1,720,998 research outputs found
Return to sport activity after Anterior Cruciate Ligament Reconstruction in skeletally immature athletes with manual drilling Original All Inside Reconstruction at 8ys follow-up
No full textA Comprehensive Review and Update on Conservative and Surgical Treatment of Carpal Tunnel Syndrome: Current Evidence and Future Research Direction
No full textCarpal tunnel syndrome (CTS) is a multifactorial neuropathy caused by compression of the median nerve at the carpal tunnel. Its symptoms include pain, tingling or numbness affecting mainly the thumb, index and middle finger (sometimes the ring finger is also involved), with this sensation that could travel up the arm; hand weakness (mainly the thumb’s pinching muscles). Symptoms may vary in characteristics and severity and can be confound with other upper arm neuropathies and radiculopathies. The diagnosis is made with accurate history taking and clinical examination, supported by electromyography (EMG) and nerve conduction studies. Most people with mild to moderate symptoms are initially treated non-operatively. However, surgery is thought to provide more effective and durable symptom relief, especially for the most severe cases. CTS is becoming more common, as is its surgical management. This constitutes a significant economic burden for societies. All surgical techniques have provided satisfactory results and have been proven to be effective options. After reviewing the most up to date literature, it could be said that evidence of superiority of one technique over the others is lacking from a high level of evidence point of view. Specific advantages and disadvantages of surgical methods can, however, be taken into account when choosing among treatments. The simple algorithm of leaving the choice of the surgical method to surgeons’ preference and experience (together with consideration of patients’ related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. Research towards a universally accepted standardization should be aimed for by the authors, who have failed to date to sufficiently limit bias and limitations
Serologic and radiographic outcome of total hip arthroplasty with CoCr modular neck at midterm followup
No full textAbstract
Purpose
The aim of this study is a radiographic evaluation and to determine serologic
values of chromium and cobalt in the blood and urine of patients who have been
implanted with a Stryker ABG II Modular Neck and see if there is correlation
with the features of prosthesis and patients.
Methods
The study involves the collection of data from patients operated on for total hip
model with the ABG II Modular Neck with a minimum followup
of 1 year.
Results
We evaluated 22 patients who underwent implantation of a hip prosthesis with
modular neck in CoCr. Of these, the average Cr in the blood was 0.63 μgL
(range 0.1–2.15 μgL ), the average of Co in the blood was 3.50 μgL (range
0.62–7.78 μgL ), the average Cr in the urine was 1.24 μgL (range 0.48–
2.21 μgL ), and the average Co in urine was 14.22 μgL (range 3.3–31.2 μgL ).
None of these patients had undergone revision surgery.
Conclusions
Our study seems to indicate that the restoration of offset and age are correlated
with the release of metal ions, although the correlation is weak and needs better
methodological studies and a greater number of patients to confirm this
hypothesis
CAPSULAR DETENSIONING IN HIP OSTEOARTHRITÌS
No full textThe causes of pain in Hip Osteoarthritìs (OA) can be dìvided in Intra-articular
causes (i. e. cartilage or labrum lesions, subcondral bone damages or lose
bodies) and Extrarticular causes (i. e. capsule or muscles sufferance.
For patients in good generai condition, under eighteens thè first choice of
treatment is thè hip replacement that ensures excellent resuits. How orthopaedic
surgeons can manage symptomatic hip OA in elderly or fragile patients?
We have some possibilities like theraoeutic exercise orpharmacolojical therapies
that provide few guarantees in term of clinical evidences.
Our experience in recent years has led us to practice a new therapeutic option
called Ca.S.L.I. that combines ali thè safer treatments to ensure an effective
therapy for older patients.
What is thè rationale: thè Ca. S. is for Capsular Streatching. in patient in
whom movements are almost lost and deformities are big, thè capsular
derived pain is predominant because thè capsule surrounding thè femoral
neck, is like a thought collar. So thè first step is thè Capsular detensioning:
patient is placed on bed tractions and is praticateti 10 times of tractioning
and unloading under fluoroscopy check.
The second step is thè articular Lavage: using an hip needle by Anterolateral
portai is inflated from 500 cc to 2000 cc of saline solution until thè joint fluid
does not become clear.
The last step is thè Injection of Hyaluronic Acid and Long acting Corticosteroid
to ensure thè pain and inflammation decrease.
