Stefano Di Paolo

• PhD
• Researcher at Istituto Ortopedico Rizzoli

Background High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investi...

Background Anterior cruciate ligament (ACL) tears combined with medial collateral ligament (MCL) injury has been associated with an increased rate of ACL reconstruction (ACLR) failure, high-grade pivot shift (PS), and lower return to sports rate. On the other hand, medial-sided procedures in the setting of ACLR are associated with knee stiffness an...

The aim of this study was to assess the kinematic differences in the upper limb and trunk between healthy and shoulder-injured softball position (non-pitchers) players. Eleven first-division softball players (mean age: 25.9 ± 8.1 years) were enrolled: five players who had experienced a shoulder injury with consequent surgery (time from surgery to t...

Background In recent years, lateral extra-articular tenodesis (LET) has been shown to be promising in reducing the graft failure rate at short-term follow-up. However, there is a lack of studies investigating the incidence of complications and lateral osteoarthritis (OA) after this procedure, and only a few studies have reported long-term results a...

Background An anterior cruciate ligament (ACL) tear impairs knee biomechanics in daily activities and potentially breaks the synergy among other knee ligaments. Previous studies have demonstrated that the biomechanics of collateral ligaments is influenced by ACL deficiency. Purpose To investigate changes in the elongation patterns of the medial co...

Objectives Modern lateral extra-articular tenodesis (LET) has shown promising results at short term follow-up but there is a lack of studies investigating the incidence of complication and lateral osteoarthritis (OA) at long-term. The aim of the study was to compare in terms of failure rates, clinical outcomes and OA incidence three different ACL r...

Objectives The purpose of this study was to compare the survival rates and clinical outcomes of patients who received medial MAT+HTO (MAT+HTO group) with a control group undergoing isolated medial MAT (MAT group), to define if a surgically corrected varus malignment may affect patient’s outcomes and the survivorship of MAT over time. The hypothesis...

Background Landing with poor knee sagittal plane biomechanics has been identified as a risk factor for Anterior Cruciate Ligament (ACL) injury. However, it is unclear if the horizontal hop test battery reflects knee function and biomechanics. Hypothesis/Purpose To investigate the correlation between clinical limb symmetry index (LSI) and landing a...

Background Collagen meniscal implant (CMI) is considered an effective procedure for reducing knee pain and improving knee function after previous meniscectomy. Nevertheless, the current knowledge regarding long-term patient reported-outcome measures after CMI is limited. Purpose To evaluate clinical outcomes, reoperations, and failures of CMI at a...

Laboratory studies have limitations in screening for anterior cruciate ligament (ACL) injury risk due to their lack of ecological validity. Machine learning (ML) methods coupled with wearable sensors are state-of-art approaches for joint load estimation outside the laboratory in athletic tasks. The aim of this study was to investigate ML approaches...

Total Ankle Replacement (TAR) could, in theory, partially restore joint sensation and motion, enhancing motor coordination, functional stability, and proprioception in a joint affected by osteoarthritis. The aim of this study is to evaluate ankle proprioception before and after a Total Ankle Replacement via an instrumental objective assessment. The...

Background Satisfactory clinical results of meniscal allograft transplantation (MAT) have been reported in recent years. However, it remains unclear whether the clinical outcomes of MAT when combined with an osteotomy are inferior to those of isolated MAT. Purpose To compare the survival rates and clinical outcomes of patients who received isolate...

Purpose To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACL study and to provide normative values and differences between males and females for full‐body kinematics based on two‐dimensional (2D) video analysis and scoring system. Methods One‐thousand‐and‐two comp...

Ankle osteoarthritis (OA) represents a significant social burden and is one of the main causes of chronic disability in a rapidly growing part of the world’s population. Total ankle arthroplasty (TAA) has become increasingly popular despite the poor results obtained with the first dedicated designs. The purpose of this paper was to evaluate the ank...

