Publications by authors named "Paolo Di Benedetto"

59 Publications

Controversies in ACL revision surgery: Italian expert group consensus and state of the art.

J Orthop Traumatol 2022 Jul 15;23(1):32. Epub 2022 Jul 15.

UOS Knee SURGERY-1st University Clinic of Orthopaedics, ASST Pini-CTO, Milan, Italy.

Background: Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction.

Methods: A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience.

Conclusions: The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case.

Level Of Evidence: V (Expert opinion).
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http://dx.doi.org/10.1186/s10195-022-00652-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287504PMC
July 2022

Arthroscopic reduction and fixation of partial posterior wall acetabular fractures.

Acta Biomed 2022 03 10;92(S3):e2021551. Epub 2022 Mar 10.

Università degli studi di Torino, Torino, Italy.

Background And Aim: Reduction and fixation of partial posterior wall fracture is usually performed with an open posterolateral approach. When the fragment may be fixed without a plate (with screws only), reduction and fixation may be also achieved via hip arthroscopy. To our knowledge no study described this technique. Aim of our study is to describe the surgical technique and to present the achieved outcomes and the occurred complications.

Methods: Six cases of arthroscopic fixation of partial posterior wall fracture have been reviewed for the purpose of this study. Patients were treated arthroscopically if the fragment was not bigger than 25% of the posterior wall. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score.

Results: Fracture reduction was classified as anatomic on post-operative x-rays in all patients. The mean clinical score was 98 points at one year follow-up. No patient developed symptomatic femoral head AVN, none had heterotopic ossification. In one patients a screw breakage occurred without clinical complications.

Conclusions: Arthroscopic reduction and fixation of partial posterior wall fracture is an effective treatment and showed good outcomes if a careful patients' selection is done.
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http://dx.doi.org/10.23750/abm.v92iS3.12536DOI Listing
March 2022

Outcomes in arthroscopic surgery and proposal rehabilitative treatment in femoral acetabular impingement syndrome.

Acta Biomed 2022 03 10;92(S3):e2021575. Epub 2022 Mar 10.

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Background and aim of the work Femural Acetabular impingement syndrome (FAIS) is a patologic condition that can lead to hip pain, functional limitation and stiffness. In the last few decades orthopedics and physiotherapists have improved both surgery and riabilitative treatment leading to a better and better treatment. The target of this paper il to verify the efficiency of an early and multimodal physiotherapic treatment after and arthroscopic surgery of the FAIS   Materials and Methods We performed arthroscopic treatment and rehabilitation on 19 patients with mean age of 37±8,3 years, 12 males and 7 females. Each patient has been evaluated preoperatively (T0), postoperatively after 6 week (T1) and after 3 months of follow up (T2), the assessment was carried out by: administration of the VAS and WOMAC score for pain and function and joint examination of active hip movement through an inertial sensor system.   Results VAS score shows a decrease of pain after 6 week (mean decrease was 36%) and after 3 months (mean decrease was 33%). WOMAC score shows an increase of the funcional performance of the hip after 3 weeks and after 3 months (in both phases the mean score increase of the 44%) At last, the analysis of the active movement and of the hip joint showed a generalized increase in all movements both 6 weeks and 3 months after surgery, in particular for flexion (with the knee flexed) and internal rotation movements. of the hip.   Conclusion The results of this study are in line with the current scientific literature and the protocol used represents a valid tool to complete the surgical treatment. The proposal of an early, intensive treatment combined with hydrokinesitherapy seems to be safe and effective, however further studies are needed (increasing the sample size) to investigate the results.
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http://dx.doi.org/10.23750/abm.v92iS3.12710DOI Listing
March 2022

Early failure of cement with loosening and dislocation of the femoral component in a unicompartmental knee replacement: a case report with microscopic assessment.

Acta Biomed 2022 03 10;92(S3):e2021574. Epub 2022 Mar 10.

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Background Medial unicompartimental knee artrhoplasty (UKA) is a valuable and well-known option in the treatment of medial osteoarthritis (OA). Early recovery and good results are usually reported. Failure mechanism include septic and mechanical loosening, bearing dislocation and lateral or patello-femoral joint OA evolution. The rare case of an atraumatic dislocation of the cemented femoral component of a UKA is presented together with a literature review and a microscopic analysis of the loosened component. Methods The case of a 60-years old man who suffered a UKA failure due to a complete loosening and migration of the cemented femoral component 5 months after its implantation is reported. A review of the literature pertaining early similar catastrophic failures is discussed. Furthermore a stereo-microscopic and scanning electronic microscopic evaluation of the femoral component was performed. Results A UKA-to-TKA revision was performed. Septic loosening was ruled out and one-year follow up showed patient satisfaction with good clinical and radiographic results. Few cases of complete dislocation of the UKA femoral component are reported in the literature. Macro- and microscopic evaluation showed an almost completely smooth surface at the cemented surface of the posterior condyle of the femoral component.   Conclusions Whilst mobile bearing dislocation is a well-known complication of UKA, few cases of this potentially catastrophic complication are reported in the literature. Early UKA failure with complete implant loosening may be determined by a suboptimal cementing technique with inadequate cement penetration into the trabecular bone. In the present case, the absence of cement penetration into the posterior condyle may be one of the reason of the component dislocation after standing up starting with the knee in a highly flexed position.
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http://dx.doi.org/10.23750/abm.v92iS3.12711DOI Listing
March 2022

Management of bladder dysfunction in multiple sclerosis: a systematic review and meta-analysis of studies regarding bladder rehabilitation.

Eur J Phys Rehabil Med 2022 Jun 1;58(3):387-396. Epub 2022 Feb 1.

