31 research outputs found
Surgical treatment of a rare isolated bilateral agenesis of anterior and posterior cruciate ligaments.
The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments
IS PRINCIPAL COMPONENT ANALYSIS MORE EFFICIENT TO DETECT DIFFERENCES ON BIOMECHANICAL VARIABLES BETWEEN GROUPS?
The biomechanical analysis investigates variables such as angles, inter-segmental forces and moments at the joints. When the relevant parameters (e.g., range of motion, peak values) are selected a priori from these variables, they could not perfectly represent the information content of the original dataset. Therefore, in this study we want to validate the efficacy of the Principal Component Analysis (PCA) in overcoming the limitations of the a priori selection of the parameters. An application study is reported; the lower-limb joint mechanics between patients operated with two different surgical techniques for a total hip
arthroplasty are analyzed with both the traditional analysis and the PCA. The findings from the two methods converged, but the PCA identified new sources of variability not previously detected
A VIRTUAL CRANKSHAFT THIGH MODEL TO ESTIMATE TIBIAL-FEMORAL TRANSVERSE PLANE KINEMATICS
Sports injuries often require a thorough evaluation of the knee that includes transverse plane measurements, which are difficult to measure accurately using motion capture. We have developed a method to estimate thigh position modelling the lower limb as a modified slider-crank mechanism. Our model does not rely on cutaneous thigh markers; its motion is defined by a functionally determined hip joint center and constrained distally to the tibial plateau. Motion capture was used to acquire normal gait and countermovement jump data from three unimpaired subjects. The transverse plane translations and rotation along with frontal plane rotation estimated by our model were shown to be reflective of those reported in literature. Our slider-crank model of the pelvis-femur-tibia complex has been demonstrated to perform well in both low and high impact motions
Kyphoplasty vs conservative treatment: a case-control study in 110 post-menopausal women population. Is kyphoplasty better than conservative treatment?
Abstract. – OBJECTIVE: Osteoporosis is a
highly prevalent disease worldwide. Consequences
of vertebral osteoporotic fractures include
pain and progressive vertebral collapse
resulting in spinal kyphosis, decreased quality
of life, disability and mortality. Minimally invasive
procedures represent an advance to the treatment
of osteoporotic VCFs. Despite encouraging
results reported by many authors, surgical intervention
in an osteoporotic spine is fraught with
difficulties. Advanced patients age and comorbidities
are of great concern.
PATIENTS AND METHODS: We designed a
retrospective case-control study on 110 postmenopausal
women consecutively visited at our
institution. Study population was split in a surgical
and a conservative cohort, according to the
provided treatment.
RESULTS: Kyphoplasty treated patients had
lower back pain VAS scores at 1 month as compared
with conservatively treated patients (p <
0.05). EQ5D validated questionnaire also showed
a better quality of life at 1 month for surgically
treated patients (p < 0.05). SF-12 scores showed
greater improvements at 1 month and 3 months
with statistically significant difference between
the two groups just at 3 months (p < 0.05). At 12
months, scores from all scales were not statistically
different between the two cohorts, although
surgically treated patients showed better trends
than conservatively treated patients in pain and
quality of life. Kyphoplasty was able to restore
more than 54.55% of the original segmental
kyphosis, whereas patients in conservative cohort
lost 6.67% of the original segmental kyphosis
on average.
CONCLUSIONS: Kyphoplasty is a modern
minimal invasive surgery, allowing faster recovery
than bracing treatment. It can avoid the deformity
in kyphosis due to VCF. In fact, the risk
to develop a new vertebral fracture after the first
one is very high
Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures
The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32–56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for ≥6, ≥9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained ≥50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy
Amelogenin-Derived Peptides in Bone Regeneration: A Systematic Review
Amelogenins are enamel matrix proteins currently used to treat bone defects in periodontal surgery. Recent studies have highlighted the relevance of amelogenin-derived peptides, named LRAP, TRAP, SP, and C11, in bone tissue engineering. Interestingly, these peptides seem to maintain or even improve the biological activity of the full-length protein, which has received attention in the field of bone regeneration. In this article, the authors combined a systematic and a narrative review. The former is focused on the existing scientific evidence on LRAP, TRAP, SP, and C11's ability to induce the production of mineralized extracellular matrix, while the latter is concentrated on the structure and function of amelogenin and amelogenin-derived peptides. Overall, the collected data suggest that LRAP and SP are able to induce stromal stem cell differentiation towards osteoblastic phenotypes; specifically, SP seems to be more reliable in bone regenerative approaches due to its osteoinduction and the absence of immunogenicity. However, even if some evidence is convincing, the limited number of studies and the scarcity of in vivo studies force us to wait for further investigations before drawing a solid final statement on the real potential of amelogenin-derived peptides in bone tissue engineering
Quadriceps muscles activity during gait: comparison between PFPS subjects and healthy control
Purpose
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
Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study.
