- [Show abstract] [Hide abstract] ABSTRACT: The Mayo Clinic Institutional Review Board approved this project, “General Radiologic Patterns of Elbow Injury” on October 10, 2011 (IRB protocol number 11-002988).
Chapter: Biceps and Triceps Tendon Lesions[Show abstract] [Hide abstract] ABSTRACT: The treatment of lesions of the distal tendon of the humeral biceps still represents an open chapter of orthopaedic surgery, with questions related to the anatomy of the native tendon and to the epidemiology, diagnosis and therapeutic options.
- [Show abstract] [Hide abstract] ABSTRACT: The first reports of elbow arthroscopy appeared in 1931 with Burman , but that kind of surgery was originally considered to be an unsafe procedure because of the small size of the elbow joint.
- [Show abstract] [Hide abstract] ABSTRACT: Total Elbow Arthroplasty in the last decades underwent an important improvement in long-term durability and complication rates, making them increasingly suitable even for challenging conditions as post-traumatic elbows. In this work we present our case series of 28 elbow prostheses in sequelae of trauma, discussing the specific aspects and factors influencing the outcome with the evidence of the available literature.
- [Show abstract] [Hide abstract] ABSTRACT: Arthroscopy of the elbow is a relatively recent surgical procedure. Although the first experience described in the literature dates back to the 80s, it is only in the last 15 years that a real and increasing interest can be seen with the inclusion of series of patients  and case reports that describe the research for new indications.
- [Show abstract] [Hide abstract] ABSTRACT: Radial head prosthetic replacement is indicated in case of comminuted fracture not amenable to internal fixation, especially when the radial head fracture is part of a pattern of lesions configuring a complex instability of the elbow. Thirty-one SBi radial head prostheses were implanted in 30 patients (one bilateral simultaneous fracture) over a 2 years period. In 10 patients, the mean time from trauma to surgical treatment was 2.4 days, while the remaining 20 patients were treated as "second opinion" cases presenting with elbow stiffness or instability after an average of 19 days from trauma. The implants were monopolar in 12 cases and bipolar in 19. The clinical results were evaluated through the Mayo Elbow performance scoring system. At an average follow-up of 2 years (range 13-36 months), the mean MEPS was 90 points (range 65-100). At late radiographic analysis, radiolucent lines around the stem were found in 11 of the 31 cases. Heterotopic ossifications were found in 14 cases. Bone resorption was observed in 9 cases. Two of the 31 prostheses were removed after 16 and 20 months, in one case to correct stiffness in pronation/supination, in the other one for asymptomatic aseptic mobilization. These short-term results are satisfactory, especially when considering that they were obtained in complex elbow lesions treated in many cases at a delayed stage. Our preference over time went more and more to bipolar implants, but from a comparison of the results we could find no evidence of a superiority of bipolar or monopolar implants. The evolution of these prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.
- [Show abstract] [Hide abstract] ABSTRACT: Interest is increasing in biological scaffolds for tissue regeneration such as extracellular matrix membranes, developed through soft tissue decellularization. Extracellular matrix membranes were developed to heal different tendon and soft tissue lesions that are very frequent in the general population with high health-care costs and patient morbidity. The aim of this research was to evaluate a human dermal matrix (HDM) decellularized by a chemico-physical method. A primary culture of rat tenocytes was performed: tenocytes were seeded on HDM samples and on polystyrene wells as controls (CTR). Cell viability and synthetic activity were evaluated at 3 and 7 days. An in vitro microwound model was used to evaluate HDM bioactivity: after tenocyte expansion, artificial wounds were created, HDM extracts were added, and closure time and decorin synthesis were monitored histomorphometrically at 1, 4, 24, and 72 hr. A significant higher amount of collagen I was observed when cells were cultured on HDM in comparison with that on CTR (3 days: p < 0.0001; 7 days: p < 0.05). In HDM group, fibronectin synthesis was significantly higher at both experimental times (p < 0.0001). At 3 days, proteoglycans and transforming growth factor-β1 releases were significantly higher on HDM (p < 0.0001 and p < 0.005, respectively). The artificial microwound closure time and decorin expression were significantly enhanced by the addition of 50% HDM extract (p < 0.05). In vitro data showed that the decellularization technique enabled the development of a matrix with adequate biological and biomechanical properties.
- [Show abstract] [Hide abstract] ABSTRACT: Multidirectional instability (MDI) is a complex shoulder pathology with involuntary subluxation or dislocation in more than one direction accompanied by pain. The pathogenesis is multifactorial including capsular redundancy, significant trauma or repetitive microtrauma. The management of patients with MDI is primarily conservative, with a dedicated rehabilitation protocol of the gleno-humeral and scapulo-thorax joints. When non-operative treatment fails surgical capsuloplasty and labral repair has to be considered.