Polimedica Center Pradamano, Udine, Italy.

Introduction: The aim of the study was to investigate the efficacy of rehabilitation programs for bladder disorders in patients with multiple sclerosis (MS) and to guide physicians in delineating therapeutic tools and programs for physiatrists, using the best current strategies.

Evidence Acquisition: A search was conducted on PubMed, EMBASE, the Cochrane Library and Web of Science. Studies were eligible if they included adults with bladder disorders related to MS and described specific treatments of rehabilitation interest. The search identified 190,283 articles using the key words "multiple sclerosis" AND "rehabilitation" AND "urinary" OR "bladder," of which the reviewers analyzed 81 full-texts; 21 publications met the criteria and were included in the systematic review.

Evidence Synthesis: The systematic review identified the specific rehabilitation treatments reported in the current literature. The meta-analysis compared the scores and scales used to quantify bladder disorders due to MS, both before and after rehabilitation or in a comparison with a control group.

Conclusions: The present study suggests the need of a specific therapeutic protocol, based on the degree of disability and symptom complexity in patients with MS-related neurogenic lower urinary tract dysfunction (NLUTD). Particularly, the meta-analysis shows the effectiveness of peripheral tibial nerve stimulation (PTNS) and pelvic floor muscle training (PFMT) for neurogenic detrusor overactivity (NDO). However, the goal of physiotherapy is to treat incontinence without making urinary retention worse and vice-versa, reducing the loss of urine urgency, while ensuring the emptying of the bladder.
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http://dx.doi.org/10.23736/S1973-9087.22.07217-3DOI Listing
June 2022

Endoscopic gluteus maximus tendon release for external snapping hip syndrome: a functional assessment.

J Orthop Traumatol 2021 Nov 10;22(1):45. Epub 2021 Nov 10.

Division of Orthopaedic Surgery, DAME University of Udine, ASUFC, Udine, Italy.

Purpose: The aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure.

Methods: Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated.

Results: Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16-76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in a statistically significant manner: VAS value decreased from 6.8 (range 6-8) to 0.6 (range 0-4) (p  < 0.001), mHHS increased from 48.6 (range 17.6-67) to 88.2 (range 67-94.6) (p  <  0.001), NAHS increased from 49.0 (range 21.5-66) to 90.8 (range 66-98.75) (p  <  0.001). A statistically significant reduction of operated limb thigh circumference compared to the contralateral side (3.7%) was also found, while there were no statistical differences regarding the strength of gluteus maximus muscles.

Conclusions: Endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined.

Level Of Evidence: IV: retrospective comparative trial.
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http://dx.doi.org/10.1186/s10195-021-00610-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581119PMC
November 2021

Surgical hip dislocation vs arthroscopy for fixation of subfoveal femoral head fractures: A new technique for Pipkin type 1 fractures.

Acta Biomed 2021 07 26;92(S3):e2021016. Epub 2021 Jul 26.

University of Turin, Turin, Italy.

Background: Reduction and fixation of Pipkin type I femoral head fractures may be performed either via surgical dislocation either via hip arthroscopy but to our knowledge no studies compared those techniques. Aim of our study is to compare (1) Fracture reduction quality, (2) modified Harris hip score at a minimum of 2 years, and (3) Frequency of complications in a case series of patients with femoral head fractures treated with those approaches. Methods Five cases of arthroscopic fixation of femoral head fracture (AG) have been compared with our historical cohort (8 patients, SDG). Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score. Results Fracture reduction was anatomic in five hips and imperfect in two in the SDG while four hip were classified as anatomic and one imperfect in the AG. The mean clinical scores were significantly different between the two groups (p=0.03): 88 points in SDG (SD 7) and 94 points in AG (SD 5). In the SDG, one patient developed symptomatic femoral head AVN and one had heterotopic ossification. In the AG, no complication (heterotopic ossification and AVN) but one grade I sign of arthritis were noted. Conclusions Arthroscopic reduction and fixation of Pipkin type I fracture shows radiographic results comparable to surgical dislocation but better clinical results and lower rate of comorbidity.
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http://dx.doi.org/10.23750/abm.v92iS3.11724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420819PMC
July 2021

Cementless reverse total shoulder arthroplasty in a patient affected by Osteogenesis Imperfecta: a case report and review of the literature.

Acta Biomed 2021 07 26;92(S3):e2021024. Epub 2021 Jul 26.

Clinica Ortopedica - ASUFC - Udine, Italy DAME - University of Udine, Italy.

Background And Aim Of The Work: Osteogenesis Imperfecta is a rare genetic condition. The use of total shoulder arthroplasty in these patients is very uncommon, with only two cases reported in the literature. This study describes a cementless reverse total shoulder arthroplasty (rTSA) for a multi-fragmented fracture in a patient affected by Osteogenesis Imperfecta (OI) type 1 and aims to review literature results of shoulder replacement in patients affected by this uncommon condition.

Methods: the case of a woman affected by OI type 1 treated with a cementless rTSA for a multi-fragmented proximal humerus facture is reported. Focusing on the fixation technique, a research of all articles regarding the orthopaedic treatments in patients affected by Osteogenesis Imperfecta was performed and compared to the techniques used in the unaffected population.

Result: Our patient shows good results in terms of clinical and radiological outcomes at the short term follow up. Few studies treat the orthopaedic manifestation of this rare genetic condition and only two are focused on shoulder arthroplasty. Cement is the preferred method for fixation in both papers.

Conclusion: Cementless reverse shoulder arthroplasty may be an option in patients affected by OI type 1, although literature seems to support cement as the fixation method of choice.
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http://dx.doi.org/10.23750/abm.v92iS3.11756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420817PMC
July 2021

Treatment options for massive rotator cuff tears: a narrative review.

