Stefano Zaffagnini

Stefano Zaffagnini
Istituto Ortopedico Rizzoli | IOR · Complex Structure: 2nd Orthopaedic and Traumatologic Clinic

Professor

About

692
Publications
119,261
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13,468
Citations
Citations since 2017
349 Research Items
8387 Citations
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201720182019202020212022202305001,0001,500
201720182019202020212022202305001,0001,500

Publications

Publications (692)
Article
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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...
Preprint
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Background Patient-reported outcome measures (PROMs) are increasingly being used to assess the effectiveness of elective total knee arthroplasty (TKA). However, little is known about the change over time of PROMs scores in these patients. The aim of this study was to identify the trajectories of quality of life and joint functioning, and their asso...
Article
Background Plantar heloma is a keratotic disorder that can be described as a circumscribed area of thickening with a central core that may penetrate the dermis. Although often considered a minor complaint, longstanding lesions can be debilitating and severely impact on person’s quality of life. We present the first retrospective case series at long...
Article
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Anterior cruciate ligament (ACL) tear is one of the most common sport-related injuries and the request for ACL reconstructions is increasing nowadays. Unfortunately, ACL graft failures are reported in up to 34.2% in athletes, representing a traumatic and career-threatening event. It can be convenient to understand the various risk factors for ACL f...
Article
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Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors’ aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction...
Article
The knee is a complex anatomic structure. A solid knowledge of the anatomy and biomechanics helps to understand the mechanisms of injury and provides a useful tool for accurate diagnosis, with a positive impact on management and prognosis. A good understanding of the different surgical procedures used to treat pathology helps in providing as much i...
Article
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Background and Objectives: Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developin...
Article
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Hereditary multiple exostoses (HME), also known as familiar osteochondromatosis or diaphyseal aclasis, are an autosomal dominant inherited genetic pathology that is characterized by the presence of multiple benign osteochondromas. Knee deformity is common in patients with HME, with nearly a third of patients developing genu valgus. Total knee arthr...
Article
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The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the evidence about the safety and efficacy of these products. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was asse...
Article
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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...
Article
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Background: "Windswept" deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgi...
Article
PurposeThe aim of this study was to evaluate the clinical and imaging findings up to 24 months of follow-up in patients treated with combined subchondral and intra-articular bone marrow aspirate concentrate (BMAC) injections for the treatment of knee osteoarthritis (OA).Methods Thirty consecutive patients (19 males, 11 females) aged between 40 and...
Article
Zusammenfassung Verletzungen des vorderen Kreuzbandes (VKB) bei Kindern und Jugendlichen sind eine bedeutsame gesundheitliche und ökonomische Belastung und ihre Inzidenz steigt schneller als die in der erwachsenen Bevölkerung. Diese Verletzung beeinträchtigt die Lebensqualität, indem sie sich auf die Entwicklung des Kniegelenkes ebenso wie auf sein...
Article
Background and aim of the work: Hallux rigidus represents a surgical challenge, with a multitude of possible surgical options, but with no ideal procedures. The propose of this paper was to review the actual knowledge on the operative techniques, paying particular attention to the evolution of interposition arthroplasties, as an alternative to art...
Article
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Purpose: The anterolateral ligament (ALL) has been defined as a key stabilizer of internal tibial rotation at 35° or more of knee flexion, with a minimal primary or secondary stabilizing role in the AP direction. This study aimed to demonstrate that anatomical reconstruction of the ALL confers rotational stability equal to that of the uninjured kn...
Article
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Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about custo...
Article
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Introduction The present study aimed to investigate differences in survivorship between medial and lateral unicompartmental knee arthroplasty (UKA) by analyzing the data of an Italian regional registry. The hypothesis was that, according to recent literature, lateral implants have comparable survivorship with regard to the medial implants. Materia...