- [Show abstract] [Hide abstract] ABSTRACT: The high incidence of recurrent tendon tears after repair of massive cuff lesions is prompting the research of materials aimed at mechanically or biologically reinforcing the tendon. Among the materials studied upto now, the extracellular matrix (ECM) scaffolds of human origin have proved to be the safest and most efficient, but the current laws about grafts and transplants preclude their use in Europe. In order to overcome this condition in 2006, we started a project regarding the production of an ECM scaffold of human origin which could be implanted in Europe too. In 2009, the clinical study began with the implantation of dermal matrix scaffolds in 7 middle-aged patients affected with large/massive cuff lesions and tendon degeneration. Out of 5 cases, followed for at least 1 year in which the scaffold was employed as an augmentation device, there were 3 patients with complete healing, 1 partial re-tear, and 1 total recurrence. The absence of adverse inflammatory or septic complications allows to continue this line of research with a prospective controlled study in order to define the real advantages and correct indications offered by scaffold application.
- [Show abstract] [Hide abstract] ABSTRACT: Sterno Clavicular Joint (SCJ) dislocations are rare injuries of the shoulder girdle. Their management is controversial due to a not guaranteed outcome after any kind of treatment (conservative or open). Open reduction is challenging because of the anatomical site, while the conservative treatment does not always improve pain or instability discomfort. We report a case of traumatic and painful anterior SCJ dislocation of a young policewoman treated with open reduction by a new surgical technique. Functional result is extremely good at 2 years of follow-up.
- [Show abstract] [Hide abstract] ABSTRACT: Invalidating elbow contractures, a frequent problem after injury, are commonly treated by physical therapy or surgical release. In both cases, results can be frustrating: physical therapy is often not sufficient to gain functional range of motion, and after surgical release it is common to lose part of the motion gained in operating room. Thanks to the viscous-elastic properties of the soft tissue, the mobilization elbow braces can stretch the retracting or retracted tissues inducing a biological lengthening of collagen fibres. In post-traumatic contracture, mobilization braces are effectively employable in two main critical situations: to treat recent onset contractures which do not respond to simple physical therapy and to help in preserving range of motion gained after surgical release. We report our experience with mobilization brace used in 42 patients, 5 for post-traumatic contracture, 4 for contracture following articular fracture fixation and 33 after surgical release. Classification, indications and treatment protocols of the mobilization braces utilized are reported.
- [Show abstract] [Hide abstract] ABSTRACT: Plate fixation with cortical allograft struts has been used at our Institute for decades to treat aseptic shaft nonunion. The aim of this study was to assess the results of this technique in humeral nonunion. We retrospectively reviewed 57 consecutive patients with humeral diaphyseal nonunion treated by internal fixation combined with cortical allograft struts in the last 7 years in our Department. The patients were followed-up for a mean of 48 months. We had union in 53 cases out of 57. There were 3 cases of infection out of 15 patients previously treated with an external fixator. In our experience the cortical allograft strut is a well standardised and reproducible technique that enables the treatment of severe atrophic non-union with a relatively low complication rate and quick functional recovery.
- [Show abstract] [Hide abstract] ABSTRACT: Irreparable rotator cuff tears are infrequent but well defined lesions consisting of massive or not rotator cuff tears that are not completely reparable, because of their size and retraction. Patients can present with a variety of manifestations. They may have no or mild symptoms, or may be completely disabled and in severe pain. The true incidence is unknown. The presenting history, physical examination, radiographs and MRI imaging help to guide both diagnosis and treatment. There are no perfect solutions to this complex and sometimes disabling problem. The treatment options range from conservative to surgical intervention and no treatment is best for all irreparable rotator cuff tears. Surgical reconstruction (debridement and partial repair) must be considered for those younger patients for whom functional reconstruction is important; conservative treatment or simple surgical debridement and or clb tenotomy can manage symptoms in other patients.
Article: Irreparable rotator cuff tears
- [Show abstract] [Hide abstract] ABSTRACT: Tissue engineering may play a major role in the treatment of rotator cuff tendon lesions through replacement of an injured tendon segment. Tendons have very poor spontaneous regenerative capabilities, and despite intensive remodelling, complete regeneration is never achieved and the strength of tendon and ligaments remains as much as 30% lower than normal even months or years following an acute injury. Tendons seem to be the least complex of the connective tissues with respect to their composition and architecture and this leads to the expectation that they would be more amenable to tissue engineered approaches than other tissues. An accurate literature revision was done in order to know the state of the art of tissue engineering therapies in the field of rotator cuff regeneration. The following techniques of tissue engineering were considered: local injection of stem cells or growth factors, gene transfer, in situ tissue engineering and in vitro production of bioengineered tendons to be further transplanted in the lesion site. So far, few experimental or clinical studies have been done on tendon tissue engineering compared to the extensive work on other tissues of orthopaedic interest, such as bone and cartilage. The existing studies are related to the following tissue engineering methodologies: gene transfer, in situ tissue engineering and in vitro production of bioengineered tendons. In our opinion the previously described literature revision showed the necessity for future studies in this area also because of recent advances in biological and bioactive scaffolds.