Background Improving our understanding of the situations and biomechanics that result in an anterior cruciate ligament (ACL) injury in basketball players may support the design of more effective programs to mitigate the risk of injury. Purpose To (1) describe the mechanisms, situational patterns, and gross biomechanics (kinematics) of ACL injuries...

Purpose Surgeons generally consider the donor age as a factor that negatively influences the quality of allograft used in anterior cruciate ligament (ACL) reconstruction, however, the available evidence does not clearly support this statement. The purpose of the study was to investigate if donor age influences the biomechanical properties of allogr...

Background Establishing anterior cruciate ligament (ACL) injury risk during cutting movements has traditionally been performed in relatively standardized laboratory environments. This current paradigm inherently assumes that cutting biomechanics is independent of a sport-specific context. However, measuring movement in an ecological valid environme...

Individual performance in team sports is a multifactorial reflection of how well a player can cope and accomplish tasks in varied playing situations. Thus, performance analysis should not only focus on outcomes, but also on underlying mechanisms of those outcomes. We adopted principles of the ecological dynamics approach (EDA) to investigate the ef...

Purpose: To assess the survival rate and associated risk factors of a wide cohort of patient's underwent surgical treatment for posterior cruciate ligament (PCL)-based multiligament knee injury (MLKI) at long-term follow-up and to investigate the long-term patient's reported outcomes (PROMS) and functional activity. Methods: All cases of PCL-bas...

Purpose: The purpose of this study was to investigate the in vivo kinematics of the same femoral design mechanically aligned posterior-stabilised (PS) total knee arthroplasty (TKA) with either fixed-bearing (FB) or mobile-bearing (MB) inlay, implanted by the same surgeon, using model-based dynamic radiostereometric analysis (RSA). The hypothesis o...

Background The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players. Hypothesis/Purpose The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female...

Objectives Collagen Meniscus Implant (CMI) is considered an effective procedure for reducing knee pain and improving knee function after previous meniscectomy. Nevertheless, the current knowledge regarding the clinical results of CMI are limited to small case series at short- to mid-term follow-up studies. The goal of the present study was to evalu...

Background The role of meniscal lesions and repair in combination with anterior cruciate ligament (ACL) injury and reconstruction has not been extensively investigated in vivo and under weightbearing conditions. Purpose The purposes of this study were to (1) compare the in vivo knee kinematics between patients with ACL tear and those with combined...

Purpose: A combined anterior cruciate ligament (ACL) reconstruction and high tibial osteotomy (HTO) is considered a valuable treatment in young patients affected by symptomatic medial osteoarthritis and ACL deficiency. However, only a few studies have investigated the outcomes of this procedure, especially in the long term. Therefore, the aim of t...

Background: Lateral movements are challenging for 2D video-analysis and are therefore often omitted in functional tests for Anterior Cruciate Ligament (ACL) injury risk assessment. The purpose of the present study was to investigate the association between frontal and transverse plane angles obtained from 2D video-analysis and knee abduction momen...

The aim of the present case report was to provide a longitudinal functional assessment of a patient with transfemoral amputation from the preoperative status with socket-type prosthesis to one year after the osseointegration surgery. A 44 years-old male patient was scheduled for osseointegration surgery 17 years after transfemoral amputation. Gait...

Purpose The purpose of this study was to synthesize and quantitatively assess the outcomes of ACL Revision using a quadriceps tendon (QT) graft and to compare them with those of ACL Revisions performed with hamstring tendons (HT) graft. Methods A comprehensive search based on the PRISMA protocol was performed across PubMed, Scopus, Embase, and Coc...

The aim of the present study was to investigate if the presence of anterior cruciate ligament (ACL) injury risk factors depicted in the laboratory would reflect at-risk patterns in football-specific field data. Twenty-four female footballers (14.9 ± 0.9 year) performed unanticipated cutting maneuvers in a laboratory setting and on the football pitc...

Pivoting sports expose athletes to a high risk of knee injuries, mainly due to mechanical overloading of the joint which shatters overall tissue integrity. The present study explored the magnitude of tibiofemoral contact forces (TFCF) in high-risk dynamic tasks. A novel musculoskeletal model with modifiable frontal plane knee alignment was develope...

