Stefano Zaffagnini

• Professor
• Istituto Ortopedico Rizzoli

Purpose Arthroscopic rotator cuff repair has evolved, with suture anchor‐based techniques like single‐row (SR) and Double‐row Suture‐bridge (DRSB) gaining popularity. Despite improvements, early repair failures remain concerning, necessitating continued assessment of repair methods and devices' lasting impact. This study compares DRSB versus SR rep...

Introduction Intra-articular injections of mesenchymal stromal cells concentrates showed promising results in the treatment of knee osteoarthritis (OA). Among these, bone marrow aspirate concentrate (BMAC) has been widely adopted in clinical practice. More recently, microfragmented adipose tissue (MFAT) has been proposed as a more suitable solution...

Purpose To assess long term survivorship, patient reported (PROMs) and radiological outcomes, and rate of adverse events and hardware removal after lateral closing wedge high tibial osteotomy (CWHTO) for the treatment of medial knee osteoarthritis (OA) and varus malalignment. Methods Retrospective analysis of patients who underwent isolated CWHTO...

Aims Patients with knee osteoarthritis (OA) and varus deformity present altered gait parameters, especially a large knee adduction moment that is predictive of OA progression. The distinct role of each coexisting parameter, such as OA grade, varus deformity, and previous meniscectomy, in the setting of high tibial osteotomy is not clear. Therefore,...

Objective The aim of this study was to establish the minimal clinically important difference (MCID) thresholds for the International Knee Documentation Committee (IKDC) subjective and Visual Analogue Scale (VAS) pain scores in patients affected by knee chondral and osteochondral lesions treated with cell-free scaffold implantation. Design For the...

Purpose Treatment strategies for osteochondral defects (OCDs) of the ankle have substantially increased over the last decade. The development of a small metallic implant to fill the defect has led to the second‐generation patient‐specific metal implant (Episealer Talus® Implant) designed based on computed tomography and magnetic resonance imaging i...

Purpose Bone marrow lesions (BMLs) of the knee are a common magnetic resonance imaging finding and are present in a wide range of pathologies, including traumatic contusions and fractures, following cartilage surgery alterations, osteoarthritis, transient BMLs syndromes, subchondral insufficiency fractures of the knee and spontaneous osteonecrosis...

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...

This study aims to investigate the association between chronic lateral meniscus posterior root tears (LMPRTs) and chondral or osteochondral lesions of the lateral femoral condyle (LFC), particularly in cases involving prior anterior cruciate ligament (ACL) injuries. Given the challenges in diagnosing LMPRTs and the biomechanical significance of the...

Purpose This study aimed to evaluate the demographic features of patients undergoing wrist arthroscopy in Italy. A secondary aim was to perform an economic analysis of this type of surgery. Methods The National Hospital Discharge Records database was employed to conduct the analysis. Wrist arthroscopy surgical procedures were defined by the primar...

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...

Purpose Enhancing implant placement to achieve optimal gap balance is crucial in total knee arthroplasty (TKA). Given the limited precision of traditional instrumentation, tools like computer‐assisted surgery and robotic‐assisted TKA have emerged. This experimental cadaveric study aimed to evaluate the accuracy and reproducibility of the collaborat...

Background: The most effective treatment approach for sacroiliac joint (SIJ) pain in spondyloarthropathy (SpA) patients remains unclear. This systematic review and meta-analysis aimed to assess the safety and effectiveness of different injective therapies for SIJ pain in SpA patients. Methods: A comprehensive literature search was conducted up to J...

Purpose This study intended to estimate the annual number of hallux valgus surgical procedures in Italy and the patients' epidemiological features. A secondary goal was to compare the demographic differences in access to hallux valgus surgery amongst three Italian macroregions. Methods The analysis was conducted by using the National Hospital Disc...

Knee cartilage lesions are frequent in football players, but evidence for surgical treatment is lacking. The aim of this International Cartilage Regeneration & Joint Preservation Society, Fédération Internationale de Football Association, and Aspetar (ICRS-FIFA-Aspetar) consensus was to develop specific expert-based, patient-specific practical reco...

Purpose To quantify the influence of baseline values of a specific patient‐reported outcome measure (PROM) on the minimal clinically important difference (MCID) calculation in a homogeneous series of knee osteoarthritis patients treated with platelet‐rich plasma (PRP) injections. Methods A data set of 312 patients with knee osteoarthritis treated...

Background Staphylococcus epidermidis is one of the pathogens most commonly involved in prosthetic joint infections, and when methicillin resistant, poses significant challenges in treatment, owing to its virulence and antibiotic resistance. Intravenous fosfomycin disodium is a broad-spectrum antibiotic recently introduced in clinical practice for...