Acta Biomed 2021 07 26;92(S3):e2021026. Epub 2021 Jul 26.

Clinica Ortopedica - ASUFC - Udine, Italy DAME - University of Udine, Italy.

The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears. Compared with smaller tears, massive rotator cuff tears are often complicated by structural failure and poor outcomes and present a higher rate of recurrent tearing after surgical repair. Several management options are available but the selection of the most appropriate treatment for each patient can be challenging. To achieve the best outcomes, the orthopedic surgeon should have a good understanding of the indications, the pathomechanics and the clinical outcomes of the various treatment modalities. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. The purpose of this article is to review treatment options and clinical outcomes for the management of massive rotator cuff tears.
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http://dx.doi.org/10.23750/abm.v92iS3.11766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420830PMC
July 2021

Kinetic and Kinematic analysis of ACL reconstruction in association with lateral-extrarticular tenodesis of the knee in revision surgery: a pilot study.

Acta Biomed 2021 07 26;92(S3):e2021027. Epub 2021 Jul 26.

Clinica Ortopedica - ASUFC - Udine, Italy DAME - University of Udine, Italy.

Background Anterior cruciate ligament reconstructions are a very frequent surgery. The key role of the anterolateral ligament in the knee rotational stability has been undelighted in recent years. Extra-articular tenodesis in association with ACL reconstructions, serves to eliminate anterolateral rotatory instability. The aim of our study is to compare treated knees with the contralateral uninjured knee in those cases whom been treated with ACL arthroscopic reconstruction and lateral extra-articular tenodesis in revision surgery, and evaluate clinical results with kinematic and kinetic examinations methods. Materials and methods Sixteen patients (10 males and 6 females) with ages from 21 to 37 had been treated at the Orthopaedic Clinic of Udine for failure of previous ACL reconstruction. In all patients was performed ACL arthroscopic reconstruction with the association of a lateral extra-articular tenodesis (Coker-Arnold). We have decided to asses the patients at one year after surgery with GNRB arthrometer and Bioval inertial sensor system. Results All patients treated with arthroscopic ACL reconstruction and lateral extra-articular tenodesis have regained pre-injury sagittal knee stability and gait dynamics.
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http://dx.doi.org/10.23750/abm.v92iS3.11776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420824PMC
July 2021

Are vascular grafts at risk of occlusion after total hip replacement? A systematic review of the literature.

Acta Biomed 2021 07 26;92(S3):e2021030. Epub 2021 Jul 26.

Clinica Ortopedica - ASUFC - Udine, Italy DAME - University of Udine, Italy.

Vascular complications during and after total hip replacement are relatively uncommon despite the close relationship between the involved structures. Previous surgical procedure of arterial reconstruction or substitution may be at higher risk of damage due to the modification in the anatomical landmarks or to the mechanical properties of the grafts different from native vessels. In literature few cases of graft occlusion or failure are reported during or soon after a total hip replacement. The aim of this review is to report them highlighting common features and risk factors.
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http://dx.doi.org/10.23750/abm.v92iS3.11783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420829PMC
July 2021

Subchondroplasty in the Treatment of Bone Marrow Lesions of the Knee: Preliminary Experience on First 15 Patients.

Joints 2019 Dec 18;7(4):174-181. Epub 2021 Jun 18.

Divisione di Ortopedia e Traumatologia, IRCCS Ospedale Classificato Equiparato Sacro Cuore - Don Calabria, Negrar (Verona), Italy.

 The aim of this prospective study was to assess the effectiveness in terms of pain relief and functional improvement of the Subchondroplasty procedure in the treatment of osteoarthritis-related bone marrow lesions (BMLs) of the knee.  The study included first 15 consecutive patients undergone to Subchondroplasty procedure for the treatment of chronic degenerative BMLs in which previous conservative treatment have failed. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), and visual analog scale (VAS) pain scores were obtained preoperatively and at 1, 6, and 12 months of follow-up.  WOMAC scores significantly improved from 39.7 ± 20.2 before surgery to 26.8 ± 16.1 at the 1-month follow-up (  = 0.045). A further significant improvement to 15.5 ± 12.7 (  = 0.02) and to 8.6 ± 3.1 (  < 0.01) was obtained both at 6-month and at 1-year follow-up. KOOS scores improved significantly from 47.5 ± 16.6 before surgery to 65.4 ± 14.9 at 1 month (  = 0.013) and to 80.4 ± 15.1 at 6-month follow-up (  = 0.01). A further improvement to 85.6 ± 15.1 was recorded 1 year postoperatively, although nonsignificant. VAS score showed a significant improvement from 55.8 ± 20.5 preoperatively to 36.2 ± 16.9 at 1 month (  = 0.008) and to 18.2 ± 17.3 at 6-month follow-up (  = 0.005). This further improved to 12.8 ± 17.9 at 1-year follow-up, although not significantly.  Subchondroplasty procedure represents a safe and valid surgical option in the treatment of osteoarthritis-related BMLs of the knee, providing an improvement in terms of pain relief and functional recovery. Longer studies are required to evaluate how long these improvements may last.  Therapeutic case-series, Level IV study.
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http://dx.doi.org/10.1055/s-0041-1730984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253614PMC
December 2019

Discoid meniscus in human fetuses: A systematic review.

Knee 2021 Jun 1;30:205-213. Epub 2021 May 1.

Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

Background: Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role.

Methods: A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation.

Results: Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week.

