Author: "Di Paolo S" / Topic: business - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Di Paolo S"' showing total 24 results

Start Over Author "Di Paolo S" Topic business

24 results on '"Di Paolo S"'

1. Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Author: Nordio, M., Reboldi, G., Di Napoli, A., Quintaliani, G., Alberici, F., Postorino, M., Aucella, F., Messa, P., Brunori, G., Bosco, M., Malberti, F., Mandreoli, M., Mazzaferro, S., Movilli, E., Ravera, M., Salomone, M., Santoro, D., Postorinolimido, M. A., Bonomini, M., Stingone, A., Maccarone, M., Di Loreto, E., Stacchiotti, L., Malandra, R., Chiarella, S., D'Agostino, F., Fuiano, G., Nicodemo, L., Bonofiglio, R., Greco, S., Mallamaci, F., Barreca, E., Caserta, C., Bruzzese, V., Galati, D., Tramontana, D., Viscione, M., Chiuchiolo, L., Tuccillo, S., Sepe, M., Vitale, F., Ciriana, E., Martignetti, V., Caserta, D., Stizzo, A., Romano, A., Iulianiello, G., Cascone, E., Minicone, P., Chiricone, D., Delgado, G., Barbato, A., Celentano, S., Molfino, I., Coppola, S., Raiola, I., Abategiovanni, M., Borrelli, S., Margherita, C., Bruno, F., Ida, M., Aliperti, E., Potito, D., Cuomo, G., De Luca, M., Merola, M., Botta, C., Garofalo, G., Alinei, P., Paglionico, C., Roano, M., Vitale, S., Ierardi, R., Fimiani, V., Conte, G., Di Natale, G., Romano, M., Di Marino, V., Scafarto, A., Meccariello, S., Pecoraro, C., Di Stazio, E., Di Meglio, E., Cuomo, A., Maresca, B., Rotaia, E., Capasso, G., Auricchio, M., Pluvio, C., Maddalena, L., De Maio, A., Palladino, G., Buono, F., Gigliotti, G., Mancini, E., La Manna, G., Storari, A., Mosconi, G., Cappelli, G., Scarpioni, R., Gregorini, M., Rigotti, A., Mancini, W., Bianco, F., Boscutti, G., Amici, G., Tosto, M., Fini, R., Pace, G., Cioffi, A., Boccia, E., Di Lullo, L., Di Zazzo, G., Simonelli, R., Bondatti, F., Miglio, L., Rifici, N., Treglia, A., Muci, M., Baldinelli, G., Rizzi, E., Lonzi, M., De Cicco, C., Forte, F., De Paolis, P., Grandaliano, Giuseppe, Cuzziol, C., Torre, V. M., Sfregola, P., Rossi, V., Fabio, G., Flammini, A., Filippini, A., Onorato, L., Vendola, F., Di Daniela, N., Alfarone, C., Scabbia, L., Ferrazzano, M., Grotta, B. D., Gamberini, M., Fazzari, L., Mene, P., Morgia, A., Catucci, A., Palumbo, R., Puliti, M., Marinelli, R., Polito, P., Marrocco, F., Morabito, S., Rocca, R., Nazzaro, L., Lavini, R., Iamundo, V., Chiappini, M., Casarci, M., Morosetti, M., Hassan, S., Firmi, G., Galliani, M., Serraiocco, M., Feriozzi, S., Valentini, W., Sacco, P., Garibotto, G., Cappelli, V., Saffioti, C., Repetto, M., Rolla, D., Lorenz, M., Pedrini, L., Polonioli, D., Galli, E., Ruggenenti, P., Scolari, F., Bove, S., Costantino, E., Bracchi, M., Mangano, S., Depetri, G., La Milia, V., Farina, M., Zecchini, S., Savino, R., Melandri, M., Guastoni, C., Paparella, M., Gallieni, M., Minetti, E., Bisegna, S., Righetti, M., Badalamenti, S., Alberghini, E., Bertoli, S., Fabbrini, P., Albrizio, P., Rampino, T., Colturi, C., Rombola, G., Lucatello, A., Guerrini, E., Ranghino, A., Lenci, F., Fanciulli, E., Santarelli, S., Damiani, C., Garofalo, D., Sopranzi, F., Santoferrara, A., Di