Since 2014 we treated 22 patients with Ca.S.L.I. procedure with thè mean
age oT84 years (range of 78-89 years) with pfimary Hip OA òbtàmmg good
results at 12 months follow-up in terms of HHS, VAS, use of NSADs and
better function
Enamel matrix proteins and their application in bone tissue regeneration. A Review.
No full textCurrent treatment options for skeletal repair (alloplastic materials, bone grafts, etc.) bave significant
limitations, especially in elderly subjects. However, bone tissue engineering seems to provide a solution for
reconstructing criticai size bone defects. Many of thè current regenerative medicine solutions developed
rely on products that combine biological agents, such as cells or biomolecules (1). In dentistry, Enamel
matrix proteins (EMP) bave been successfully employed to promote wound healing of severe infrabony
periodontal defects with regeneration of periodontal ligament, cementimi and alveolar bone (2-4). The
purpose of this review is to evaluate thè ability of enamel matrix proteins to promote bone tissue formation
and shed light on their possible application in skeletal regenerative medicine. A systematic literature
search in electronic databases (PubMed and Cochrane Library) was conducted, using thè following
search term combination: 'Amelogenins' or 'Enamel Matrix Proteins' or 'Enamel Matrix Derivative'
and Osteoblast' or 'Bone' or 'Mineralized Tissue' or 'Tissue Regeneration'. Publications were considered
for systematic review if they were published beforel January 2015 in English language and were Hsted
as reference in selected articles. Articles were excluded ìf they were without histomorphometric analysis
or quantitative analysis of calcium deposits in vitro, written in languages other than English, clinical
and/or animai periodontal regeneration studies, in vivo and in vitro tooth/root developmental studies
(with ameloblasts or cementoblasts or odontoblast). Assessment of thè methodological quality of thè
studies and data extraction were carried out by three authors. A total of 405 articles were found. Only
23 publications, 15 in vìvo and 8 in vitro studies, respected thè inclusion criteria and were used for this
review. The EMD osteoinductive property appears to be questionable and unclear if thè produci is used
in bone tissue regeneration. In thè in vivo reviewed articles, thè best results were recorded in thè presence
of restraints and not in large or criticai size defects, whereas EMD showed some osteopromotion in thè
early healing phases. Encouraging data are given on thè use of Synthetic Peptide (SP) and recombinant
amelogenins. Based on these data, it is necessary to carry out further investigation usìng amelogeninbased
compounds or with their active peptides with known composition and concentration. This would
help to standardize thè results by increasing thè effectiveness of thè work in order to better clarify thè
role and thè possible applications of amelogenins in bone tissue regeneration
STEM-NECK MODULAR TOTAL HIP ARTHROPLASTY: POSSIBLE MECHANICAL EFFECTS!
No full textIntroduction: Recentely modular neck femoral components has been considered
at risk for Fretting at thè stem-neck interface. Normally total joint
repalcement are not monitorated for COcr levels in thè various casitics are
not yet really known.
Aim: Serum, urinary levels and radiogrphic evaluation in patients with Modular
stem first implant recalled from one company.
Matheriial .and .fptKofi*^ Aivt^is -af ?_? -p^fipqts wìtb AB£> 11 Modular Npf V
From Stryker with a mìnum 1 year Follow up that has been checked wit
serum, urinary CoCr evaluation and clinical and radiographic contrai.
Results: Mean serum Cr 0,63 ugL-1 (range 0,1-2,15 ugL-1), Mean serum Co
ugL-1 (range 0,62-7,78 ugL-1), Mean urinary Cr 1,24 ugL-1 (range 0,48-2,21
HgL-1) and mean urinary Co 14,22 ugL-1 (range 3,3-31,2 MgL-1).
Conclusions: Nobody of thè patients presente any symptomps or signs that
can be attributed to thè implant. In addition thè offset recovery and thè age
seems to be correlated with high levels but this data it's quile weak and
needs more follow up an patient to be confirmed. A contro! group is in progress
at thè moment of this writing
β-NGF and β-NGF receptor upregulation in blood and synovial fluid in osteoarthritis.