Conclusion: Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
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http://dx.doi.org/10.1016/j.knee.2021.04.006DOI Listing
June 2021

Infinity ankle arthroplasty with traditional instrumentation and PSI prophecy system: preliminary results.

Acta Biomed 2020 12 30;91(14-S):e2020021. Epub 2020 Dec 30.

Department of Orthopaedic Surgery, S. Maria della Misericordia Hospital, Rovereto, Italy.

Ankle arthrodesis has been considered the surgical Gold Standard for advanced ankle arthritis; prosthetic replacement of the tibio-talar joint played a secondary role.The introduction of last generation ankle prostheses lead to better outcome and a lower rate of complication. PSI represents the most recent innovations introduced on the market of ankle arthroplasty:PSI is proposed as a surgical technique capable of making ankle arthroplasty more accurate and more reproducible compared to standard referencing guides Aim of the study is to report early clinical and radiographic outcomes obtained from a single surgeon experience by implanting the same ankle prosthesis using a standard (STD) or a PSI instrumentation Unlike no difference in the average increment of normalized sub score related to function in each group (PSI vs STD), the analysis of normalized pain sub score pointed out a greater average improvement in the PSI group(+75%)compared to the STD group(+62%);this result has been adovacated to the absence of post operative gutter impingement syndrome in the PSI group compared to the STD referencing group. The analysis of radiographic angles revealed a more accurate and reproducible positioning of the components in the PSI group; ankle arthroplasty performed with PSI reported a reduction of both surgical times and the need of intraop.fluoroscopy. PSI ankle arthroplasty achived more accurate and reproducible clinical and radiographic results compared to STD instrumentation;long-term follow-up are needed to demonstrate whether a better positioning of the implant is associated with an increased survival of the prosthesis and therefore justifies the additional costs of PSI.
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http://dx.doi.org/10.23750/abm.v91i14-S.10989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944708PMC
December 2020

Anterior cruciate ligament reconstruction: the role of lateral posterior tibial slope as a potential risk factor for failure.

Acta Biomed 2020 12 30;91(14-S):e2020024. Epub 2020 Dec 30.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy Medical Department, Universitiy of Udine, Italy.

Background and aim of the work Anterior cruciate ligament (ACL) reconstruction is an extremely frequent surgery. The analysis of anatomical factors is becoming increasingly important and the study of clinical, arthroscopic and radiological methods to evaluate and understand them aims to positively affect the patient's outcome. This work aims to analyze the role of Lateral Posterior Tibial Slope (LPTS) as a potential risk factor for ACL reconstruction failure Materials and Methods At the Clinic of Orthopedic of Udine, between November 2018 and August 2020, 47 revisions of the ACL were performed. We analyzed MRI scans with particular attention to the LPTS. Patient images were analyzed by a single senior orthopedic surgeon who was blinded to patient history, age and gender. Results Comparing with a value reported in literature as normal (LPTS estimated 6.5°) we see how the difference between the average LPTS values ​​in the sample is significantly higher than the normal values ​​(P <.0001). Furthermore, in our cohort, females show a LPTS  significantly higher than males (11,8° vs 8,7°; P <.005). Conclusion The data collected show how an increased posterior lateral tibial slope can be correlated with a higher risk of ACL reconstruction failure. The results are coherent with the literature. Our analysis is absolutely preliminary, but it is intended to be the starting point of a path that allows us to think of the reconstruction of the ACL as an intervention to be planned more carefully based on the individual characteristics of the patient.
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http://dx.doi.org/10.23750/abm.v91i14-S.10996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944695PMC
December 2020

Open-Wedge High Tibial Osteotomy Associated With Lipogems® Intra-Articular Injection For The Treatment Of Varus Knee Osteoarthritis - Retrospective Study.

Acta Biomed 2020 12 30;91(14-S):e2020022. Epub 2020 Dec 30.

Ortopedia e traumatologia, IRCCS Ospedale Sacro Cuore - Don Calabria, - Negrar (VR).

Background And Aim: Open-wedge high tibial osteotomy (HTO) is a good choice in the treatment of varus knee medial osteoarthritis, with the restore of the correct mechanical axis of the lower limb. Autologous adipose derived stem cells (aASCs) are used in cartilage regeneration and in the treatment of early osteoarthritis. Aim of this study is to retrospectively analyze clinical (and radiological) results in two populations of patients with initial varus medial knee osteoarthritis, treated with HTO, with or without associated intra-articular injection of aASCs.

Methods: In this study we analyze 85 patients treated with HTO for varus knee osteoarthritis with or without Lipogems® intra-articular injection. It was used of a single model of HTO plate. No associated procedure was performed.

Results: Significant improvement in the daily life activity assessment (KOOS score) was observed in the group treated also with aASCs compared with group treated with isolated HTO.

Conclusions: We suggest, in these patients, the surgical indication of an open-wedge high tibial osteotomy (HTO) and simultaneous injection with aASCs associated procedure to improve cartilage regeneration, with clinical improvement.
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http://dx.doi.org/10.23750/abm.v91i14-S.10992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944687PMC
December 2020

Decision/therapeutic algorithm for acetabular revisions.

Acta Biomed 2020 12 30;91(14-S):e2020025. Epub 2020 Dec 30.

University of Turin, Turin.

Background And Aim: Paprosky's classification is currently the most used classification for periacetabular bone defects but its validity and reliability are widely discussed in literature. Aim of this study was to introduce a new CT-based Acetabular Revision Algorithm (CT-ARA) and to evaluate its validity. The CT-ARA is based on the integrity of five anatomical structures that support the acetabulum. Classification's groups are defined by the deficiency of one or more of these structures, treatment is based on those groups.

