Publications by authors named "Alessandra Berton"

65 Publications

Unicompartmental Knee Arthroplasty: Minimal Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score.

Medicina (Kaunas) 2021 Apr 1;57(4). Epub 2021 Apr 1.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy.

: Unicompartmental knee arthroplasty (UKA) is a valid alternative to total knee arthroplasties (TKAs) in selected cases. After surgery, patients' experience and satisfaction were traditionally evaluated by pre- and postsurgical scores and Patient-Reported Outcome Measures (PROMs). Otherwise, a statistically significant change does not necessarily correlate to a clinically meaningful improvement when measured using PROMs. To evaluate the real effect of a specific treatment and understand the difference between groups in a clinical trial, it is necessary to use a meaningful quantum of change on the score assessed. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) can provide this meaningful change. This paper aimed to calculate the MCID and the PASS of the Forgotten Joint Score (FJS-12) after UKA. A total of 40 patients with a mean age 72.5 ± 6.4 years undergoing UKA were assessed preoperatively and six months postsurgery using the FJS-12 and the Oxford Knee Score (OKS). The baseline and 6-month postoperative scores were compared using the Wilcoxon signed ranks test. The correlation was calculated with Spearman's rho. Both distribution-based approaches and anchor approaches were used to estimate MCID for the FJS-12. The 75th percentile and the Receiver operating characteristic (ROC) curve methods were used to calculate the PASS of FJS-12. MCID estimates for normalized FJS-12 for UKA ranged from 5.68 to 19.82. The threshold of the FJS-12 with ROC method was 72.92 (AUC = 0.76). The cut-off value computed with the 75th percentile approach was 92.71. : The MCID and PASS represent valid tools to assess the real perception of clinical improvement in patients who underwent UKA. The MCID value of FJS-12 was 12.5 for patients who underwent UKA. The value of the PASS for the FJS-12 in patients who underwent UKA was 72.92.
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http://dx.doi.org/10.3390/medicina57040324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065647PMC
April 2021

Personalized, Predictive, Participatory, Precision, and Preventive (P5) Medicine in Rotator Cuff Tears.

J Pers Med 2021 Apr 1;11(4). Epub 2021 Apr 1.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy.

Rotator cuff (RC) disease is a common musculoskeletal disorder of the shoulder entailing pain, with reduced functionality and quality of life. The main objective of this study was to present a perspective of the current scientific evidence about personalized, predictive, participatory, precision, and preventive approaches in the management of RC diseases. The personalized, predictive, participatory, precision and preventive (P5) medicine model is an interdisciplinary and multidisciplinary approach that will provide researchers and clinicians with a comprehensive patrimony of knowledge in the management of RC diseases. The ability to define genetic predispositions in conjunction with the evaluation of lifestyle and environmental factors may boost the tailoring of diagnosis and therapy in patients suffering from RC diseases.
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http://dx.doi.org/10.3390/jpm11040255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066336PMC
April 2021

Epidemiology of shoulder instability in Italy: A 14-years nationwide registry study.

Injury 2021 Apr 20;52(4):862-868. Epub 2021 Feb 20.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. Electronic address:

Introduction: The aim of this study is to estimate the annual number of shoulder dislocation hospitalizations in Italy from 2001 to 2014, to explore geographical variation in access to hospitalizations between the 3 macro-regions of Italy (North, Centre and South) and to perform statistical projections of hospitalizations volumes and rates based on data from 2001 to 2014.

Materials And Methods: Data of the Italian Ministry of Health regarding the National Hospital Discharge records (SDO) were analysed for the period of the survey (2001-2014). These data are anonymous and include the patient's age, sex, domicile, region of hospitalization, length of the hospitalization, and type of reimbursement (public or private).

Results: During the 14-year study period, 92,784 hospitalizations to treat shoulder dislocation were performed in Italy, which represented an incidence of 11.2 hospitalizations for every 100,000 Italian inhabitants. 56,514 patients underwent hospitalization for non-surgical treatment. 36,270 patients underwent hospitalization for surgical treatment. The higher hospitalizations rate was among males from 15 to 64 years of age.

Conclusions: Increasing rates of surgical hospitalization and decreasing rates of hospitalization for non-surgical treatment of shoulder dislocation are observed over a 14-year period. This study confirms that the socioeconomic burden of shoulder dislocation surgery heavily affects the working population. Most shoulder instability procedures were performed on males. The present study provides a description of the frequency and national distribution of shoulder instability in Italy. This study shows an increase in surgical procedures for shoulder instability in Italy.
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http://dx.doi.org/10.1016/j.injury.2021.02.034DOI Listing
April 2021

2019 Marathon of Rome. Hamstring injuries in long distance runners: influence of age, gender, weight, height, numbers of marathon and impact profile.

J Sports Med Phys Fitness 2021 Feb 15. Epub 2021 Feb 15.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.

Background: Hamstring diseases are one of the most widespread diseases in athletes, especially in runners, sprinters, and endurance athletes. Notwithstanding the importance of the problem, risk factors are still marginally known. This transversal study analyzes the correlation between Hamstring tendinopathy and hamstring strains and age, gender, weight, height, number of marathons, and impact profile in athletes who took part in the 2019 Rome Marathon.

