Publications by authors named "Marco De Gori"

22 Publications

  • Page 1 of 1

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

An exceptional case of malignant glomus tumor and a review of the literature.

Acta Orthop Traumatol Turc 2019 Jul 31;53(4):313-317. Epub 2019 May 31.

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

Malignant glomus tumors (MGTs) are exceptional but pose diagnostic and therapeutic challenges. Wide resection is the recommended treatment method, however, no data are available concerning adjuvant therapies. We present an exceptional case of extradigital deep-seated MGT of the forearm, with an exceptional bone infiltration. Despite being treated with wide resection, the patient had an optimal functional outcome, no functional loss, no motor or sensitive deficits and has returned to his full daily activity.
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http://dx.doi.org/10.1016/j.aott.2019.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739266PMC
July 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.
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http://dx.doi.org/10.1007/s00402-018-3044-4DOI Listing
March 2019

Giant schwannoma of the foot: a case report and literature review.

Clin Cases Miner Bone Metab 2017 May-Aug;14(2):265-268. Epub 2017 Oct 25.

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

A schwannoma is a rare, benign tumor originating from Schwann cells of peripheral nerve sheath. It commonly occurs in subjects between 20 and 50 years of age, and its malignant transformation is exceptional. While schwannomas usually affect the head and neck region, localization in the lower extremity is exceptionally rare, and even fewer cases have described schwannomas occurring in the foot. We report a case of a giant schwannoma of the foot diagnosed in a 65-year-old woman. A giant schwannoma of the foot is an extremely rare soft tissue tumor. MRI may allow an earlier diagnosis and provide valuable information about the size and possible bone invasion. This case report noted that a complete excision of the schwannoma may prevent the risk of local recurrence, regardless of its size.
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http://dx.doi.org/10.11138/ccmbm/2017.14.2.265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726225PMC
October 2017

Hydatid cyst in the vastus lateralis muscle: a case report.

Clin Cases Miner Bone Metab 2017 May-Aug;14(2):262-264. Epub 2017 Oct 25.

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

Hydatidosis is a zoonotic disease; human infection occurs through the consumption of food and water contaminated with the eggs of parasites of the Echinococcus type. While the liver is the most common site of infection, involvement of the musculoskeletal system is extremely rare. In the context of musculoskeletal involvement, the spine is the most commonly infected site, while the muscles are rarely infected and account for approximately <1% of cases. It has been suggested that muscles provide an unsuitable environment for the parasite, because of the presence of lactic acid. The cysts appear as slow-growing masses of soft tissue, and signs of inflammation and fistulization often coexist. We report a rare case of an hydatid cyst located in the vastus lateralis muscle of a 41-year-old man. Muscular echinococcosis is an extremely rare disease. A MRI evaluation should be taken into account as gold standard in the diagnosis. Surgical cystectomy is often indicated, and an excision with wide margins is mandatory to avoid the rupture of the cyst and anaphylaxis. Adjuvant pharmacological therapy is recommended to minimize the risk of recurrence.
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http://dx.doi.org/10.11138/ccmbm/2017.14.2.262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726224PMC
October 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.
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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.
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http://dx.doi.org/10.1007/s00167-017-4609-4DOI Listing
January 2018

Value of the cumulative sum test for the assessment of a learning curve: Application to the introduction of patient-specific instrumentation for total knee arthroplasty in an academic department.

Knee 2017 Jun 7;24(3):615-621. Epub 2017 Apr 7.

Centre for Orthopaedic and Hand Surgery (CCOM), University Hospital of Strasbourg, Avenue Baumann, Illkirch-Graffenstaden, France. Electronic address:

Background: The purpose of the study was to use the cumulative summation (CUSUM) test to assess the learning curve during the introduction of a new surgical technique (patient-specific instrumentation) in total knee arthroplasty (TKA) in an academic department.

Methods: The first 50TKAs operated on at an academic department using patient-specific templates (PSTs) were scheduled to enter the study. All patients had a preoperative computed tomography scan evaluation to plan bone resections. The PSTs were positioned intraoperatively according to the best-fit technique and their three-dimensional orientation was recorded by a navigation system. The position of the femur and tibia PST was compared to the planned position for four items for each component: coronal and sagittal orientation, medial and lateral height of resection. Items were summarized to obtain knee, femur and tibia PST scores, respectively. These scores were plotted according to chronological order and included in a CUSUM analysis. The tested hypothesis was that the PST process for TKA was immediately under control after its introduction.

