Publications by authors named "Giuseppe Argento"

28 Publications

  • Page 1 of 1

Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions.

Handchir Mikrochir Plast Chir 2020 Nov 12. Epub 2020 Nov 12.

Università degli Studi di Roma La Sapienza Ortopedia e Traumatologia.

Backgrounds:  Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis. Osteomyelitis leads to fracture nonunion. The treatment of bone infection and infected nonunion consists primarily of the complete removal of infected and avascular bone and soft tissue from the surgical site, followed by local and systemic pathogen-specific antibiotic therapy and temporary stabilisation, but may lead to massive skeletal and soft tissue defects. The use of free or pedicled vascularised bone transfers and callus distraction techniques (bone transport) has been recommended for large bone defects. The aim of this study is to evaluate the results of patients affected by infected non-unions of the lower limbs, treated with a corticoperiosteal flap from the medial femoral condyle and to investigate the donor site morbidity of this flap.

Materials And Methods:  The patients were 11 males (average age of 45.6 years), who presented a nonunion of the tibial diaphysis in 7 cases and non-union of femoral diaphysis in 4 cases, treated with free or pedicled corticoperiosteal flap. In all patients, surgical debridement was performed before the flap of infected bone and soft tissues that would not contribute to wound healing. Clinical and radiographic evaluations of the recipient site were performed. Preoperative and postoperative X-ray and MRI scans after the 3-year follow-up of the donor site were performed, in order to observe possible bone restoration and any complications.

Results:  The patients reported complete clinical and radiographic bone healing in 90.9 % of cases. As regards donor site, there were no differences between the medial femoral donor condyle compared to the contralateral site, due to complete regeneration of donor site bone. MRI investigation showed complete restoration of the donor site with vascularised bone in all patients.

Conclusions:  Our results suggest that the use of bone flaps for the treatment of infected non-unions is an effective procedure, that must be performed after accurate debridement of the non-union site. The corticoperiosteal flap seems to have few morbidities on the donor site and a high percentage of successful bone healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1240-0181DOI Listing
November 2020

Typical and atypical COVID-19 computed tomography findings.

World J Clin Cases 2020 Aug;8(15):3177-3187

Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza"-University of Rome, Sant'Andrea University Hospital, AOU Sant'Andrea, Rome 00189, Italy.

In December 2019 a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 was identified and the disease associated was named coronavirus disease 2019 (COVID-19). Fever, cough, myalgia, fatigue associated to dyspnea represent most common clinical symptoms of the disease. The reference standard for diagnosis of severe acute respiratory syndrome coronavirus 2 infection is real time reverse-transcription polymerase chain reaction test applied on respiratory tract specimens. Despite of lower specificity, chest computed tomography (CT), as reported in manifold scientific studies, showed high sensitivity, therefore it may help in the early detection, management and follow-up of COVID-19 pneumonia. Patients affected by COVID-19 pneumonia usually showed on chest CT some typical features, such as: Bilateral ground glass opacities characterized by multilobe involvement with posterior and peripheral distribution; parenchymal consolidations with or without air bronchogram; interlobular septal thickening; crazy paving pattern, represented by interlobular and intralobular septal thickening surrounded by ground-glass opacities; subsegmental pulmonary vessels enlargement (> 3 mm). Halo sign, reversed halo sign, cavitation and pleural or pericardial effusion represent some of atypical findings of COVID-19 pneumonia. On the other hand lymphadenopathy's and bronchiectasis' frequency is unclear, indeed conflicting data emerged in literature. Radiologists play a key role in recognition of high suspicious findings of COVID-19 on chest CT, both typical and atypical ones. Thus, the aim of this review is to illustrate typical and atypical CT findings of COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12998/wjcc.v8.i15.3177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441270PMC
August 2020

The healing potential of an acutely repaired ACL: a sequential MRI study.

J Orthop Traumatol 2020 Aug 31;21(1):14. Epub 2020 Aug 31.

Hospital for Special Surgery/Weill Cornell Medical Center, New York, NY, USA.

Background: Recently, there has been renewed interest in primary anterior cruciate ligament (ACL) repair. The aim of this study is to report early clinical and radiological results of a consecutive series of acute ACL tears treated with arthroscopic primary ACL repair within 14 days from injury.

Patients And Methods: A consecutive series of patients with acute ACL tears were prospectively included in the study. Based on MRI appearance, ACL tears were classified into five types, and tissue quality was graded as good, fair, and poor. Patients with type I, II, and III tears and at least 50% of ACL tibial remnant intact with good tissue quality were ultimately included. Clinical outcomes were measured using the Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), subjective and objective International Knee Documentation Committee (IKDC) scores, and KT-1000. Patients were also followed up with MRI evaluations at 1, 3, and 6 months postoperatively. ACL appearance was graded based on morphology (normal or abnormal) and signal intensity (isointense, intermediate, and hyperintense).

