Publications by authors named "Giorgio Gasparini"

58 Publications

Spondylodiscitis After Endovascular Aortic Repair Due to Noninvasive Listeriosis: A Case Report.

JBJS Case Connect 2021 09 13;11(3). Epub 2021 Sep 13.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini University Hospital, Catanzaro, Italy.

Case: An 83-year-old man suffered progressive lower back pain 4 weeks after an endovascular aortic repair (EVAR) procedure. Computed tomography showed L4 vertebral body collapse and abnormal soft tissue-like density swelling with increased uptake on 18F-fluoro-D-glucose (FDG) positron emission tomography (PET)/CT. Listeria monocytogenes was identified from ultrasound-guided fine-needle aspiration. Ultrasound-guided drainage of the retroperitoneal abscess and intravenous antibiotic therapy with ampicillin and gentamicin resulted in the rapid relief of symptoms.

Conclusion: Spondylodiscitis after EVAR requires a timely diagnosis. Uncommon organisms such as L. monocytogenes must be suspected, even in focal infections without signs of listeriosis. Conservative treatment with preservation of the graft should be considered as long as close follow-up evaluations are performed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.CC.21.00212DOI Listing
September 2021

Periprosthetic ankle infection: eradication rate, complications, and limb salvage. A systematic review.

Foot Ankle Surg 2021 Jul 21. Epub 2021 Jul 21.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy.

Background: This systematic review investigated the outcomes of revision surgery after periprosthetic ankle infection (PAI).

Methods: According to the PRISMA statement, 9 studies with 131 PAIs surgically treated and analyzed were included. Demographics and surgical techniques with eradication rates and complications were reported.

Results: Methicillin-sensitive Staphylococcus aureus (MSSA) (30.4%) and coagulase-negative Staphylococcus (CNS) (26.5%) were the most common microorganisms. The eradication rate was 91.7% with permanent antibiotic spacers (SPC), 84.4% with 2-stage, 79.4% with arthrodesis (AA), and 58.8% with debridement and implant retention (DAIR). DAIR showed a significantly lower eradication rate than 2-stage (p = 0.016) and SPC (p = 0.043). Amputations occurred in 25% of patients after SPC, 8.8% after AA and 3.9% after DAIR. SPC showed a significantly higher amputation rate than DAIR and 2-stage (p = 0.044, and p = 0.017, respectively).

Conclusions: SPC and 2-stage revision show the highest eradication rates, but 2-stage has a lower risk of amputation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fas.2021.07.009DOI Listing
July 2021

End-stage ankle osteoarthritis: arthroplasty offers better quality of life than arthrodesis with similar complication and re-operation rates-an updated meta-analysis of comparative studies.

Int Orthop 2021 May 4. Epub 2021 May 4.

Department of Orthopaedic and Trauma Surgery, "Mater Domini" University Hospital, "Magna Græcia" University, V.le Europa, 88100, Catanzaro, Italy.

Purpose: Ankle arthrodesis (AA) has traditionally been the surgical standard for patients with an end-stage ankle osteoarthritis, with total ankle arthroplasty (TAA) recently becoming an alternative. The aim of this study was to update evidence in terms of functional outcomes, complications, and quality of life between AA and TAA by analyzing comparative studies.

Methods: PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search keywords. A total of 21 studies entered our qualitative and quantitative analysis. Demographics, functional outcomes, and complications were extracted. Random and fixed-effect models were used for the meta-analysis of standardized mean differences (SMDs) and odds ratios (ORs).

Results: A total of 18,448 patients were identified, with a mean age of 57.3 ± 11.3 years. TAA showed significantly greater post-operative range of motion (SMD - 0.883, 95% CI - 1.175 to - 0.590; I < 0.001) and Ankle Osteoarthritis Scale scores (SMD - 1.648, 95% CI - 3.177 to - 0.118; I = 97.67), but no differences in other patient-reported outcome scores were found. Patients undergoing TAA showed higher post-operative SF-36 (SMD - 0.960, 95% CI - 1.584 to - 0.336; I = 68.77). The total complication rate was similar between the two procedures (OR 0.936, 95% CI 0.826 to 1.060; I = 87.44), including the incidence of re-operations (OR 1.720, 95% CI 0.892 to 3.316; I = 77.65).

Conclusion: While TAA and AA showed no differences in most post-operative functional outcomes, our review demonstrates that patients undergoing TAA show better health-related quality of life than AA. We found no evidence to suggest that TAA carries a higher risk of complications and re-operations compared to AA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-021-05053-xDOI Listing
May 2021

Has the COVID-19 Pandemic Changed the Daily Practices and Psychological State of Orthopaedic Residents?

Clin Orthop Relat Res 2021 09;479(9):1947-1954

Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Mater Domini University Hospital, Catanzaro, Italy.

Background: The coronavirus-19 (COVID-19) pandemic has been an unprecedented time for healthcare and has substantially changed resource availability in surgeons' work practices and routines. Many orthopaedic departments suspended elective surgery, and some re-deployed orthopaedic residents to stressful nonorthopaedic tasks; long hours were commonplace. Stress-reaction symptoms such as anxiety and depression have been reported in about 10% of healthcare workers during previous infectious-diseases outbreaks (including the Ebola virus), but little is known about the psychological needs of residents faced with this global disaster.

Questions/purposes: (1) Have anxiety and depression symptoms among orthopaedic residents worsened from the period before to the period after the lockdown in Italy? (2) Are there differences in anxiety and depression symptoms between residents who worked in a COVID-19 department and those who did not?