Methods: At the 2019 Marathon of Rome, 700 runners (484 males and 216 females; mean age: 43.6 years, range 17-80 years) filled the VISA-H and FASH questionnaires. An adequately skilled orthopedic surgeon made a diagnosis of Hamstring tendinopathy and Hamstring strain injuries in line with clinical criteria.

Results: A diagnosis of Hamstring tendinopathy was made in 537 participants while in 624 of hamstring strains. There was evidence of a positive correlation statistically significant between age, weight and impact profile with Hamstring strain injuries, while there was no association between sex and number of marathons and the Hamstring strains. No statistically significant positive correlation was found between all of the parameters analyzed and VISA-H. The association between VISA-H score and FASH score has resulted statistically significant.

Conclusions: In marathon athletes, there was not found evidence of a statistically significant correlation between gender, weight, height, number of marathons, impact profile and Hamstring tendinopathy. Nonetheless, age, weight and impact profile were associated with Hamstring strains, while sex and number of marathons had not shown statistically significant positive association with Hamstring strain injuries.
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http://dx.doi.org/10.23736/S0022-4707.21.12027-4DOI Listing
February 2021

Biosensors for Detection of Biochemical Markers Relevant to Osteoarthritis.

Biosensors (Basel) 2021 Jan 24;11(2). Epub 2021 Jan 24.

Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy.

This systematic review aimed to assess the advantages of biosensors in detecting biomarkers for the early diagnosis of osteoarthritis (OA). OA is the most prevalent musculoskeletal disease and is a leading cause of disability and pain worldwide. The diagnosis of OA could be performed through clinical examinations and imaging only during the late stages of the disease. Biomarkers could be used for the diagnosis of the disease in the very early stages. Biosensors could detect biomarkers with high accuracy and low costs. This paper focuses on the biosensors mainly adopted to detect OA markers (electrochemical, optical, Quartz crystal microbalance, molecular and wearable biosensors). A comprehensive search on PubMed, Cochrane, CINAHL and Embase databases was conducted from the inception to November 2020. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. From a total amount of 1086 studies identified, only 19 articles were eligible for this study. The main advantages of the biosensors reported were accuracy, limited cost and ease of use, compared to traditional methods (ELISA). Otherwise, due to the lack of data and the low level of evidence of the papers included, it was impossible to find significant results. Therefore, further high-quality studies are required.
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http://dx.doi.org/10.3390/bios11020031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912259PMC
January 2021

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis.

BMC Musculoskelet Disord 2021 Jan 8;22(1):50. Epub 2021 Jan 8.

Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.

Background: This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.

Methods: A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.

Results: A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P < 0.001).

Conclusions: At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.
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http://dx.doi.org/10.1186/s12891-020-03872-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796609PMC
January 2021

Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note.

Medicina (Kaunas) 2020 Dec 19;56(12). Epub 2020 Dec 19.

Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, 00128 Rome, Italy.

Nowadays, surgical treatment of acute avulsions of the Achilles tendon represents a hard challenge. There is often the possibility that the calcaneus remains completely uncovered from the tendon, making the reinsertion of its distal stub complex. At the same time, the standard open surgical technique could cause difficult wound healing because of the weak blood supply, the increasing possibility of rupture, and the bacterial contamination. To overcome these risks, less invasive procedures should be considered. We developed an innovative minimally invasive procedure for fixation of acute avulsions of the Achilles tendon employing an integration of four longitudinal stab incisions and one distal semicircular Cincinnati incision. In this way, the distal Achilles tendon stub and the calcaneal insertion are exhibited. We basted the tendon through percutaneous sutures performed across the four stab incisions with a Mayo needle threaded with Ultrabraid. The procedure is repeated with another loop of Ultrabraid. After having bruised the calcaneus bone insertion of the tendon, two sites for two suture anchors were prepared using a specific hole preparation device for the anchors' footprint. Finally, we placed two suture anchors to reinsert the tendon to the calcaneal insertion. Our new less invasive technique is a promising alternative optional procedure for the Achilles tendon (AT) avulsion repair allowing clear exposure of the Achilles tendon insertion, maintaining the longitudinal wholeness of the dermis, and minimizing possible associated complications.
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http://dx.doi.org/10.3390/medicina56120715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766519PMC
December 2020

Virtual Reality, Augmented Reality, Gamification, and Telerehabilitation: Psychological Impact on Orthopedic Patients' Rehabilitation.

J Clin Med 2020 Aug 7;9(8). Epub 2020 Aug 7.

Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy.

Background: Remote virtual rehabilitation aroused growing interest in the last decades, and its role has gained importance following the recent spread of COVID19 pandemic. The advantages of virtual reality (VR), augmented reality (AR), gamification, and telerehabilitation have been demonstrated in several medical fields. In this review, we searched the literature for studies using these technologies for orthopedic rehabilitation and analyzed studies' quality, type and field of rehabilitation, patients' characteristics, and outcomes to describe the state of the art of VR, AR, gamification, and telerehabilitation for orthopedic rehabilitation.