Results: The mean TLKSS was 98.1, the mean subjective IKDC was 97.6, and the mean KOOS was 98.2. The objective IKDC score was A in eight of ten patients and B in two patients. KT-1000 measurements showed a maximum manual side-to-side difference of less than 2 mm in eight of ten patients, whereas two patients showed a difference of 3 mm. The morphology of the repaired ACL was normal (grade 1) at 1 month follow-up in ten of ten cases, and this appearance persisted at 3 and 6 months postoperatively. The signal intensity at 1 month postoperatively was graded as isointense (grade 1) in four of ten patients, intermediate (grade 2) in five of ten patients, and hyperintense (grade 3) in one of ten patients. At both 3 and 6 months postoperatively, the signal intensity was graded as isointense (grade 1) in nine of ten patients and intermediate (grade 2) in one of ten patients.

Conclusions: Arthroscopic primary ACL repair performed acutely in a carefully selected group of patients with proximal ACL tears and good tissue quality showed good early clinical and radiological results.

Level Of Evidence: Level 4.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s10195-020-00553-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459035PMC
August 2020

The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements.

J Clin Med 2020 Aug 6;9(8). Epub 2020 Aug 6.

Nuclear Medicine Unit Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, 00161 Rome, Italy.

Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques. This paper highlights the pros and cons of available imaging techniques--ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems-single photon emission tomography/computed tomography (SPECT/CT), PET/CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9082548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466174PMC
August 2020

Vascular and Bone Regeneration of the Donor Site After Corticoperiosteal Flap From the Medial Femoral Condyle.

Hand (N Y) 2020 Jul 19:1558944720930299. Epub 2020 Jul 19.

S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.

The aim of this study was to evaluate the morbidity and regeneration of descending genicular artery and bone on the donor site, the medial condyle of the femur, after harvesting the corticoperiosteal flap and to report the clinical, functional, and radiographic outcomes of the treatment of atrophic nonunions of upper limb with corticoperiosteal vascularized flap at 5-year follow-up. From January 2011 to January 2018, 36 patients (average age of 45.8 years) were enrolled and evaluated with clinical and radiographic follow-up (average time of 66 months). In 20 patients, magnetic resonance angiography was also performed preoperatively and postoperatively to investigate the fate of the descending genicular artery after harvesting the corticoperiosteal flap. Radiographic evaluation demonstrated a success rate of 94.4% (average time of bone healing of 5.2 months). At the recipient site, clinical evaluation showed excellent results in 75% to 80% of cases, and at the donor site, no statistical differences were found between before and after surgery clinical condition. In all patients who underwent magnetic resonance imaging, images showed a complete recovery of the blood supply of the medial femoral condyle. Medial condyle corticoperiosteal flap represents a valid choice for the treatment of upper limb nonunions. This technique brings a very low morbidity on the donor site, with complete restoration of blood supply and bone tissue. The limit of this flap is its low mechanical support, which suggests performing this technique especially for the treatment of upper limb nonunions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944720930299DOI Listing
July 2020

Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study.

J Clin Med 2020 May 30;9(6). Epub 2020 May 30.

Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00161 Rome, Italy.

Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), F-fluorodeoxyglucose positron emission tomography/computed tomography ((F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, < 0.0001 and 86.2% vs. 67.1%, = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, = 0.04 and = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, = 0.0009; 80.3% and 87.9% vs. 62.1%, < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9061645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356770PMC
May 2020

Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in type 2 diabetes: study protocol for a randomised clinical trial.

BMJ Open 2019 11 4;9(11):e027429. Epub 2019 Nov 4.

Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy

Introduction: Type 2 diabetes (T2D) is associated with an increased fracture risk despite normal-to-increased bone mineral density, suggesting reduced bone quality. Exercise may be effective in reducing fracture risk by ameliorating muscle dysfunction and reducing risk of fall, though it is unclear whether it can improve bone quality.

Methods And Analysis: The 'Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in T2D' is an open-label, assessor-blinded, randomised clinical trial comparing an exercise training programme of 2-year duration, specifically designed for improving bone quality and strength, with standard care in T2D individuals. Two hundred T2D patients aged 65-75 years will be randomised 1:1 to supervised exercise training or standard care, stratified by gender, age ≤ or >70 years and non-insulin or insulin treatment. The intervention consists of two weekly supervised sessions, each starting with 5 min of warm-up, followed by 20 min of aerobic training, 30 min of resistance training and 20 min of core stability, balance and flexibility training. Participants will wear weighted vests during aerobic and resistance training. The primary endpoint is baseline to end-of-study change in trabecular bone score, a parameter of bone quality consistently shown to be reduced in T2D. Secondary endpoints include changes in other potential measures of bone quality, as assessed by quantitative ultrasound and peripheral quantitative CT; bone mass; markers of bone turnover; muscle strength, mass and power; balance and gait. Falls and asymptomatic and symptomatic fractures will be evaluated over 7 years, including a 5-year post-trial follow-up. The superiority of the intervention will be assessed by comparing between-groups baseline to end-of-study changes.