Background The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current o...

Background Meniscal allograft transplant (MAT) is an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy. However, the literature contains a paucity of studies assessing the survival rate and prognostic factors of soft tissue MAT. Pur...

Diving saves are the main duty of football goalkeepers. Few biomechanical investigations of dive techniques have been conducted, none in a sport-specific environment. The present study investigated the characteristics of goalkeepers’ dive in preferred (PS) and non-preferred (nPS) side through an innovative wearables-plus-principal-component analysi...

Total ankle prosthesis as a surgical solution in the case of end-stage osteoarthritis has seen a considerable increase in the last two decades. This study protocol arises from the need to understand the in vivo kinematics of mobile-bearing, flat tibial component total ankle replacement, evaluating the real range of motion and the reciprocal relatio...

Background Collagen meniscal implant (CMI) is a biologic scaffold that can be used to replace meniscus host tissue after partial meniscectomy. The short-term results of this procedure have already been described; however, little is known about risk factors for failure. Purpose To determine the factors that predict failure of meniscal scaffold impl...

Objectives The present study aimed to determine the factors that predict failure of meniscus scaffold implantation in a large series of patients treated at a single institution, to better refine the indications for surgery and better inform future patients. Methods 156 consecutive patients with a minimum 5-year follow-up who underwent isolate CMI...

A consistent injury mechanism involving multiple joints has been highlighted in athletes experiencing anterior cruciate ligament (ACL) rupture. However, if and to what extent healthy athletes incur an unsafe biomechanical profile during high-dynamics movements is unknown. The present study aimed to investigate the occurrence of the ACL risk profile...

Purpose: To explore in vivo kinematical behavior of the same total knee arthroplasty (TKA) cruciate-retaining (CR) femoral design with either medial-congruent (MC) or ultra-congruent (UC) inlay using model-based dynamic radiostereometric analysis (RSA). The hypothesis was that there would be comparable kinematics between the two groups. Methods:...

Objective The purposes of this study were: 1) to compare three different surgical techniques for ACL reconstruction at minimum-2-years follow-up in terms of objective laxity and patient reported outcomes; 2) to inspect the role of meniscal tears and treatment alongside with ACL reconstruction. Methods 59 patients were randomly assigned to one of t...

Modifiable (biomechanical and neuromuscular) anterior cruciate ligament (ACL) injury risk factors have been identified in laboratory settings. These risk factors were subsequently used in ACL injury prevention measures. Due to the lack of ecological validity, the use of on-field data in the ACL injury risk screening is increasingly advocated. Thoug...

Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to relieve chronic pain syndromes, even if, to date, solid evidence is still needed about the effectiveness of this therapy. By this systematic review and meta-analysis, we aimed to evaluate...

Background: Limb symmetry index in the single-leg hop (SLH) test has been questioned for its low predictive value in identifying secondary anterior cruciate ligament (ACL) injury. The purpose of this study was to describe a qualitative 2-dimensional (2D) scoring system for the assessment of the SLH test and associate it with the vertical ground-re...

Background: Surf practice contributes to overuse injuries and musculoskeletal pain. Relationship between the type of surfing practiced and the onset of pain is not fully understood as well as the potential role of rehabilitation in preventing it. Objective: To investigate musculoskeletal pain and to deepen whether the age and the anatomical regi...

Background A combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is a common injury pattern encountered during clinical practice. Recent systematic reviews have found no consensus on the optimal method of managing this combined ligament injury pattern, and no long-term studies with modern techniques are avai...

Meniscal tears are common injuries in sports and their surgical treatment is one of the most performed procedures in orthopaedic surgery. The comprehension of the normal and pathological biomechanics of meniscus is mandatory to fully address this kind of injury and restore the native behaviour of the knee joint. This chapter provides an overview of...

