous resolution in the literature is a sporadic e...
Background
Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair.
Purpose
To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair.
Study Desi...
Introduction
Increases in skeletal muscle size occur in response to prolonged exposure to resistance training that is typically ascribed to increased muscle fibre size. Whether muscle fibre number also changes remains controversial, and a paucity of data exists about myofibrillar structure. This cross-sectional study compared muscle fibre and myofi...
Muscle and tendon injuries encompass a wide range of conditions, including both acute and chronic ailments, and are common among athletes, representing a significant cause of injuries in various sports. Frequently affected areas include the hamstrings, quadri-ceps, gastrocnemius, and hip flexors. Concurrently, tendinopathy presents a complex clinic...
In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger pati...
Background
Patients undergoing surgery for Superior-Labrum-anterior-to-posterior (SLAP) lesions are often worried about their return to sport performance. This systematic review determined the rate of return to sport and return to sport at the previous level (RTSP) after surgery for SLAP lesion.
Materials and Methods
The PRISMA guidelines were fol...
According to the Italian National Olympic Committee (CONI), apart from the many organic benefits, the main functions of movement concern the preservation and development of the organism as a whole, increasing information for the brain, and the expressive potential of the individual (in the form of language, culture, motor intelligence, and motor ex...
Background
Current management options for partial tendon tears may not offer future potential to heal tissue and improve clinical results. This study tested the hypothesis that treatment of a partial rabbit common calcaneus tendon (CCT) defect with uncultured, autologous, adipose derived regenerative cells (UA-ADRCs) enables regenerative healing wi...
Background
In patients with COVID-19 infection and respiratory insufficiency, corticosteroid (CCS) administration is recommended. Among the wide range of complications and interactions, time-limited high-dose CCS administration might promote avascular necrosis (AVN) in a cumulative dose. This systematic review updated the current evidence and chara...
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in w...
Wearable sensors are miniature and affordable devices used for monitoring human motion in daily life. Data-driven models applied to wearable sensor data can enhance the accuracy of movement analysis outside of controlled settings. However, obtaining a large and representative database for training these models is challenging due to the specialised...
Purpose
The present study evaluated the outcomes of anterior cruciate ligament (ACL) reconstruction in children with open physes. The outcomes of interest were to compare the increase in joint laxity and PROMs from baseline to the last follow‐up, the rate and features of the return to sport and the rate of complications.
Methods
This study was con...
Background
The present systematic review investigated the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) of several frequent and established PROMs used to assess patients who have undergone TKA. This study was conducted according to the 2020 PRISMA statement.
Methods...
Background
Several clinical investigations have compared different pharmacologic agents for the prophylaxis of venous thromboembolism (VTE). However, no consensus has been reached. The present investigation compared enoxaparin, fondaparinux, aspirin and non-vitamin K antagonist oral anticoagulants (NOACs) commonly used as prophylaxis following tota...
Tendon injuries are a common problem that can significantly impact an individual's quality of life. While traditional surgical methods have been used to address this issue, Extracellular Vesicles (EVs) have emerged as a promising approach to promote tendon repair and regeneration mechanisms, as they deliver specific biological signals to neighbouri...
Poor tendon repair is an unsolved issue in clinical practice, due to complex tendon structure. Tendon stem/progenitor cells (TSPCs) play key roles in homeostasis, regeneration, and inflammation regulation in acute tendon injuries, and rely on TGF-β signaling for recruitment into degenerative tendons. In this study, we aimed to develop an in vitro m...
Spontaneous muscle regenerative potential is limited, as severe injuries incompletely recover and result in chronic inflammation. Current therapies are restricted to conservative management, not providing a complete restitutio ad integrum; therefore, alternative therapeutic strategies are welcome, such as cell-based therapies with stem cells or Per...
Purpose: Tendinopathies and tendon ruptures are a common cause of pain and disabilities. The pathogenesis is considered multifactorial, and currently described as the failed healing response. Traditionally, tendon injuries have been mostly referred to age, overuse or mechanical factors. Recently, some authors have focused their attention on the inf...
Category
Sports; Ankle
Introduction/Purpose
Chronic Achilles tendon ruptures is challenging because the tendon ends are usually retracted, and if the gap between the proximal and distal stumps are of more than 6 cms with the ankle in plantarflexion the currently literature shows that semitendinous tendon (ST) autograft reconstruction has satisfact...