- [Show abstract] [Hide abstract] ABSTRACT: We reviewed our experience in the surgical treatment of 12 cases of proximal ulna nonunion. The primary injuries were 2 fracture-dislocations of the olecranon, 6 Monteggia lesions and 3 isolated fractures of the proximal ulna. According to the type of primary injury and its anatomical site, the nonunions were classified into 2 groups, considering that the nonunions nearest to the humerus-ulna joint present a more disabling clinical profile and are more difficult to treat: group A (6 patients - nonunion within 5 cm from the olecranon tip of the olecranon) and group B (6 patients - nonunion between 5 and 10 cm from the olecranon tip of the olecranon). In all cases, after fibrous callus debridement and bone surface remodelling, fixation was performed with plate and screws and homoplastic cortical bone graft (orthogonal or parallel to the plate) and an intercalary bone cylinder when the bone defect was severe. In 3 patients (group A), where the defect was smaller than 1 cm, fixation of the ulna was combined with a resection of the radial neck. Clinical-radiographic healing was achieved in all patients followed for a mean of 27 months. Complications included a case of nonunion due to failure of the intercalary graft with plate breakage. The patient healed after a new surgery performed with same technique. The score, according to the Broberg-Morrey scoring system, was 78 in group A patients and 93 in group B patients. The use of homoplastic cortical bone graft represents an effective technique to improve the mechanical properties of the fixation and supports biological union, even when the bone defect is severe.
Chapter: Elbow Brace in Physical Therapy[Show abstract] [Hide abstract] ABSTRACT: The elbow is a joint that, following trauma, very easily becomes stiff. In an attempt to limit the occurrence of such a complication, an articulated brace should be used in the rehabilitation phase to enable earlier movement that was impossible to obtain with the splints or casts commonly used years ago.
- [Show abstract] [Hide abstract] ABSTRACT: Calcific tendinitis of the rotator cuff is a relatively frequent pathology and at times, in some phases, it is a disabling one: for this reason, numerous therapeutic options have been proposed. The authors propose an algorithm for the classification and treatment of calcific tendinitis and report their experience with arthroscopic treatment over a three-year period from 2001 to 2004. Based on the algorithm proposed, out of a total of 126 shoulders affected with calcific tendinitis of the rotator cuff for which debridement was indicated, 106 us-guided percutaneous surgeries (EPT), and only 20 arthroscopies were performed. Arthroscopy is indicated, on the basis of the algorithm that we followed, in patients affected by chronic and persistent calcific tendinitis who did not benefit from the execution of previous types of non-surgical treatment for a period of at least 6 to 12 months. Shoulder instability was found to be present in 8 patients out of 20 treated arthroscopically. After arthroscopy, short- and medium-term results were always positive with the exception of one case that evolved into adhesive capsulitis. Based on an analysis of this series, we were able to confirm the usefulness and clinical applicability of an algorithm to classify and treat calcific tendinitis of the rotator cuff; we also confirmed the role of arthroscopic treatment that in cases which did not respond to conservative procedures proved to be effective in resolving symptoms.
- [Show abstract] [Hide abstract] ABSTRACT: Although lateral popliteal sciatic nerve damage is not one of the commonest diseases in the general population, it is quite frequent among athletes. Several physiopathologic mechanisms have been thought to bring about this damage in athletes. Soft tissue ganglions with neurological involvement of the lateral popliteal sciatic nerve or its terminal rami are in differential diagnosis with several lesions of this area, as direct or indirect trauma, subcutaneous rupture of anterior tibialis muscle and long peroneal muscle, disc hernia, intraspinal tumor, anterior tarsal tunnel syndrome, cysts, neurofibroma, baker's cyst, vascular claudication, stenosing or inflammatory pathology of 2(nd) motoneuron, antimicrobial agents for urinary tract infection (nitrofurnantoin). The authors report the case of a 34-year-old amateur athlete with a recent paralysis of the hallux extensor, paresis of the toe extensor and hyposthenia of the tibialis anterior. The patient had been suffering from episodes of lumbalgia for a long time. He was sent to us because neurological damage due to disc herniation was suspected. Electromyography, sonography, and CT showed peripheral compression of the deep peroneal nerve caused by a mucous cyst at the capitulum peronei, a ''rare'' condition. The patient underwent surgery to excise the cyst, which led to the rapid resolution of the nerve deficit shown by clinical and electromyographical tests. A meticulous anamnesis and accurate objective examination, followed by specific tests (radiographs, sonography, and possibly CT scan) generally enable a correct diagnosis to be made. If diagnosis and therapy are carried out correctly, and without delay, symptoms quickly resolve and the nerve deficit progressively regresses.