Giovanni Alfonso Borelli: The precursor of medial pivot concept in knee biomechanics

A new philosophy of science and medicine had spread throughout the 17th-century Italy: the "Scientific Revolution." Giovanni Alfonso Borelli (1608-1679) was one of the most charismatic and brilliant scientists of his generation in Europe. He extended to biology the rigorous analytic methods developed by his indirect mentor Galileo in the field of mechanics. In his masterpiece " De Motu Animalium ," Borelli analyzed structure, motion, balance, and forces concerning almost all the principal joints of the human body, in static and dynamic situations. In particular, he accurately studied the anatomy and biomechanics of the knee joint. He sustained that femoral condyles shift backward during flexion, allowing a wider range of movement. Furthermore, he observed that, when the knee flexes, the lateral condyle moves backward more than the medial condyle: this concept is nowadays known as medial pivoting. The aim of this article is to describe the life and work of this important Italian scientist and to present his unrecognized contribution to modern knee biomechanics

Quick recovery and no arthrofibrosis in acute anterior cruciate ligament reconstruction. A prospective trial of early versus delayed reconstruction

Background. Anterior cruciate ligaments tears is one of the most frequent orthopae- dics and sports medicine injuries in the athletically active population and timing of reconstruction represents a debated topic. The aim of the study is to compare range of motion (ROM) recovery and clinical outcomes between patients operated for acute reconstruction (maximum 2 weeks injury-surgery interval) and delayed reconstruction (minimum 3 weeks injury-surgery interval). Methods. A total of 52 patients were prospectively involved in the study. 26 patients underwent acute reconstruction and 26 delayed reconstruction. A standard physical examination with Lachman and Pivot shift test and a passive ROM measurement with a goniometer were performed at each follow-up (2, 4, 8, 12 and 24 weeks postoper- atively). Clinical outcomes were measured at final follow-up using Knee Injury and Osteoarthritis outcome score (KOOS), Tegner Lysholm Score and International Knee Documentation Committe (IKDC 2000) and KT-1000 evaluation. Single-leg hop test and thigh circumference measurement were performed at final follow-up. Results. Both groups showed no statistically significant differences regarding the ROM. Full ROM was achieved 12 weeks after surgery in both groups. The mean IKDC was 98.7 and 95.2; the mean Tegner Lysholm was 100 and 93.8 and the mean KOOS was 99 and 95.5 in the acute group and delayed ACLR group respectively. Conclusions. There were no differences between acute and delayed anterior cruci- ate ligament reconstruction regarding the risk of arthrofibrosis and clinical outcomes. Acute reconstruction can be performed safely with no increased risk of arthrofibrosis

Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS‑CoV‑2 pandemic: the European Hip Society and European Knee Associates Survey of Members

The COVID-19 pandemic has disrupted the health care system around the entire globe. A consensus is needed about resuming total hip and knee procedures. The European Hip Society (EHS) and the European Knee Association (EKA) formed a panel of experts that have produced a consensus statement on how the safe re-introduction of elective hip and knee arthroplasty should be undertaken. Methods A prospective online survey was done among members of EHS and EKA. The survey consisted of 27 questions. It includes basic information on demographics and details the participant’s agreement with each recommendation. The participant could choose among three options (agree, disagree, abstain). Recommendations focussed on pre-operative, perioperative, and post-operative handling of patients and precautions. Results A total of 681 arthroplasty surgeons participated in the survey, with 479 fully completing the survey. The participants were from 44 countries and 6 continents. Apart from adhering to National and Local Guidelines, the recommendations concerned how to make elective arthroplasty safe for patients and staf. Conclusion The survey has shown good-to-excellent agreement of the participants with regards to the statements made in the recommendations for the safe return to elective arthroplasty following the frst wave of the COVID-19 pandemi

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations

The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. Methods A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. Results The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. Conclusion Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe retur

Management of chronic lateral instability due to lateral collateral ligament deficiency after total knee arthroplasty: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lateral instability following total knee arthroplasty (TKA) is a rare condition with limited report of treatment options. The objective of this case presentation is to demonstrate the outcomes of different surgical procedures performed in a single patient with lateral collateral ligament (LCL) deficiency.</p> <p>Case presentation</p> <p>We present a case of chronic lateral instability due to LCL deficiency after primary TKA in a 47-year-old Caucasian woman with an obesity problem. Multiple treatment options have been performed in order to manage this problem, including the following: ligament reconstruction; combined ligament reconstruction and constrained implant; and rotating-hinge knee prosthesis that was the most recent surgery. All ligament reconstruction procedures failed within one year. The varus-valgus constrained prosthesis provided stability for six years.</p> <p>Conclusions</p> <p>Ligament reconstruction alone cannot provide enough stability for the treatment of chronic lateral instability in patients with obesity problems and LCL deficiency. When the reconstruction fails, a salvage procedure with rotating-hinge knee is still available.</p

Quality of life of homebound patients with advanced cancer: Assessments by patients, family members, and oncologists

Evaluation of quality of life (QoL) in advanced cancer patients and identification of reliable alternative sources of raters other than the patient, are important topics in a palliative care program for terminally ill patients. In order to investigate such aspects, QoL of 49 homebound cancer patients was evaluated through the Quality of Life Index (QLI) by the patients themselves, their next-of-kin and oncologists on two different occasions (2-3 weeks after admission to the home care program and four weeks later). Patients also completed the Functional Living Index for Cancer (FLIC), and relatives and oncologists filled out the Index of Independence in Activities of Daily Living (ADL-I). Significant associations, in particular on the second assessment, were shown between QLI as rated by the patient, the family and the oncologist. Nevertheless, physicians were less concordant with the patient in rating the single QLI-dimensions support and mood, as also indicated by the significant difference between physicians and patients on QLI mean scores. Signficant levels of concordance were shown between family and oncologist ratings both on QLI and ADL-I. The FLIC was associated with the QLI score, irrespective of the source of rating (the patients themselves, the family member or the oncologist), especially on the second assessment. Karnofsky scores were associated with FLIC-Physical factor and QLI-Relative, but correlations for QLI improved over time. The results indicate that in the context of a home care program, family members most involved in the assistance and, to a less degree, physicians may be helpful in assessing some aspects of the patient’s experience, particularly health and functional dimensiosn of QoL

Photoinduced Electron and Energy Transfer in Covalently Linked Supramolecular Systems

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