Article
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Background Achilles tendon rupture (ATR), while rare in football, is a severe career-threatening injury associated with long-layoff times. To date, no study has documented ATR’s mechanism in professional football players. Aim To describe the mechanisms, situational patterns and gross biomechanics (kinematics) of ATR injuries in professional male f...
Article
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Objective Aim of this systematic review was to describe all classification systems for knee osteochondritis dissecans (OCD) lesions, evaluating their accuracy and reliability, as well as their use in the literature on knee OCD. Design A systematic review of the literature was performed in July 2021 on PubMed, WebOfScience, and Cochrane Collaborati...
Article
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Purpose The purpose is to verify the intra- and inter-operator reliability of an extramedullary (EM) accelerometer-based smart cutting guide for distal femoral resection during primary total knee arthroplasty (TKA). The hypothesis of the present study was that the use of the device would result in a good correlation between different operators with...
Article
Introduction Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus defo...
Article
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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...
Article
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Background Patient-reported outcome measures (PROMs) are an extensively used tool to assess and improve the quality of healthcare services. PROMs can be related to individual demographic and clinical characteristics in patients undergoing hip arthroplasty (HA). The aim of this study is to identify distinct subgroups of patients with unique trajecto...
Article
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Introduction Subchondral and intra-articular injections of bone marrow aspirate concentrate (BMAC) showed promising results for knee osteoarthritis (OA) patients. To date, there is no evidence to demonstrate whether the combination of these treatments provides higher benefits than the intra-articular injection alone. Methods and analysis Eighty-si...
Article
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Purpose: This study aimed at reporting the long-term second revision rate and subjective clinical outcomes from a cohort of patients who underwent a double-bundle (DB) ACLR first revision with allograft at a single institution. Methods: The Institutional database was searched according to the following inclusion criteria: (1) patients that under...
Article
Background Intra-articular microfragmented adipose tissue (MF-AT) injections have been proposed for the treatment of knee osteoarthritis (OA). Purpose To compare a single injection of MF-AT or platelet-rich plasma (PRP) in terms of clinical outcomes and OA progression. Study Design Randomized controlled trial; Level of evidence, 1. Methods A tot...
Article
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According to the most popular scientific literature database in 2022, nearly 20 papers mentioning the “Kaplan Fiber” complex have been published in the last 2 years, highlighting the role of this anatomical structure in the context of anterior cruciate ligament tear [...]
Article
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The treatment of segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons [...]
Article
Purpose: The aim of this study is to illustrate an overview of the registries currently operative in many countries to support the introduction of new prospective registries in other countries. Methods: The authors carried out a systematic web research in July 2021 to identify national ACL registries' annual reports and scientific literature on...
Article
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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...
Article
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In recent years, total ankle replacement (TAR) has undergone a series of evolutions and changes in terms of materials, prosthetic designs, and surgical techniques [...]
Article
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Introduction Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects, plays an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for retur...
Article
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Platelet-rich plasma (PRP) is increasingly used for the intra-articular treatment of knee osteoarthritis (OA). However, clinical studies on PRP injections reported controversial results. Bone marrow edema (BME) can cause symptoms by affecting the subchondral bone and it is not targeted by intra-articular treatments. The aim of this study was to inv...
Article
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The presence of pain sensitisation has been documented and reported as being a possible cause of treatment failure and pain chronicity in several musculoskeletal conditions, such as tendinopathies. The aim of the present study is to analyse existing evidence on pain sensitisation in tendinopathies comparing the local and distant pain thresholds of...
Article
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...
Article
Objectives Pre-clinical and clinical studies supported the use of intra-articular micro-fragmented adipose tissue (MF-AT) injections to address knee osteoarthritis (OA), suggesting their safety and clinical benefits. Nevertheless, no high-level studies investigated the potential of MF-AT over other biological products like platelet-rich plasma (PRP...