Methods: In 105 patients the validity of the CT-ARA was retrospectively evaluated using preoperative X-rays, CT-scan and surgery reports. The surgical indications suggested by Paprosky's algorithm and by CT-ARA were compared with the final surgical technique. Patients were divided into two groups according to time of surgery.

Results: We reported concordance of indications in 56,2% of cases with the Paprosky's algorithm and in 63,8% of cases with the CT-ARA. Analysing only the most recent surgeries (group 2), we reported even higher difference of concordance (67,3% Paprosky's algorithm and 83,7% CT-ARA). The concordance of the CT-ARA among Group 1 and Group 2 resulted significantly different.

Conclusions: the CT-ARA may be a useful tool for the preoperative decision-making process and showed more correlation with performed surgery compared to the Paprosky's algorithm.
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http://dx.doi.org/10.23750/abm.v91i14-S.10999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944694PMC
December 2020

Capsular management in the arthroscopic treatment of the femoro-acetabular impingement in athletes: our experience.

Acta Biomed 2020 12 30;91(14-S):e2020023. Epub 2020 Dec 30.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy Medical Department, Universitiy of Udine, Italy.

Background and aim of the work  In the last decade arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral-acetabular impingement in athletes. The function of the joint capsule  has been better understood, opening a heated debate. The aim of the present retrospective study is to assess the influence of different capsulotomy techniques and a possible capsular suture role on the patient's functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated. Methods 36 patients (competitive athletes) treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled  during a period of two years (2016-2018). Patients have been divided into three equivalent groups, 12 without a suitable capsular management (T-Capsulotomy technique), 12 performing a Longitudinal Capsulotomy but without a final suture and 12 treated with a conservative Longitudinal Capsulotomy and a capsular suture. Patient's post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and the Hip Outcome Score-Sport Scale (HOS-SS). Return to sport. Results In our series there was no statistically significant difference in functional scores, however longitudinal capsulotomy seems to be associated with a higher percentage of return to sports activity (91,6% vs 75%). Conclusions The new longitudinal shape capsulotomy technique and a capsular suture with a single side-to-side stitch at the end of the procedure in athletes can positively influence the patient's functional outcome.
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http://dx.doi.org/10.23750/abm.v91i14-S.10988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944699PMC
December 2020

Clinical and radiological outcomes with PEEK suture anchors used in rotator cuff repair: our experience confirm that a perianchor fluid signal on RM does not affect clinical outcome at one year of follow up.

Acta Biomed 2020 12 30;91(14-S):e2020019. Epub 2020 Dec 30.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy Medical Department, Universitiy of Udine, Italy.

Introduction / objectives  Osteolytic-type reactions of the perianchor bone which in magnetic resonance are manifested as hyperintensity of the signal in T2 images are reported in many studies. T  The objective of the present study is to evaluate and compare to the literature data the clinical and radiological results of a group of patients who underwent arthroscopic suture of a rotator cuff tear using polyetherketone (PEEK) suture anchors. Materials and methods Twenty patients, aged between 44 and 73 years, who underwent arthroscopic repair of the rotator cuff for lesions smaller than 4 cm considered reparaible between August 2017 and January 2019, were enrolled in the present study. Patients were evaluated clinically with clinical examination, Constant scale and ASES scale pre and post surgery. MRI either pre and post operation at one year were evaluated to obtain data about tendon healing and evaluate bone reaction to PEEK anchors. Results: MRI analysis showed a tendon signal according to Sugaya classification of type 1 in the 25% of patients, type 2 in the 60% of cases and type 3 in the remaining 15% . Osteolysis was grade 0 in 65%, grade 1 in 30 % and grade 2 in 5% of cases. No anchors pull out or mobilization were reported. Conclusions: The presence of a T2 hyperintense signal osteolysis like on MRI control using PEEK anchors for the sutur of rotator cuff lesions does not find correlation whit the final clinical result of the procedure.
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http://dx.doi.org/10.23750/abm.v91i14-S.10986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944709PMC
December 2020

The Exposure to Osteoarthritic Synovial Fluid Enhances the Immunomodulatory Profile of Adipose Mesenchymal Stem Cell Secretome.

Stem Cells Int 2020 18;2020:4058760. Epub 2020 Jul 18.

Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy.

Objective: Several clinical studies have proposed the infusion of adipose mesenchymal stem cells (AMSCs) as an alternative therapy for joint diseases with inflammatory components, such as osteoarthritis. Indeed, AMSCs are able to stimulate tissue repair through a paracrine activity and the interaction with the inflammatory microenvironment seems to have a critical role.

Design: To reproduce the inflammatory microenvironment, AMSCs were exposed to osteoarthritic synovial fluid (SF) for 48 h and the effect of their secretome on differentiation of monocytes (M0) into macrophages M1-like and mature dendritic cells (mDCs) was evaluated. Furthermore, the effect of the secretome of AMSCs exposed to SF was evaluated on the T cell population in terms of T cell proliferation and expansion of T regulatory cells (T reg).

Results: Our data show that the exposure of AMSCs to SF activates cells and promotes the release of immunosuppressive factors, which induce macrophage polarization of M0 into the M2-like phenotype and inhibit differentiation of monocytes into mature dendritic cells (mDCs). Only the secretome of exposed AMSCs was able to inhibit T cell proliferation and promote T reg expansion.

Conclusions: Our results suggest that the microenvironment plays a fundamental role for the development of anti-inflammatory and immunomodulatory properties of AMSCs.
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http://dx.doi.org/10.1155/2020/4058760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383307PMC
July 2020

Reliability of open architecture anchors in biocomposite material: medium term clinical and MRI evaluation. Our experience.