Ethics And Dissemination: This study was approved by the institutional ethics committee. Written informed consent will be obtained from all participants. The study results will be submitted for peer-reviewed publication.

Trial Registration Number: NCT02421393; Pre-results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-027429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858163PMC
November 2019

High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries: A Case-Control Series From the SANTI Study Group.

Orthop J Sports Med 2019 Jun 25;7(6):2325967119852916. Epub 2019 Jun 25.

Department of Orthopaedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of Sao Paulo (IOT-HCFMUSP), Sao Paulo, Brazil.

Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)-detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)-injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making.

Purpose/hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures.

Study Design: Cohort study (diagnosis); Level of evidence, 3.

Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries.

Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears ( < .001). No correlation was found between ALL lesions and iliotibial band lesions ( = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1).

Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2325967119852916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593931PMC
June 2019

Correlation Between Magnetic Resonance Imaging and Surgical Exploration of the Anterolateral Structures of the Acute Anterior Cruciate Ligament-Injured Knee.

Am J Sports Med 2019 04;47(5):1186-1193

Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Rome, Italy.

Background: Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction is associated with improved clinical outcomes as compared with isolated intra-articular reconstruction, but the indications are not precisely defined. It may be the case that patients with proven anterolateral injury on preoperative imaging are most likely to benefit, but the accuracy of magnetic resonance imaging (MRI) is not known.

Purpose/hypothesis: To evaluate the correlation between MRI and surgical exploration in acute ACL-injured knees. The hypothesis was that a positive correlation would be identified between imaging and surgical findings for ALL/capsule and iliotibial band (ITB) injuries and that MRI would be highly sensitive, specific, and accurate.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: Between January and May 2016, patients presenting with acute ACL injuries were considered for study eligibility. Included patients underwent 1.5-T MRI, which was evaluated by 3 investigators who attributed a Ferretti grade of injury to the anterolateral structures. At the time of ACL reconstruction, a lateral exploration was undertaken, and macroscopic injuries were identified. An evaluation of correlation between MRI and surgical exploration findings was performed.

Results: Twenty-six patients participated in the study, and 96% had an ALL/capsule injury. The sensitivity, specificity, and accuracy of MRI and the correlation ( K) with surgical exploration findings were as follows, respectively: any ALL/capsule abnormality-88%, 100%, 88.5%, and 0.47; differentiating partial or complete ALL/capsule tears-78.6%, 41.7%, 61.5%, and 0.23; ITB injuries-62.5%, 40%, 50%, and 0.27. The percentage agreement between MRI and surgical findings was 88% for ALL/capsule injury, 65% for ITB injury, and 53% for Ferretti grading.

Conclusion: Surgical exploration demonstrates that injuries occur to the anterolateral structures in almost all acute ACL-injured knees. MRI is highly sensitive, specific, and accurate for detection of abnormalities of the ALL/capsule and shows a high percentage of agreement with surgical findings. MRI has low sensitivity, specificity, and accuracy for the diagnosis of ITB injury. The Ferretti grade could not be reliably established from MRI, and there was only fair agreement between MRI and surgical findings with respect to ITB abnormalities and determination of whether ALL/capsular tears were partial or complete.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546519831686DOI Listing
April 2019

Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging.

Joints 2018 Sep 2;6(3):153-156. Epub 2018 Nov 2.

Orthopaedic Unit and "Kirk Kilgour" Sports Injury, S. Andrea Hospital, University of Rome "Sapienza," Rome, Italy.

 The purpose of this study was to describe the anatomy of the anterolateral ligament (ALL) of the knee by the use of 1.5 Tesla (T) magnetic resonance imaging (MRI) in a series of young patients without knee injuries.  Subjects aged 18 years or older without an anterior cruciate ligament injury, as confirmed on MRI, were included. MRI examinations were all performed on 1.5 T scans. The ALL was defined as the low signal band originating from the region of the lateral epicondyle of the femur, crossing the proximal surface of the lateral collateral ligament, deep to the iliotibial band, and inserting onto the tibia between the Gerdy's tubercle and the fibular head.  Twenty-six patients met the eligibility criteria and were enrolled into the study. In one patient, it was not possible to visualize the ALL. In all the other subjects, the ligament originated anterior and distal to the lateral epicondyle and inserted on the proximal tibia approximately 5 mm below the joint line and just distal to the Gerdy's tubercle. It had an average length of 33 ± 1.2 mm, an average width of 5.5 ± 0.3 mm, and an average thickness of 2 mm.  The ALL is a distinct structure of the anterolateral capsule that can be easily identified using 1.5 T MRI scans.  This is a level IV, observational study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1675163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301852PMC
September 2018

Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation.

Knee Surg Sports Traumatol Arthrosc 2019 Aug 7;27(8):2577-2584. Epub 2018 Nov 7.

Orthopaedic Unit and Kirk Kilgour Sports Injury Center, S. Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-1039, 00189, Rome, Italy.