Article
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Purpose: The purpose of this study is to compare the functional and clinical outcomes, blood loss, complication rate, and hospital length of stay (LOS) of total hip replacement (THR) using a minimally invasive tissue-sparing posterior superior (TSPS) approach and the standard posterior approach. Materials and methods: This retrospective, observa...
Article
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Purpose To analyze the MRI features, in particular bone bruises pattern, of Anterior Cruciate Ligament (ACL) injured footballers, and to correlate them with the characteristics of injury mechanism and situation obtained from direct video footage. Methods Nineteen professional football (soccer) players that sustained ACL injury while playing during...
Article
Purpose: New scaffold-based cartilage regeneration techniques have been developed to improve the results of microfractures also in complex locations like the patello-femoral joint. The aim of this study was to analyse the results obtained in patellar lesions treated with a bioscaffold, a mixture composed by a chitosan solution, a buffer, and the p...
Article
Aims: Meniscal allograft transplantation (MAT) for patients with symptomatic meniscal loss has demonstrated good clinical results and survivorship. Factors that affect both functional outcome and survivorship have been reported in the literature. These are typically single-centre case series with relatively small numbers and conflicting results. O...
Article
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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:...
Article
Purpose: Meniscal repairs are the most common associated procedures during ACL reconstruction, but they present challenging indications and possible risks of complications or failures. The aim of the present study is to assess the clinical outcomes of all-inside meniscal repairs in the setting of ACL reconstruction. Methods: Twenty patients with...
Article
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...
Article
Background and objective: In orthopedic medical devices, elasto-plastic behavior differences between bone and metallic materials could lead to mechanical issues at the bone-implant interface, as stress shielding. Those issue are mainly related to knee and hip arthroplasty, and they could be responsible for implant failure. To reduce mismatching-re...
Article
Purpose: Anterior cruciate ligament (ACL) ruptures are considered high burden injuries in sports with high pivotal activity, especially for professional footballers. A lack of evidence exists about long-term follow up of professional elite athletes who underwent ACL reconstruction. The purpose of the study is to analyze the return to play and the...
Article
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Objective The aim of this meta-analysis was to study the evidence on pain sensitization in knee osteoarthritis (OA), providing a quantitative synthesis of its prevalence and impact. Factors associated with pain sensitization were also investigated. Methods Meta-analysis; PubMed (MEDLINE), Cochrane Central Register (CENTRAL), and Web of Science wer...
Article
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Purpose: The increasing incidence of knee injuries among children is well known by sports physicians. Papers dealing with this topic have often collected patient-reported outcomes measures (PROMs) in a retrospective manner; this limitation could lead to a misinterpretation of the results, because pediatric patients might not remember their preoper...
Article
Background Lateral unicompartmental knee arthroplasty (UKA) is a viable solution for isolated lateral compartment arthritis. Several prosthetic designs are available such as Fixed Bearing Metal-Backed (FB M-B), Fixed Bearing All Polyethylene (FB A-P), and Mobile Bearing Metal Backed (MB M-B) implants. The purpose of this meta-analysis is to compare...
Article
Background: Platelet-rich plasma (PRP) is gaining large interest in clinical practice as a minimally invasive injective treatment for knee osteoarthritis (OA). Different preparation methods are available, and the presence of leukocytes, deemed detrimental in some preclinical studies, is one of the most debated aspects regarding PRP efficacy. Purp...
Article
Background A fully personalized combination of Gait Analysis (GA), including Ground Reaction Force (GRF), and patient-specific knee joint morphology has not yet been reported. This can provide valuable biomechanical insight in normal and pathological conditions. Abnormal knee varus results in medial knee condylar hyper-compression and osteoarthriti...
Article
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...
Article
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Background Depression and anxiety symptoms can occur in patients following an anterior cruciate ligament (ACL) injury, and the presence of these symptoms has been associated with poorer self-reported knee function in this type of injury. Purpose To investigate the prevalence and severity of self-reported symptoms of depression and anxiety followin...