Methods: A comprehensive search on PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted. This review was performed according to PRISMA guidelines. Studies published between 2015 and 2020 about remote virtual rehabilitations for orthopedic patients were selected. The Methodological Index for Non-Randomized Studies (MINORS) and Cochrane Risk-of-Bias assessment tool were used for quality assessment.

Results: 24 studies (9 randomized controlled trials (RCTs) and 15 non-randomized studies) and 2472 patients were included. Studies mainly concern telerehabilitation (56%), and to a lesser extent VR (28%), AR (28%), and gamification (16%). Remote virtual technologies were used following knee and hip arthroplasty. The majority of included patients were between 40 and 60 years old and had a university degree. Remote virtual rehabilitation was not inferior to face-to-face therapy, and physical improvements were demonstrated by increased clinical scores. Orthopedic virtual remote rehabilitation decreased costs related to transports, hospitalizations, and readmissions.

Conclusion: The heterogeneity of included studies prevented a meta-analysis of their results. Age and social context influence adaptability to technology, and this can modify compliance to treatment and outcomes. A good relationship between patient and physiotherapist is essential for treatment compliance and new technologies are useful to maintain clinical interactions remotely. Remote virtual technologies allow the delivery of high-quality care at reduced costs. This is a necessity given the growing demand for orthopedic rehabilitation and increasing costs related to it. Future studies need to develop specific and objective methods to evaluate the clinical quality of new technologies and definitively demonstrate advantages of VR, AR, gamification, and telerehabilitation compared to face-to face orthopedic rehabilitation.
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http://dx.doi.org/10.3390/jcm9082567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465609PMC
August 2020

Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study.

J Clin Med 2020 Jul 17;9(7). Epub 2020 Jul 17.

Orthopaedic and Trauma Surgery Unit, Campus Bio-Medico University, 00128 Rome, Italy.

Purpose: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel.

Methods: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient's Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment.

Results: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red-white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red-white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements.

Conclusion: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.
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http://dx.doi.org/10.3390/jcm9072280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408658PMC
July 2020

Erratum: Longo, U.G., et al. Scapular Dyskinesis: From Basic Science to Ultimate Treatment. 2020, , 2974.

Int J Environ Res Public Health 2020 05 27;17(11). Epub 2020 May 27.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.

The authors would like to correct the names and surnames of the following authors of their previous paper [...].
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http://dx.doi.org/10.3390/ijerph17113810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312209PMC
May 2020

Scapular Dyskinesis: From Basic Science to Ultimate Treatment.

Int J Environ Res Public Health 2020 04 24;17(8). Epub 2020 Apr 24.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy.

: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. : We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords "Rotator cuff", "Scapula", "Scapular Dyskinesis", "Shoulder", "Biomechanics" and "Arthroscopy". : SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. : A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.
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http://dx.doi.org/10.3390/ijerph17082974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215460PMC
April 2020

Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis.

Int J Environ Res Public Health 2020 04 21;17(8). Epub 2020 Apr 21.

Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy.

Background: The objective of the present study was to compare the efficacy between supervised and unsupervised rehabilitation after rotator-cuff (RC) repair in terms of clinical outcomes, visual-analog-scale (VAS) score, range of motion (ROM), and risk of retear.

Material: a comprehensive search of Pubmed, CINAHL, Cochrane, EMBASE, Ovid, and Google Scholar databases through a combination of the following keywords with logical Boolean operators: "informed", "uninformed", "unsupervised", "supervised", "rehabilitation", "physical therapy", "physical therapies", "postoperative period", "physical-therapy techniques", "physical-therapy technique", "exercise", "exercise therapy", "rotator cuff", "rotator-cuff tear", and "rotator-cuff repair". For each article included in the study, the following data were extracted: authors, year, study design, sample size and demographic features, RC tear characteristics, clinical outcomes, ROM, VAS score, retear rate, and time of follow-up. Meta-analysis was performed in terms of VAS score.

Results: Four randomized control trials with 132 patients were included. One study demonstrated significant improvement in VAS, active ROM, and the activity of the muscle's motor units at stop and during maximal effort in supervised patients. Another one showed lower retear rates in the supervised group. The remaining two randomized controlled trials did not reveal any significant differences between supervised and unsupervised rehabilitation in terms of clinical outcomes. Moreover, higher costs were described for supervised rehabilitation. The VAS was not significantly different in the two groups (9.9 compared with 8.25, p = 0.23).

Conclusions: although several publications address the problem of RC lacerations, there is a paucity of evidence in the literature regarding the effectiveness of supervised and unsupervised rehabilitation protocols. This systematic review and meta-analysis showed no significant differences between the two types of rehabilitation in terms of VAS scores, while outlining the pros and cons of each protocol.
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http://dx.doi.org/10.3390/ijerph17082852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216111PMC
April 2020

Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014.

Int J Environ Res Public Health 2020 04 20;17(8). Epub 2020 Apr 20.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.

Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient's age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0-14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001-2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction.
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http://dx.doi.org/10.3390/ijerph17082834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215533PMC
April 2020

Physical therapy and precision rehabilitation in shoulder rotator cuff disease.