Results: CUSUM test showed that positioning of the PST significantly differed from the target throughout the study. There was a significant difference between all scores and the maximal score. No case obtained the maximal score of eight points. The study was interrupted after 20 cases because of this negative evaluation.

Conclusion: The CUSUM test is effective in monitoring the learning curve when introducing a new surgical procedure. Introducing PST for TKA in an academic department may be associated with a long-lasting learning curve. The study was registered on the clinical.gov website (Identifier NCT02429245).
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http://dx.doi.org/10.1016/j.knee.2017.03.007DOI Listing
June 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.
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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.].
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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.
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http://dx.doi.org/10.1016/j.arthro.2016.06.024DOI Listing
February 2017

Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears.

J Shoulder Elbow Surg 2016 Apr 14;25(4):658-65. Epub 2015 Nov 14.

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

Background: Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has been recently introduced for treatment of irreparable, posterosuperior massive rotator cuff tears. We sought to evaluate the functional outcomes of this technique and to check for possible outcome predictors.

Methods: The study reviewed 86 patients (aged 59.8 ± 5.9 years) who underwent an arthroscopic-assisted latissimus dorsi tendon transfer after 36.4 ± 9 months of follow-up. Of these, 14 patients (16.3%) sustained an irreparable massive rotator cuff tear after a failed arthroscopic rotator cuff repair. The Constant and Murley score (CMS) was used to assess patients' functionality preoperatively and at follow-up.

Results: As a group, the CMS improved with surgery from 35.5 ± 6.1 to 69.5 ± 12.3 (P < .001). A lower preoperative CMS and a previous failed rotator cuff repair resulted in lower postoperative range of motion (P = .044 and P = .007, respectively) and CMS (P = .042 and P = .018, respectively). A previous rotator cuff repair resulted in lower satisfaction with surgery (P = .009). Gender and age did not affect the clinical outcomes.

Conclusions: Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior massive rotator cuff tears in pain relief, functional recovery, and postoperative satisfaction. Patients with lower preoperative CMS and a history of failed rotator cuff repair have a greater likelihood of having a lower clinical result. However, the favorable values of summary postoperative scores do not exclude these patients as candidates for arthroscopic-assisted LDTT.
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http://dx.doi.org/10.1016/j.jse.2015.08.043DOI Listing
April 2016

Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization.

Knee Surg Sports Traumatol Arthrosc 2016 Feb 16;24(2):406-13. Epub 2015 Sep 16.

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

Purpose: To investigate what factors might predict the results of arthroscopic stabilization for anterior shoulder instability.

Methods: One hundred and forty-three patients averaging 25 (15-58) years with traumatic anterior shoulder instability who underwent arthroscopic stabilization were reviewed at a median follow-up of 81 (24-172) months. Sixty-two (56.4 %) individuals were involved in contact sport activities, and there were 40 (30 %) patients who had only one dislocation prior to having surgery. Rowe score was measured preoperatively and at follow-up.

Results: Thirty-three (23.1 %) patients experienced recurrent instability 12 (1-120) months after surgery, and 15 of those underwent further surgery. There was a statistically significant lower risk of failure (p = 0.027) for patients who had a surgical procedure after only one episode of shoulder dislocation. Patients treated after the second or further episode of shoulder dislocation exhibited a mean odds ratio for failure of 3.8 (95 % confidence interval 1.2-11.6, p = 0.044) with regard to first-time dislocators. The Rowe score significantly improved from a preoperative value of 25 (5-55) to a postoperative value of 100 (40-100) (p < 0.001). A significantly higher postoperative Rowe score was found in patients older than 24 years of age at the operation (p = 0.011) and in patients with less than eight dislocations prior to surgery (p = 0.05).

Conclusions: These results suggest that better functional results following arthroscopic stabilization can be expected in patients over 24 years of age and in those with a fewer number of dislocations preoperatively. A lower rate of recurrence can be expected if the patient undergoes surgery after the first episode of dislocation.

Level Of Evidence: Prognostic study, Level II.
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http://dx.doi.org/10.1007/s00167-015-3785-3DOI Listing
February 2016

Synovial hemangioma and osteoarthritis of the knee: a case report.

