Loris Perticarini

Platelet-rich plasma in the treatment of acute hamstring injuries in professional football players

PURPOSE muscle injuries have a high incidence in professional football and are responsible for the largest number of days lost from competition. Several in vitro studies have confirmed the positive role of platelet-rich plasma (PRP) in accelerating recovery and in promoting muscle regeneration, and not fibrosis, in the healing process. This study examines the results of intralesional administration of PRP in the treatment of primary hamstring injuries sustained by players belonging to a major league football club. METHODS twenty-five hamstring injuries (grade 2 according to MRI classification) sustained by professional football players during a 31-months observation period were treated with PRP and analyzed. Sport participation absence (SPA), in days, was considered to correspond to the healing time, and we also considered the re-injury rate, and tissue healing on MRI. The mean follow-up was 36.6 months (range 22-42). RESULTS there were no adverse events. The mean SPA for the treated muscle injuries was 36.76±19.02 days. The re-injury rate was 12%. Tissue healing, evaluated on MRI, was characterized by the presence of excellent repair tissue and a small scar. CONCLUSIONS this study confirmed the safety of PRP in treating hamstring lesions in a large series of professional football players. PRP-treated lesions did not heal more quickly than untreated lesions described in the literature, but they showed a smaller scar and excellent repair tissue. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Total knee replacement in acute and chronic traumatic events.

Total knee replacement (TKR) is a widely used procedure for the treatment of post-traumatic arthritis. This type of solution has also been used recently for the treatment of acute fractures around the knee, particularly in joints that were already arthritic before the trauma. The purpose of this paper is to present our experience with TKR in both acute and chronic traumatic events, highlighting the main problems associated with these conditions and focussing on the indications, principles of technique, tips, tricks and pitfalls of this procedure. The main issues related to post-traumatic arthritis and the problem of TKR in acute fractures are discussed, and our case series of both groups of patients is presented.

Periprosthetic acetabular fractures.

PurposeThe aim of this article is to propose a diagnostic and therapeutic algorithm for the acetabular periprosthetic fractures.MethodsThis article explores the current literature on the epidemiology, causes and classification of periprosthetic acetabular fractures. Integrating data with the experience of the authors, it offers a guide to diagnosis and possible therapeutic strategies.ResultsIntra-operative fractures can occur during rasping, reaming or implant impaction, and they must be treated immediately if the component(s) is (are) unstable. Post-operative fractures can be due to major trauma (acute fractures) or minor forces in bone osteolysis; it is possible to plan reconstruction and fixation according to fracture characteristics. Treatment choice depends upon fracture site and implant stability.ConclusionsPeriprosthetic acetabular fractures are uncommon complications that can occur intra-operatively or post-operatively, and a reconstructive surgeon must be able to manage the procedure. Accurate planning and reconstruction implant are necessary to achieve good cup stability.

MODULUS Stem for Developmental Hip Dysplasia: Long-term Follow-up

Between October 2001 and December 2010, 143 patients with developmental dysplasia underwent hip arthroplasty surgery using a conical stem with modular necks (MODULUS system, Lima Corporate, Villanova di San Daniele del Friuli, Italy). Thirty (21.0%) patients had both hips replaced, for a total of 173 implants. The mean age at the time of surgery was 55 years (range: 22-81 years). The mean follow-up was 87 months (range: 36-146 months); average Harris Hip Score increased from 42 (range: 23-65) preoperatively to 92 (range: 76-100) at the last follow-up. Stem revision was required in two cases. The MODULUS stem showed good long-term clinical and radiographic results, with a Kaplan-Meier survivorship of 97.6% (95% CI: 94.8-100.0%) at 8 years.

La protesizzazione nelle fratture laterali del femore prossimale

In case of extracapsular hip fractures, whatever the anatomic type, internal fixation is currently the standard approach. Hip conical modular implants are an excellent alternative to osteosynthesis in old patients with unstable trochanteric fractures, rheumatoid arthritis or end-stage osteoarthritis with substantial hip symptoms before fracture, or like rescue procedure in the failure of osteosynthesis.