Luca, M., Galiotta, P., Brigante, M., Manganaro, M., Maffei, S., Berto, I., Besso, L., Viglino, G., Cusinato, S., Chiarinottichiappero, D. F., Tognarelli, G., Gianoglio, B., Forneris, G., Biancone, L., Savoldi, S., Vitale, C., Boero, R., Filiberti, O., Borzumati, M., Gesualdo, L., Lomonte, C., Gernone, G., Pallotta, G., Di Paolo, S., Vernaglione, L., Specchio, A., Stallone, G., Dell'Aquila, R., Sandri, G., Russo, F., Napoli, M., Marangi, A., Morrone, L., Di Stratis, C., Fresu, A., Cicu, F., Murtas, S., Manca, O., Pani, A., Pilloni, M., Pistis, R., Cadoni, M., Contu, B., Logias, F., Ivaldi, R., Fancello, S., Cossu, M., Lepori, G., Vittoria, S., Battiati, E., Arnone, M., Rome, M., Barbera, A., Granata, A., Collura, G., Dico, C. L., Pugliese, G., Di Natale, E., Rizzari, G., Cottone, L., Longo, N., Battaglia, G., Marcantoni, C., Giannetto, G., Tumino, G., Randazzo, F., Bellissimo, L., Faro, F. L., Grippaldi, F., Urso, S., Quattrone, G., Todaro, I., Vincenzo, D., Murgo, A., Masuzzo, M., Pisacane, A., Monardo, P., Pontorierro, M., Quari, C., Bauro, A., Chimenz, R. R., Alfio, D., Girasole, F., Cascio, A. L., Caviglia, A., Tornese, F., Sirna, F., Altieri, C., Cusumano, R., Saveriano, V., La Corte, A., Locascio, G., Rotolo, U., Musso, S., Risuglia, L., Blanco, G., Minardo, G., Castellino, S., Zappulla, Z., Randone, S., Di Francesca, M., Cassetti, C. C., Oddo, G., Buscaino, G., Mucaria, F., Barraco, V. I., Di Martino, A., Rallo, D., Dani, L., Campolo, G., Manescalchi, F., Biagini, M., Agate, M., Panichi, V., Casani, A., Traversari, L., Garosi, G., Tabbi, M., Selvi, A., Cencioni, L., Fagugli, R., Timio, F., Leveque, A., Manes, M., Mennella, G., Calo, L., Fiorini, F., Abaterusso, C., Calzavara, P., Meneghel, G., Bonesso, C., Gambaro, G., Gammaro, L., Rugiu, C., Ronco, C., Nordio M., Reboldi G., Di Napoli A., Quintaliani G., Alberici F., Postorino M., Aucella F., Messa P., Brunori G., Bosco M., Malberti F., Mandreoli M., Mazzaferro S., Movilli E., Ravera M., Salomone M., Santoro D., PostorinoLimido M.A., Bonomini M., Stingone A., Maccarone M., Di Loreto E., Stacchiotti L., Malandra R., Chiarella S., D'Agostino F., Fuiano G., Nicodemo L., Bonofiglio R., Greco S., Mallamaci F., Barreca E., Caserta C., Bruzzese V., Galati D., Tramontana D., Viscione M., Chiuchiolo L., Tuccillo S., Sepe M., Vitale F., Ciriana E., Martignetti V., Caserta D., Stizzo A., Romano A., Iulianiello G., Cascone E., Minicone P., Chiricone D., Delgado G., Barbato A., Celentano S., Molfino I., Coppola S., Raiola I., Abategiovanni M., Borrelli S., Margherita C., Bruno F., Ida M., Aliperti E., Potito D., Cuomo G., De Luca M., Merola M., Botta C., Garofalo G., Alinei P., Paglionico C., Roano M., Vitale S., Ierardi R., Fimiani V., Conte G., Di Natale G., Romano M., Di Marino V., Scafarto A., Meccariello S., Pecoraro C., Di Stazio E., Di Meglio E., Cuomo A., Maresca B., Rotaia E., Capasso G., Auricchio M., Pluvio C., Maddalena L., De Maio A., Palladino G., Buono F., Gigliotti G., Mancini E., La Manna