1,721,027 research outputs found
Functional assesment of symptomatic snapping scapula after scapulothoracic arthroscopy: a prospective study protocol
Full text linkGiovanni Merolla Co-investigator: Giuseppe Porcellini Investigation performed at Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica - Italy PLAN OF CLINICAL INVESTIGATION (PCI): Version 1.0 of December 10, 2012 Approved by AV/IRST Ethical Committee (Comitato Etico Area Vasta Romagna) Reg. Sperimentazioni 914 Prot. N°: 1785/2013/I.5/46
Patellofemoral instability: surgical treatment of soft tissues
Full text linkInstability of the patella is a relatively frequent occurrence in adolescents. Its pathogenesis, which is multifactorial, is still much debated. Stability of the patella is guaranteed by a delicate balance of a series of factors (osteo-cartilaginous, ligamentous and muscular), and it is not surprising that alteration of one or more of these can lead to pathological conditions that can range from simple anterior pain associated with a hypermobile patella to recurrent dislocation. The aim of surgical treatment is to correct these anatomical abnormalities.
Surgical procedures on the soft tissues comprise reefing, realignment and reconstruction of the medial stabilizing structures, and release of the lateral structures. These procedures, although having precise indications, provide the surgeon with the instruments necessary to deal with almost all these anatomo-pathological conditions. Furthermore, preserving the osteo-cartilaginous components results in less morbidity than is associated with traditional surgical procedures, such as trochleoplasty and transposition of the anterior tibial tuberosity
Snapping scapula syndrome: current concepts review in conservative and surgical treatment
Full text linkThe snapping scapula, also called �washboard syndrome� is a controversial condition attributed to bony and soft tissue abnormalities. The syndrome was understimated for long time and often associated only with specific osseous abnormalities.
The nodal point in the overview of the syndrome is that crepitus associated with symptomatic bursitis may be physiologic and is not uncommon a clinical presentation without any form of crepitus or craquement. In the current rewiew we analyzed the current concepts in the conservative and surgical management of snapping scapula syndrome, preceded by a description of scapular anatomy, pathophysiology of scapulothoracic articulation and clinical features of snapping scapul
Regarding “Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt. A Cost-Effectiveness Model”
No full textWe read with great interest the paper “Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model” by Makhni et al.1 The surgical treatment of anterior glenohumeral insta- bility is a common worldwide issue as well as the management of failed operations. For both primary and revision cases, bone-block procedures and soft tissue repairs have been proposed. The authors have perfectly shown the social costs of these 2 operations and their cost-effectiveness. In Europe, the cost of surgical pro- cedures is even more relevant in daily practice. In Italy, all patients have the right of being assisted by the public health system due to the fact of paying taxes. The health system reimburses the hospitals and the subsi- dized private hospitals for their activity according to the diagnosis-related group (DRG). This is based on patients’ pathologies and on the interventions the physicians perform and accounts for hospitalization, implantable materials, and physicians.
The reimbursement for primary or revision open stabilization is 4,303V (code 8182, DRG224) (open), whereas the reimbursement for the same procedure under arthroscopy is 1,333V (code 8182þ8021, DRG232). The same reimbursement is given for revi- sion surgeries. However, the costs for these 2 operations are completely different.
The DRG of an arthroscopic Bankart repair covers 2 nights of hospitalization (as decided by the health sys- tem) (600V), implanted materials (480V for burr and shaver, 290V for a radiofrequency system, 2,000V for 4 absorbable anchors, and 88V for 2 cannulas) (data from Mitek Italy), occupation of the operating room (300V for 60 minutes), and various other costs (100V, which includes drugs, irrigation bags, sutures, surgical drapes). In case of associated remplissage, 2 additional anchors (1,080V) and 1/2 hour of operating room (150V) must be considered. The total cost is 3,858V with additional 1,230V in case of remplissage, whereas the DRG covers only 1,333V.
The DRG of an open Latarjet covers implanted materials (40V for 2 malleolar screws and washers) and occupation of the operating room (225V for 45 mi- nutes). Drugs and hospitalization are the same as Bankart repair (600V). The total cost is 965V, whereas the cost that the DRG covers is 4,303V.
The cost for imaging analysis (150V for a computed tomography scan), physician consultation (300V for 3 consultations), and postoperative physical therapy (400V for 10 sessions) is not included in the DRG reimbursement but has been calculated (850V) as a comparison with the study by Makhni et al.
The total cost for an arthroscopic soft tissue repair varies from 4,708V to 5,938V all included (in the study by Makhni et al., it is 15,287). The functional outcomes of both bone-block procedures (either open or arthroscopic) and soft tissue repairs are extremely satisfying.2 However, they greatly differ in terms of costs for the public health system. Open Latarjet is much more convenient in terms of costs/DRG reimbursement (all costs account for one-fourth of the expected reim- bursement) than arthroscopic soft tissue repairs (all costs exceed almost 4 times the expected reimburse- ment). The problem of expected expenses of surgical procedures has great relevance in some European countries. In fact, a policy of cost reduction has been introduced and could therefore influence surgeons’ decision making, favoring open procedures over arthroscopy
Femoral component malrotation is not correlated with poor clinical outcomes after total knee arthroplasty
No full textPurpose
Proper rotational alignment of the femoral component is critical for a successful total knee arthroplasty (TKA). The aim of this systematic review was to analyse the available literature to examine the effect of the TKA femoral component malrotation on clinical outcomes and assess a cut-off value for femoral rotation leading to revision surgery.