Comment on: Modular titanium alloy neck failure in total hip replacement

To the Editor of the SICOT-J Orthopaedic Journal, I am writing to you as I would like to kindly express some considerations on the case-report of Dr. Marco Ceretti on ‘‘Modular titanium alloy neck failure in total hip replacement’’ published in your on-line journal last April (M. Ceretti and F. Falez SICOT J 2016, 2, 20). The Authors report on ‘‘a case of a repetitive modular femoral neck prosthesis fracture’’; they had initially revised a broken modular Metha stem with a MODULUS stem, neck 135 long, head 36 medium in a 43-year-old woman with body mass index (BMI) 38.6 kg/m (weight 110 kg, height 170 cm); both stems presented modular necks in titanium alloy. The MODULUS stem was then revised with a Wagner monoblock uncemented titanium stem following the fracture at the neckstem junction. This article reports a clinical case but it does not include any laboratory evidence in terms of fracture analysis to support the Authors’ conclusions and to elucidate the mechanisms of failure. No retrieval analysis on the two stems seems to have been in fact carried out, such as standard macroscopic inspection and observations, standard corrosion testing, micro analysis of the implant alloy, light microscopy, Scanning Electron Microscopy (SEM) and patient’s blood sample to check the release of metal ions. Besides, several publications nowadays report comparative analysis of cobalt-chromium and titanium modular femoral necks, showing that the first material present ‘‘improved resistance against fretting’’ with ‘‘lower incidence of surface micromotions’’ (e.g. [1, 2]). Nevertheless, the fracture of these two modular necks should be attributable to an error of indication and not to a failure of the devices themselves, meant to be used in patients with lower BMI. The surgical technique of the MODULUS stem reports:

Knee: Multiligament Injuries

Knee ligament injuries can be considered a common lesion due to increased participation in football. Multiligament knee injuries result in disruption of at least two of the major ligaments of the knee and may lead to significant chronic laxity and functional instability. Decision-making often is based on each individual’s pre-injury function and the extent of the ligament damage. Several studies have suggested that patients receiving operative treatment will result in improved functional outcomes when compared with non-operative treatment. The timing of surgery is critical, and evidence exists showing that if surgery is performed as soon as possible after the injury, the results are satisfactory.

Protesi di ginocchio in acuto

Total knee arthroplasty is a reliable solution not only for the primary arthritic knee but also for severe knee fractures, either affected by osteoarthritis or not, or in case of severe bone loss in young patients. In this paper we present our experience and we suggest different technical solutions related to different segmental bones involved.

Ceramic-Ceramic Bearing in Difficult Hips (Primary and Revision)

The primary goal of total hip arthroplasty (THA) is to provide the patient with end-stage arthritis of the hip with a long-lasting, pain-free, functional hip joint.

Il ruolo del PRP nel trattamento delle lesioni muscolari in atleti di alto livello

Le lesioni dell’apparato muscolo-scheletrico rappresentano una causa importante di assenza dalle competizioni negli gli atleti professionisti. In particolare le lesioni muscolari presentano un’incidenza variabile dal 10 al 55% di tutti i traumi e si rendono complessivamente responsabili della maggior parte dei giorni di assenza dall’attivita sportiva negli atleti professionisti. In ambito muscolare il PRP ha dato buoni risultati in studi in vitro e in modelli animali, mentre nell’uomo si e di fronte ad una carenza di dati a causa delle restrizioni WADA che ne hanno proibito l’utilizzo fino all’anno 2010. Lo scopo del nostro studio e stato quello di valutare l’efficacia del PRP nel trattamento delle lesioni muscolari in atleti di alto livello. Abbiamo trattato 21 pazienti per un totale di 38 lesioni, di cui 35 di II grado e 3 di III grado. Le iniezioni sono state effettuate a distanza di 7-10 giorni l’una dall’altra, monitorando il processo di guarigione tramite Risonanze Magnetiche effettuate prima dell’applicazione, a 14 e 21 giorni dalla prima iniezione. Abbiamo ottenuto un tempo medio di guarigione di 26.74 giorni per le lesioni di II grado e di 36 giorni per le lesioni di III grado; rigenerazione tessutale, diminuzione del dolore dopo la prima applicazione e assenza di cicatrice fibrotica in tutti i casi; recidiva in un caso e seconda lesione nello stesso muscolo ma in sede diversa in 5 casi. Il vantaggio non e stato solamente in termini di tempo di guarigione delle lesione ma anche in termini di qualita del tessuto rigenerato. Il PRP rappresenta quindi una possibile opzione terapeutica per stimolare ed accelerare la guarigione e la rigenerazione del tessuto muscolare. Vista anche la carenza di dati in letteratura, a nostro avviso il suo uso merebbe ulteriori indagini tramite studi multicentrici che potranno fornire maggiori informazioni circa le sue potenzialita.