Int Orthop 2020 05 10;44(5):893-903. Epub 2020 Mar 10.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.

Purpose: To describe the main features of the rehabilitation protocols for RC disease based on the phases of tendon healing and to investigate about the use of wearable devices as monitoring systems.

Methods: We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL, and EMBASE databases using various combination of the keywords "rotator cuff," "rotator cuff tear," "rehabilitation protocol," "accelerated," "conservative," "stiffness," "exercises," and "wearable devices." All articles concerning precision orthopaedic rehabilitation therapy in rotator cuff disease were retrieved.

Results: To date, rehabilitation protocols are not comparable due to wide heterogeneity of RC diseases. Wearable technologies are becoming a revolutionary tool for movement and posture monitoring.

Conclusion: Rehabilitation protocols for RC disease should be tailored on the basis of the different phases of tendon healing. Wearable devices hold the promise to offer a new outlook for long-term follow-up during the postoperative period providing information to the clinician about patient's status.
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http://dx.doi.org/10.1007/s00264-020-04511-2DOI Listing
May 2020

Autologous Chondrocyte Implantation and Mesenchymal Stem Cells for the Treatments of Chondral Defects of the Knee- A Systematic Review.

Curr Stem Cell Res Ther 2020 ;15(6):547-556

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.

Background: There is still a lack of consensus about the best treatment of chondral defects of the knee. We conducted a systematic PRISMA review to evaluate clinical outcomes of Autologous Chondrocyte Implantation (ACI) and Mesenchymal Stem Cell (MSC) injections for the treatment of focal chondral defects of the knee.

Methods: A systematic review of literature was performed according to the PRISMA guidelines. All the articles reporting data on ACI and MSC treatments for chondral defects of the knee were considered for inclusion. The main databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar. The statistical analysis was performed using the Review Manager Software.

Results: In the p-ACI group (987 knees), the Cincinnati Score improved by 18.94% (p=0.1), VAS by 38% (p=0.01), Tegner score by 19.11% (p=0.03), Lysholm score by 22.40% (p=0.01), IKCD by 27.36% (p=0.003). In the c-ACI group (444 knees), the Cincinnati Score improved by 23.80% (p=0.08), KOOS by 23.48% (p=0.03), VAS by 33.2% (p=0.005), IKDC by 33.30% (p=0.005). In the m-ACI group (599 knees), the Cincinnati Score improved by 26.80% (p=0.08), KOOS by 31.59% (p=0.1), VAS by 30.43% (p=0.4), Tegner score by 23.1% (p=0.002), Lysholm score by 31.14% (p=0.004), IKCD by 30.57% (p<0.001). In the MSCs group (291 knees), the KOOS improved by 29.7% (p=0.003), VAS by 41.89% (p<0.001), Tegner score by 25.81% (p=0.003), Lysholm score by 36.96% (p<0.001), IKCD by 30.57% (p=0.001).

Conclusion: Both ACI and MSC therapies can be considered as a concrete solution to treat focal chondral defects of the knee.
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http://dx.doi.org/10.2174/1574888X15666200221122834DOI Listing
January 2020

Correction to: Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia.

Knee Surg Sports Traumatol Arthrosc 2019 Nov 22. Epub 2019 Nov 22.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.

Unfortunately, the given name and the family name of the authors were incorrectly identified in the original article.
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http://dx.doi.org/10.1007/s00167-019-05784-wDOI Listing
November 2019

Wearable systems for shoulder kinematics assessment: a systematic review.

BMC Musculoskelet Disord 2019 Nov 15;20(1):546. Epub 2019 Nov 15.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.

Background: Wearable sensors are acquiring more and more influence in diagnostic and rehabilitation field to assess motor abilities of people with neurological or musculoskeletal impairments. The aim of this systematic literature review is to analyze the wearable systems for monitoring shoulder kinematics and their applicability in clinical settings and rehabilitation.

Methods: A comprehensive search of PubMed, Medline, Google Scholar and IEEE Xplore was performed and results were included up to July 2019. All studies concerning wearable sensors to assess shoulder kinematics were retrieved.

Results: Seventy-three studies were included because they have fulfilled the inclusion criteria. The results showed that magneto and/or inertial sensors are the most used. Wearable sensors measuring upper limb and/or shoulder kinematics have been proposed to be applied in patients with different pathological conditions such as stroke, multiple sclerosis, osteoarthritis, rotator cuff tear. Sensors placement and method of attachment were broadly heterogeneous among the examined studies.

Conclusions: Wearable systems are a promising solution to provide quantitative and meaningful clinical information about progress in a rehabilitation pathway and to extrapolate meaningful parameters in the diagnosis of shoulder pathologies. There is a strong need for development of this novel technologies which undeniably serves in shoulder evaluation and therapy.
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http://dx.doi.org/10.1186/s12891-019-2930-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858749PMC
November 2019

Genetic basis of rotator cuff injury: a systematic review.

BMC Med Genet 2019 09 2;20(1):149. Epub 2019 Sep 2.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.

