151 research outputs found
Infraspinatus strength assessment and ultrasound evaluation of posterior capsulotenodesis after arthroscopic Hill-Sachs remplissage in traumatic anterior glenohumeral instability: a retrospective controlled study protocol
No full textGiovanni Merolla Co-investigator: Giuseppe Porcellini Investigation performed at the Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica - Italy PLAN OF CLINICAL INVESTIGATION (PCI): Version 1.0 of June 12, 2012 Approved by AV/IRST Ethical Committee (Comitato Etico Area Vasta Romagna) and authorized by AUSL RN ("Determina AUSL Rimini numero 326 del 29/03/2013: Remplissage U.O Chirurgia della Spalla - Valutazione clinica ed ultrasonografica dell'infraspinato dopo capsulo-tenodesi artroscopica (remplissage) nell'instabilità anteriore traumatica di spalla con lesione di Bankart e difetto omerale di Hill-Sachs")
Functional assesment of symptomatic snapping scapula after scapulothoracic arthroscopy: a prospective study protocol
No full textGiovanni 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
Correction to: Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up (Journal of Orthopaedics and Traumatology, (2021), 22, 1, (55), 10.1186/s10195-021-00619-2)
No full textFollowing publication of the original article [1], the authors identified an error in the author names. The given name and family name were erroneously transposed. The incorrect author names: Micheloni Gian Mario, Tarallo Luigi, Negri Alberto, Giorgini Andrea, Merolla Giovanni and Porcellini Giuseppe. The correct author names: Gian Mario Micheloni, Luigi Tarallo, Alberto Negri, Andrea Giorgini, Giovanni Merolla, Giuseppe Porcellini. The author group has been updated above and the original article [1] has been corrected
Protesi inversa di spalla con componente glenoidea lateralizzata con innesto osseo o metallo per preservare il bone-stock glenoideo: analisi dei parametri radiografici e dei risultati clinici
No full textIntroduzione: La protesi inversa rappresenta una opzione valida per il trattamento dell’artrosi di spalla con severa deformità ossea glenoidea, ma richiede un alesaggio correttivo esteso per il ripristino della versione ed inclinazione glenoidea nativa, con relativi rischi di medializzazione della glenoide e fallimento della fissazione. L’utilizzo di un innesto osseo, prelevato dalla testa omerale e fissato sul “baseplate” all’ interfaccia della glenoide nativa, è stato proposto per minimizzare l’alesaggio glenoideo e ripristinare il bone stock glenoideo (“Bony-Increased Offset, BIO- RSA”). Il “baseplate” aumentato metallico ("Metallic-Increased Offset – MIO-RSA”), rappresenta un’alternativa alla BIO-RSA per ripristinare la interlinea articolare. Ad oggi, persistono ancora delle controversie sulla scelta del “bone graft” o dell’ “augment” metallico nella protesi inversa di spalla lateralizzata.
Obiettivi: Abbiamo testato due ipotesi: i) la MIO-RSA garantisce risultati clinici e un tasso di “scapular notching” simile alla BIO-RSA, ii)la integrazione del graft osseo nella BIO-RSA è compromessa nel tempo, aumentando il rischio fallimento della fissazione.
Materiali e Metodi: Abbiamo arruolato in modo retrospettivo 72 pazienti (74 spalle) sottoposti a BIO-RSA (44) o MIO-RSA (30). La deformità glenoidea primaria (A1, A2, B1, B2, B3, C, D) e secondaria a rottura di cuffia (E1, E2, E3, E4), è stata classificata secondo specifici criteri, utilizzando la tomografia computerizzata. La mobilità attiva e il “Western Ontario Osteoarthritis of the Shoulder (WOOS) Index” sono stati usati per la misura dell’ ”outcome” clinico.
Tutte le alterazioni radiografiche postoperatorie dell’impianto sono state valutate all’ultimo follow-up.
Presenza e dimensione delle linee di radiolucenza glenoidea sono state utilizzate per valutare la integrazione del “bone graft” (gruppo BIO-RSA) e il “baseplate seating” (gruppo MIO-RSA) (assenza di radiolucenza: “perfect seating”; linee di radiolucenza 2 mm: mobilizzazione).
Abbiamo valutato lo spessore del “bone graft” (mm), la posizione della glenosfera sulla glenoide (alta, centrata, bassa, molto bassa), la versione (metodo di Friedman) e la inclinazione (“ angle”) glenoidea preoperatoria e postoperatoria.