Methods
A detailed and systematic search from 1996 to 2019 of the PUBMED, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword terms “total knee arthroplasty OR replacement” AND “femoral alignment OR malalignment OR femoral rotation OR malrotation” AND “clinical outcome”. We used the methodological index for non-randomized studies (MINORS) to identify scientifically sound articles in a reproducible format.
Results
Eleven articles met inclusion criteria. A total of 896 arthroplasties were included in this review; 409 were unexplained painful TKA patients, while 487 were painless TKA patients. The mean age of patients was 67.5 (± 2.1) years. The mean post-operative follow-up delay was 46.8 (± 32.2) months. The mean of MINORS score was 21 points indicating good methodological quality in the included studies.
Conclusions
The present review confirms that the malrotation of the femoral component in TKA does not correlate automatically to poor clinical and functional outcome. The clinical relevance of this study was that, to improve accuracy in femoral component rotation, surgeons should consider the anatomical variability of femur in each knee and perform additional measurements pre- and intra-operatively. Taking a more accurate approach will shed light on unanswered questions in unhappy TKA.
Level of evidence
III
Readability and Quality of Online Patient Education Materials Concerning Posterior Cruciate Ligament Reconstruction
Full text linkObjective This study aimed to assess the quality of online patient educational materials regarding posterior cruciate ligament (PCL) reconstruction. Methods We performed a search of the top -50 results on Google (R) (terms: "posterior cruciate ligament reconstruction," "PCL reconstruction," "posterior cruciate ligament surgery," and "PCL surgery") and subsequently filtered to rule out duplicated/inaccessible websites or those containing only videos (67 websites included). Readability was assessed using six formulas: Flesch-Kincaid Reading Ease (FRE), FleschKincaid Grade Level (FKG), Gunning Fog Score (GF), Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index (CLI), Automated Readability Index (ARI); quality was assessed using the JAMA benchmark criteria and recording the presence of the HONcode seal. Results The mean FRE was 49.3 (SD 11.2) and the mean FKG level was 8.09. These results were confirmed by the other readability formulae (average: GF 8.9; SMOG Index 7.3; CLI 14.7; ARI 6.5). A HONcode seal was available for 7.4 % of websites. The average JAMA score was 1.3. Conclusion The reading level of online patient materials concerning PCL reconstruction is too high for the average reader, requiring high comprehension skills. Practice implications Online medical information has been shown to influence patient healthcare decision processes. Patientoriented educational materials should be clear and easy to understand
Stiffness in total knee arthroplasty
Full text linkStiffness is a relatively uncommon complication after total knee arthroplasty. It has been defined as a painful limitation in the range of movement (ROM). Its pathogenesis is still unclear even if some risk factors have been identified. Patient-related conditions may be difficult to treat. Preoperative ROM is the most important risk factor, but an association with diabetes, reflex sympathetic dystrophy, and general pathologies such as juvenile rheumatoid arthritis and ankylosing spondylitis has been demonstrated. Moreover, previous surgery may be an additional cause of an ROM limitation. Postoperative factors include infections, arthrofibrosis, heterotrophic ossifications, and incorrect rehabilitation protocol. Infections represent a challenging problem for the orthopaedic surgeon, and treatment may require long periods of antibiotics administration. However, it is widely accepted that an aggressive rehabilitation protocol is mandatory for a proper ROM recovery and to avoid the onset of arthrofibrosis and heterotrophic ossifications. Finally, surgery-related factors represent the most common cause of stiffness; they include errors in soft-tissue balancing, component malpositioning, and incorrect component sizing. Although closed manipulation, arthroscopic and open arthrolysis have been proposed, they may lead to unpredictable results and incomplete ROM recovery. Revision surgery must be proposed in the case of well-documented surgical errors. These operations are technically demanding and may be associated with high risk of complications; therefore they should be accurately planned and properly performed
The kinematic control during the backward gait and knee proprioception: insights from lesions of the anterior cruciate ligament
No full textAn already existing large volume of work on kinematics documents a reduction of step length during unusual gaits, such as backward walking. This is mainly explained in terms of modifications of some biomechanical properties. In the present study, we propose that the proprioceptive information from the knee may be involved in this change of motor strategy. Specifically, we show that a non-automated condition such as backward walking can elicit different motor strategies in subjects with reduced proprioceptive feedback after anterior cruciate ligament lesion (ACL). For this purpose, the kinematic parameters during forward and backward walking in subjects with ACL deficit were compared to two control groups: a group with intact ACL and a group with surgically reconstructed ACL. The knee proprioception was tested measuring the threshold for detection of passive knee motion. Subjects were asked to walk on a level treadmill at five different velocities (1-5km/h) in forward and backward direction, thereby calculating the cadence and step length. Results showed that forward walking parameters were largely unaffected in subjects with ACL damage. However, they failed to reduce step length during backward walking, a correction that was normally observed in all control subjects and in subjects with normal proprioceptive feedback after ACL reconstruction. The main result of the present study is that knee proprioception is an important signal used by the brain to reduce step length during the backward gait. This can have a significant impact on clinical evaluation and rehabilitation
Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results
Full text linkPurpose Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. Methods Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final follow-up. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. Results Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 +/- 9 years at the time of surgery. The mean interval between the injury and surgery was 53.4 +/- 36.7 days. The mean duration of postoperative follow-up was 49.9 +/- 11.8 months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 +/- 7.6 and 64.6 +/- 7.2, respectively. They improved to 91.8 +/- 2.3 (p = 0.0001) and 95.2 +/- 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 +/- 3.2 mm while the mean CCD ratio was 2.1 +/- 0.1. At final FU, the mean CCD was 11.9 +/- 1.4 mm (p = 0.002) and the mean CCD ratio was 1.1 +/- 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. Conclusions The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques
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