Acta Biomed 2020 05 30;91(4-S):189-195. Epub 2020 May 30.

Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy; DAME - University of Udine.

Objectives: Comparing radiologic bone ingrowth and the clinical outcomes of an open-construct (PEEK) (polyether ether ketone) suture anchor with those of a bio-composite suture anchor (glycolic polylactic acid anchors, beta-tricalcium phosphate and calcium sulphate) in patients with arthroscopic rotator cuff repair.

Methods: From August 2017 to January 2019, 33 patients of both sexes, aged between 44 and 78 years underwent arthroscopic rotator cuff repair for tears considered repairable with an extension not exceeding4 cm. The bioabsorbable anchors used comprised glycolic polylactic acid/beta-tricalcium phosphate/ calcium sulphate, and the non-absorbable anchors in polyetheretherketone (PEEK). All patients underwent MRI evaluation at 12 months postoperatively to determine complications and identify any re-tear.

Results: Clinical scores showed an improvement from both clinical and functional point of view. There were no statistically significant changes compared to the physical examination. On radiographs, mobilizations, anchor pull-outs or other complications did not occur in each group.

Conclusions: Shoulder function improved after complete repair of the rotator cuff and similar clinical results were achieved regardless of the material and shape of the suture anchor. The bioabsorbable anchors in innovative open architecture material seem to have results comparable to peek anchors. Unfortunately, further studies are needed to define the advantages in using one material compared to the other. (www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v91i4-S.9709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944835PMC
May 2020

Total knee revision arthroplasty: comparison between tibial tubercle osteotomy and quadriceps snip approach. Complication rate.

Acta Biomed 2020 05 30;91(4-S):146-151. Epub 2020 May 30.

Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy; DAME - University of Udine.

Background And Aim Of The Work: The total knee arthroplasty (TKA) revision is not a second time of primary implant surgery but is a very complex issue for orthopedic surgeon. When local conditions make necessary a greater visualization, medial para-patellar access with quadriceps snip (QS) or the osteotomy of the tibial tuberosity (TTO) can be the solutions. This work aims to compare the quadriceps snip and the detachment of the tibial tubercle, focusing on possible complications.

Materials And Methods: At our institution, between January 2017 and February 2019 52 TKA revision for periprosthetic joint infection (PJI) or aseptic mobilization were performed. In 43 cases an extensive surgical approach was required: for patients with range of movement (ROM) < 60° was chosen TTO, while with ROM > 60° a QS was performed. Clinical and radiological follow-up was available for all the 43 cases.

Results: The data about clinical outcome in our study show that both groups have a positive trend in KSS score over time with similar ROM results. Two partial avulsions of patellar tendon during revision surgery were reported. Clinical outcome in both groups has shown good results at the end of follow-up with no post-operative incidence of complications.

Conclusion: We can assert that both QS and TTO are good approach for TKA revision. Future studies will be needed to understand if preparatory ROM is a good way to decide which surgical approach to use.(www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v91i4-S.9705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944827PMC
May 2020

Histological analysis of ACL reconstruction failures due to synthetic-ACL (LARS) ruptures.

Acta Biomed 2020 05 30;91(4-S):136-145. Epub 2020 May 30.

Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy..

Introduction: Anterior Cruciate Ligament (ACL) reconstruction is an established surgical procedure. Synthetic ligaments represent an option for ACL reconstruction. Their popularity declined for the raising concerns due to re-ruptures, knee synovitis and early arthritis related to I and II generation artificial ligaments. The introduction of a III generation synthetic ligament (Ligament Advanced Reinforcement System-LARS) permitted renewed interest in the adoption of this kind of graft. Main purpose of our study was to describe the histological findings on samples obtained from a consecutive series of ACL revision surgeries due to LARS ACL reconstruction failures. Secondary aim was to determine the reason for LARS rupture.

Methods: In a period between 2016 and 2018 eleven patients underwent ACL revision surgery due to LARS ACL reconstruction failure. At the time of the arthroscopic procedure, samples of synovial membrane and remnants of the torn LARS were sent to the Pathological-Anatomy Institute of our Hospital for a histological analysis.

Results: Histological analysis of the synovial tissues confirmed the arthroscopic evidence of synovitis mainly characterized by chronic inflammation with predominance of multinucleated giant cells. The adoption of polarized light microscopy revealed the presence of brightly bi-refractive material (LARS wear particles) in the synovial tissue; at higher magnification wear debris were detected inside the cytoplasma of multi nucleated cells. The histological analysis of the removed LARS revealed a surrounding typical foreign body reaction with poor signs of fibrovascular ingrowth of the synthetic ligament.

Conclusions: Our findings could not clearly advocate a unique mechanism of LARS-ACL reconstruction failure: biologic issues (poor tissue ingrowth) and mechanical issues (fibers properties and tunnel position) probably concur in a multi factorial manner. ACL reconstruction using artificial ligaments can not be considered a simple surgery. Artificial augments require some expertise and could therefore achieve better results if used by skilled sport surgeons other than trainees or low volume surgeons. The Authors believe that ACL reconstruction with synthetic devices still have restricted indications for selected patients (e.g. elderly patients who require a fast recovery, professional athlete, autologous tendons not available and/or refusing donor tendons). Our study arises additional suspicion on the unresponsiveness of synthetic fibers and claim some concern in the implantation of synthetic devices.
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http://dx.doi.org/10.23750/abm.v91i4-S.9702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944832PMC
May 2020

Capsular closure after hip arthroscopy: our experience.

Acta Biomed 2020 05 30;91(4-S):92-97. Epub 2020 May 30.

Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy; 2DAME - University of Udine.