Risultati: Al follow-up medio di 36.5 mesi gli “scores” preoperatori e postoperatori sono aumentati in modo significativo in entrambi i gruppi (p < 0.001). Morfologia ossea glenoidea preoperatoria, radiolucenza glenoidea postoperatoria, ossificazioni scapolari ed omerali eterotopiche, “spot welds” omerali sono risultati simili nei due gruppi. Lo scapular notching non ha mostrato differenze. Le linee di condensazione omerali sono state più comuni nella MIO-RSA (p = 0.01), l’assottigliamento corticale e riassorbimento tuberositario è stato maggiore nel gruppo BIO-RSA (p= 0.027 e p = 0.004). La retroversione glenoidea postoperatoria è risultata simile, ma i “delta score” preoperatori e postoperatori sono stati più alti nella BIO-RSA (p < 0.001). Linee di radiolucenza < 2 mm intorno al “bone graft” in 16 pazienti (36.4%) e ridotto spessore in 15 pazienti (34.1%) sono state registrate nella BIO-RSA. La integrazione del bone graft è stata del 64%. “Incomplete baseplate seating” è stato trovato in 3 spalle del gruppo MIO-RSA.
Conclusioni: I risultati clinici simili, ottenuti con i modelli BIO-RSA e MIO-RSA, confermano la prima ipotesi dello studio. Il “baseplate seating” completo riscontrato in > 90% dei pazienti con MIO-RSA esprime la eccellente stabilità e capacità di fissazione del metallo. Il tasso di riassorbimento del “bone graft” conferma la seconda ipotesi dello studio sui potenziali rischi di fallimento del “baseplate” a lungo termine.Background : Reverse shoulder arthroplasty (RSA) is a valid option to address shoulder osteoarthritis with severe glenoid deformity, but requires an extensive reaming to restore the native version with high risk of baseplate failure. The use of autologous bone graft harvested from the humeral head and fixed on the baseplate at the interface of the native glenoid, was proposed to minimize glenoid reaming and restore glenoid bone stock (Bony-Increased Offset, BIO- RSA).
Metallic-augmented glenoid components (Metallic-Increased Offset – MIO-RSA) have been proposed as viable alternative to BIO-RSA, preserving more native bone stock and restoring the joint line, with a final goal of increasing the baseplate support.
Thus, controversies still exist about the choice of bone grafting or metal augments in RSA.
Objectives: In this study we tested two hypotheses: i) metal augmented baseplate give similar clinical outcomes and rate of scapular notching compared with BIO-RSA patients, ii) bone graft viability and healing in BIO-RSA patients are impaired over time, thus making concern about baseplate fixation and stability in the long-term.
Materials and Methods: This was a retrospective study involving seventy-two consecutive patients (74 shoulders) who underwent RSA with glenoid lateralization using bone (BIO-RSA group, 44) or metal augmented baseplate (MIO-RSA group, 30).
Glenoid deformities was classified according to established criteria by computed tomography in primary osteoarthritis (A1, A2, B1, B2, B3, C, D) and cuff tear arthropathy (E1, E2, E3, E4).
Active range of motion, and the Western Ontario Osteoarthritis of the Shoulder (WOOS) Index were assessed before arthroplasty and at the last follow-up visits.
Radiologic changes around the humeral and glenoid components were recorded at latest follow-up and compared with immediate postoperative X-rays. Glenoid radiolucent lines and their size were used to evaluate bone graft healing (BIO-RSA group) and baseplate seating (MIO-RSA group) (no radiolucent lines: perfect seating; radiolucent lines 2 mm: loosening). Postoperative thickness of bone graft (mm) was also measured. Glenosphere position was recorded as: high, flush, low and very low. Glenoid version (Friedman method) and inclination ( angle) were recorded and compared with preoperative values.
Results: At a mean follow-up of 36.5 months the preoperative and postoperative shoulder mobility and WOOS Index were significantly different in both groups (all p < .0001). The two groups showed a similar rate of preoperative glenoid deformities. The rate of postoperative glenoid radiolucency, scapular notching, scapular spurs, glenosphere position, heterotopic ossifications and humerus spot weld were similar. We found higher rate of humerus condensation lines in MIO-RSA group (p= 0.01) and higher rate of cortical tinning and tuberosity resorption in the BIO-RSA group (p= 0.027 and p = 0.004, respectively).