Background: Rotator cuff disease is a widespread musculoskeletal pathology and a major cause of shoulder pain. Studies on familial predisposition suggest that genetic plays a role in the pathogenesis of rotator cuff disease. Several genes are responsible for rotator cuff disease. The aim of this study was to perform a systematic review on genetic association between rotator cuff disease and genes variations.

Methods: A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases were searched comprehensively using the keywords: "Rotator cuff", "Gene", "Genetic", "Predisposition", "Single-nucleotide polymorphism" and "Genome-wide association".

Results: 8 studies investigating genes variations associated with rotator cuff tears were included in this review. 6 studies were case-control studies on candidate genes and 2 studies were GWASs. A significant association between SNPs and rotator cuff disease was found for DEFB1, FGFR1, FGFR3, ESRRB, FGF10, MMP-1, TNC, FCRL3, SASH1, SAP30BP, rs71404070 located next to cadherin8. Contradictory results were reported for MMP-3.

Conclusion: Further investigations are warranted to identify complete genetic profiles of rotator cuff disease and to clarify the complex interaction between genes, encoded proteins and environment. This may lead to individualized strategies for prevention and treatment of rotator cuff disease.

Level Of Evidence: Level IV, Systematic Review.
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http://dx.doi.org/10.1186/s12881-019-0883-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720871PMC
September 2019

Hip scores: A current concept review.

Br Med Bull 2019 09;131(1):81-96

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.

Introduction: During the past decades, several rating scales have been developed to assess the functional status of patients with hip pain.

Source Of Data: A search in Medline, PubMed, Cochrane and CINAHL was performedusing combinations of the following'hip', 'scoring system', 'scale', 'scores', 'outcome assessment', 'arthroplasty', 'arthroscopy' and 'clinical evaluation'.

Areas Of Agreement: A total 16 scoring systems are currently available for the evaluation of the hip.

Areas Of Controversy: Two types of questionnaires are available: physician-rated and patient-rated questionnaires.

Growing Points: Each hip score consists of different domains. Interpreting these domains becomes sometimes difficult, because, even though they can be common to more than one scoring system, each stresses them in a different way.

Areas Timely For Developing Research: Although many scoring systems have been used to evaluate hip function, we are still far from a single outcome evaluation system which is reliable, valid and sensitive.
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http://dx.doi.org/10.1093/bmb/ldz026DOI Listing
September 2019

Impact of Tourniquet Use on Systemic Inflammatory Parameters, Functional Physical Recovery, and Cardiovascular Outcomes of Patients Undergoing Knee Arthroplasty: A Case-Control Study.

J Knee Surg 2020 Aug 7;33(8):762-767. Epub 2019 May 7.

Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy.

The benefits of tourniquet use during orthopaedic surgery are controversial. We aim to investigate its effects on systemic inflammation, functional physical recovery, and cardiovascular complications of patients undergoing knee arthroplasty. We enrolled 129 consecutive patients (57 treated with tourniquet vs. 72 in the control group) undergoing total unilateral knee arthroplasty, followed by inpatient rehabilitation protocol at our institution. Blood samples were drawn in all patients at baseline and within 24 hours after surgery for complete blood cell count assessment. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated as the ratio between the absolute number of neutrophil and platelets over the absolute number of lymphocytes, respectively. The numeric rating scale (NRS; 0-10) assessed the current pain, day after the surgery. All subjects underwent physical functional evaluation measured by the modified Barthel's index (MBI) at the end of the rehabilitation. We also recorded the incidence of major bleeding, typical angina, and occurrence of atrial fibrillation after surgery. In the overall population, a significant postprocedural increase in NLR and PLR was observed ( < 0.001). Baseline NLR and PLR were similar in patients with and without tourniquet (1.5 ± 0.8 vs. 1.95 ± 1.2,  = 0.081; 120 ± 42 vs. 131 ± 55,  = 0.240); however, patients treated with tourniquet showed significantly lower NLR at 24 hours (6.1 ± 3.6 vs. 8.1 ± 5.7,  = 0.043). NRS scores were significantly higher in the tourniquet group without compromising functional and physical recovery whereas no significant differences were appreciated in MBI scores between the two groups. Moreover, the rates of postoperative atrial fibrillation (1 [2%] vs. 9 [12%],  = 0.042) and major bleeding (2 [4%] vs. 11 [15%],  = 0.038) were significantly lower in the tourniquet group. Tourniquet seems a useful tool which is able to mitigate the inflammatory activation and prevent the occurrence of atrial fibrillation and major bleeding without altering functional physical recovery of patients undergoing total knee arthroplasty.
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http://dx.doi.org/10.1055/s-0039-1688565DOI Listing
August 2020

Alpine junior world ski championship: nutritional habits and performance in elite skiers.

J Sports Med Phys Fitness 2019 Aug 12;59(8):1339-1345. Epub 2019 Feb 12.

Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.

Background: Young athletes need to consume an appropriate diet in order to maintain health and optimize growth and athletic performance. We evaluated nutritional habits of junior elite skiers.

Methods: Alpine junior elite skiers (N.=68; 42 males and 26 females; age range 16-20 years) coming from 20 countries were recruited during the Alpine Junior World Ski Championship, Roccaraso, Italy. Nutritional habits were assessed using a 3-day food record and the NHANES Food Frequency Questionnaire. Data were compared with nutritional recommendations and Recommended Dietary Allowances (RDAs) for athletes.