Background And Aim Of The Work: In the last decade, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral- acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been hugely developed, opening a heated debate. The Literature is still torn about the need for a capsular suture, but more recent studies are more oriented in its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function of primary stability, and its closure is therefore necessary to restore the native anatomy and physiology. Nevertheless, capsular management remains a controversial topic. This is a retrospective study with the aim of assessing the influence of capsular suture on the patient's functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated.

Hypothesis: Our hypothesis is that an adequate capsular suture positively influences the patient's functional outcome.

Methods And Results: 50 patients treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two-years (2017-2018); collected data have been analysed and compared with a retrospective model. Patients have been divided into two equivalent groups, 25 treated with capsular suture, 25 without performing the suture. Patient's post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS) and the Hip Outcome Score-Sport Scale (HOS-SS). The functional outcome in patients where capsular sutures were performed was better than in non-sutured patients, in all three analysed scales.

Conclusions: Capsular suture with a single side-to-side stitch at the end of the procedure can positively influence the patient's functional outcome.
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http://dx.doi.org/10.23750/abm.v91i4-S.9664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944825PMC
May 2020

All-suture anchors in arthroscopic acetabular labral repair: our experience.

Acta Biomed 2020 05 30;91(4-S):85-91. Epub 2020 May 30.

Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC) - Udine, Italy; DAME - University of Udine.

Background: Over the past years, the role of the acetabular labrum in hip joint biomechanics and its relations with joint health has been of particular interest. There is a good clinical improvement of patients in whom the acetabular labrum is preserved during arthroscopic hip surgery. The purpose of this study is to report the results of arthroscopic repair of labral tears at a medium term follow up.

Materials And Methods: We performed a retrospective review of all cases that underwent hip arthroscopy at our Institution from January 2013 until December 2018. There were 24 patients, 13 males and 11 females, and their mean age at the time of surgery was 29, 42 years (range, 19 to 43 years). All patients were treated by the same surgeon with an extracapsular OUT-IN approach. Suture was performed using a non-absorbable suture anchor all-suture. Clinical assessment was performed at December 2019 using a modified Harris hip score (mHHS), hip outcomes score activities of daily living (HOS ADL), hip outcomes score activities of sport scale (HOS SS). All patients with acetabular labrum injury had femoro-acetabular impingement.

Results: The mean overall values in the preoperative period were 67.21 ± 10.31 for mHHS, 70.04 ± 12.11 for HOS-ADL and 60.06 ± 14.58 for HOS -SS. The results obtained in the re-evaluations of patients in December 2019 with a mean follow-up of 38, 3 months (minimum 1 year) are on average 82.17 ± 11.36 for mHHS, 83.00 ± 12.80 for HOS-ADL and 76.09 ± 18.52 for HOS-SS.

Conclusions: The progress of knowledge and the advancement of diagnostic and therapeutic skills has led to a greater awareness of the importance of treating acetabular labrum tears. Arthroscopic treatment with suture appear to be a good option for these patients and we had encouraging results in our center.
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http://dx.doi.org/10.23750/abm.v91i4-S.9661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944822PMC
May 2020

Groin pain caused by iliopsoas synovial cyst treated with endoscopic approach. A case report.

Acta Biomed 2019 12 5;90(12-S):174-177. Epub 2019 Dec 5.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy.

The diagnosis of iliopsoas synovial cyst is a rare finding. The normal approach to treat this condition has been conservative therapies or open surgery, with its associated complications and morbidity. The arthroscopic - endoscopic surgery is less invasive and with an increase in complications and days of hospitalization. We report the case of a 70-year old woman with clinical and imaging signs of a fluid-filled cyst near iliopsoas distal tendon. After fluid aspiration, the patient reported symptom-free interval of several weeks, but then groin pain and swelling feeling return, increased with hip movements. The cyst was removed through arthroscopy approach and the iliopsoas tendon was released. The removal of iliopsoas synovial cyst is necessary to avoid complications such as pain and functional limits. Arthroscopy has the advantage of less soft-tissue damage and quicker recovery. The treatment of associated tendon pathology can be done. Hip arthroscopy can be a safe and effective technique for the removal of iliopsoas synovial cyst.
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http://dx.doi.org/10.23750/abm.v90i12-S.8992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233692PMC
December 2019

Comparison between standard technique and image-free robotic technique in medial unicompartmental knee arthroplasty. Preliminary data.

Acta Biomed 2019 12 5;90(12-S):104-108. Epub 2019 Dec 5.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy.

The factors that guarantee the survival of the unicompartmental prosthesis implant seems to be linked to the accurate positioning of the components. The aim of our study is to compare the standard operative technique and the assisted navigation technique to understand if the robotic technology is able to obtain more accurate implants and with a better outcome. In the period between January 2016 and February 2018, in our Clinic, were performed 94 medial unicompartmental knee implants. The implantation of the medial unicompartmental prosthesis was performed in 30 cases with the standard technique and in 29 cases with the image-free robotic technique (Navio Surgical System). The objective of our study was to evaluate the anatomical and mechanical axes, the tibial slope, the coronal inclination of the femoral tibial space, the coronal angulation of the tibial and femoral component and the height of the Joint-Line. Furthermore, to evaluate the outcome we has execute international scores (IKDC and KSS Insall mod.). The advanced navigation seems to allow the implantation of the unicompartmental prosthesis more precisely, although not always with a statistically significant difference compared to the standard technique. further clinical studies are needed to analyze the medium and long-term survival rate, as well as the patient's subjective outcome.
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http://dx.doi.org/10.23750/abm.v90i12-S.8994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233696PMC
December 2019

Pre-operative and post-operative kinematic analysis in total knee arthroplasty. A pilot study.