Methods: The Italian Association of Orthopaedic and Traumatology Residents is comprised of 365 members who were recruited through the organization's mailing list; they were asked to respond to a survey about their health and well-being at the beginning and end of the first COVID-19 Italian lockdown (March 9, 2020 to May 3, 2020). For the survey's development, 10 orthopaedic surgery residents at the Magna Graecia University of Catanzaro were preliminarily asked to answer the surveys, and both face validity and content validity were tested. The test-retest reliability was 0.9. Impact on and future concerns about family life and daily work practice, as well as sleep disorders, were investigated. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), which includes 14 questions (seven for anxiety, HADS-A; and seven for depression, HADS-D) on a Likert scale (0-3); thus, a patient can have a score between 0 and 21 for either the HADS-A or HADS-D, with higher scores indicating a greater likelihood of anxiety or depression. Previously reported minimum clinically important differences ranged from 1.5 to 1.7. For each scale, total scores of ≤ 7 , 8 to 10, and ≥ 11 were taken to represent normal, borderline, or abnormal level of anxiety or depression, respectively. Overall, 75% (272 of 365) of residents completed the survey at both the beginning and end of the lockdown; 72% (196 of 272) were men, the mean ± SD age was 30 ± 3 years, 72% (197 of 272) worked in a hospital setting with patients who were COVID-19-positive, 20% (55 of 272) served in a COVID-19 department, and 5% (7 of 139) tested positive for COVID-19 by nasal-pharyngeal swab. Overall, 9% (24 of 272) of residents had family members who contracted COVID-19, and 3% (8 of 272) had a relative who died. Because of the risk of possible COVID-19 exposure, 18% (48 of 272) of residents needed to temporarily change their household given that social distancing was considered the best way to slow the spread of COVID-19.

Results: At the end of the lockdown, orthopaedic residents exhibited signs of worsening anxiety and depression as measured by the overall HADS score (median 9 [IQR 5 to 14] versus median 11 [IQR 6 to 17.8], respectively; median difference -1 [95% CI -1.5 to -0.5]; effect size [r] = -0.24; p < 0.001) as well as in the depression subscale (median 4 [IQR 2 to 7] versus median 5.5 [IQR 3 to 8], respectively; median difference -1 [95% CI -1.5 to -0.5]; r = -0.36; p < 0.001). We found no difference in the development of anxiety or depression between residents who worked in a COVID-19 department and those who did not, as demonstrated by comparing the change in HADS scores between these groups (median 1 [IQR -3 to 4] versus median 1 [IQR -2 to 4] in HADS change score over time; median difference 0 [95% CI -1 to 2]; r = -0.03; p = 0.61).

Conclusion: The COVID-19 pandemic has affected the daily practice of orthopaedic residents and has had important, far-reaching consequences on their health and well-being, including social implications. Residents showed higher anxiety and depression symptoms at the end of the lockdown. No differences were found in changes of anxiety and depression, over time, for residents who worked in a COVID-19 department compared with those who did not. The evaluation of anxiety and depression through standardized questionnaires could help to identify residents at risk of higher psychological distress who could be referred to regular psychological counseling as a possible prevention strategy during stressful times. Future studies should confirm the long-term effects of these findings.

Level Of Evidence: Level II, prognostic study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CORR.0000000000001728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373398PMC
September 2021

Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis.

Arch Orthop Trauma Surg 2021 Feb 26. Epub 2021 Feb 26.

Royal Aberdeen Children's Hospital, Aberdeen, UK.

Introduction: Tibial shaft fractures are common occurrence in children and surgical treatment is sometimes required, particularly in unstable or open fractures, and in polytrauma. The aim of this study was to investigate the available evidence on the efficacy and safety of flexible intramedullary nailing (FIN) for both open and closed tibia fractures in children, exploring the main surgical outcomes and rate of complications.

Materials And Methods: Pubmed/Medline, Scopus and Cochrane Central databases were searched following the PRISMA guideline. Studies reporting on the outcomes of FIN for paediatric tibia shaft fractures were included. Weighted means were evaluated for surgical outcomes. Meta-analysis of proportion and odd ratios were used to analyse total complication rates and differences between open and closed fractures.

Results: Twenty-eight studies (835 patients) were included; the mean age was 11.0 ± 3.0 years. The mean follow-up was 22.5 ± 13.5 months; the mean time to full weight-bearing was 7.5 ± 3.7 weeks. The total complication rate was 28.1% (minor = 20.7%, major = 6.3%); this was greater in open fractures (13.6% vs 5.1%, p = 0.007). The rate of union was 97.5%, with a mean time to union of 11.9 ± 7.2 weeks. Malunion was found in 8.5% cases, delayed union in 3.8%, non-union in 1.4%, symptomatic hardware in 5.1%, leg-length discrepancy in 5.0%, superficial infections in 2.3%, deep infections in 1.0%, compartment syndromes in 1.4%, and refracture in 0.2%. Almost all patients returned to unrestricted physical activity.

Conclusions: FIN offers excellent outcomes for the treatment of paediatric tibia shaft fractures. Patients presenting with an open fracture have a higher but acceptable complication rate. Comparative studies are needed to clarify if other treatments have superior outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-021-03839-7DOI Listing
February 2021

Single- versus double-incision technique for the treatment of distal biceps tendon rupture.

Bone Joint J 2020 Dec;102-B(12):1608-1617

Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital of Catanzaro, Catanzaro, Italy.

Aims: The aim of this systematic review and meta-analysis is to evaluate differences in functional outcomes and complications between single- (SI) and double-incision (DI) techniques for the treatment of distal biceps tendon rupture.

Methods: A comprehensive search on PubMed, MEDLINE, Scopus, and Cochrane Central databases was conducted to identify studies reporting comparative results of the SI versus the DI approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 606 titles, 13 studies met the inclusion criteria; methodological quality was assessed with the Newcastle-Ottawa scale. Random- and fixed-effects models were used to find differences in outcomes between the two surgical approaches. The range of motion (ROM) and the Disabilities of the Arm, Shoulder and Hand (DASH) scores, as well as neurological and non-neurological complications, were assessed.

Results: A total of 2,622 patients were identified. No significant differences in DASH score were detected between the techniques. The SI approach showed significantly greater ROM in flexion (standardized mean difference (SMD) -0.508; 95% confidence interval (CI) -0.904 to -0.112) and pronation (SMD -0.325, 95% CI -0.637 to -0.012). The DI technique was associated with significantly less risk of lateral antebrachial cutaneous nerve damage (odds ratio (OR) 4.239, 95% CI 2.171 to 8.278), but no differences were found for other nerves evaluated. The SI group showed significantly fewer events of heterotopic ossification (OR 0.430, 95% CI 0.226 to 0.816) and a lower reoperation rate (OR 0.503, 95% CI 0.317 to 0.798).