Results: During the training period, the energy intake in both males and females was significantly lower with respect to estimated energy needs. Carbohydrate intake expressed in terms of grams per kilogram of body weight did not meet the RDAs in both groups (4.19 and 5.15 g/kg in males and females, respectively). Protein and fat consumption exceeded the RDAs with a protein intake of 2.34 g/kg in males and 2.10 g/kg in females, and a fat intake >35% of total daily calories. During competition days, both males and females increased carbohydrate intake to 6.23 and 8.11 g/kg respectively, reaching the RDAs. Protein intake increased to 2.56 and 3.14 g/kg in males and females, respectively, and fat intake slightly decreased, still exceeding the RDAs.

Conclusions: Junior elite skiers reported a low intake of carbohydrates and a high intake of protein and fat. Nutritional counselling should be given to athletes to maintain their health and improve their physical performance.
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http://dx.doi.org/10.23736/S0022-4707.19.09386-1DOI Listing
August 2019

2017 Marathon of Rome: Anthropometry and Sport Profile in 350 Runners and Association With Achilles and Patellar Tendinopathy.

Clin J Sport Med 2021 Jan;31(1):e15-e20

Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy; and.

Background: Achilles and patellar tendinopathy are common in runners. Despite the relevance of the problem, causative factors remain poorly understood. This cross-sectional study evaluated the association between Achilles and patellar tendinopathy and age, sex, weight, height, number of marathons, and impact profile in runners who participated in the 2017 Marathon of Rome.

Methods: At the 2017 Marathon of Rome, 350 athletes (256 men and 94 women; mean age: 44.8 years, range 12-80 years) filled in the VISA-A and VISA-P questionnaires. A fully trained orthopedic surgeon made a diagnosis of Achilles and patellar tendinopathy according to clinical criteria.

Results: Ninety-five participants were diagnosed with Achilles tendinopathy and 96 with patellar tendinopathy. There was evidence of a statistically significant positive association between age and Achilles and patellar tendinopathy, with no effect of sex, weight, and height on the presence of Achilles tendinopathy. There was no evidence of a statistically significant positive association between the number of marathons and impact profile and VISA-A score. There was a statistically significant association between VISA-P score and impact profile. Finally, there was evidence of a statistically significant positive association between VISA-A score and VISA-P score (P = 0.007).

Conclusions: In marathon runners, there was no evidence of a statistically significant association between sex, weight, height, number of marathons, and Achilles and patellar tendinopathy. However, age was associated with Achilles and patellar tendinopathy, and impact profile was associated with patellar tendinopathy.
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http://dx.doi.org/10.1097/JSM.0000000000000695DOI Listing
January 2021

Surgical management of chordoma: A systematic review.

J Spinal Cord Med 2020 11 26;43(6):797-812. Epub 2018 Jul 26.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.

Chordomas are rare primary tumors of bone characterized by local aggressiveness and poor prognosis. The surgical exeresis plays a critical role for their management. The aim was to provide an overview of the surgical management of chordomas of the mobile spine and sacrum, describing the most common surgical approaches, the role of surgical margins, the difficulties of en block resection, the outcomes of surgery, the recurrence rate and the use of associated therapies. We performed a systematic search using the keywords "chordoma" in combination with "surgery", "spine", "sacrum" and "radiotherapy". Fifty-eight studies, describing 1359 patients with diagnosis of chordoma were retrieved. 17 studies were performed on subjects with cervical chordomas and 49 focused on patients with sacrococcygeal chordomas. The remaining studies included patients with chordomas in cranial region and/or mobile spine and/or sacroccygeal region. The recurrence rate ranged from 25% to 60% for cervical chordomas, and from 18% to 89% for sacrococcygeal chordomas. Despite the remarkable advances in the local management of chordoma performed in the last decades, the current results of surgery alone are still unsatisfactory. The radical en bloc excision of tumour is technically demanding, particularly in the cervical spine. Although radical surgery must still be considered the gold standard for the management of chordomas, a multidisciplinary approach is required to improve the local control of the disease in patients who undergo both radical and non-radical surgery. Adjuvant radiation therapy increases the continuous disease-free survival and the local recurrence-free survival. Systematic review; level III.
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http://dx.doi.org/10.1080/10790268.2018.1483593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808319PMC
November 2020

A case of methicillin-resistant wound infection: phylogenetic analysis to establish if nosocomial or community acquired.

Clin Case Rep 2018 May 13;6(5):871-874. Epub 2018 Mar 13.

Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy.

Methicillin-resistant (MRSA) infection is rapidly increasing in both hospital and community settings. A 71-year-old man admitted at the Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, with MRSA wound infection consequent to orthopedic surgery was studied and the MRSA transmission evaluated by phylogenetic analysis.
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http://dx.doi.org/10.1002/ccr3.1442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930232PMC
May 2018

Knee Osteoarthritis after Arthroscopic Partial Meniscectomy: Prevalence and Progression of Radiographic Changes after 5 to 12 Years Compared with Contralateral Knee.

