Alberto Vascellari

A New Tool for Surgical Training in Knee Arthroscopy

This paper presets an educational method for minimally invasive surgery (MIS) and an integrated system to train a priori knowledge and to exercise manual dexterity. The approach is generally suitable for MIS interventions but has been developed specifically for knee arthroscopy. Based on a classification of the knowledge required for performing arthroscopy procedures, the system provides multimedia modules to train and assess anatomical and procedural knowledge and a virtual reality-based simulator for training perceptual-motor skills. The system is currently being experimented for metrics definition and extended incorporating networked database management.

Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study.

PURPOSE the purpose of this retrospective study was to present the outcomes of three different techniques for the treatment of type III acromioclavicular joint dislocations: arthroscopic TightRope (TR), arthroscopic GraftRope (GR), and open reconstruction of the coracoclavicular (CC) ligament using the Ligament Augmentation and Reconstruction System (LARS). METHODS eighteen patients underwent clinical and radiological evaluations after a mean follow-up time of 43 months. The following clinical outcome measures were considered: the Disability of the Arm, Shoulder and Hand outcome measure (DASH), the Nottingham Clavicle Score (NCS), and the Constant score (CS). On X-rays, the CC distance was measured. RESULTS the median DASH score at follow-up was 12.5 in the TR group, 5 in the GR group, and 4.2 in the LARS group. The median NCS value was 88 in the TR group, 88 in the GR group, and 91 in the LARS group. The median CS was 100 in the TR group, 95 in the GR group, and 94.5 in the LARS group. The mean CC distance was 10.3 mm in the TR group, 13.8 in the GR group, and 16.6 in the LARS group. CONCLUSIONS all three techniques proved to be reliable in providing good clinical outcomes, although none of the studied techniques demonstrated reliability in maintaining anatomical reduction after surgery. LEVEL OF EVIDENCE Level III, retrospective comparative study.

Outcome evaluation after Achilles tendon ruptures. A review of the literature.

The optimal treatment and the best rehabilitation protocol after an acute Achilles tendon rupture (ATR) remain a matter of controversy in orthopaedic and sports medicine. The use of validated injury-specific outcome instruments is the only way to clarify these issues, in order to ensure that patients receive the best possible treatment. This article describes the most commonly reported outcome measures used to assess patients treated for ATR. On the basis of the available evidence, the Achilles tendon Total Rupture Score (ATRS) is the most appropriate outcome measure for evaluating the management of acute ATR.

Emerging Orthobiologic Approaches to Tendon Injuries

With the increasing popularity of sport activities, the frequency of sport-related lesions, such as tendon injuries, is rapidly rising [1]. Orthobiology is a new exciting area of medical research aimed to enhance tendon tissue healing. New therapies are emerging with promising results, but further investigation is warranted to better define indications, techniques, modalities, safety, and cost-effectiveness.

Psychometric properties of three different scales for subjective evaluation of shoulder pain and dysfunction in Italian patients after shoulder surgery for anterior instability

BACKGROUND The Italian versions of Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California-Los Angeles (UCLA) Shoulder Rating Scale have been validated to assess shoulder dysfunction in patients treated for neck cancer. The present study investigated the psychometric properties of the Italian versions of the SPADI, SST, and UCLA in patients after shoulder surgery for anterior instability. MATERIALS AND METHODS The study population included 98 patients. Patients completed the Italian SPADI, SST, and UCLA, and Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Oxford Shoulder Score (OSS), and 36-Item Short Form Health Survey (SF-36). Reproducibility was assessed by asking patients to complete another UCLA, SPADI, and SST 48 hours after the first. Validity was assessed by calculating the correlation between the SPADI, SST, and UCLA and the WOSI, ASES, OSS, and the SF-36 Physical Health subscales. RESULTS The internal consistencies of the SPADI (α = 0.97) and the SST (α = 0.87) were very high. The test-retest reliability was excellent with intraclass correlation coefficient of 0.97 for the SPADI, 0.93 for UCLA pain, 0.95 for UCLA function, and 0.97 for the SST. A significant correlation was found between the Italian SPADI, SST, and UCLA and the WOSI, the ASES and the OSS. DISCUSSION Psychometric properties of the Italian SPADI, SST, and UCLA compared well with those reported for the original versions, supporting their use as reliable clinimetric instruments in the setting of shoulder disorders after surgery for recurrent anterior instability.

Surgical Treatment of Patellar Tendinopathy

Patellar tendinopathy is a common musculoskeletal disorder among recreational and professional athletes. It has an important impact on the athletes’ careers, because of its high prevalence, the resulting impairment of knee function, and its chronic clinical course Surgery is recommended in the presence of patellar tendinopathy only when the conservative treatment has failed. Both open and arthroscopic procedures are widely used, even if arthroscopy is preferred due to its shorter recovery times. The surgical rationale consists in the debridement of the damaged tissue, and performing apicectomy could be an option in case of bony protrusion. The mean time to return to sports activities is 3–6 months.The healing process requires time to avoid postoperative complications, thus the rehabilitation program should not be too aggressive.