Purpose: To compare clinical outcomes and tunnel widening following anterior cruciate ligament reconstruction (ACLR) performed with an all-inside technique (Group A) or with a bioabsorbable tibial screw and suspensory femoral fixation (Group B).

Methods: Tunnel widening was assessed using computed tomography (CT) and a previously validated analytical best fit cylinder technique at approximately 1-year following ACLR. Clinical follow-up comprised evaluation with IKDC, KSS, Tegner, Lysholm scores, and knee laxity assessment.

Results: The study population comprised 22 patients in each group with a median clinical follow-up of 24 months (range 21-27 months). The median duration between ACLR and CT was 13 months (range 12-14 months). There were no significant differences in clinical outcome measures between groups. There were no differences between groups with respect to femoral tunnel widening. However, there was a significantly larger increase in tibial tunnel widening, at the middle portion, in Group B (2.4 ± 1.5 mm) compared to Group A (0.8 ± 0.4 mm) (p = 0.027), and also at the articular portion in Group B (1.5 ± 0.8 mm) compared to Group A (0.8 ± 0.8 mm) (p = 0.027).

Conclusion: Tibial tunnel widening after ACLR using hamstring tendon autograft is significantly greater with suspensory femoral fixation and a bioabsorbable tibial interference screw when compared to an all-inside technique at a median follow-up of 2 years. The clinical relevance of this work lies in the rebuttal of concerns arising from biomechanical studies regarding the possibility of increased tunnel widening with an all-inside technique.

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

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-018-5275-xDOI Listing
August 2019

Ultrasonographic assessment of the anterolateral ligament of the knee in healthy subjects.

Muscles Ligaments Tendons J 2017 Jul-Sep;7(3):485-490. Epub 2018 Jan 10.

Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.

Objective: The aim of our study was to determine inter-observer agreement in the ultrasonographic identification of the anterolateral ligament (ALL) and in the evaluation of its length and thickness in healthy subjects.

Methods: 80 healthy volunteers (160 knees) (42 males and 38 females) were enrolled in the study. All subjects underwent ultrasound (US) examination of both knees, performed by two physicians with over ten years of musculoskeletal US experience. In order to keep the ALL under optimal tension, the knee was flexed at approximately 30-35°, slightly internally rotated and length and thickness of the ligament were measured.

Results: ALL was identified in 93.8% (150 out of 160) and in 92.5% (148 out of 160) of the knees by Evaluator 1 and Evaluator 2, respectively. Interobserver agreement was substantial to almost perfect for the visualization of the ALL ( =0.90) and for measurements of its length (ICC = 0.83), and strong for measurements of its thickness (ICC = 0.75).

Conclusion: In our study on healthy subjects, ALL has been visualized with a high rate of reproducibility. Further studies are needed to see if US may be a reliable and reproducible diagnostic tool in patients with traumatic or degenerative knee disorders.

Level Of Evidence: II, evidence obtained from cohort study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11138/mltj/2017.7.3.485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774922PMC
January 2018

Hybrid imaging of musculoskeletal infections.

Q J Nucl Med Mol Imaging 2018 Mar 22;62(1):3-13. Epub 2017 Nov 22.

Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands -

This review article highlights the role of radiological and nuclear medicine techniques in diagnosis of musculoskeletal infections with particular regard to hybrid imaging of osteomyelitis, prosthetic joint infections, sternal infections and spine infections. Authors conclude on the complementary role of the several techniques with indications for an appropriate diagnostic flow chart, in the light of the recent European Association of Nuclear Medicine guidelines on infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S1824-4785.17.03045-XDOI Listing
March 2018

In-out versus out-in technique for ACL reconstruction: a prospective clinical and radiological comparison.

J Orthop Traumatol 2017 Dec 8;18(4):335-341. Epub 2017 May 8.

Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza", University of Rome, Via di Grottarossa, 1035-1039, Rome, Italy.

Background: Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out-in (OI) technique.

Materials And Methods: Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed.

Results: In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups.

Conclusions: The OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise.

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

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10195-017-0458-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685978PMC
December 2017

Therapeutic management of patients with rheumatoid arthritis and associated interstitial lung disease: case report and literature review.

Ther Adv Respir Dis 2017 01 12;11(1):64-72. Epub 2016 Oct 12.