J Knee Surg 2019 May 3;32(5):407-413. Epub 2018 May 3.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.

The purpose of this study was to study the clinical and radiographic changes in the knee after arthroscopic partial meniscectomy (APM) at a long-term follow-up compared with the contralateral knee. We assessed 57 patients (38 males and 19 females) with pre- and postoperative weight-bearing radiography with a follow-up ranging from 5.1 to 12.1 years (mean: 8.1) to analyze prevalence and progression of knee osteoarthritis (OA) after APM. We stratified patients according to body mass index (BMI), type of lesion (degenerative vs. traumatic), and side of meniscectomy (medial, lateral, and medial plus lateral). Patients were evaluated both clinically with Knee Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and radiographically with the Kellgren and Lawrence (K/L) score. Radiographic OA was defined as K/L grade 2 or worse. The prevalence of knee OA was 62.69% in the tibiofemoral compartment. The progression of knee OA was statistically significant, ranging from 17.2% preoperatively to 65.95% postoperatively ( = 0.001) in the medial compartment and from 17.64% preoperatively to 58.82% postoperatively ( = 0.0324) in the lateral compartment. The progression of knee OA in the patellofemoral compartment ranged from 5.26 to 42.10% ( = 0.001). The OA progression regarding BMI was higher into the obese group than the normal-weight group and greater in the degenerative group than the traumatic one. The mean KOOS was 72.01 and the mean WOMAC was 73.84. The Spearman's test showed a statistical significance between clinical and radiographic results. Patients in the obese, overweight, and degenerative tear group had a greater predisposition to OA in the tibiofemoral and patellofemoral compartments after meniscectomy. The level of evidence is III, retrospective study.
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http://dx.doi.org/10.1055/s-0038-1646926DOI Listing
May 2019

A 3D finite element model of prophylactic vertebroplasty in the metastatic spine: Vertebral stability and stress distribution on adjacent vertebrae.

J Spinal Cord Med 2020 01 15;43(1):39-45. Epub 2018 Feb 15.

Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic, Rochester, Minnesota, USA.

Patients with metastatically compromised vertebra can experience pathologic fracture with relevant neurological complications. Vertebroplasty is a low cost procedure and it can potentially prevent neurologic impairment if performed at an early stage. The aim of this study is to evaluate the effects of prophylactic vertebroplasty on stability of the metastatic spine and analyze load distribution at adjacent vertebrae. A 3D finite element model of two spinal motion segments (L3-L5) was developed. A central core of elements was selected in L4 vertebral body and material properties of a lytic metastasis and successively PMMA were assigned. The model was settled in order to simulate a non-osteoporotic spine and an osteoporotic spine. Vertebral stability was assessed by the measurement of vertebral bulge (VB) and vertebral height (VH) on L4. Load transfer on adjacent vertebrae was evaluated by observing the distribution of the von Mises stress on L3 and L5 endplates. The metastasis increased VB by 424% and VH by 626%, while prophylactic vertebroplasty decreased VB and VH by 99% and 95%, respectively, when compared to the normal/non-metastatic model. Prophylactic vertebroplasty increased the average von Mises stress of L3 lower endplate by 1.33% in the non-osteoporotic spine, while it increased to 16% in the osteoporotic model. Prophylactic vertebroplasty could represent an interesting option to improve vertebral strength of metastatically compromised spine without excessively increasing the stresses on adjacent vertebrae in non-osteoporotic spine.
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http://dx.doi.org/10.1080/10790268.2018.1432309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006681PMC
January 2020

Biomechanical effects of metastasis in the osteoporotic lumbar spine: A Finite Element Analysis.

BMC Musculoskelet Disord 2018 02 5;19(1):38. Epub 2018 Feb 5.

Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic, Rochester, MN, USA.

Background: Cancer patients are likely to undergo osteoporosis as consequence of hormone manipulation and/or chemotherapy. Little is known about possible increased risk of fracture in this population. The aim of this study was to describe the biomechanical effect of a metastatic lesion in an osteoporotic lumbar spine model.

Methods: A finite element model of two spinal motion segments (L3-L5) was extracted from a previously developed L3-Sacrum model and used to analyze the effect of metastasis size and bone mineral density (BMD) on Vertebral bulge (VB) and Vertebral height (VH). VB and VH represent respectively radial and axial displacement and they have been correlated to burst fracture. A total of 6 scenarios were evaluated combining three metastasis sizes (no metastasis, 15% and 30% of the vertebral body) and two BMD conditions (normal BMD and osteoporosis).

Results: 15% metastasis increased VB and VH by 178% and 248%, respectively in normal BMD model; while VB and VH increased by 134% and 174% in osteoporotic model. 30% metastasis increased VB and VH by 88% and 109%, respectively, when compared to 15% metastasis in normal BMD model; while VB and VH increased by 59% and 74% in osteoporotic model.

Conclusion: A metastasis in the osteoporotic lumbar spine always leads to a higher risk of vertebral fracture. This risk increases with the size of the metastasis. Unexpectedly, an increment in metastasis size in the normal BMD spine produces a greater impact on vertebral stability compared to the osteoporotic spine.
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http://dx.doi.org/10.1186/s12891-018-1953-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799979PMC
February 2018

Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia.