Conclusion: No significant differences in functional scores can be expected between the SI and DI approaches after distal biceps tendon repair. The SI approach showed greater flexion and pronation ROM and a lower risk of heterotopic ossification and reoperation. The DI approach was favourable in terms of lower risk of neurological complications. Cite this article: 2020;102-B(12):1608-1617.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.102B12.BJJ-2020-0822.R2DOI Listing
December 2020

Conversion of Fused Hip to Total Hip Arthroplasty: Long-Term Clinical and Radiological Outcomes.

J Arthroplasty 2021 03 17;36(3):1060-1066. Epub 2020 Oct 17.

Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.

Background: Despite promising results at the mid-term followup, several aspects of conversion of the fused hip to total hip arthroplasty (THA) remain controversial. The aim of this study was to evaluate clinical and radiological outcomes with a minimum 5-year followup in patients who underwent conversion of the fused hip to THA.

Methods: Fifty-seven patients (59 hips) were evaluated. The Harris Hip Score (HHS), range of motion (ROM), and the Visual Analogue Scale (VAS) were used to assess hip function and low back pain. Subjective satisfaction with surgery and the presence of the Trendelenburg sign was also evaluated. Radiological assessment was performed pre- and postoperatively to evaluate loosening and heterotopic ossification (HO).

Results: After a mean followup of 13.0 ± 6.2 years, HHS and VAS significantly improved from 46.0 ± 16.7 to 80.8 ± 18.8 and from 4.4 ± 1.5 to 2.1 ± 1.4 (both P < .001), respectively. Twenty-three patients (40.4%) had a positive Trendelenburg sign, and HOs were found in 29 cases (49.1%). An overall 29.8% complication rate was noted. Smoking habits and rheumatoid arthritis were predictive of Trendelenburg sign (P = .046 and P = .038, respectively). Implant survival rate as the end point was 98.7 ± 1.3% at 5 years, 92.4 ± 3.3% at 10 years, 82.1 ± 5.7% at 15 years, and 73.4 ± 8.0% at 20 and 25 years. A worse cumulative implant survival rate was noted in patients who underwent previous hip surgery, defined as any hip operation before fusion (P = .005).

Conclusion: Conversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term followup. An implant survival rate higher than 70% can be expected 25 years postoperatively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2020.09.030DOI Listing
March 2021

Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated With Improved Shoulder Function and High Patient Satisfaction.

Arthroscopy 2021 02 15;37(2):480-486. Epub 2020 Oct 15.

Division of Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.. Electronic address:

Purpose: To investigate associations between clinical and demographic parameters and Constant-Murley (CM) scores after subacromial balloon placement for massive, irreparable rotator cuff tears and to evaluate implant survival, shoulder function, and patient satisfaction.

Methods: We prospectively analyzed patients with rotator cuff tears deemed irreparable on preoperative magnetic resonance imaging for whom nonoperative therapy was unsuccessful and who underwent balloon placement from 2014 to 2017 with minimum 1-year follow-up. Shoulder function was assessed using the CM score and the 12-Item Short Form Health Survey.

Results: The study included 51 patients (22 women and 29 men) with a mean age at surgery of 63 years (range, 50-78 years). The mean follow-up period was 36 months (range, 24-56 months). The postoperative acromiohumeral interval and total preoperative CM score predicted the postoperative CM score at final follow-up. The implant survival rates were 92% at 6 and 12 months, 90% at 2 years, and 87% at 3 and 4 years. Five patients underwent reverse total shoulder arthroplasty, and 1 underwent latissimus dorsi tendon transfer. Postoperatively, mean CM scores (± standard deviation) improved for range of motion (from 11 ± 5.4 to 34 ± 6.8) and strength (from 13 ± 5.4 to 28 ± 12) (P < .01 for both). The total CM score improved from 27 ± 7.4 preoperatively to 77 ± 15 postoperatively (P < .01). The physical and mental component summary scores on the 12-Item Short Form Health Survey improved from 27 ± 5.0 to 51 ± 6.5 (P = .02) and from 44 ± 15 to 56 ± 8.0, respectively (P < .01). Thirty-eight patients reported excellent satisfaction, 8 were satisfied, and 5 were dissatisfied. Of the patients, 50 (98%) exceeded the minimal clinically important difference (≥10.4) and patient acceptable symptom state (≥44).

Conclusions: At mean 3-year follow-up, subacromial balloon spacer placement for massive, irreparable rotator cuff tears was associated with a significant improvement in shoulder function, limited need for revision surgery, and high patient satisfaction. A greater postoperative acromiohumeral interval and lower preoperative CM score predicted a lower postoperative CM score at final follow-up.

Level Of Evidence: Level IV, retrospective cohort study and treatment study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2020.09.048DOI Listing
February 2021

The 50 Highest Cited Papers on Rotator Cuff Tear.

Arthroscopy 2021 01 14;37(1):61-68. Epub 2020 Aug 14.

Department of Orthopaedics and Traumatology, Villa del Sole Clinic, Catanzaro, Italy.

Purpose: The purpose of this study was to determine the 50 most cited articles on rotator cuff tear and their characteristics.

Methods: Thomson ISI Web of Science was searched for the following search terms "rotator cuff" and "tear." The following characteristics were determined for each article: author(s), year of publication, source journal, geographic origin, article type (and subtype), and level of evidence for clinical articles.

Results: The number of citations ranged from 1558 to 253. The 50 most often cited articles were published in 7 journals. The majority of the articles (n = 46) were clinical, with the remaining representing some type of basic science research. Among clinical articles, the case series (n = 23) was the most common article subtype. Nine articles were methodologic in that they proposed a new classification/scoring system or technique. The most common level of evidence was Level IV (n = 31).