Tailored surgical strategies for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients are presented, emphasizing techniques to minimize growth plate damage and ensure stability. As ACL injuries in youth increase, delaying surgery can lead to joint damage and poor recovery outcomes. Using magnetic resonance imaging‐based a...

Purpose This study aimed to compare the use of cortisone (C), intra‐articular injected at the end of hip arthroscopy in patients with femoroacetabular impingement (FAI), to a new Class III medical device based on hydrolyzed collagen peptides ‘PEPTYS’ (P) and, to investigate potential associations among preoperative symptoms and hip function, outcom...

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...

Planning primary total hip arthroplasty (THA) is critical to restore the hip’s native biomechanics. Preoperative X-ray is required to determine the correct positioning of implant components, aiming to equalize limb length and restore the hip’s center of rotation. The chapter outlines the steps for radiographic evaluation, including standardizing th...

Osteoarthritis commonly affects the medial compartment of the knee, and high tibial osteotomies (HTO) aims to realign the knee to relieve symptoms and delay joint degeneration. Two main techniques are described: medial opening wedge HTO (OWHTO) and lateral closing wedge HTO (CWHTO). OWHTO is preferred for its accuracy but may result in mild limb le...

Knee osteotomies are surgical procedures aimed at correcting varus or valgus deformities. Key points during patient’s surgical preparation include the use of spinal or general anesthesia, and the application of a tourniquet to minimize bleeding. The patient is positioned supine on the operating table. Intraoperative fluoroscopy is crucial, requirin...

Distal femoral osteotomy (DFO) for valgus knee emphasizes the importance of mechanical alignment in preventing and treating knee osteoarthritis. DFO aims to correct valgus malalignment by shifting the mechanical axis medially, thus sparing the joint and delaying the need for knee arthroplasty. Two main techniques are described: lateral opening wedg...

In this chapter the most common surgical approaches for total hip arthroplasty (THA) are described: direct lateral, posterior, and direct anterior. Patient positioning impacts implant placement, limb length monitoring, and surgical access. In this chapter, anesthesia options are also discussed, highlighting the benefits of regional anesthesia over...

Background Transfemoral osseointegrated prostheses, like other uncemented prostheses experience the risk of aseptic loosening and post-operative periprosthetic fractures, with an incidence between 3% and 30%. To date, however, osseointegrated off-the-shelf prostheses are manufactured in a limited number of sizes, and some patients do not meet the s...

Introduction Two-stage revision is considered the gold standard treatment in chronic periprosthetic joint infection (PJI) but no specific criteria or examination exist to determine infection eradication before reimplantation. This study aimed to assess the diagnostic performance of leukocyte scintigraphy after the first-stage procedure in two-stage...

Purpose The learning curve of a single surgeon performing hip arthroscopy is reported to be steep, but, to date, the inflection point after which procedures are more successful is still unknown. The aim of this study was to design a learning curve focused on clinical outcomes, complications and revision/conversion rates. Methods Seventy‐one hip ar...

Osteotomies around the knee have a variety of indications, including pain reduction, functional improvement, knee joint stabilization, and articular cartilage preservation. Thorough preoperative planning is essential, including a determination of the precise location of any deformity (proximal tibia, distal femur, or both). High tibial osteotomies...

Meniscal extrusion (ME), defined as the radial displacement of the meniscal body outside the margins of the tibial plateau, has been seen as an independent and relevant predictor of intra‐articular knee degeneration. Nonetheless, available classifications for ME are exclusively quantitative assessments not considering the context in which extrusion...

Background Treating hip osteoarthritis in the presence of retained proximal femoral hardware presents significant challenges. Conventional total hip arthroplasty techniques require hardware removal, which increases surgical complexity and risks and may not always be feasible, with reported success rate ranging from 85% and 95%. This case describes...

The medial collateral ligament (MCL) is by far the most commonly injured ligament of the knee. The medial ligament complex covers a broad bony surface on the extraarticular portion of the femur and is highly vascularized, which allows for a high healing potential. For this reason, most MCL complex lesions were treated conservatively in the past. Ho...

Purpose Hip arthroscopy has gained popularity among orthopaedic procedures over the last decade. The present study aims to evaluate the trends of hip arthroscopy procedures in Italy analysing data recorded by the Italian Ministry of Health, reporting demographics, length of hospitalisation (LOS), diagnosis and the economic impact of the procedure....

Purpose: The aim of this study was to investigate how meniscal extrusion, assessed either with ultrasounds or magnetic resonance (MR), correlates with clinical symptoms in knee osteoarthritis (OA). Methods: One hundred patients with symptomatic knee OA were enrolled (60.3 ± 9.7 years). Patients underwent MR evaluation and ultrasound analyses (clino...