Acta Orthop Traumatol Turc 2014 ;48(5):607-10

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

This report presents an adult patient suffering from knee osteoarthritis and gross hypertrophy of the synovium, preoperatively interpreted as a nonspecific synovial reaction. The patient underwent a total knee replacement and a complete synovectomy was performed. Histological examination disclosed a synovial hemangioma, which is a rare intra-articular, benign tumor of youth.
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http://dx.doi.org/10.3944/AOTT.2014.14.0036DOI Listing
August 2015

Drug elution from high-dose antibiotic-loaded acrylic cement: a comparative, in vitro study.

Orthopedics 2014 Nov;37(11):e999-1005

High-dose antibiotic-loaded acrylic cement (ALAC) is used for managing peri-prosthetic joint infections (PJIs). The marked increase in resistant high-virulence bacteria is drawing the attention of physicians toward alternative antimicrobial formulations loaded into acrylic bone cement. The aim of this in vitro study was to determine the elution kinetics of 14 different high-dose ALACs. All ALAC samples showed a burst release of antibiotics in the first hour, progressively decreasing over time, and elution curves strictly adhered to a nonlinear regression analysis formula. Among aminoglycosides, commonly seen as the most appropriate antibiotics to be loaded into the bone cement, the highest elution rate was that of tobramycin. Among the glycopeptides, a class of antibiotics that should be considered to treat PJIs because of the prevalence of aminoglycoside resistance, vancomycin showed better elution than teicoplanin. Clindamycin, which can be associated with aminoglycosides to prepare ALACs and represents a useful option against the most common pathogens responsible for PJIs, showed the highest absolute and relative elutions among all the tested formulations. A noticeable elution was also detected for colistin, an antibiotic of last resort for treating multidrug-resistant bacteria. The current study demonstrates theoretical advantages in the preparation of ALAC for some antibiotics not routinely used in the clinical setting for PJIs. The use of these antibiotics based on the infecting bacteria sensitivity may represent a useful option for physicians to eradicate PJIs. In vivo testing should be considered in the future to confirm the results of this study.
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http://dx.doi.org/10.3928/01477447-20141023-57DOI Listing
November 2014

Health-related quality of life and functionality after reverse shoulder arthroplasty.

J Shoulder Elbow Surg 2013 Dec 19;22(12):1639-49. Epub 2013 Mar 19.

Department of Orthopaedic and Trauma Surgery, Casa di Cura "Villa Verde," Fermo, Italy.

Background: Modern semiconstrained reverse shoulder arthroplasty (RSA) has shown a great improvement in function and range of motion (ROM) in different etiologies, including revision surgery, sequelae of fractures, or tumors. Few studies have evaluated RSA for primary glenohumeral osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy excluding any other shoulder disease, and data on patients' quality of life after this surgery are lacking.

Methods: In this prospective cohort study, 80 patients were evaluated after an RSA for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy with the Constant-Murley score (CMS), ROM, and Short Form Health Survey (SF-36). A radiologic assessment was performed preoperatively and postoperatively in 62 of these patients.

Results: At a mean 5-year follow-up, the cumulative survival rate was 97.3% and significant improvements in the CMS and ROM were observed when compared with the baseline values. The CMS was 93.2% of the sex- and age-matched normal values. The postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA. The length of follow-up was found to be associated with the severity of scapular notching.

Conclusions: This study introduces new predictors for surgical outcomes, and it shows that patients who had undergone RSA a mean of 5 years earlier exhibit similar functionality and health-related quality of life with respect to healthy controls. Physicians should consider these results when discussing the outcomes of this surgery with patients.

Level Of Evidence: Level IV, Case series, treatment study.
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http://dx.doi.org/10.1016/j.jse.2013.01.020DOI Listing
December 2013

Midterm results and complications after minimally invasive distal metatarsal osteotomy for treatment of hallux valgus.

Foot Ankle Int 2013 Jul 5;34(7):969-77. Epub 2013 Mar 5.

Magna Græcia University of Catanzaro, Catanzaro, IT 88180, Italy.

Background: Minimally invasive distal metatarsal osteotomy (MIDMO) is a common technique used to correct the hallux valgus deformity, but controversy remains regarding the expected outcomes of this surgery.