Conclusion: This article provides clinicians, researchers, and trainees with a group of articles that should be taken into consideration as building blocks in the treatment of rotator cuff tears.

Level Of Evidence: Level IV, literature review.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2020.07.044DOI Listing
January 2021

Letter regarding article by Clavert et al.: long-term outcomes of latissimus dorsi transfer for irreparable rotator cuff tears.

Int Orthop 2020 07 3;44(7):1441-1442. Epub 2020 May 3.

Department of Medical and Surgical Sciences, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-020-04588-9DOI Listing
July 2020

Personality traits predict residual pain after total hip and knee arthroplasty.

Int Orthop 2020 07 3;44(7):1263-1270. Epub 2020 Apr 3.

Psychiatric Unit, Department of Medical and Surgical Sciences, "Mater Domini" University Hospital, "Magna Græcia" University, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.

Aim Of The Study: We assessed the role of personality traits, anxiety, and depression in residual pain among patients who underwent total hip (THA) and knee (TKA) arthroplasty.

Method: Eighty-three patients (40 THA and 43 TKA) were interviewed pre-operatively (t); five days (t) after surgery; and one (t), three (t), six (t), and 12 months (t) after surgery. Personality (TCI-R), pain (VAS), anxiety and depression (HADS), quality of life (SF-12), functionality (HHS/KSS), and disability (WOMAC) were evaluated.

Results: Pain reduction and functional improvement were reported at t (both p < 0.001) in both THA and TKA patients. THA patients showed earlier and greater functional improvement after surgery (both p < 0.001) in comparison with TKA. Residual pain (VAS > 30 mm) was noted in 15% of the THA patients and 25% of the TKA patients, and it correlated with the SF-12 PCS (r = - 0.412; p < 0.001), SF-12 MCS (r = - 0.473; p < 0.001), HADS-A (r = 0.619; p = <0.001), HADS-D (r = 0.559; p < 0.001), functionality (r = - 0.482; p < 0.001), and WOMAC (r = 0.536; p < 0.001) scores at t. High pre-operative harm avoidance, persistence, and anxiety scores were predictive of residual pain after both THA and TKA (p < 0.001).

Discussion: The proportion of patients complaining of residual pain in this study was similar to that in previous findings. Multiple predictors of residual pain after THA and TKA have been previously described, and several studies evaluated the influence of psychological factors on the outcome of joint arthroplasty; however, only four studies investigated the role of personality traits in the outcome of THA and TKA patients, and a unique study out of these investigations demonstrated the effect of personality on persisting pain.

Conclusion: The current study demonstrated that personality traits and anxiety predict residual pain; thus, pre-operative evaluation of these factors could be helpful in identifying patients at risk for residual pain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-020-04553-6DOI Listing
July 2020

Modified Weaver-Dunn Procedure for Type 3 Acromioclavicular Joint Dislocation: Functional and Radiological Outcomes.

Orthop J Sports Med 2020 Mar 6;8(3):2325967120905022. Epub 2020 Mar 6.

Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy.

Background: Controversy surrounds the indication for treatment of type 3 acromioclavicular joint dislocation, and the optimal reconstructive technique has not yet been defined. Since the first description of the Weaver-Dunn procedure, several studies have described the clinical and radiological results that can be expected postoperatively; however, few studies have evaluated the outcomes of this technique for chronic type 3 acromioclavicular joint dislocation.

Purpose/hypothesis: The purpose of this study was to evaluate the functional and radiographic mid- to long-term outcomes of a modified Weaver-Dunn procedure for chronic Rockwood type 3 acromioclavicular joint dislocation. We hypothesized that (1) functional outcomes comparable with sex- and age-matched healthy individuals could be achieved with the modified Weaver-Dunn procedure and (2) joint stability could be restored after surgery.

Study Design: Case series; Level of evidence, 4.

Methods: Out of 30 patients who sustained a chronic type 3 acromioclavicular joint dislocation, 27 had a minimum 12-month follow-up and were included in the study. All patients underwent a modified Weaver-Dunn procedure. The Constant-Murley score was used to assess patient postoperative function. Subjective evaluation of patient satisfaction with surgery was also recorded. Radiological assessment was performed postoperatively to evaluate superoinferior and anteroposterior joint stability.

Results: After a mean follow-up period of 51.6 months, the mean Constant-Murley score was 90.1, which was 97.2% that of a group of sex- and age-matched healthy individuals. In the multivariate analysis, higher Constant-Murley score was associated with male sex (β = 0.385; = .043) and higher subjective satisfaction scale (β = 0.528; = .003). All patients returned to their previous work and sport activity levels having high satisfaction with surgery. Successful vertical acromioclavicular joint reduction was obtained in all but 1 patient; however, horizontal joint stability was not completely restored with the modified Weaver-Dunn procedure. No intraoperative complications occurred, and the postoperative complication rate was 7.4%.

Conclusion: In patients with chronic type 3 acromioclavicular joint dislocation, the modified Weaver-Dunn procedure is an effective technique to restore vertical but not horizontal joint stability 4 years after surgery. High levels of satisfaction with surgery and functional outcomes comparable with sex- and age-matched healthy individuals can be achieved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2325967120905022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065288PMC
March 2020

The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears.

Knee Surg Sports Traumatol Arthrosc 2020 Jul 6;28(7):2367-2376. Epub 2019 Dec 6.

Division of Orthopedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy.

Purpose: Latissimus dorsi tendon transfer is a surgical option for the treatment of massive irreparable posterosuperior rotator cuff tear. Whether a favourable clinical outcome is due to the latissimus dorsi muscle contraction rather than the passive tenodesis effect remains to be confirmed. The purpose of the current case-control study was to evaluate the shoulder kinematics and latissimus dorsi activation after latissimus dorsi tendon transfer.

Methods: Eighteen patients suffering from irreparable rotator cuff tear that underwent latissimus dorsi tendon transfer and 18 healthy individuals were examined using a 3D kinematic tracking system and electromyography. Active maximal flexion-extension and abduction-adduction of the humerus were measured for the operated and the contralateral shoulder of the patients and the shoulder of healthy individuals to evaluate the range of motion (ROM) and scapulohumeral rhythm. Electromyographic comparison of isometric contraction between the latissimus dorsi of the operated and contralateral shoulder was carried out.