Article
PurposeArticular cartilage lesions remain a challenge for orthopedic surgeons. The identification of the most important articles can help identifying the most influential techniques of the past, the current prevalent focus, and emerging strategies. The aim of this study was to identify milestones and trends in cartilage research. Methods This study...
Article
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Background Few studies on outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have provided insight into the very long-term effects of this procedure. Purpose To systematically review the outcomes, failure rate, incidence, and predictors of osteoarthritis (OA) for different ACLR techniques at a minimum 20-year follow-up. Study D...
Article
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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...
Chapter
Track and field is composed of a variety of events including running, throwing, jumping, and combined events. Although injuries to knee ligaments, including the anterior and posterior cruciate ligaments and medial and lateral collateral ligaments, occur less frequently in track and field than in other sports, knee ligament injuries may still occur...
Chapter
The management of patients affected by isolated patellofemoral osteoarthritis and associated anterior knee pain represents a challenging diagnosis for the orthopedic surgeons. Newer generation patellofemoral replacement implants have emerged as an excellent option for patients presenting with isolated patellofemoral osteoarthritis (PFOA). However,...
Chapter
Patella fractures are a common injury caused by excessive tension through the extensor mechanism or a direct trauma to the anterior knee. The patella is a vital sesamoid bone that articulates with the femoral trochlea and increases the leverage and efficiency of the extensor mechanism. The following case report is of a 27-year-old male involved in...
Chapter
In this chapter, three surgeons from various regions of the world review a case of patellofemoral (PF) instability in the adult female with recurrent instability, the chondrosis of patella and trochlea. The case was 40 years old female who underwent medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability on her left...
Chapter
The case presented in this chapter is a 40-year-old sedentary female with right knee pain and instability. She has recurrent low energy patellar dislocations and has failed conservative management. Her diagnoses include bipolar patellofemoral chondrosis, incompetent medial soft tissue restraints, lateral patellar retinacular tightness, abnormal axi...
Chapter
The role of orthobiologics injections for the management of meniscal lesions has gained growing interest, thanks to their minimal invasiveness, the possibility to combine them with other treatments, and the not always satisfactory results of other available treatments. Corticosteroids, hyaluronic acid (HA), and platelet-rich plasma (PRP) represent...
Chapter
Muscle injuries lead to a functional impairment and to a subsequent considerable absence from training and competition, with potentially significant consequences on the athlete’s season and career. Therefore, the management of muscle tears and the choice of treatment strategy represent a challenging topic. To achieve a quick yet full recovery, ther...
Article
A trend within the orthopedic community is rejection of the belief that “one size fits all.” Freddie Fu, among others, strived to individualize the treatment of anterior cruciate ligament (ACL) injuries based on the patient’s anatomy. Further, during the last two decades, greater emphasis has been placed on improving the outcomes of ACL reconstruct...
Article
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Background: Anterior cruciate ligament (ACL) tear represents a common orthopedic traumatic issue that often leads to an early development of osteoarthritis. To improve the diagnostic and prognostic techniques involved in the assessment of the joint after the trauma and during the healing process, the present work proposes a multi-parametric approa...
Article
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Cadaver studies represented a milestone in surgical orthopaedic research, and still today they play a crucial role in the achievement of new knowledge about joint disease behaviour and treatment. In this review, an overview of the cadaver studies available in the literature about the anatomy, role, and treatment of the antero-lateral ligament (ALL)...
Article
Clinical evaluation and management of anterior cruciate ligament (ACL) injury is one of the most widely researched topics in orthopedic sports medicine, giving providers ample data on which to base their practices. The ACL is also the most commonly treated knee ligament. This study reports on current topics and research in clinical management of AC...
Article
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Purpose The purpose of this study was to evaluate the main focus areas for research and development for furthering the state of meniscus science in 2021. Methods An electronic survey including 10 questions was sent in a blind fashion to the faculty members of the 5 th International Conference on Meniscus Science and Surgery . These faculty served...