Objectives: The main aim of this study was to describe the epidemiology of infected non-unions (INUs) managed at an Infectious Disease (ID) referral centre and to investigate the factors associated with treatment failure. Methods: This was an observational retrospective study on adult patients with INUs managed between 2012 and 2018 at the ID Unit...

Rationale and objective The visualization of soft tissues, like the meniscus, through X-ray micro-computed tomography (micro-CT), requires the use of contrast agents (CAs). While other studies have investigated CA diffusion in fibrocartilagineous tissues, this work aimed to optimize iodine staining protocols for meniscal tissue that improve their v...

Introduction Knee osteotomy combined with meniscal allograft transplantation (MAT) showed promising results to treat unicompartmental knee osteoarthritis (OA) secondary to meniscal deficiency and knee malalignment. However, there is still no high-level evidence to demonstrate whether the combination of these two treatments is superior to osteotomy...

This study aim was to analyze the joint temperature of patients affected by bilateral knee osteoarthritis (OA) using infrared thermography to investigate whether thermographic imaging patterns are influenced by the severity of symptoms and joint degeneration. Sixty-sixpatients ranging from 43 to 78 years old (63.3 ± 8.8 years) with bilateral knee O...

Introduction Histology is still considered the gold standard method for the evaluation of soft tissues in the musculoskeletal field, thanks to the possibility of studying structures using different staining and high magnification microscopy. To overcome the intrinsic limits of this method, contrast enhanced microtomographic (CE- microCT) protocols...

Purpose The aim of this systematic review and survival analysis was to quantify the benefits of orthobiologic augmentation therapies for the treatment of avascular necrosis (AVN) of the femoral head and identify the most effective approach to delay the need for total hip arthroplasty (THA). Methods A systematic review of the literature was perform...

Purpose: The Minimal Clinically Important Difference (MCID) is important to assess the clinical relevance of treatment results. The aim of this study was to establish the MCID values for VAS, WOMAC, and HHS scores in patients treated with intra-articular orthobiologic injections for hip osteoarthritis (OA). Methods: Ninety-six patients (62.5% men,...

Background Posttraumatic extension contracture of the knee (PECK) is common after knee injury. Initial management is conservative to improve the range of motion; if it fails, surgery may be necessary. This systematic review analyses existing literature on Judet quadricepsplasty for PECK. We will assess clinical outcomes, complications, patient sati...

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...

Purpose The association of adipose tissue-derived injectable products with platelet-rich plasma (PRP) has been promoted for osteoarthritis (OA) treatment. The aim of this study was to investigate the preclinical and clinical evidence supporting the potential of this combined approach to treat OA. Methods A systematic review was performed in Januar...

Background Arthroscopic meniscectomy is one of the most performed surgical procedures in orthopaedics. Different approaches have been proposed to improve patient recovery but with unsatisfactory results. Platelet-rich plasma (PRP) augmentation has been proposed as a strategy to improve the recovery after meniscectomy. Purpose To investigate the cl...

Background Platelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients’ clinical outcomes. Purpose To analyze if platelet concentration can influence the safet...

Background Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules. Purpose To compare the safety...

Early-stage knee osteoarthritis is often suitable for treatment with high tibial osteotomy (HTO). This is an effective joint-preserving treatment, resulting in good postoperative outcomes. To overcome the limitations of traditional HTO, the surgical technique and correction accuracy can be enhanced by personalised procedures using three-dimensional...

Purpose The aim of this study was to quantify meniscal extrusion through ultrasound (US) evaluation in supine and standing positions and to compare the results with those documented through magnetic resonance (MR) imaging in patients affected by knee osteoarthritis (OA). Methods Sixty patients (38 men, 22 women, mean age 60.8 ± 9.7 years) with kne...

Background: This study aimed to evaluate post-operative lower limb function following second-generation mechanically aligned medial pivot (MP) TKA implantation. Standard gait analysis was performed to collect kinematic and kinetic data, which were then compared with physiological data from the literature obtained using the same evaluation methodolo...

Background: Platelets and lymphocytes levels are important in assessing systemic disorders, reflecting inflammatory and immune responses. This study investigated the relationship between blood parameters (platelet count (PLT), mean platelet volume (MPV), lymphocyte count (LINF), and platelet-to-lymphocyte ratio (PLR)) and osteoarthritis (OA) severi...

Purpose The aim of this study was to evaluate if the operated knee environment remains abnormal in patients successfully treated with anterior cruciate ligament reconstruction (ACL‐R). Methods Thirty asymptomatic patients were enrolled (28 men, 2 women, age 28.6 ± 6.54 years, body mass index: 24.9 ± 3.0 kg/m²) and evaluated at 42.2 ± 12.5 months a...