Results: After arthroscopic-assisted latissimus dorsi tendon transfer, patients showed comparable flexion and abduction ROM to their asymptomatic contralateral shoulders and to the shoulders of healthy individuals. Significantly higher scapular ROM values were found between the latissimus dorsi tendon transfer side and the shoulders of healthy individuals. While performing external rotation with 0° shoulder abduction, a greater percentage of the electromyographic peak value (p = 0.047) and a higher latissimus dorsi internal/external rotation ratio (p = 0.004) were noted for the transferred muscle in comparison to the contralateral shoulder.

Conclusion: Although the arthroscopic-assisted latissimus dorsi tendon transfer failed to normalize scapulothoracic joint movements of patients, a functional latissimus flap and a shoulder ROM similar to the contralateral side or the shoulder of healthy individuals can be expected after this procedure in patients with massive irreparable posterosuperior rotator cuff tear.

Level Of Evidence: III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-019-05819-2DOI Listing
July 2020

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review.

J Knee Surg 2021 Feb 28;34(3):303-321. Epub 2019 Aug 28.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), Catanzaro, Italy.

This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's ( = 0.0102) and International Knee Documentation Committee (IKDC;  = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation ( = 0.0008). Fresh frozen allografts had higher Lysholm's scores ( < 0.0001) and showed significantly lower failure rates ( < 0.0001) than cryopreserved allografts. Age ( < 0.015, = 0.80), sex ( < 0.034,     8.52), and body mass index (BMI;  < 0.014, = -4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1695043DOI Listing
February 2021

Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence.

Foot Ankle Surg 2020 Jun 29;26(4):439-444. Epub 2019 May 29.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.

Background: Controversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity.

Methods: Sixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence.

Results: After a mean 38±15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P<0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P=0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β=-3.42, P=0.030; β=0.262, P=0.022; β=-0.181, P=0.025, respectively). The BMI influenced postoperative PCS-12 (β=-0.244, P=0.002). Preoperative HVA was directly related to postoperative DMAA (P=0.002) and tibial sesamoid position (P=0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P=0.043 and P=0.035, respectively).

Conclusions: Satisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fas.2019.05.013DOI Listing
June 2020

Outcomes of revision surgery after periprosthetic shoulder infection: a systematic review.

J Shoulder Elbow Surg 2019 Jun 16;28(6):1193-1203. Epub 2019 Apr 16.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.

Background: Periprosthetic shoulder infection (PSI) is one of the most challenging complications after shoulder arthroplasty. Different treatments have been proposed, but the best surgical procedure remains disputed in the current literature. This systematic review investigated the outcomes of revision surgery after PSI.

Methods: The PubMed and Scopus databases were used to search keywords in April 2018. Of 2157 titles, 34 studies were finally analyzed. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported.

Results: A total of 754 patients were identified. Cutibacterium acnes (C. acnes) was the most common microorganism found both in PSI (33%) and persistent infections (40%). Preoperatively, C-reactive protein was elevated in 70% of patients with PSI. Reverse shoulder arthroplasty had a lower prevalence of infection (P < .001). The eradication rate was 96% with 1 stage, 93% with permanent spacers, 86% with 2 stages, 85% with resection arthroplasty, and 65% with irrigation and débridement. One-stage revision was the best treatment, considering postoperative flexion and abduction, compared with resection arthroplasty, permanent spacers, and 2-stage revision. One-stage revision showed fewer postoperative complications than irrigation and débridement, resection arthroplasty, and 2-stage surgery. Two-stage surgery was the most common treatment, and the functional score demonstrated no differences between 2-stage and 1-stage procedures.

Conclusions: Our review suggests that a 1-stage procedure should be recommended to treat PSI. Two-stage revision could be reserved for select cases in which the bacterium involved is unknown.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2019.02.014DOI Listing
June 2019

ZNF521 Represses Osteoblastic Differentiation in Human Adipose-Derived Stem Cells.

Int J Mol Sci 2018 Dec 18;19(12). Epub 2018 Dec 18.

Department of Clinical and Experimental Medicine, Laboratory of Molecular Haematopoiesis and Stem Cell Biology, University "Magna Græcia", Catanzaro 88100, Italy.

Human adipose-derived stem cells (hADSCs) are multipotent mesenchymal cells that can differentiate into adipocytes, chondrocytes, and osteocytes. During osteoblastogenesis, the osteoprogenitor cells differentiate into mature osteoblasts and synthesize bone matrix components. Zinc finger protein 521 (ZNF521/Zfp521) is a transcription co-factor implicated in the regulation of hematopoietic, neural, and mesenchymal stem cells, where it has been shown to inhibit adipogenic differentiation. The present study is aimed at determining the effects of ZNF521 on the osteoblastic differentiation of hADSCs to clarify whether it can influence their osteogenic commitment. The enforced expression or silencing of ZNF521 in hADSCs was achieved by lentiviral vector transduction. Cells were cultured in a commercial osteogenic medium for up to 20 days. The ZNF521 enforced expression significantly reduced osteoblast development as assessed by the morphological and molecular criteria, resulting in reduced levels of collagen I, alkaline phosphatase, osterix, osteopontin, and calcium deposits. Conversely, ZNF521 silencing, in response to osteoblastic stimuli, induced a significant increase in early molecular markers of osteogenesis and, at later stages, a remarkable enhancement of matrix mineralization. Together with our previous findings, these results show that ZNF521 inhibits both adipocytic and osteoblastic maturation in hADSCs and suggest that its expression may contribute to maintaining the immature properties of hADSCs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms19124095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321315PMC
December 2018

Bacterial biofilm formation is variably inhibited by different formulations of antibiotic-loaded bone cement in vitro.

Knee Surg Sports Traumatol Arthrosc 2019 Jun 28;27(6):1943-1952. Epub 2018 Oct 28.

Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples. Via S. Pansini 5, 80131, Naples, Italy.

Purpose: The aim of the present study was to quantitatively assess biofilm growth on the surface of bone cements discs containing different antibiotics, including colistin and linezolid. Biofilms of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Staphylococcus epidermidis were grown on bone cement discs for 96 h.

Methods: Biofilm amounts were measured by confocal laser microscopy using live/dead staining and dedicated software at different time intervals (48, 72, and 96 h).

Results: Bone cement containing vancomycin was not effective at reducing MRSA biofilm formation 96 h following bacterial inoculation. At a comparable time interval, linezolid-, clindamycin-, and aminoglycoside-loaded cement was still active against this biofilm. At the 72- and 96-h observations, S. epidermidis biofilm was present only on tobramycin and gentamicin discs. P. aeruginosa biofilms were present on cement discs loaded with colistin at all time intervals starting from the 48-h observation, whereas no biofilms were detected on tobramycin or gentamicin discs.

Conclusion: Bone cements containing different antibiotics have variable and time-dependent windows of activity in inhibiting or reducing surface biofilm formation. The effectiveness of bone cement containing vancomycin against MRSA biofilm is questionable. The present study is clinically relevant, because it suggests that adding the right antibiotic to bone cement could be a promising approach to treat periprosthetic infections. Indeed, the antibiofilm activity of different antibiotic-loaded bone cements could be preoperatively assessed using the current methodology in two-stage exchange procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-018-5230-xDOI Listing
June 2019

Functional outcomes and repair integrity after arthroscopic repair of partial articular supraspinatus tendon avulsion.

Arch Orthop Trauma Surg 2019 Mar 29;139(3):369-375. Epub 2018 Sep 29.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.

Introduction: Partial-thickness rotator cuff tears are a common cause of shoulder pain and disability. Arthroscopic repair is an effective treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions, and transtendon repair and completion of the tear and repair are the surgical techniques commonly used to treat such lesions. Our aim was to retrospectively evaluate the minimum 24-month clinical and radiological results of PASTA.

Materials And Methods: Patients suffering from PASTA lesion who underwent arthroscopic repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess the patients' functionality pre- and postoperatively. The postoperative patient assessment included the simple shoulder test (SST). Postoperative tendon integrity was evaluated by ultrasound examination.

Results: 151 patients (153 shoulders) were retrospectively evaluated 73.9 (24-142) months after a completion-repair (94 cases) or transtendon repair (59 cases) of a PASTA lesion. The CMS significantly improved from 47.7 (22-63) preoperatively to 84.2 (62-100) postoperatively (p < 0.001). The mean postoperative SST score was 10.1 (5-12), and 95% of patients were satisfied with the surgery. No significant differences were noted between the two techniques in terms of postoperative CMS, SST score and satisfaction. Seventy-four and 43 cases treated with completion and repair and transtendon repair, respectively, performed ultrasound examination 66.1 (24-142) months after surgery. The overall retear rate was 13.7%, supraspinatus retears were observed in ten shoulder subjected to completion and repair (13.5%) and six shoulders subjected to transtendon repair (13.9%), and no significant differences were noted between the two techniques as for CMS (p = 0.896), SST (p = 0.973), satisfaction (p = 0.621) and retear (p = 0.999). Males and younger patients had a higher postoperative CMS (p values < 0.001), and SST score (p < 0.001 and p = 0.038, respectively).

Conclusions: Arthroscopic repair of PASTA lesion achieves high rates of repair integrity regardless of repair type and high levels of functional recovery and patient satisfaction 6 years after surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-018-3044-4DOI Listing
March 2019

ZNF521 Has an Inhibitory Effect on the Adipogenic Differentiation of Human Adipose-Derived Mesenchymal Stem Cells.

Stem Cell Rev Rep 2018 Dec;14(6):901-914

Laboratory of Molecular Haematopoiesis and Stem Cell Biology, University Magna Græcia, Catanzaro, Italy.

Mesenchymal stem cells (MSCs) are multipotent progenitors present in the bone marrow stroma and in subcutaneous abdominal fat, an abundant and easily accessible source of MSCs with the ability to differentiate along multiple lineage pathways. The stem cell-associated transcription co-factor Zinc Finger Protein 521 (ZNF521/zfp521) has been implicated in the control of the homeostasis of hematopoietic, neural and osteo-adipogenic progenitors. Here we document through the analysis of a panel of human adipose-derived stem cells (hADSCs), that ZNF521 strongly inhibits the generation of mature adipocytes. Enforced overexpression of ZNF521 in these cells resulted in a significant delay and reduction in adipocyte differentiation upon exposure to inducers of adipogenesis. Of particular relevance, ZNF521 was able to inhibit the expression of ZNF423, recently identified as an essential commitment factor necessary for the generation of pre-adipocytes. Conversely, silencing of ZNF521 was found to significantly enhance the adipogenic differentiation of hADSCs. Inhibition of adipogenesis by ZNF521 was at least in part due to inhibition of EBF1. Taken together, these results confirm a role for ZNF521 as a key negative regulator of adipocyte differentiation of hADSCs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12015-018-9830-0DOI Listing
December 2018

All-Arthroscopic Treatment of Intra- and Extra-Articular Localized Villonodular Synovitis of Knee.

Joints 2017 Sep 8;5(3):184-187. Epub 2017 Aug 8.

Department of Orthopaedic & Trauma Surgery, Messina University, Messina, Italy.

Pigmented villonodular synovitis (PVNS) is a rare, benign, proliferative neoplastic condition affecting synovial-lined anatomic spaces. PVNS is characterized by hypertrophy of a synovial membrane by villous, nodular, and villonodular proliferation, with pigmentation secondary to hemosiderin deposition. The two forms of PVNS that have been described are diffuse (DPVNS) and localized (LPVNS). The knee is the most commonly involved anatomic location, followed by hip, ankle, shoulder, and elbow. Diagnosis of PVNS is not always obvious clinically. Various imaging modalities are often necessary to exclude other conditions and narrow the diagnosis. Magnetic resonance imaging has become the modality of choice for diagnosing PVNS. We present a case of intra-articular LPVNS with an extra-articular extension through the posterior capsule that has been successfully removed in an all-arthroscopic fashion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1605586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738479PMC
September 2017

Effects of Notchplasty on Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Joints 2017 Sep 8;5(3):173-179. Epub 2017 Aug 8.