G., Storari A., Mosconi G., Cappelli G., Scarpioni R., Gregorini M., Rigotti A., Mancini W., Bianco F., Boscutti G., Amici G., Tosto M., Fini R., Pace G., Cioffi A., Boccia E., Di Lullo L., Di Zazzo G., Simonelli R., Bondatti F., Miglio L., Rifici N., Treglia A., Muci M., Baldinelli G., Rizzi E., Lonzi M., De Cicco C., Forte F., De Paolis P., Grandaliano G., Cuzziol C., Torre V.M., Sfregola P., Rossi V., Fabio G., Flammini A., Filippini A., Onorato L., Vendola F., Di Daniela N., Alfarone C., Scabbia L., Ferrazzano M., Grotta B.D., Gamberini M., Fazzari L., Mene P., Morgia A., Catucci A., Palumbo R., Puliti M., Marinelli R., Polito P., Marrocco F., Morabito S., Rocca R., Nazzaro L., Lavini R., Iamundo V., Chiappini M., Casarci M., Morosetti M., Hassan S., Firmi G., Galliani M., Serraiocco M., Feriozzi S., Valentini W., Sacco P., Garibotto G., Cappelli V., Saffioti C., Repetto M., Rolla D., Lorenz M., Pedrini L., Polonioli D., Galli E., Ruggenenti P., Scolari F., Bove S., Costantino E., Bracchi M., Mangano S., Depetri G., La Milia V., Farina M., Zecchini S., Savino R., Melandri M., Guastoni C., Paparella M., Gallieni M., Minetti E., Bisegna S., Righetti M., Badalamenti S., Alberghini E., Bertoli S., Fabbrini P., Albrizio P., Rampino T., Colturi C., Rombola G., Lucatello A., Guerrini E., Ranghino A., Lenci F., Fanciulli E., Santarelli S., Damiani C., Garofalo D., Sopranzi F., Santoferrara A., Di Luca M., Galiotta P., Brigante M., Manganaro M., Maffei S., Berto I., Besso L., Viglino G., Cusinato S., ChiarinottiChiappero D.F., Tognarelli G., Gianoglio B., Forneris G., Biancone L., Savoldi S., Vitale C., Boero R., Filiberti O., Borzumati M., Gesualdo L., Lomonte C., Gernone G., Pallotta G., Di Paolo S., Vernaglione L., Specchio A., Stallone G., Dell'Aquila R., Sandri G., Russo F., Napoli M., Marangi A., Morrone L., Di Stratis C., Fresu A., Cicu F., Murtas S., Manca O., Pani A., Pilloni M., Pistis R., Cadoni M., Contu B., Logias F., Ivaldi R., Fancello S., Cossu M., Lepori G., Vittoria S., Battiati E., Arnone M., Rome M., Barbera A., Granata A., Collura G., Dico C.L., Pugliese G., Di Natale E., Rizzari G., Cottone L., Longo N., Battaglia G., Marcantoni C., Giannetto G., Tumino G., Randazzo F., Bellissimo L., Faro F.L., Grippaldi F., Urso S., Quattrone G., Todaro I., Vincenzo D., Murgo A., Masuzzo M., Pisacane A., Monardo P., Pontorierro M., Quari C., Bauro A., Chimenz R.R., Alfio D., Girasole F., Cascio A.L., Caviglia A., Tornese F., Sirna F., Altieri C., Cusumano R., Saveriano V., La Corte A., Locascio G., Rotolo U., Musso S., Risuglia L., Blanco G., Minardo G., Castellino S., Zappulla Z., Randone S., Di Francesca M., Cassetti C.C., Oddo G., Buscaino G., Mucaria F., Barraco V.I., Di Martino A., Rallo D., Dani L., Campolo G., Manescalchi F., Biagini M., Agate M., Panichi V., Casani A., Traversari L., Garosi G., Tabbi M., Selvi A., Cencioni L., Fagugli R., Timio F., Leveque A., Manes M., Mennella G., Calo L., Fiorini F., Abaterusso C., Calzavara P., Meneghel G., Bonesso C., Gambaro G., Gammaro L., Rugiu C., and Ronco C.