Department of Clinical and Molecular Medicine, School of Medicine and Psychology, 'Sapienza' University of Rome, Sant'Andrea University Hospital, Rome, Italy.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can present different extrarticular manifestations involving heart, lungs and kidneys. In recent years there has been a growing awareness of the central role played by the lungs in the onset and progression of RA. In particular interstitial lung disease (ILD) is a common pulmonary manifestation that may be related to the inflammatory process itself, infectious complications and to the treatments used. Management of patients with ILD/RA is still a challenge for clinicians, both synthetic [mainly methotrexate (MTX), leflunomide] and biologic immunosuppressors [mainly anti-tumor necrosis factor (TNF)α] have in fact been related to the onset or worsening of lung diseases with conflicting data. Here we report the case of a 61-year-old male patient with severely active early RA, previously treated with MTX, who developed subacute ILD, along with a review of ILD/RA topic. Tocilizumab (humanized monoclonal antibody against the interleukin-6 receptor) was introduced on the basis of its effectiveness in RA without concomitant MTX and the ability to overcome the profibrotic effects of interleukin (IL)-6. After 3 months of treatment the clinical condition of the patient strongly improved until it reached low disease activity. He no longer complained of cough and dyspnea and bilateral basal crackles were no more present. Considering its distinctive features, tocilizumab, in such a challenging clinical condition, appears to be a safe and effective therapy, thus it enables RA remission without deteriorating ILD, at 1-year follow up, as confirmed by ultrasonography of the affected joints and chest high-resolution computed tomography (HRCT).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1753465816668780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5941974PMC
January 2017

Importance of perforating vessels in nipple-sparing mastectomy: an anatomical description.

Breast Cancer (Dove Med Press) 2015 14;7:179-81. Epub 2015 Jul 14.

Radiology Unit, University of Roma, La Sapienza Sant'Andrea Hospital, Rome, Italy.

Background: Nipple-sparing mastectomy (NSM), understood as an oncologically valid procedure, is relatively new, and is an evolution of traditional mastectomy, particularly in relation to breast-conserving surgery. The anterior perforating branches are responsible for the cutaneous vascularization of the breast skin, and their preservation is a fundamental step to avoid possible postoperative necrosis. Therefore, evaluating the potential complications of cancer-related reconstructive surgical procedures such as NSM, both the distance of the tumoral lesion from the skin and the surgical incision site should be carefully considered. The preferred site of incision corresponds to the inframammary fold or possibly the periareolar area.

Methods: We retrospectively reviewed 113 patients who underwent NSM from January 2005 to October 2012 to evaluate skin complications. The anatomical study was performed by magnetic resonance imaging of the breast.

Results: Only one of the 113 women who had undergone a NSM procedure had total necrosis (0.9%) and six patients had partial necrosis (5.8%) of the nipple-areola complex.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/BCTT.S78705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507458PMC
July 2015

Can platelet-rich plasma have a role in Achilles tendon surgical repair?

Knee Surg Sports Traumatol Arthrosc 2016 Jul 22;24(7):2231-7. Epub 2015 Mar 22.

Physical Medicine and Rehabilitation Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.

Purpose: Our hypothesis was that the Achilles tendon healing process after surgical treatment would be promoted by PRP with a faster return to sports activities.

Methods: Thirty patients with Achilles tendon rupture and surgically treated with a combined mini-open and percutaneous technique were prospectively enroled in the study. Patients were alternately case-by-case assigned to Group A (control group; 15 patients) or Group B (study group; 15 patients). In Group B, PRP was locally infiltrated both during surgery and 14 days after surgery. Patients in both groups were followed up at 1, 3, 6 and 24 months post-operatively via physical examination, VAS, FAOS and VISA-A scales; ultrasonography (US) and MRI were also conducted at one and 6 months; at the 6-month follow-up, isokinetic and jumping capacity tests were also performed.

Results: The VAS, FAOS and VISA-A scale showed no difference between the two groups at 1, 3, 6 and 24 months post-operatively. Isokinetic evaluation showed no differences at both angular speeds. Jumping evaluation showed no difference at 6 months. Also US evaluation showed no differences. MRI data analysis before administration of gadolinium did not reveal significant differences between the two groups. Moreover, after intravenous injection of gadolinium, patients in Group B showed signal enhancement in 30 % of patients compared to 80 % in Group A at 6 months, as indirect evidence of better tendon remodelling (P < 0.05).

Conclusions: A substantial equivalence in structural and functional results in Achilles tendon ruptures surgically treated with and without addition of PRP is shown by present study. Clinical results, morphological features and jumping capability were similar in both groups. The addition of PRP to the surgical treatment of Achilles tendon rupture does not appear to offer superior clinical and functional results.

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

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-015-3580-1DOI Listing
July 2016

Could early rheumatoid arthritis resolve after periodontitis treatment only?: case report and review of the literature.

Medicine (Baltimore) 2014 Dec;93(27):e195

From the Division of Allergy, Clinical Immunology and Rheumatology (SS, MIB, CF, MC, APD, RD); Division of Radiology (GA), S. Andrea University Hospital, Sapienza University of Rome, Rome; Department of Periodontology (MP, CDM), G. D'Annunzio University; and Department of Endodontics (VAM), G. D'Annunzio University, Chieti-Pescara, Italy.