The aim of this study was to investigate the shape and the attachments of the medial patellofemoral ligament (MPFL) in cadaver specimens to determine an anatomical basis for the best MPFL reconstruction.
METHODS:
Twenty fresh-frozen knees were used. Dissection protocol implied performing dissections from within the knee joint. We investigated the shape and the attachments between the MPFL and the quadriceps tendon, the patellar and femur insertions, and all the other relationships with the medial soft tissues of the knee.
RESULTS:
The distal fibers of MPFL were interdigitated with the deep layer of the medial retinaculum. All isolated ligament had a sail-like shape with the patellar side bigger than the femoral side. The femoral insertion, distinct both from medial epicondyle and adductor tubercle, was located at 9.5 mm (range 4-22) distal and anterior respect to adductor tubercle and proximal and posterior to epicondyle. The medial third of the thickness of patella was involved in the insertion. The proximal third of the patella is always involved in the MPFL attachment; in 45% of the cases, it was extended to the medial third and in one case, an extension at the distal third was found. Additionally in 35% (7 cases), it extended to the quadriceps tendon and it were inconstantly attached at the vastus medialis obliques (VMO) tendon and at the vastus intermedius (VI) tendon in an aponeurotic structure.
CONCLUSIONS:
The MPFL is a distinct structure that goes from patella to femur with a sail-like shape; its patellar insertion, that mostly occur via an aponeurosis tissue with VMO and VI, is at the proximal third of the patella but it may extend in some cases to the medial third patella or to the quadriceps tendon, or very rarely to the distal third of the patella. In the femoral side, the MPFL is inserted in its own site, in most cases distinct both from epicondyle and adductor tubercle, located on average at a 9.5 mm distance distally and anteriorly in respect to the adductor tubercle. Its lower margin was difficult to define. Given the importance of this structure, it must be reconstructed as anatomically as possible in its insertion and in its shape. Many attempts have been made to make functional reconstructions with less than excellent results
EBM: VALUTAZIONE DELLO SPORTIVO
IL RITORNO ALLO SPORT NELLA PATOLOGIA ARTICOLARE DEL GINOCCHIO E' UN ARGOMENTO ATTUALISSIMO E IN CONTINUA EVOLUZIONE
Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic
The purpose of our study was that to systematically
review the fixation techniques for the ACL
reconstruction and associated clinical outcomes at the early
follow-up. Systematic search on three electronic databases
(Cochrane register, Medline and Embase) of fixation
devices used for primary ACL reconstruction with doubled
semitendinosus and gracilis and bone\u2013patellar tendon\u2013bone
autografts in randomized clinical trials of level I and II of
evidence published from January 2001 to December 2011.
Therapeutic studies collected were with a minimum 12-
month follow-up, and the clinical outcomes were evaluated
by at least one of International Knee Documentation
Committee, Lysholm and Tegner functional scales and at
least one of the following knee stability tests: arthrometric
AP tibial translation, Lachman test and pivot-shift test.
Nineteen articles met the inclusion criteria. At the femoral
side cross-pin, metallic interference screw, bioabsorbable
interference screw, and suspensory device were used in
32.3, 27.3, 24.8, 15.5 % of patients, respectively. At the
tibial side fixation was achieved with metallic interference
screw, bioabsorbable interference screw, screw and plastic
sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and
1.7 % of patients, respectively. Side-to-side anterior\u2013
posterior tibial translation was 1.9 \ub1 0.9, 1.5 \ub1 0.9,
1.5 \ub1 0.8, 2.2 \ub1 0.4 mm for metallic interference screw,
bioabsorbable screw, cross-pin and suspensory device,
respectively. At least two-third of all the patients achieved
good-to-excellent clinical outcomes. Rate of failure was
6.1, 3.3, 1.7 and 1.2 % for bioabsorbable interference
screw, metallic interference screw, cross-pin and suspensory
device, respectively. Clinical outcomes are good to
excellent in almost two-third of the patients but several
pitfalls that affect the current fixation techniques as graft
tensioning such as graft-tunnel motion are still
unaddressed