Methods: Seventy-two patients (85 feet) suffering from hallux valgus underwent MIDMO with a modified Bösch technique. Patients were prospectively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and the AOFAS recovery rate was calculated. Before surgery and at follow-up, the hallux valgus (HVA), intermetatarsal (IMA), and distal metatarsal articular (DMAA) angles were measured, and the severity of disease was categorized according to the preoperative HVA. The tibial sesamoid position and articular congruence were evaluated. Postoperative complications were noted.

Results: After an average follow-up of 73.3 ± 38.1 months, the total AOFAS score improved from 47.6 ± 13.3 to 87.3 ± 11.5 (P < .001). The HVA decreased from 34.7 ± 8.2 to 14.8 ± 7.8 degrees, the IMA from 14.7 ± 4 to 6.6 ± 3.6 degrees, and the DMAA from 20.9 ± 9.8 to 9 ± 6.6 degrees (P < .001 for all). Postoperative improvement in AOFAS was inversely related to the preoperative severity of disease (P < .001, β = -.378). Sixteen (18.8%) deformity recurrences were noted, 9 of which were observed in patients with preoperative HVA more than 40 degrees. Worse preoperative congruence of the metatarsophalangeal joint and tibial sesamoid position correlated with a higher rate of recurrence of the disease after surgery (P = .001, β = -.353 and P < .001, β = .427, respectively).

Conclusions: Satisfactory clinical and radiological results can be expected after MIDMO, but caution should be exercised when using this technique because of the likelihood of possible complications (29.4% overall complication rate). Predictors of surgical outcomes can be used to select the best candidates for this surgery.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1177/1071100713481453DOI Listing
July 2013

Functional relationship between high mobility group A1 (HMGA1) protein and insulin-like growth factor-binding protein 3 (IGFBP-3) in human chondrocytes.

Arthritis Res Ther 2012 Oct 4;14(5):R207. Epub 2012 Oct 4.

Introduction: Insulin-like growth factor I (IGF-I) regulates articular cartilage homeostasis. During osteoarthritis (OA), the anabolic responses of chondrocytes to IGF-I are likely to be prevented by the enhanced production of IGF-binding proteins (IGFBPs), especially IGFBP-3. The aim of this study is to evaluate whether the architectural transcription factor high mobility group A1 (HMGA1) influences IGFBP-3 overexpression in vitro, in cultured chondrocytic cell lines, and ex vivo, in human osteoarthritic cartilage compared to healthy human cartilage controls.

Methods: Quantitative real-time reverse transcription-PCR (qRT-PCR) was performed to assess the relative transcript levels of HMGA1 and IGFBP-3 in vitro, in the human chondrocytic cell lines T/C-28a4 and C-28/I2. An electrophoretic mobility shift assay (EMSA), chromatin immunoprecipitation (ChIP) and transient transfection assays were performed to investigate the HMGA1-IGFBP-3 gene interaction. Samples of articular cartilage were harvested from osteoarthritic patients and controls and analyzed by qRT-PCR for HMGA1 and IGFBP-3 mRNA levels.

Results: A parallelism between HMGA1 protein levels and IGFBP-3 gene expression has been observed in T/C-28a4 and C-28/I2 cells. The interaction of HMGA1 with the IGFBP-3 gene promoter has been demonstrated by EMSA and ChIP. In transient transfections, IGFBP-3 promoter activity increased in cells overexpressing HMGA1 and decreased in cells pretreated with siRNA detected against HMGA1. IGFBP-3 mRNA expression was higher in cartilage from patients with OA, where the increased expression of IGFBP-3 closely paralleled the increased expression of HMGA1 mRNA.

Conclusions: Our observations indicate that increased HMGA1 expression in human chondrocytes is associated with increased expression of IGFBP-3. It is tempting to speculate that, through the regulation of IGFBP3 expression, HMGA1 may act as a pathogenetic factor for OA.
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http://dx.doi.org/10.1186/ar4045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580519PMC
October 2012

Recent findings on the role of gelatinases (matrix metalloproteinase-2 and -9) in osteoarthritis.

Adv Orthop 2012 26;2012:834208. Epub 2012 Jul 26.

Department of Orthopaedic and Trauma Surgery, School of Medicine, University Magna Græcia of Catanzaro, Europa Avenue, 88100 Catanzaro, Italy.