Postoperative glenoid retroversion and inclination were similar in the two groups but the preoperative and postoperative delta score were higher in the BIO-RSA group (p < 0.001). BIO-RSA group showed radiolucent lines < 2mm around bone graft in 16 patients (36.4%) and decreased thickness in 15 (34.1%). The bone graft healing was 64%. Incomplete baseplate seating found in 3 shoulders of MIO-RSA group.
Conclusion: The clinical outcomes and rate of notching found in BIO-RSA and MIO-RSA patients confirm the first hypothesis of this study. The complete baseplate seating found in most of MIO-RSA patients explains the excellent stability and fixation of the metal. Our findings about bone graft healing confirm the second hypothesis about the risk of baseplate failure in the long-term
Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review
No full textThe correct functionality of the upper limbs is an essential condition for the autonomy of people with disabilities, especially for those in wheelchair.
In this review we focused on the biomechanics of wheelchair propulsion and we described the instrumental analysis of techniques for the acquisition of wheelchair propulsio
Clinical and Radiographic Mid-Term Outcomes After Total Shoulder Replacement: A Retrospective Study Protocol Including 400 Anatomical and Reverse Prosthetic Implants
No full textTo obtain outcomes data on anatomical and reverse total shoulder arthroplasty by analysis of clinical scores and standard radiographs
Robotics in shoulder rehabilitation
No full textIn the last few decades, several researches have been conducted in the field of robotic rehabilitation to meet the intensive, repetitive and task-oriented training, with the goal to recover the motor function. Up to now, robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors leaving less explored the field of orthopaedic shoulder rehabilitation. In this review
we analyse the present status of robotic technologies, in order to understand which are the current indications and which may be the future perspective for their application in both neurological and orthopaedic shoulder rehabilitation
Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study
No full textBackground: Acromioclavicular (AC) dislocation involves complete loss of articular contact; it is defined as chronic when it follows conservative management or unsuccessful surgical treatment. Materials and methods: The study compared the clinical and radiographic outcomes of AC joint stabilization performed in 40 patients with chronic dislocation using a biological allograft (group A) or a synthetic ligament (group B). Demographic data included: M/F: 25/15; mean age: 35 ± 3.2 years; previous surgery in 11 patients, including Weaver-Dunn (3), coracoacromial ligament repair (4), stabilization with K-wires (4). Dislocation was type III in 14 (35 %) and type IV in 26 (65 %) patients. Clinical assessment was with the Constant-Murley score (pre- and postoperative) and with the modified UCLA score. Enrollment started in January 2004 and was completed in March 2008. Patients were evaluated at 1 and 4 years. Postoperative X-rays were examined to assess joint stability in the coronal and axial planes, coracoclavicular ossification, and signs of AC joint osteoarthritis and distal clavicular osteolysis. Results: The "biological" group achieved significantly better clinical scores than the "synthetic" group at both 1 and 4 years. Poor subjective satisfaction and lower clinical scores were found in the 3 patients (1 from group A and 2 from group B) who experienced complete postoperative dislocation. No significant correlations were found with other radiographic parameters. Conclusions: The biological graft afforded better clinical and radiographic outcomes than the synthetic ligament in patients with chronic AC joint instability. Fixation to the clavicle constitutes the main weakness of both approaches and needs improving. © 2012 The Author(s)
Efficacy of anatomical prostheses in primary glenohumeral osteoarthritis
No full textMore than 32.8% of the over-60s suffer from shoulder osteoarthritis. For advanced osteoarthritis, arthroplasty is the treatment of choice. Current systems have moved on from the first shoulder prosthesis implanted by Neer in 1974, thanks to the use of adaptable modular systems. The aim of this study was to investigate the effectiveness of anatomical shoulder replacements in 30 cases of primary glenohumeral osteoarthritis through clinical and radiographic follow-up for a mean of 5 years. All implants were total cemented prostheses. Preoperative investigations included a clinical examination, conventional X-rays and CT. The Constant-Murley scale was used to evaluate the results; the mean score increased from 21.4 preoperative to 69.8 postoperative (p<0.05). In patients aged under 50, the increase in the mean postoperative Constant Score and ROM was greater than for the sample as a whole. The following complications were encountered: 2 postoperative radial nerve paralyses, resolving in 3 months, 2 cases of glenoid loosening, 1 periprosthetic fracture and 3 cases of pain and stiffness. The results led us to conclude that anatomical prostheses are effective in the treatment of severe primary glenohumeral arthropathy
Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment
No full textCalcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff
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