Purpose The presence and severity of bone bruise is more and more investigated in the non-contact anterior cruciate ligament (ACL) injury context. Recent studies have advocated a correlation between bone bruise and preoperative knee laxity. The aim of the present study was to investigate the correlation between bone bruise and preoperative rotatory...

Purpose The deceleration (pressing) is a common situational pattern leading to anterior cruciate ligament (ACL) injury in football. Although mainly assessed for performance purposes, a stronger focus on movement quality might support the screening of at-risk athletes. The aim of the present study was to describe a 2D scoring system for the assessme...

Background: Sport activities were interrupted due to a quarantine imposed to limit the spread of Coronavirus disease 2019 (COVID-19) in Italy. This study aimed to describe the impact of COVID-19 on sports and on daily activities in an Italian cohort of school children signed up in a football school. Methods: A total of 44 children from an Italian f...

PurposeTo evaluate the in vivo knee laxity in the presence of a partial medial meniscectomy before and after a single-bundle ACL reconstruction with a lateral plasty (SBLP) and to compare it with the knee laxity after a single-bundle ACL reconstruction (SB). Methods One-hundred and one patients with ACL tear were enrolled in the study and grouped a...

Purpose: To assess the complications and second surgeries rates at 1 year follow-up in a group of patients underwent minimally invasive fixation with screws or hybrid external fixation (HEF) for tibial plateau fractures (TPF). The hypothesis was that low Schatzker (I-IV) TPF would have shown a lower complication rate with respect to high Schatzker...

The anterolateral ligament (ALL) has been suggested as an important secondary knee restrain on the dynamic laxity in anterior cruciate ligament- (ACL-) deficient knees. Nevertheless, its kinematical contribution to the pivot-shift (PS) phenomenon has not been clearly and objectively defined, and noninvasive sensor technology could give a crucial co...

Background Lateral extra-articular tenodesis in the context of anterior cruciate ligament (ACL) reconstruction (ACLR) is performed to better control anterolateral knee instability in patients with high-grade preoperative pivot shift. However, some authors believe these procedures may cause lateral compartment overconstraint, affecting knee motion i...

Motor coordination and lower limb biomechanics are crucial aspects of anterior cruciate ligament (ACL) injury prevention strategies in football. These two aspects have never been assessed together in real scenarios in the young population. The present study aimed to investigate the influence of motor coordination on lower limb biomechanics in young...

PurposeThe aim of the present study was to compare the in vivo under weight-bearing kinematic behavior of a posterior-stabilized (PS) and an ultra-congruent (UC) total knee arthroplasty (TKA) model during a sit-to-stand motor task, a common activity of daily life.MethodsA cohort of 16 randomly selected patients (8 PS Persona Zimmer, 8 UC Persona Zi...

Background: Surfing is an increasingly popular sport in the world, but it is not sufficiently investigated in terms of epidemiology of injuries and possible prevention strategies. Moreover, there are different surfing disciplines, with specific characteristics and therefore different potential risks of injury. The aim of this study was to look at...

Background Lateral meniscal deficiency increases the pivot shift in the knee, and although meniscal allograft transplantation (MAT) is a well-established procedure with satisfactory clinical results, biomechanical studies have failed to show whether this procedure is able to restore knee kinematics. Purpose To assess, in vivo, the kinematic effect...

Purpose Abnormal joint biomechanics and poor neuromuscular control are modifiable risk factors for Anterior Cruciate Ligament (ACL) injury. Although 3D motion capture is the gold standard for the biomechanical evaluation of high-speed multidirectional movements, 2D video analysis is a growing-interest alternative because of its higher cost-effectiv...

Background Knee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients’ expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically re...

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four...

Purpose: The aim of the present study was to trace knee position at the time of bone bruise (BB) and investigate how much this position departed from the knee biomechanics of an in vivo flexion-extension. Methods: From an original cohort of 62 patients, seven (11%) presented bicompartmental edemas and were included in the study. 3D models of bon...