Knee Surg Sports Traumatol Arthrosc 2018 Sep 31;26(9):2640-2658. Epub 2017 May 31.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.

Purpose: The aim of this systematic review is to compare the clinical outcomes of patients treated with different trochleoplasty procedures, the rate of complications and recurrence of patellar dislocation.

Methods: A systematic review of the literature was performed, in accord with the PRISMA guidelines. PubMed, MEDLINE, CINAHL, Cochrane, EMBASE and Google Scholar databases were comprehensively searched using the keyword combinations, "Dejour trochleoplasty", "Bereiter Trochleoplasty", "Albee Trochleoplasty", "Recession Trochleoplasty", "Trochlear Dysplasia", "Instability", "Adult", "Clinical Outcome" and "Surgery".

Results: Three-hundred and ninety-two knees in 371 patients were included. Bereiter U-shaped deepening trochleoplasty was the most commonly used technique for the treatment of trochlear dysplasia in the included studies with the lowest rate of recurrence and post-operative ROM deficiency. On the other hand, Dejour V-shaped deepening trochleoplasty showed the highest mean post-operative value of Kujala score with 79.3 (SD 8.4) points. Statistical differences were found in terms of redislocation rate between Goutallier procedure and Bereiter trochleoplasty (p < 0.05) and in terms of post-operative osteoarthritis between Bereiter and Dejour procedures (p < 0.05).

Conclusion: Bereiter trochleoplasty seems to be the most efficiency procedure in terms of post-operative patellar redislocation, post-operative osteoarthritis and ROM, but the highest mean post-operative Kujala score is obtained by Dejour procedure. Therefore, none of the surgical techniques analysed highlighted a real superiority. Randomised clinical trials are needed to establish whether of available surgical technique is the best to treat patient with trochlear dysplasia. The clinical relevance of this paper is that the three most popular trochleoplasty techniques are associated with significantly improved stability and function, showing a relatively low rate of osteoarthritis and pain, and a moderate rate of complications.

Level Of Evidence: Systematic review, Level IV.
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http://dx.doi.org/10.1007/s00167-017-4584-9DOI Listing
September 2018

Reverse total shoulder arthroplasty: research models.

Joints 2016 Oct-Dec;4(4):236-246. Epub 2017 Feb 7.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy; Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Trigoria, Rome, Italy.

Purpose: the past decade has seen a considerable increase in the use of research models to study reverse total shoulder arthroplasty (RTSA). Nevertheless, none of these models has been shown to completely reflect real conditions.

Methods: we performed a systematic review of the literature matching the following key words: "reverse total shoulder arthroplasty" or "reverse total shoulder replacement" or "reverse total shoulder prosthesis" and "research models" or "biomechanical models" or "physical simulators" or "virtual simulators". The following databases were screened: Medline, Google Scholar, EMBASE, CINAHIL and Ovid. We identified and included all articles reporting research models of any kind, such as physical or virtual simulators, in which RTSA and the glenohumeral joint were reproduced.

Results: computer models and cadaveric models are the most commonly used, and they were shown to be reliable in simulating conditions. Bone substitute models have been used in a few studies. Mechanical testing machines provided useful information on stability factors in RTSA.

Conclusion: because of the limitations of each individual model, additional research is required to develop a research model of RTSA that may reduce the limitations of those presently available, and increase the reproducibility of this technique in the clinical setting.
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http://dx.doi.org/10.11138/jts/2016.4.4.236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297348PMC
February 2017

Treatment of Primary Acute Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature.

Clin J Sport Med 2017 Nov;27(6):511-523

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.

Purpose: The aim of this study was to evaluate clinical outcomes, rate of redislocation, and complications after conservative or surgical procedures used to treat primary acute patellar dislocation.

Methods: A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the keywords "patella," "dislocation," "treatment," "acute," "primary" was performed. The following data were extracted: demographics, chondral defects and soft tissue lesions, outcome measurements, type of management, recurrence of instability, and complications.

Results: A total of 2134 knees in 2086 patients were included, with an average age at dislocation of 20.3 years. The average Kujula score was 75.6 for patients treated conservatively and 88.7 for patients undergoing surgical treatment in the short-medium follow-up (less than 5 years); the average Kujula score was 87.5 for patients treated conservatively and 86.6 for patients undergoing surgical treatment in the long-term follow-up (more than 5 years). The rate of recurrence was significantly lower in the surgical group (25%) than in the conservative group (36.4%). The overall complication rate was 6.5% (29 of 441 knees) in the surgical management group. No complications were reported for patients treated conservatively.

Conclusions: Surgical treatment of primary acute patellar dislocation leads to significantly lower rate of redislocation and provides better short-medium clinical outcomes, whereas in the long-term follow-up, results of patients treated conservatively were as good as those of surgical patients. Further randomized controlled trials, describing anatomical abnormalities and soft-tissue integrity that may influence the choice of treatment, are needed.

Level Of Evidence: Systematic review, level IV.
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http://dx.doi.org/10.1097/JSM.0000000000000410DOI Listing
November 2017