Search

Lo studio della cinematica articolare del ginocchio protesizzato, a distanza di più di 70 anni dai primi interventi di artroprotesi dell’articolazione, rappresenta, ancora oggi, un campo di ricerca di estremo interesse ed in continua evoluzione e valutazione sia dal punto di vista ortopedico che ingegneristico. Diverse tecniche sono descritte in letteratura per valutare la biomeccanica della protesi come la chirurgia assistita da navigatore, ma la recente tecnologia “RSA”, sviluppata nel 1972 a Lund (Svezia), risulta la più accurata. Nella seguente dissertazione, redatta in collaborazione con il gruppo di ricerca del Laboratorio di Biomeccanica e Innovazione Tecnologica dell’Istituto Ortopedico Rizzoli di Bologna e dall’Università di Bologna, è stato studiata, in vivo e sotto carico, la cinetica articolare del ginocchio protesizzato attraverso il suo studio cinematico intraoperatorio mediante navigatore e post-operatorio mediante tecnica RSA a 2,5 anni di follow up. Il protocollo di studio comprendeva una valutazione cinematica intraoperatoria, un valutazione clinica ed una valutazione radiologica post-operatoria tramite tecnica RSA dinamica effettuata presso gli ambulatori dell’Istituto Ortopedico Rizzoli di Bologna. La valutazione intraoperatoria è stata effettuata utilizzando un sistema di chirurgia navigata, la valutazione clinica, composta da un esame obiettivo ortopedico ed un questionario, ha permesso di ottenere dati utili alla costruzione di score quali Knee Society Score clinico (KSSc), Knee Society Score funzionale (KSSf) e VAS ed infine la valutazione radiografica post-peratoria è stata condotta mediante l’utilizzo di un macchinario per RSA dinamica e si è avvalsa di un software dedicato. Scopo dello studio è stato quello di analizzare la cinematica intra operatoria mediante il sistema di navigazione e la cinematica post-operatoria mediante tecnica di RSA dinamica durante l’esecuzione di comuni task motori quali discesa di uno scalino, alzata dalla sedia e passo e di correlare i dati intraoperatori con quelli post-operatori ottenuti., The study of the joint kinematics of the knee prosthesis, after more than 70 years from the first measures of joint arthroplasty, is still today a very interesting research field in continuous evolution and evaluation both from an orthopedic and engineering point of view. Several techniques are described in the literature to evaluate the biomechanics of the prosthesis as a navigator assisted surgery, but the recent "RSA" technology, developed in 1972 in Lund (Sweden), is the most accurate. In the following essay, written in collaboration with the research group of the Laboratory of Biomechanics and Innovation Technological Rizzoli Orthopaedic Institute of Bologna and the University of Bologna, he has been studied in vivo and under load, the prosthetic knee joint kinetics through its kinematic study using intraoperative navigation system and postoperative using RSA technique to 2.5 years of follow up. The study protocol included a kinematics intraoperative assessment, a clinical evaluation and postoperative radiographic evaluation performed by RSA dynamic technique at the clinics Rizzoli Orthopaedic Institute of Bologna. The intraoperative evaluation was performed using a navigated surgery system, clinical assessment, consisting of an orthopedic physical examination and a questionnaire, it has resulted in data useful to the construction of a clinical score as Knee Society Score (KSSC), functional Knee Society Score (KSSf) and VAS and finally the post-postoperative radiographic evaluation it was conducted through the use of a machine for RSA dynamic and has made use of a dedicated software. Aim of the study was to analyze the kinematic operating intra using the navigation system and the postoperative kinematics using RSA dynamic technique when performing common tasks such engines descent stepped, got up from the chair and step and to correlate intraoperative data with post-operative obtained.

Purpose The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction. Methods All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank. Lysholm score was administered to patients that met inclusion criteria. In addition, patients were divided in two groups based on the donor age ( Results Fifty-two patients were evaluated at a mean 4.8 ± 0.8 years follow-up with Lysholm score. The Lysholm significantly improved from 62.3 ± 6.6 at preoperative status to 84.4 ± 12.3 at final follow-up. The mean donor age was 48.7 ± 8.4 years; a significant difference in Lysholm score was noted between patients that received an allograft with a donor age Conclusion Donor age of nonirradiated Achilles tendon allograft influenced the mid-term results of revision ACL reconstruction, thus advising the use of grafts from young donors. Level of Evidence Level III, retrospective comparative study.

The purposes of this paper are to summarize the concepts relating to the use of a combined intra-articular and extra-articular reconstructive procedure in the arthroscopic treatment of a torn ACL and to review several operative techniques utilizing gracilis and semitendinosus tendons that are currently in use to treat this instability. The highly satisfactory results obtained over the time show that a combination of intra- and extra-articular procedures for ACL reconstruction is a valid surgical option.

PURPOSE: Good clinical results have been demonstrated in numerous clinical studies using the collagen meniscus implant (CMI); however, the MRI behaviour of the scaffold, evaluated with Genovese score, is limited to a few cases series. The purpose was to evaluate, using the Genovese score, the MRI behaviour of the CMI at different follow-up periods and investigate possible differences in the behaviour of lateral and medial CMI. METHODS: A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using various combinations of the following keywords: "collagen meniscus implant" or "collagen meniscal implant". All the studies evaluating medial or lateral CMI using Genovese score for MRI were included in the systematic review. RESULTS: Six studies have been included in the systematic review, with no RCT's. The pooled number of patients involved in CMI surgery was 194 (83 % medial and 17 % lateral), with a mean age at surgery of 37.7 years. Concomitant procedures raged from 11 to 52 %. CMI morphology was grade 1 in 0, 2.7, 5.9, 0, 16.7 %, respectively, at 6 months, 1, 2, 5, 10 years. It was grade 2 in 12.5, 60.9, 60.3, 74.4, 75 %, respectively, at 6 months, 1, 2, 5, 10 years and grade 3 in 87.5, 36.4, 33.8, 25.6, 8.3 % at the same time points. CMI signal intensity was grade 1 in 80, 18.2, 25, 11.1, 22.2 %, respectively, at 6 months, 1, 2, 5, 10 years. It was grade 2 in 20, 78.2, 54.7, 55.6, 66.7 %, respectively, at 6 months, 1, 2, 5, 10 years and grade 3 in 0, 3.6, 20.3, 33.3, 11.1 % at the same time points. Slight differences were found between medial and lateral CMI in size and signal intensity. CONCLUSIONS: Higher rates of scaffolds with reduced size and with an MRI signal intensity more similar to normal meniscus were reported at longer follow-up compared with initial evaluations. Correlation between MRI findings and gross CMI appearance has not been reported. LEVEL OF EVIDENCE: IV.