Background Distal femur osteotomies are a well known and valuable treatment option to manage valgus malalignment with unicompartmental arthritis. Early postoperative complications are well known, and risk factors, such as pulmonary diseases, smoke, high dependent functional status, and body mass index, have been studied, but no study is available a...

Background Commercially available osseointegrated devices for transfemoral amputees are limited in size and thus fail to meet the significant anatomical variability in the femoral medullary canal. This study aimed to develop a customized osseointegrated stem to better accommodate a variety of femoral anatomies in transfemoral amputees than off-the-...

Advanced tools for the in situ treatment of articular cartilage lesions are attracting a growing interest in both surgery and bioengineering communities. The interest is particularly high concerning the delivery of cell-laden hydrogels. The tools currently available in the state-of-the-art hardly find an effective compromise between treatment accur...

Purpose To evaluate long-term clinical outcomes and redislocation rate after medial patellotibial ligament reconstruction. Materials and methods A total of 26 knees with mean age 26.3 ± 10.6 years (25 patients, 7 males and 18 females) treated for patellar instability (at least two objective dislocations) with medialization of the patellar tendon m...

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...

Osteochondritis dissecans (OCD) can lead to detrimental effects in the affected joints. Osteochondral autologous transplantation (OAT) allows to restore the articular surface with an autologous osteochondral unit. While short-term results are documented, there is a lack of long-term data. Aim of this study was to analyze the long-term clinical resu...

Purpose A cell‐free biomimetic osteochondral scaffold was developed to treat cartilage knee lesions, with positive clinical results documented in small case series. However, clear evidence on patient and lesion characteristics that might affect the outcome is still lacking. The aim of this study is to analyse a large cohort of patients treated with...

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...

Introduction: The development of reliable treatments for infected or potentially infected bone loss resulting from open fractures and non-unions is extremely urgent, especially to reduce the prolonged courses of antimicrobial therapy to which affected patients are subjected. Numerous bone graft substitutes have been used over the years, but there a...

Background A few studies have documented the long-term results of chondrocyte-based procedures for the treatment of patellofemoral cartilage lesions, but specific results are lacking after matrix-assisted autologous chondrocyte transplantation (MACT) for patellar and trochlear lesions. Purpose To document the clinical results of MACT for the treat...

Purpose Patellar cartilage lesions are a frequent and challenging finding in orthopaedic clinical practice. This study aimed to evaluate a chitosan‐based scaffold's mid‐term clinical and imaging results patients with patellar cartilage lesions. Methods Thirteen patients (nine men, four women, 31.3 ± 12.7 years old) were clinically evaluated prospe...

Purpose to provide a comprehensive overview of all the surgical techniques published in the literature for repairing meniscal ramp lesions focusing on the technical aspects and the pros and cons of every procedure. Such lesions can be managed using various approaches, each of this with its specific advantages and disadvantages. Methods Pubmed Cent...

Background Meniscal allograft transplantation (MAT) is a viable option for patients experiencing unicompartmental knee pain after total or subtotal meniscectomy. Nonetheless, caution is recommended when suggesting this procedure in the presence of knee osteoarthritis (OA) because of the higher risk of poor survival and outcomes. Purpose/Hypothesis...

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 The aim of this study was to prospectively evaluate the long‐term clinical results and failure rate of patients treated with complex salvage procedures using a combined mechanical and biological approach to address unicompartmental knee osteoarthritis (OA) and postpone the need for joint replacement. Methods Thirty‐nine patients (40.3 ± 10...

Background The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise seri...

Three-dimensional information is essential for a proper understanding of the healing potential of the menisci and their overall role in the knee joint. However, to date, the study of meniscal vascularity has relied primarily on two-dimensional imaging techniques. Here we present a method to elucidate the intricate 3D meniscal vascular network, reve...

Osteonecrosis of the knee is a degenerative syndrome characterized by osseous necrosis of a load-bearing portion of the distal femur or proximal tibia, followed by subchondral insufficient fractures, subsequent segmental collapse and osteoarthritis which may require surgical intervention. It can be divided into three clinical entities with differen...

Purpose The aim of this study was to assess how gender might affect the clinical outcome and survival of meniscal allograft transplantation (MAT). Methods A total of 358 patients (23.2% women, 76.8% men) were treated with fresh‐frozen nonirradiated allografts implantated arthroscopically using a single‐ or double‐tunnel technique without bone plug...

(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases in our research. Studies reporting the results of posterior shoulder dislocations su...

Purpose The aims of the present study were (1) to evaluate the survival of patellofemoral joint (PFJ) arthroplasty in a large cohort of patients using data obtained from an Italian regional arthroplasty registry and (2) to collect clinical outcomes of a subgroup of patients, with a minimum follow‐up of 4 years. The hypotheses were that PFJ arthropl...