Rheumatoid arthritis (RA) is an immune-mediated polyarthritis; currently no pathogenic agent has been identified as a disease trigger. A patient with RA, presumably caused by periodontal infection, whose remission has been observed after periodontitis treatment in absence of specific RA therapy, is reported here for the first time, to our knowledge. A 61-year-old male patient presented migrant arthritis associated with antibodies against citrullinated protein antigens positivity. The clinical features allowed to make RA diagnosis according to the 2010 European League against Rheumatism/American College of Rheumatology RA classification criteria. X-ray of the second upper molar showed chronic apical periodontitis. After its treatment, arthritis remission has been observed in the absence of specific RA therapy. It has been suggested that periodontitis may have a trigger role in RA pathogenesis. This could be explained by the enzymatic action of Porphyromonas gingivalis, probably leading to break tolerance to collagen. The identification and subsequent treatment of periodontitis should therefore be considered pivotal in RA prophylaxis and management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000000195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602768PMC
December 2014

A giant intraperineal and extraperineal mass.

BMJ Case Rep 2014 Sep 25;2014. Epub 2014 Sep 25.

Surgery 1 Unit, Surgical and Medical Department of Traslational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2014-206711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180564PMC
September 2014

Isolated asymptomatic short sternum in a healthy young girl.

Case Rep Radiol 2014 20;2014:761582. Epub 2014 Jul 20.

Orthopaedic Unit, S. Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy.

Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process) in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2014/761582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129178PMC
August 2014

Magnetic resonance cholangiopancreatography in the diagnosis of haemobilia.

Case Rep Radiol 2013 22;2013:792109. Epub 2013 Dec 22.

Deptartment of Radiology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.

Haemobilia is a rare cause of unrecognized gastrointestinal bleeding and is hard to diagnose. Through the present case report we aim to corroborate magnetic resonance relevance in the evaluation of biliary system and bile features, investigating on its role in patients with acute biliary diseases. We report a case of a Caucasian 48-year-old man who was admitted due to abdominal pain and fever. After an ultrasonography exam we detected multiple cysts in the hepatic left lobe: imaging features, laboratory findings, and patient past work experience (woodcutter) suggested a diagnosis of hepatic Echinococcosis. Once surgery decision was taken, patient underwent an intervention of cystopericystectomy. On the 8th postoperative day, the procedure was complicated by black stool, jaundice, and severe anaemia. Acomputed tomography revealed an inhomogeneous collection with some air bubbles in the area of previous surgical intervention, but it was not able to solve the diagnosis question. At this stage a magnetic resonance study was mandatory. On T2-weighted images we observed an expanse gallbladder with hypointense intraluminal material and a considerable intrahepatic biliary system dilatation due to bloody material. On the basis of these examination results, we supposed haemobilia arising from previous surgical intervention. A therapeutic endoscopic retrograde cholangiopancreatography procedure led to decompression of biliary system through a major papilla sphincterotomy with spillage of bile mixed with blood clots.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/792109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881441PMC
January 2014

Bilateral quadriceps rupture: results with and without platelet-rich plasma.

Orthopedics 2013 Nov;36(11):e1474-8

This article presents a 46-year-old man with bilateral atraumatic quadriceps rupture that occurred while he was descending stairs. The patient underwent surgery the day after the accident. In the left knee, quadriceps reinsertion was performed using a conventional technique. In the right knee, platelet-rich plasma (PRP), both in its liquid and semisolid patterns, was added intraoperatively. Ultrasonography and magnetic resonance imaging evaluations were performed 1, 6, and 24 months postoperatively. At 6 and 24 months postoperatively, clinical and functional evaluations also were performed. Clinical examination showed no differences between the knees, and functional scores were the same for both knees. Ultrasonographic evaluation showed bilateral persistent tendon thickening and gross echotexture abnormalities, with no side-to-side differences. Magnetic resonance imaging showed signals of vascularized granulation tissue in both knees, which was more evident in the right (PRP) knee at 1 month postoperatively, along with a better signal of scar tissue in the right knee at 6 and 24 months postoperatively. The use of PRP yielded no better clinical or functional results than the lack of its use. However, a more intense and significant reparative healing process occurred where the PRP was used, thus suggesting a more rapid completion of the healing process, although this effect seems to remain only a radiographic finding with no clinical correlation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/01477447-20131021-37DOI Listing
November 2013

Evaluation of the accuracy of a patient-specific instrumentation by navigation.

Knee Surg Sports Traumatol Arthrosc 2013 Oct 27;21(10):2194-9. Epub 2012 Jun 27.

Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "Sapienza", Via Grottarossa, 1035, Rome, RM, Italy.

Purpose: The aim of this study is to evaluate the accuracy of a patient-specific instrumentation (PSI) as assessed by the intraoperative use of knee navigation software during the surgical procedure.

Methods: Fifteen patients with primary gonarthrosis were selected for unilateral total knee arthroplasty. The first three patients were excluded from this study, as they were considered to be a warm up to set-up the procedure. All patients were operated on with a cemented posterior-stabilised prosthesis cruciate ligament-sacrificing by the same surgeon using the patient matched cutting jigs. The size of the implant, level of resection, and alignment in the coronal and sagittal planes were evaluated. An unsatisfactory result was considered an error ≥2° in both planes for each component as a possible error of 4° could result in aggravation.

