Matteo Ricci

One-stage Posterior Decompression-Stabilization and Trans-sacral Interbody Fusion after Partial Reduction for Severe L5-S1 Spondylolisthesis

Study Design. A retrospective clinical study was conducted. Objectives. To evaluate the clinical and radiologic outcomes of one-stage posterior decompression-stabilization after partial reduction and trans-sacral interbody fusion with a titanium cage for severe L5–S1 spondylolisthesis. Summary of the Background Data. Trans-sacral interbody fusion for the management of severe L5–S1 spondylolisthesis with or without partial reduction and pedicular fixation has been previously described. The use of a trans-sacral titanium cage has not been previously reported. Methods. Fifteen patients with severe L5–S1 spondylolisthesis were treated consecutively with posterior decompression, partial reduction, pedicular fixation, and posterior lumbar interbody fusion using a trans-sacral titanium cage. The mean age at the time of surgery was 22.4 years (range, 11–37 years). The mean follow-up period was 31.4 months (range, 12–58 months). Nine patients had severe back pain and six patients radicular pain. Three patients had a partial unilateral L5 motor deficit and two an L5 sensory deficit. Five patients had extremely tight hamstrings. The mean preoperative percentage of slipping was 69.3% (range, 53–91%). Patients were evaluated for complications and fusions, and outcomes were collected using the modified Scoliosis Research Society Outcomes Instrument. Results. At follow-up, all patients, except one with major vascular complications, were extremely or reasonably satisfied with the surgery. All patients showed improvements in radiologic indexes and stable fusion at the final follow-up examination. Conclusions. Posterior decompression and partial reduction followed by circumferential stabilization performed in one stage combining pedicle fixation with trans-sacral titanium cage interbody fusion is an effective and safe technique for the management of severe spondylolisthesis.

Clinical and radiologic outcomes of total knee arthroplasty using the Advance Medial Pivot prosthesis. A mean 7 years follow-up

BACKGROUND Medial Pivot total knee prosthesis has been designed according to studies on normal knee kinematics aiming to replicate physiological knee movement. The purpose of this study was to evaluate clinical and radiologic results of the Advance Medial Pivot Total Knee Arthroplasty, at a mean follow-up of seven years. METHODS One hundred seventy two Medial Pivot total knee arthroplasties in 160 consecutive patients have been evaluated using the American Knee Society Score and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Statistical analysis was performed using the Students t-test and the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test in order to evaluate the significance of differences within the groups of patients. Patients compliance was 93.75% thus only six patients (3.75%) lost to follow-up and four patients (2.5%) died for reasons unrelated to the surgery. RESULTS The mean Knee Society score and range of motion was improved from 77.6 points and 97.7° to 152.8 points and 112.5° respectively (p<.001). In total 85.8% and 82.4% of the knees had an excellent (≥ 80) or good (70-79) functional and knee scores respectively. Relief of pain was satisfactory in 88.9% of the patients, while 96% of the patients return to age-related daily life activities. Stability and comfort during walking was subjectively judged by the patients as satisfactory in about 90%. Anterior knee pain was observed in eight patients (5.4%). The Kaplan-Meier survivorship analysis showed a cumulative success rate of 98.6%. CONCLUSIONS The results are encouraging but longer follow-up of this cohort is necessary in the study of this specific design. Level of evidence IV.

Autologous chondrocyte implantation: Prospective MRI evaluation with clinical correlation