Department of Orthopaedic and Trauma Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy.

 Notchplasty is a complementary surgical procedure often performed during anterior cruciate ligament reconstruction (ACLR) with the aim to widen the intercondylar notch and to avoid graft impingement. The aim of this review was to analyze the current literature evidence concerning the effects of notchplasty on clinical outcome after primary ACLR.  Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE were used to search English language studies, from January 1990 to July 2015, concerning the effects of the notchplasty on ACLR, using the following keywords: "ACL" OR "anterior cruciate ligament" OR "ACL reconstruction" OR "anterior cruciate ligament reconstruction" AND "notch" OR "notchplasty" OR "intercondylar notch". Randomized and nonrandomized trials, case series, technical notes, biomechanical studies and radiological study were included.  At the final screening 16 studies were included. Despite widely used, the usefulness of notchplasty during ACLR remains unclear. Some concerns emerged regarding potential harmful effects of notchplasty, mostly related to the knee biomechanics and postoperative blood loss. Notchplasty can be useful in the treatment of arthrofibrosis and in presence of bony spurs of the notch both in primary and revision surgery. However, the level of evidence of available literature is poor and there is a strong need for randomized controlled trials investigating the role of notchplasty on ACLR.  We suggest being aware of potential complications following notchplasty during ACLR before deciding to perform notchplasty in primary ACLR, reserving it for the surgical management of arthrofibrosis, treatment of notch osteophytosis and revision ACLR.  Level IV, systematic review of level II-IV studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1605551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738469PMC
September 2017

Understanding the potentiality of accelerator based-boron neutron capture therapy for osteosarcoma: dosimetry assessment based on the reported clinical experience.

Radiat Oncol 2017 Aug 15;12(1):130. Epub 2017 Aug 15.

National Atomic Energy Commission (CNEA), Av. General Paz, 1499, Buenos Aires, Argentina.

Background: Osteosarcoma is the most frequent primary malignant bone tumour, and its incidence is higher in children and adolescents, for whom it represents more than 10% of solid cancers. Despite the introduction of adjuvant and neo-adjuvant chemotherapy that markedly increased the success rate in the treatment, aggressive surgery is still needed and a considerable percentage of patients do not survive due to recurrences or early metastases. Boron Neutron Capture Therapy (BNCT), an experimental radiotherapy, was investigated as a treatment that could allow a less aggressive surgery by killing infiltrated tumour cells in the surrounding healthy tissues. BNCT requires an intense neutron beam to ensure irradiation times of the order of 1 h. In Italy, a Radio Frequency Quadrupole (RFQ) proton accelerator has been designed and constructed for BNCT, and a suitable neutron spectrum was tailored by means of Monte Carlo calculations. This paper explores the feasibility of BNCT to treat osteosarcoma using this neutron source based on accelerator.

Methods: The therapeutic efficacy of BNCT was analysed evaluating the dose distribution obtained in a clinical case of femur osteosarcoma. Mixed field dosimetry was assessed with two different formalisms whose parameters were specifically derived from radiobiological experiments involving in vitro UMR-106 osteosarcoma cell survival assays and boron concentration assessments in an animal model of osteosarcoma. A clinical case of skull osteosarcoma treated with BNCT in Japan was re-evaluated from the point of view of dose calculation and used as a reference for comparison.

Results: The results in the case of femur osteosarcoma show that the RFQ beam would ensure a suitable tumour dose painting in a total irradiation time of less than an hour. Comparing the dosimetry between the analysed case and the treated patient in Japan it turns out that doses obtained in the femur tumour are at least as good as the ones delivered in the skull osteosarcoma. The same is concluded when the comparison is carried out taking into account osteosarcoma irradiations with photon radiation therapy.

Conclusions: The possibility to apply BNCT to osteosarcoma would allow a multimodal treatment consisting in neo-adjuvant chemotherapy, high-LET selective radiation treatment and a more conservative surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13014-017-0860-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557419PMC
August 2017

Transient osteoporosis of the hip with a contralateral delayed involvement: a case report.

Clin Cases Miner Bone Metab 2017 Jan-Apr;14(1):83-86. Epub 2017 May 30.

Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.

We describe a case of non-simultaneous bilateral hip pain with bone marrow edema occurring in an adult male, with the contralateral hip being involved 12 years later after the onset of symptoms. On the basis of clinical and imaging findings, together with a complete resolution after conservative management, a post-hoc diagnosis of metachronous bilateral transient osteoporosis of the hip (TOH) was made. Non-simultaneous bilateral presentation of TOH is exceptional, and contralateral involvement with a 12-year delay has never been previously described.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11138/ccmbm/2017.14.1.083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505719PMC
May 2017

Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions.

Knee Surg Sports Traumatol Arthrosc 2018 Jan 16;26(1):169-175. Epub 2017 Jun 16.

Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy.

Purpose: To compare the effectiveness of tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. The null hypothesis was that there is no difference in functional scores between the tenotomy and tenodesis groups.

Methods: A total of 69 patients with a combined supraspinatus tear and LHBT lesion aged over 40 years entered this prospective comparative study and were randomly assigned to the arthroscopic LHB tenotomy or tenodesis group. Fifty-five patients (31 in the tenotomy group and 24 in the tenodesis group) were available for the 6- and 24-month post-operative evaluations.

Results: There were no statistically significant differences in post-operative Constant and Murley score, quality of life, pain, and strengths between groups. Higher rates of Popeye's sign were noted 6 and 24 months post-operatively in the tenotomy group compared to tenodesis.