Several studies dealing with the pathomechanisms of OA refer to MMP-1, -3, -7, -8, and -13 whereas a smaller number of investigations have pointed out the pathogenic role of gelatinases in OA. These gelatinases are best known for their involvement in pulmonary, myocardial, and neoplastic disease but they are emerging as important proteases implicated in the OA progression. This paper highlights the role of the gelatinases as emerging factors in OA pathogenesis through the regulation of subchondral bone resorption and microvascular invasion. The most significant new findings over the last year that add to our knowledge of the activity of these proteins in OA have been reported.
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http://dx.doi.org/10.1155/2012/834208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412089PMC
August 2012

Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy.

Eur Spine J 2013 Jan 2;22(1):128-34. Epub 2012 Aug 2.

Department of Orthopaedic and Trauma Surgery, School of Medicine, University "Magna Græcia" of Catanzaro, V.le Europa (Loc. Germaneto), 88100 Catanzaro, Italy.

Purpose: To assess the long-term results of anterior cervical discectomy and fusion using the Cloward procedure for the treatment of cervical spondylotic myelopathy, and to identify possible clinical outcome predictors.

Methods: A total of 14 cases with a 10-year postoperative follow-up were available (82.4 % of the surviving patients). Patients underwent preoperative and postoperative neurological examination. The symptom severity was graded according to the Nurick scale. MRI measurements were obtained preoperatively. Cervical spine radiographs were obtained preoperatively and at the time of follow-up.

Results: The mean improvement of the clinical status of patients on the Nurick scale was 1.43 ± 0.51 (range 1-2) with respect to the baseline values (p < 0.001), with a 62.5 % recovery rate. A positive association between the improvement of the Nurick scale and the length of follow-up was detected with an age-adjusted univariate analysis (p = 0.042). The Nurick grade improvement was also directly related to preoperative lower limb hyperreflexia (p = 0.039), spasticity (p = 0.017), and bladder dysfunction (p = 0.048). At the time of follow-up, an adjacent discopathy was noted above and below the operated level(s) in eight and six patients, respectively.

Conclusions: The Cloward technique is a safe and effective procedure for the treatment of cervical spondylotic myelopathy. The patients' preoperative neurological status and the length of follow-up affect the grade of postoperative ambulatory improvement.
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http://dx.doi.org/10.1007/s00586-012-2457-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540308PMC
January 2013

Radial artery achieves better flowmetric results than saphenous vein in the elderly.

Heart Vessels 2009 Mar 1;24(2):108-15. Epub 2009 Apr 1.

Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Due to the limited life expectancy and the supposed higher morbidity with complete arterial grafting, extensive arterial graft in the elderly is still questioned. It was the aim of this study to evaluate transit time flow and clinical, biochemical and echocardiographic results of elderly patients undergoing coronary artery bypass grafting (CABG) with either saphenous vein (SV) or radial artery (RA) employed as the second conduit of choice. The present study evaluates clinical and flowmetric results of a prospective series of elderly patients (>or=70 years old) undergoing RA CABG (75 patients, Group A) or SV CABG (163 patients, Group B) during isolated myocardial revascularization, performed either off-pump (OPCABG) and on-pump during the last 5 years at a single academic institution (between January 2003 and December 2007). Transit time flowmetric (TTF) maximum and mean flow, pulsatility index (P.I.), and graft flow reserve (GFR) were compared. Hospital outcome was analyzed. Clinical data were compared between the two groups and one-year follow-up was completed. The two groups showed comparable preoperative and intraoperative variables. When TTF analysis was considered, patients undergoing RA grafting demonstrated a significantly higher maximum (systolic) and mean flow compared to SV grafting, either in circumflex, diagonal, and right coronary territory. Pulsatility index was significantly lower in the RA group in circumflex, diagonal, and right coronary grafts. Furthermore, when GFR was calculated significantly higher values were found in RA conduits in the circumflex, diagonal, and right coronary grafts. Comparable troponin I leakage was detected between the two groups. Postoperative variables addressing hospital outcome were similar in the two groups. When echocardiographic data were analyzed, no differences were recorded in postoperative recovery of left ventricular ejection fraction and wall motion score index. One-year follow-up showed better freedom from acute cardiovascular events in the RA group (P = 0.04). Our data show that despite comparable clinical, biochemical, and echocardiographic results in elderly patients undergoing RA or SV grafting, better flowmetric results - in terms of GFR, mean flow, and pulsatility index - can be detected in arterial conduits.
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http://dx.doi.org/10.1007/s00380-008-1095-0DOI Listing
March 2009
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