Category
Sports; Ankle
Introduction/Purpose
Chronic Achilles tendon ruptures is challenging because the tendon ends are usually retracted, and if the gap between the proximal and distal stumps are of more than 6 cms with the ankle in plantarflexion the currently literature shows that semitendinous tendon (ST) autograft reconstruction has satisfact...
It is unclear whether manual lymphatic drainage (MLD) following primary total knee arthroplasty (TKA) is effective in reducing pain and swelling and improving knee function. The present study investigated the efficacy of MLD after TKA. The outcomes of interest are the range of motion (ROM), pain (visual analogue scale, VAS), and circumference of th...
Introduction
The existing treatment modalities for knee osteoarthritis (OA) do not actually address the pathology. Biological therapies, including those using material derived from perinatal tissues, represent a ground-breaking approach to alleviating the symptoms of OA of the knee.
Source of data
Current scientific literature published in PubMed...
Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 differen...
Total hip arthroplasty (THA) is a common procedure for patients suffering from hip pain e.g. from osteoarthritis, osteonecrosis, or hip fractures. The satisfaction of patients undergoing THA is influenced by the choice of implant type and material, with one key factor being the selection of the appropriate material combination for the bearing surfa...
The prophylactic action of non-steroidal anti-inflammatory drugs (NSAIDs) in heterotopic ossification (HO) was first described following analgesic therapy with indomethacin. Following that evidence, several compounds have been successfully used for prophylaxes of HO. Ibuprofen has been also proposed for the prevention of HO following THA. The prese...
Rotator cuff (RC) tears in pediatric and adolescent athletes are rare events. In these patients, RC tears are more likely to be traumatic or related to overuse among overhead. Repeated movements of abduction and external rotation are frequent mechanisms of injury. The supraspinatus is the most commonly involved tendon and the articular-sided tears...
Background
Conservative management has emerged as an attractive option for partial thickness rotator cuff tears (PT-RCTs). A single algorithmic treatment strategy for patients with symptomatic PT-RCT has not yet been developed. This systematic review aims to ascertain whether a conservative approach to PT-RCTs yields positive results in terms of cl...
Highly prone to injury, the rotator cuff greatly contributes to the stability and mobility of the shoulder. Clinicians prioritize conservative treatment, resorting to surgery only when necessary, although they are hindered by inherent limitations. Biological therapies, including perinatal tissue, such as umbilical cord (UC) tissue, hold promise for...
Rotator cuff tears (RCTs) negatively impacts patient well-being. Artificial intelligence (AI) is emerging as a promising tool in medical decision-making. Within AI, deep learning allows to autonomously solve complex tasks. This review assesses the current and potential applications of AI in the management of RCT, focusing on diagnostic utility, cha...
Symptomatic, partial-thickness rotator cuff tears (sPTRCT) are problematic. This study tested the hypothesis that management of sPTRCT with injection of fresh, uncultured, unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs) is safe and more effective than injection of corticosteroid even in the long run. To this end, subjects who...
Purpose
The goal of the current study was to ascertain whether there is an association between foot pronation and anterior cruciate ligament (ACL) injury in a group of elite professional soccer players.
Methods
Two groups of soccer players were studied, all of whom played in the Greek Super League. The ACL group included players who had suffered an...
The temporomandibular joint (TMJ) is crucial for functions of daily living such as mastication and articulation. Common TMJ issues include osteoarthritis, internal derangement, and myofascial pain dysfunction. Conservative methods such as physical therapy and medications are used, with surgical options such as arthroscopy and replacement for severe...
Introduction
Computer tomography (CT) based navigation is considered by some authors as an advance in total hip arthroplasty (THA). A meta-analysis was conducted to compare CT based versus conventional THA in terms of surgical duration of the procedure, leg length difference, acetabular cup position, and rate of dislocation.
Material and methods
T...
Tendon injuries caused by overuse or age-related deterioration are frequent. Incomplete knowledge of somatic tendon cell biology and their progenitors has hindered interventions for the effective repair of injured tendons. Here, we sought to compare and contrast distinct tendon-derived cell populations: type I and II tendon stem cells (TSCs) and te...
Purpose
Meniscal tears are common and may impair knee function and biomechanics. This meta-analysis compared meniscal repair versus resection in patients with symptomatic meniscal tears in terms of patient-reported outcomes measures (PROMs), joint width, surgical failure, and rate of progression to osteoarthritis (OA) at conventional radiography....