Conclusions: Although tenotomy is affected by a higher incidence of cosmetic deformity, there is no superiority of arthroscopic tenodesis over tenotomy in the treatment of LHBT lesion as a concomitant procedure to an arthroscopic repair of the supraspinatus tendon in terms of functional outcomes, quality of life, pain, and strength measured 6 and 24 months post-operatively.

Level Of Evidence: I.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-017-4609-4DOI Listing
January 2018

Arthroscopic Partial Repair of Irreparable, Massive Rotator Cuff Tears.

Arthrosc Tech 2017 Feb 30;6(1):e143-e147. Epub 2017 Jan 30.

Department of Orthopaedic & Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy.

Several treatment options for chronic, massive rotator cuff tears exist, and they include debridement with possible biceps tenotomy or tenodesis, open or arthroscopic partial repair, muscle or tendon transfer, superior capsule reconstruction, synthetic patch augmentation, and reverse total shoulder arthroplasty. The aim of this technique article is to describe our preferred surgical option for irreparable, massive rotator cuff tears with an irreparable supraspinatus, a reparable infraspinatus, and an intact or reparable subscapularis tendon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2016.09.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368352PMC
February 2017

Social media for patients: benefits and drawbacks.

Curr Rev Musculoskelet Med 2017 Mar;10(1):141-145

Orthopedic Surgery Division, Department of Medical and Surgical Sciences, University of Catanzaro Magna Græcia, Viale Europa, Germaneto, 88100, Catanzaro, CZ, Italy.

Purpose Of Review: Social media is increasingly utilized by patients to educate themselves on a disease process and to find hospital, physicians, and physician networks most capable of treating their condition. However, little is known about quality of the content of the multiple online platforms patients have to communicate with other potential patients and their potential benefits and drawbacks.

Recent Findings: Patients are not passive consumers of health information anymore but are playing an active role in the delivery of health services through an online environment. The control and the regulation of the sources of information are very difficult. The overall quality of the information was poor. Bad or misleading information can be detrimental for patients as well as influence their confidence on physicians and their mutual relationship. Orthopedic surgeons and hospital networks must be aware of these online patient portals as they provide important feedback on the patient opinion and experience that can have a major impact on future patient volume, patient opinion, and perceived quality of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12178-017-9394-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344865PMC
March 2017

Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival.

Biomed Res Int 2016 5;2016:2606521. Epub 2016 Dec 5.

Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy.

The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1-167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure ( = 0.921), nor to the reconstruction site ( = 0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions ( = 0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/2606521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165145PMC
February 2017

Risk Factors for Perimegaprosthetic Infections After Tumor Resection.

Orthopedics 2017 Jan 7;40(1):e11-e16. Epub 2016 Dec 7.

Periprosthetic joint infection remains one of the most challenging and pervasive complications following megaprosthetic replacement after tumor resection. The authors conducted a systematic review of the literature for clinical studies that reported a risk factor analysis for perimegaprosthetic joint infections. The search included English-language studies published up to July 2015. Eight studies fulfilled the inclusion criteria. Identified factors mostly related to both surgical procedure and hospitalization. Physicians should consider these results when discussing the outcomes of limb salvage surgery with patients and trying to reduce the overall burden of perimegaprosthetic joint infections. [Orthopedics. 2017; 40(1):e11-e16.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/01477447-20161128-01DOI Listing
January 2017

Quality of Life and Functional Results of Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears.

Arthroscopy 2017 Feb 7;33(2):261-268. Epub 2016 Sep 7.

Department of Orthopaedic & Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy.

Purpose: To evaluate the minimum 2-year results and possible outcomes of arthroscopic partial repair in different patterns of irreparable rotator cuff tears (RCTs).

Methods: Patients suffering from an irreparable supraspinatus and a reparable infraspinatus tendons who underwent arthroscopic partial repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess patients' functionality pre- and postoperatively. Postoperative patient assessment included the Simple Shoulder Test (SST) and the Short Form Health Survey questionnaire (SF-36). A postoperative range of motion, CMS, and strength were compared with the contralateral side. Postoperative SF-36 was compared with age- and sex-matched norms.

Results: Ninety patients (95 shoulders) were reviewed after a mean follow-up of 7 (range 2-12) years. The subscapularis tendon was intact in 80 shoulders and torn but completely reparable in the remaining 15 shoulders. The CMS improved from 39.1 ± 8.4 (10-61) to 76.3 ± 9.7 (32-93) (P < .001). The mean postoperative SST was 9.1 ± 2.2 (1-12). Although the patients had lower postoperative abduction and internal rotation, strength in abduction and CMS in comparison with the measurements from the contralateral side, the median postoperative SF-36 physical and mental component summaries were 98% and 100% of the matched norms. No significant differences were found in postoperative outcomes according to the RCT pattern. Males showed significantly higher strengths in abduction (B = -1.384, 95% confidence interval [CI] -2.144 to -0.624, η = 0.123, P < .001, 95% power), external rotation (B = -3.646, 95% CI -5.2 to -2.092, η = 0.189, P < .001, 100% power), and internal rotation (B = -3.867, 95% CI -5.676 to -2.057, η = 0.162, P < .001, 99% power) than females. Significantly higher ranges of abduction (η = 0.431, P = .019, 98% power) and external rotation (η = 0.417, P < .03, 97% power) were noted in younger patients. Higher strengths in abduction (η = 0.495, P = .002, 100% power) and internal rotation (η = 0.464, P = .006, 99% power) were also reported in these patients.

Conclusions: When there is an irreparable supraspinatus but there is still the possibility to repair the infraspinatus and subscapularis, the arthroscopic partial cuff repair should be considered as an effective surgical option. Indeed, a significant clinical improvement can be achieved and, differently from pure symptomatic surgical procedures, this technique represents a reasonable effort to restore, at least in part, the shoulder joint functionality. Successful and reliable results can be expected at an average 7-year follow-up, regardless of the RCT pattern. Female and older patients have a greater likelihood of lower functional outcomes.

Level Of Evidence: Level IV, therapeutic case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2016.06.024DOI Listing
February 2017
-->