Acta Biomed 2019 12 5;90(12-S):91-97. Epub 2019 Dec 5.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy.

Introduction: Total knee replacement is the treatment of choice in knee osteoarthritis. Despite this, there is still a percentage of unsatisfied patients. Recently, prosthetic designs have been developed to improve the kinematics of the prosthetic knee.

Materials And Methods: Between June 2016 and November 2016 we enrolled 26 patients underwent to total knee arthroplasty divided in two groups (A and B) treated respectively with Journey 2 implant and the Attune impltant. Each patient was evaluated with functional scores (KOOS and KSS) and with kinematic analysis using the Bioval System.

Results: In the group A, compared to the pre-operative, the flexion of the operated knees is significantly increased (31.27°±3.13° → 35.02°±2.1°) as well as that of the unoperated knee (34.34°±2.8° → 35.39°±3.5°). The pre/post-operative comparison of the muscles' activation timing showed an improvement for the unoperated side, which is closed to the physiological pattern, while the operated side showed an incorrect activation of all the investigated muscles.

Conclusions: The Journey 2 prosthesis seems to reach better results in rotational flexion, rotational freedom and muscles activation during free walking. Furthermore, it seems that with this prosthesis the patient can feel his "new prosthetic knee" more similar and closer to the physiological one. More studies are needed to confirm these results.
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http://dx.doi.org/10.23750/abm.v90i12-S.8984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233708PMC
December 2019

Onlay versus Inlay humeral steam in Reverse Shoulder Arthroplasty (RSA): clinical and biomechanical study.

Acta Biomed 2019 12 5;90(12-S):54-63. Epub 2019 Dec 5.

Clinic of Orthopaedics, University Hospital of Udine, Italy.

Background And Aim Of The Work: Reverse shoulder arthroplasty (RSA) is becoming treatment of choice in glenohumeral arthropathies with massive lesion of the rotator cuff, due to a gradual extension of indications and new designs that provide better outcome. In this study we compared two different reverse shoulder prosthesis designs, defined as Inlay (or typical Grammont type) and a relatively new model defined as Onlay (that preserves tuberosity bone stock). We analyzed clinical, biomechanical and radiological outcomes, as well as complications of RSA in these two groups.

Methods: We performed a prospective study on a population of 42 patients undergoing Reverse Shoulder Replacement by a single expert surgeon. We consider 21 patients (group A) who underwent to reverse shoulder replacement with a curved onlay steam with 145° inclination (Ascend Flex group, Wright medical, Memphis, TN, USA)  and 21 patients who underwent to reverse shoulder replacement with a traditional Inlay Grammont steam (Modular Shoulder System SMR, Systema Multiplana Randelli; Lima-LTO, San Daniele del Friuli, Italy) between August 2010 and October 2018. We studied the following items: active range of motion (AROM), radiological parameters (lateralization shoulder angle LSA, Distalization Shoulder Angle DSA), functional scale (Constant-Murley Score), post-operative complications (infection, aseptical implant mobilitazion, residual pain, scapular notching, fractures, tuberosity reabsorbtion, dislocation, bleedings, nerve palsy, pulmonary embolus).

Results: A significant improvement in ROM and functional score (Constant Shoulder Score) were observed in both groups. Group A (Onlay design 145°, medial tray) provides improvement in adduction, extension and external rotation compared to group B. No significant differences were found in abduction, external rotation and forward flexion. At 6 months follow-up, pain relief was detected in all patients. Although complications occur in a high percentage of patients in literature, no postoperative complications were observed in our cases series.

Conclusions: Our results showed how RSA is a real solution to improve quality of life and to restore pain-free shoulder ROM in patients where cuff tear arthropathy occurs. Onlay design 145° may provides better active external rotation, extension, adduction: it is necessary to continue follow up and include more cases to prove these data.
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http://dx.doi.org/10.23750/abm.v90i12-S.8983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233693PMC
December 2019

Leukocyte esterase strip test as a reliable intraoperative PJIs biomarker. Our experience.

Acta Biomed 2019 12 5;90(12-S):43-47. Epub 2019 Dec 5.

Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy.

ackgroud and aim of work: Prosthetic joint infection (PJI) is the most common cause of total knee replacement failure and the third most common cause of total hip replacement failure, accounting for 16.8% of all knee revisions and 14.8% of the hip revisions; nevertheless, the diagnosis of PJI is often a challenge for the orthopaedic surgeon. The aim of these study was to evaluate the reliability of the LE strip test for diagnosis of PJI.

Materials And Methods: From December 2016 to January 2019, we enrolled 50 patients with suspected PJI; 32 females and 18 males, the average age at the time of the surgery was 76 years. Twenty-four patients underwent knee revision surgery and twenty-six hip revision surgery. In all patients during the surgery, the synovial fluid was aspirated and used for leukocyte esterase strip test. The result of the tests was compared to periprosthetic tissues culture, histological examination and sonication fluid culture for PJI.

Results: Comparing the results obtained from the LE test with the results obtained from the other diagnostic methods, we found that the concordance between the results of the leukocyte-esterase test and those of the culture test with peri-prosthetic tissue or synovial fluid was shown to be 93%, between LE and histological examinations, the concordance was 93% and finally with the culture of the sonicated fluid the concordance was 86% of the cases.

Conclusions: The results of our serie show a good intraoperative diagnostic accuracy of the LE test, especially in its ability to exclude the hypothesis of periprosthetic infection in case of a negative result.
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http://dx.doi.org/10.23750/abm.v90i12-S.8993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233717PMC
December 2019
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