Results: On the coronal plane the mean deviation of the tibial guide from the ideal alignment was 1.2 ± 1.5 (range 0-5°) and in the sagittal plane was 3.8 ± 2.4 (range 0-7.5°). On the coronal plane the mean deviation of the femoral guide from the ideal alignment was 1.2 ± 0.6 and in the sagittal was 3.7 ± 2.

Conclusion: On the basis of this preliminary experience the PSI system based only on data acquisition with A-P radiograms and RMN cannot be defined as accurate. In cases of the use of the custom made cutting jigs it is recommended to perform an accurate control of the alignment before making the cuts, for any step of the procedure.

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

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-012-2098-zDOI Listing
October 2013

Are MRI-based, patient matched cutting jigs as accurate as the tibial guides?

Int Orthop 2012 Aug 18;36(8):1589-93. Epub 2012 Mar 18.

Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Via Grottarossa 1035, Rome (RM), Italy.

Purpose: The aim of this study is to evaluate the accuracy of VISIONAIRE (Smith & Nephew Inc., Memphis, TN, USA) Patient Matched cutting tibial jigs in comparison with extramedullary (EM) tibial instrumentation by analysing data as detected by intra-operative use of VectorVision knee navigation software from BrainLAB (Redwood City, CA, USA).

Methods: Twelve patients were selected for unilateral total knee replacement (TKR). They underwent a full-length weight-bearing anteroposterior (AP) radiograph and magnetic resonance imaging (MRI). During surgery, once the EM guides were placed and fixed on the tibia, the orientation in the coronal and sagittal planes was checked by the navigator and then compared with the data obtained by measuring the orientation of VISIONAIRE Patient Matched cutting tibial jigs. An unsatisfactory result was considered an error ≥2° in both coronal and sagittal planes for the tibial component as a possible error of 4° could result.

Results: In the coronal plane the mean deviation of the EM tibial guides from the ideal alignment (0°) was 0.7 ± 0.39° and of the VISIONAIRE was 129 ± 1.55° (P = 0.22). In the sagittal plane the mean deviation of the EM tibial guides from 3° of posterior slope was -1.62 ± 1.78° and of the VISIONAIRE was +1.16 ± 4.29° (P < 0.05). Negative values indicate a more posterior slope from the ideal and positive values an anterior slope.

Conclusions: This preliminary study documented only a fair accuracy of the method with a consistent risk of error of more of 3° especially in the sagittal plane. We could speculate that the problem in the sagittal plane was due to the fact that the pre-operative protocol does not include a lateral X-ray projection of the knee and only includes an AP standing X-ray of the straight leg and MRI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-012-1522-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535040PMC
August 2012

Extracorporeal shock wave therapy in early osteonecrosis of the femoral head: prospective clinical study with long-term follow-up.

Arch Orthop Trauma Surg 2012 Apr 7;132(4):499-508. Epub 2012 Jan 7.

Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant'Andrea Hospital, Rome, Italy.

Introduction: Extracorporeal shock wave therapy (ESWT) may exert beneficial effects in avascular necrosis of femoral head (AVNFH).

Patients: The current study evaluated the effectiveness of ESWT in reducing pain and in slowing down the progression of bone damage in 36 patients with unilateral AVNFH of stage Association Research Circulation Osseous (ARCO) I, II and III. At the beginning of the study, 10 hips were classified as stage I, 11 as stage II and 15 as stage III. Each treatment cycle included four sessions, with 2,400 impulses each administered at 0.50 mJ/mm(2), at 48-72 h intervals. Follow-up examinations were scheduled at 3, 6, 12 and then 24 months.

Method: Clinical assessments included assessment of pain scores, Harris Hip Scores and Roles and Maudsley score. Plain radiographs and magnetic resonances of the hip were used to evaluate the size of the lesion, the extent of collapse of subchondral bone, and degenerative changes of the hip joint.

Results: Patients from ARCO stage I group and stage II group achieved significantly better results than patients from ARCO stage III group at all follow-up time points (p < 0.005). During the follow-up period, 10 of the 15 stage III ARCO patients received an arthroplasty. ARCO stages I and II lesions were unchanged on radiographs and on magnetic resonance images.

Conclusion: ESWT in ARCO stages I and II may help to prevent progression of the area of avascular necrosis and manage pain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-011-1444-9DOI Listing
April 2012

Minimizing internal rotation strength deficit after use of semitendinosus for anterior cruciate ligament reconstruction: a modified harvesting technique.

Arthroscopy 2008 Jul 21;24(7):786-95. Epub 2008 Apr 21.

Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy.

Purpose: The purpose of this study was to test a new method of harvesting semitendinosus tendon during anterior cruciate ligament reconstruction that would allow an anatomic reinsertion of the regenerated tendon and minimize postoperative internal rotation strength loss.