No full textOsteoarthritis (OA) of the knee is the most common form of non traumatic joint
disease. Previous studies have shown the involvement of β-NGF and its receptors
TrKA and p75NTR in OA-related pain, but their role in its pathogenesis is still
unclear. The aim of our study was to investigate the amount of β-NGF and the
expression levels of its receptors on cells isolated from synovial fluid and
blood from OA patients who had undergone total knee arthroplasty, in order to
check any possible correlation with the disease staging. Our results show a
progressive stage-related increase of β-NGF and its receptors both in serum and
synovial fluid. Furthermore, respect to control subjects, OA patients show an
increased amount of inflammatory monocytes along with an increased expression of
β-NGF, TrKA and p75NTR. In conclusion, our study suggests a stage-related
modulation of β-NGF and its receptors in the inflammatory process of OA
Electromechanical delay of the knee flexor muscles after anterior cruciate ligament reconstruction using semitendinosus tendon.
No full textThe purpose of the study was to evaluate whether using only the semitendinosus as a tripled short graft would affect the electromechanical delay (EMD) of the knee flexors. EMD was evaluated in volunteers (N = 15) after they had undergone surgery for anterior cruciate ligament (ACL) reconstruction where the semitendinosus tendon alone was used as a graft. The results were compared with the intact leg and healthy controls (N = 15). After warming up, each subject performed four maximally explosive isometric contractions on an isokinetic dynamometer. Torques were measured by the dynamometer, while the electrical activity of the semitendinosus and biceps femoris muscles was detected using surface electromyography. EMD was found to be significantly increased (p = 0.001) in patients who had undergone ACL reconstruction compared to the controls. On the contrary, no significant differences (p = 0.235) were found for the biceps femoris muscle between the two groups. Similar results were found when the study group was compared with the intact leg group (p = 0.027 for semitendinosus and p = 0.859 for biceps femoris). Harvesting the semitendinosus tendon increases the EMD for the semitendinosus muscle but does not influence the EMD outcomes for the biceps femoris muscle
Dual mobility for total hip arthroplasty revision surgery: A systematic review and metanalysis
Get PDFIntroduction: Revision THA (R-THA) is thought to have a higher complication rate if compared to primary THA. Dual Mobility (DM) implants have been designed aiming for achieving greater stability, with good clinical results. However, scarce material can be found about the real improvements provided by this type of implant compared to traditional implant in Revisions of Total Hip Arthroplasties. Methods: A systematic review and meta-analysis of comparative studies were performed in December 2019. This was in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Our primary outcome measure was overall survivorship and dislocation rate, either treated with a conservative method or requiring surgery. Results: Regarding the overall implant survival, we found a slight significant risk ratio, with a statistically meaningful difference between the two groups in questions in favour of the DM implant. A statistically significant difference in favour of the DM group turned out considering only the Dislocation rate Risk ratio and the aseptic loosening risk as well. No statistical difference was found between the two groups about the risk ratio of infection. Discussion: A steady increase of evidence is demonstrating the efficacy of using a DM cup system in THA revisions with low dislocation rates, but currently there is no study in the literature that demonstrates with statistically significant evidence. The main finding of the present study is that implant’s Survivor and prevention of dislocation at medium follow-up showed better results with a DM if compared to a fixed-bearing cup, for Revision THA
Quadriceps muscles activity during gait: comparison between PFPS subjects and healthy control
No full textPurpose
The purpose of the study was to evaluate if during a common activity as walking,
altered quadriceps muscular activity may be present in patellofemoral pain
syndrome (PFPS) patients.
Methods
Forty subjects with clinically diagnosed PFPS and forty healthy males matching
in age, weight, height and level of sport activity were enrolled in the study.
Subjects were asked to walk on an instrumented walking path at their selfselected
speed. Force platform and motion tracking system were used for the analysis of
the gait. Wireless surface EMG probes were used to evaluate quadriceps muscles
activity. Rectus femoris, vastus medialis and lateralis activity percentage, onset
and offset time, walking speed, cadence, step length, stride length, knee ROM
during gait were measured and reported. Tegner activity questionnaire was
reported.
Results
Patient group showed a significant increasing in all quadriceps muscles activity
when compared to the control (p < 0.05). In particular, for VM and VL muscle
onset time was anticipated and offset time was postponed in PFPS group when
compared with healthy group (p < 0.05). Knee range of motion during walking
was significantly decreased in the patient group.
Conclusions
Young athletes with PFPS showed increased length of quadriceps muscles activity
and reduced functional knee Rom while walking, comparing with healthy
subjects, in particular muscular onset was anticipated in respect of the loading
response event of the gait. Nonetheless, walking parameters were not affected by
these alterations
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