Adherence is important for an exercise program’s efficacy. This study aims at investigating whether the COVID-19 lockdown had different consequences on the adherence to an exercise program specifically designed for women with postmenopausal osteoporosis when administered as individual home training (IHT) or gym group training (GGT). At the start of...

Background and Objective : The aim of the present study was to review the literature concerning the analysis of periprosthetic bone remodeling through finite element (FE) simulation. Methods : A systematic review was conducted on 9 databases, taking into account a ten-year time period (from 2009 until 2020). The inclusion criteria were: articles p...

Background The lateral femoral notch sign (LNS) is a bony impression on the lateral femoral condyle correlated with anterior cruciate ligament (ACL) injury. Its presence is associated with lateral meniscal injury and higher cartilage degradation on the lateral femoral condyle. Purpose/Hypothesis The purpose was to investigate the effect of the pre...

Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not....

Loosening is considered as a main cause of implant failure in total knee replacement (TKR). Among the predictive signs of loosening, migration is the most investigated quantitative parameter. Several studies focused on the migration of the tibial component in TKR, while no reviews have been focused on the migration of the femoral component and its...

In the last two decades, osseointegrated prostheses have been shown to be a good alternative for lower limb amputees experiencing complications in using a traditional socket-type prosthesis; however, restraining biomechanical issues, such as peri-prosthetic bone fractures or loosening, are present. To better understand and overcome these limiting i...

The aim of the present Letter was to comment on the paper “Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises” from Shi et al. (Ann Biomed Eng, 2020, https://doi.org/10.1007/s10439-020-02523-y). Though the authors provided an extremely interesting paper on a debated topic in Sport Medicine,...

PurposeThe aim of this study was to evaluate the efficacy of a new minimally invasive surgical technique for the reconstruction of the medial patellofemoral ligament (MPFL) with fascia lata allograft at 60-month minimum follow-up.Methods Nineteen consecutive patients with chronic recurrent patellar dislocation were treated with MPFL reconstruction...

PurposeThe role of the anterior cruciate ligament (ACL) in knee biomechanics in vivo and under weight-bearing is still unclear. The purpose of this study was to compare the tibiofemoral kinematics of ACL-deficient knees to healthy contralateral ones during the execution of weight-bearing activities.Methods Eight patients with isolated ACL injury an...

Purpose: To evaluate if there was a correlation between in vivo kinematics of a medial-stabilized (MS) total knee arthroplasty (TKA) and post-operative clinical scores. We hypothesized that (1) a MS-TKA would produce a medial pivot movement and that (2) this specific pattern would be correlated with higher clinical scores. Methods: 18 patients w...

PurposeThe aim of the present study was to translate, cross-culturally adapt, and assess the psychometric properties of the Pedi-IKDC and Pedi-FABS scores in the Italian paediatric population with various knee pathologies.Methods In accordance with the Paediatric Anterior Cruciate Ligament Monitoring Initiative (PAMI) research protocol, the origina...

PurposeThe purpose of this study was to compare two types of posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasties (TKAs). The hypothesis was that no major differences were going to be found among the two TKA designs.Methods Two cohorts of patients who were divided according to implant design (Cohort A, new design gradually reduci...

PurposeThe purpose of the present study was to assess the kinematical behavior of a multi-radius posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) during an activity of daily living (Sit-To-Stand—STS) and a high demanding motor task (Deep-Knee-Lunge—DKL) using model-based dynamic RSA. We hypothesized the achievement of med...

Background: Meniscus allograft transplantation (MAT) is a surgical procedure performed in patients complaining post-meniscectomy syndrome. Although the effectiveness of MAT on knee stability has been already demonstrated in cadaveric studies, its biomechanical role has been poorly evaluated in-vivo. Methods: A narrative review of the biomechanic...

Background Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact...

Importance Meniscal tears are frequently associated with anterior cruciate ligament (ACL) injury and the correct management of this kind of lesion during ACL-reconstruction procedure is critical for the restoration of knee kinematics. Although the importance of meniscus in knee biomechanics is generally accepted, the influence of medial and lateral...