Methods: We prospectively selected 35 patients surgically treated for anterior knee instability. The patients were randomly assigned to either the study group (group A) (19 patients) or the control group (group B) (16 patients). A modified harvesting technique of the semitendinosus, which reserves its distal insertion, was performed in group A, with the aim to allow a better postoperative recovery of flexion and internal rotation strength. Patients in group B underwent a "standard" harvesting technique. All patients were postoperatively evaluated by clinical examination, isokinetic tests, and magnetic resonance imaging.

Results: At a follow-up of 25 months, all patients showed satisfactory postoperative knee stability. Isokinetic tests showed a significant deficit in internal rotation strength at 60 degrees /s in patients in group B (84.60% v 97.37% in patients in group A). No deficits were found in group A. Magnetic resonance imaging evaluations showed a higher percentage of regenerated semitendinosus in group A patients (100%) than that in group B patients (50%) at the joint line level. In group A, the site of reinsertion was found to be on the pes anserinus in 71% of the patients and in the posteromedial corner of the tibial plateau in the other 29%; in group B, a distal signal was detected in 50% of the patients, which was at the posteromedial corner of the tibia in every case.

Conclusions: This study seems to show that the proposed harvesting technique could minimize the postoperative loss of strength in internal rotation after anterior cruciate ligament reconstruction with hamstrings.

Level Of Evidence: Level I, high-quality therapeutic randomized controlled trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2008.02.010DOI Listing
July 2008

The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study.

Knee Surg Sports Traumatol Arthrosc 2007 Apr 6;15(4):365-71. Epub 2006 Dec 6.

Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome La Sapienza, Via Grottarossa 1065, Rome, Italy.

The mechanism of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction is not yet clearly understood. Many authors hypothesized that aggressive rehabilitation protocols may be a potential factor for bone tunnel enlargement, especially in reconstructions performed with hamstrings autograft. The purpose of this study was to evaluate the effect of a brace free rehabilitation on the tunnel enlargement after ACL reconstruction using doubled semitendinosus and gracilis tendons (DGST): our hypothesis was that early post-operative knee motion increase the diameters of the tibial and femoral bone tunnels. Forty-five consecutive patients undergoing ACL reconstruction for chronic ACL deficiency were selected. All patients were operated by the same surgeon using autologous DGST and the same fixation devices. Patients with associated ligaments injuries and or severe chondral damage were excluded. The patients were randomly assigned to enter the control group (group A, standard post-operative rehabilitation) and the study group (group B, brace free accelerated rehabilitation). A CT scan was used to exactly determine the diameters of both femoral and tibial tunnels at various levels of lateral femoral condyle and proximal tibia, using a previously described method [17]. Measurements were done by an independent radiologist in a blinded fashion the day after the operation and at a mean follow-up of 10 months (range 9-11). Statistical analysis was performed using paired t-test. The mean femoral tunnel diameter increased significantly from 9.04 +/- 0.05 (post-operative) to 9.30 +/- 0.8 mm (follow-up) in group A and from 9.04 +/- 0.03 to 9.94 +/- 1.12 mm in group B. The mean tibial tunnel diameter increased significantly from 9.03 +/- 0.04 to 10.01 +/- 0.80 mm in group A and from 9.04 +/- 0.03 to 10.60 +/- 0.78 mm in group B. The increase in femoral and tunnel diameters observed in the study group was significantly higher than that observed in the control group. Our results suggest that bone tunnel enlargement after ACL reconstruction using hamstrings autograft can be increased by an accelerated, brace free, rehabilitation protocol.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-006-0219-2DOI Listing
April 2007

Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study.

Int Orthop 2007 Feb 9;31(1):49-55. Epub 2006 May 9.

Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy.

Purpose: To evaluate prospectively the increase in the size of the tibial and femoral bone tunnel following arthroscopic anterior cruciate ligament (ACL) reconstruction with quadrupled-hamstring autograft.

Methods: Twenty-five consecutive patients underwent arthroscopic ACL reconstruction with quadrupled-hamstring autograft. Preoperative clinical evaluation was performed using the Lysholm knee score, Tegner activity level, and International Knee Documentation Committee forms and a KT-1000 arthrometer (side to side). Computed tomography (CT) of the femoral and tibial tunnel was performed on the day after operation in all cases and at mean follow-up of 10 months (range 9-11 months).

Results: All of the clinical evaluation scales performed showed an overall improvement. The postoperative anterior laxity difference was <3 mm in 16 patients (70%) and 3-5 mm in seven patients (30%). The mean average femoral tunnel diameter increased significantly (3%) from 9.04+/-0.05 mm postoperatively to 9.3+/-0.8 mm at 10 months; tibial tunnel increased significantly (11%) from 9.03+/-0.04 mm to 10+/-0.8 mm. There were no statistically significant differences between tunnel enlargement, clinical results, and arthrometer evaluation.

Conclusions: The rate of tunnel widening observed in this study seems to be lower than that reported in previous studies that used different techniques. We conclude that an anatomical surgical technique and a less aggressive rehabilitation process influenced the amount of tunnel enlargement after ACL reconstruction with doubled hamstrings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-006-0118-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267545PMC
February 2007