PurposeThis study was done to assess the progression of cartilage repair after autologous chondrocyte implantation (ACI) with magnetic resonance imaging (MRI) and to correlate the findings with the clinical outcome.Materials and methodsForty-one patients (mean age 30 years) affected by chondral defects of the knee (27 patients) and ankle joint (14 patients) who underwent arthroscopic autologous osteochondral grafting were studied 6 months and 1 year postoperatively with MRI. Cartilage repair after chondrocyte implantation was studied by assessing the degree of defect filling, graft integration, graft signal intensity, integrity of the subchondral lamina and trabecular oedema underneath the graft. MR findings were correlated with clinical data.ResultsPostoperative MRI evaluation at 6 months demonstrated complete filling of the osteochondral defect in 12/41 cases, complete integration in 18/41, mild hyperintensity in 28/41, intact subchondral lamina in 38/41 and trabecular oedema in 11/41. Postoperative MRI evaluation at 1 year demonstrated complete filling of the osteochondral defect in 9/41 patients, complete integration in 22/41, mild hyperintensity in 23/41, intact subchondral lamina in 36/41 and trabecular oedema in 8/41. Filling of the osteochondral defect and incomplete integration, nonintact subchondral lamina, high signal intensity and absence of oedema were found to correlate with worse clinical-functional outcomes.ConclusionsMRI shows direct prognostic signs of the clinical outcome of ACI.RiassuntoObiettivoValutare con risonanza magnetica (RM) l’evoluzione dell’impianto di cartilagine autologa nelle lesioni condrali e correlare i dati con i risultati clinici.Materiali e metodiSono state esaminate con RM a sei mesi ed un anno dall’intervento, 41 lesioni cartilaginee del ginocchio (27) e tibio-tarsiche (14), trattate per via artroscopica con impianto di condrociti autologhi su supporto tridimensionale di acido ialuronico. L’evoluzione dell’impianto è stata studiata analizzando il grado di colmatura del difetto osteocondrale, il grado di integrazione, l’intensità di segnale della cartilagine trapiantata, l’integrità della lamina corticale subcondrale e l’edema trabecolare. Tutti i dati sono stati correlati con la clinica.RisultatiA sei mesi: completo grado di colmatura in 12/41 pazienti, integrazione completa dell’impianto in 18/41, modesta iperintensità del segnale in 28/41, lamina subcondrale intatta in 38/41, edema trabecolare in 11/41. Ad un anno: completo grado di colmatura in 9/41 pazienti, integrazione completa dell’impianto in 22/41, modesta iperintensità del segnale in 23/41, lamina subcondrale intatta in 36/41, edema trabecolare in 8/41. Il grado di colmatura e di integrazione incompleti, la lamina subcondrale non intatta, l’iperintensità del segnale e l’assenza di edema sono risultati correlare con i risultati clinico-funzionali peggiori.ConclusioniLa valutazione RM presenta elementi prognostici in termini di buon attecchimento dell’impianto.

Preoperative autologous blood donation in primary total knee arthroplasty: critical review of current indications

Preoperative autologous blood donation (PABD) is a well established transfusion practice in elective orthopaedic surgery, involving immunologic and infective advantages but also involving exposure to not negligible risks, and costs as well. The aim of this study was to assess the real need for blood transfusions in primary total knee arthroplasty (TKA). Between January 2000 and July 2005, 214 patients underwent primary unilateral TKA. Altogether, 416 autologous blood units were collected, however only 47 (11.3%) were transfused. Thirty-eight patients (17.8%) received autologous blood, while 4 of them (10.5%) also received allogeneic blood. Based on the results of this study, PABD should be recommended in well selected patients undergoing TKA: older female patients with a low basal haemoglobin level.

A clinical and radiological study of biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tears

Total knee replacement is a common treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty. As in the prosthetic hip a gradual transition from cemented to uncemented fixation techniques occurred over time, increasing interest is growing also around cementless knee fixation, with the theoretical advantages of preserving the bone stock and obtaining a biological fixation avoiding cement fragmentation. On the basis of the actual knowledge, the uncemented knee prosthesis represents an interesting alternative especially for the patient under 65 years of age, with viable bone quality, in which a biological bone-prosthesis fixation is desirable, while avoiding the drawbacks of cement fragmentation and of the possible future revision of a cemented implant. However the weak link remains the tibial fixation, so that technical tips are important to avoid micromovements with subsequent lack of osteointegration. In our experience, gap balancing, mobile bearings and no haemostatic tourniquet well combine with this kind of implant.Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

Evolution of TKA design

Background and aim of the work : The international literature and analysis of the prosthetic registers highlight a significant relationship between the alignment of the components and the survival of prosthetic implants of the knee. The patient specific instrumentation (PSI) technology exploits the data obtained with the MRN for the production of cutting blocks (CB) useful to a TKA. Revisiting the recent international literature, comparing the results of the conventional method and PSI, numerous studies confirm a statistically significant difference of inliers (± 3 degrees) for HKA. The purpose of this retrospective study was to investigate whether these statistically significant difference is also present in our group. Methods : Postoperative radiographic measures of alignment based on a mechanical limb axis (hip-knee-ankle angle, HKA) of 180° were sought. A range of 180° ± 3° varus/valgus was defined as optimal for mechanical axis. Results: The percentage of knees that had a HKA within ±3° of the desired value was 92.2. Conclusion: the CB did accurately produce the desired HKA. The PS system is an effective and reproducible, whose organizational effort is fully justified.

An unusual case of osteochondritis dissecans of the medial tibial plateau

Abstract We report the case of a 17-year-old boy with osteochondrosis of the medial tibial plateau treated with reasorbable screw. This is an unusual location for osteochondritis dissecans, a pathologic process resulting from ischemic necrosis and characterized by the detachment of a fragment of the cartilage together with the subchondral bone of the articular surface. The lesion may be located in many joints, most frequently in the knee, close to lateral side of the articular surface of the medial femoral condyle.