Subjects: Male, Contextual analysis, medicine.medical_treatment, Population, 030232 urology & nephrology, Recursive partitioning, 030204 cardiovascular system & hematology, Rate ratio, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Classification tree, COVID-19, Renal replacement therapy, Risk Factors, Medical, Surveys and Questionnaires, Health care, medicine, Settore MED/14 - NEFROLOGIA, Humans, education, Pandemics, Societies, Medical, Female, Italy, Nephrology, education.field_of_study, business.industry, Multilevel model, Decision rule, Confidence interval, Original Article, Hemodialysis, business, Contextual analysi, Societies, Demography
Abstract: Background and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.
Published: 2021

2. Sirolimus for Kaposi's Sarcoma in Renal-Transplant Recipients

Author: Barbara Infante, Giuseppe Grandaliano, Giovanni Stallone, Francesco Paolo Schena, Loreto Gesualdo, Maggio G, Antonio Schena, Di Paolo S, Antonia Loverre, and Elena Ranieri
Subjects: Male, Vascular Endothelial Growth Factor A, Pathology, medicine.medical_specialty, Biopsy, medicine.medical_treatment, Protein Serine-Threonine Kinases, Lesion, Immunocompromised Host, chemistry.chemical_compound, Proto-Oncogene Proteins, medicine, Humans, Phosphorylation, Sarcoma, Kaposi, Kaposi's sarcoma, Skin, Antibacterial agent, Sirolimus, Antibiotics, Antineoplastic, medicine.diagnostic_test, business.industry, Ribosomal Protein S6 Kinases, 70-kDa, General Medicine, Middle Aged, medicine.disease, Kidney Transplantation, Vascular Endothelial Growth Factor Receptor-2, Vascular endothelial growth factor, surgical procedures, operative, Immunosuppressive drug, chemistry, cardiovascular system, Female, Sarcoma, medicine.symptom, business, Proto-Oncogene Proteins c-akt, Immunosuppressive Agents, Signal Transduction, medicine.drug
Abstract: Recipients of organ transplants are susceptible to Kaposi's sarcoma as a result of treatment with immunosuppressive drugs. Sirolimus (rapamycin), an immunosuppressive drug, may also have antitumor effects.We stopped cyclosporine therapy in 15 kidney-transplant recipients who had biopsy-proven Kaposi's sarcoma and began sirolimus therapy. All patients underwent an excisional biopsy of the lesion and one biopsy of normal skin at the time of diagnosis. A second biopsy was performed at the site of a previous Kaposi's sarcoma lesion six months after sirolimus therapy was begun. We examined biopsy specimens for vascular endothelial growth factor (VEGF), Flk-1/KDR protein, and phosphorylated Akt and p70S6 kinase, two enzymes in the signaling pathway targeted by sirolimus.Three months after sirolimus therapy was begun, all cutaneous Kaposi's sarcoma lesions had disappeared in all patients. Remission was confirmed histologically in all patients six months after sirolimus therapy was begun. There were no acute episodes of rejection or changes in kidney-graft function. Levels of Flk-1/KDR and phosphorylated Akt and p70S6 kinase were increased in Kaposi's sarcoma cells. The expression of VEGF was increased in Kaposi's sarcoma cells and even more so in normal skin cells around the Kaposi's sarcoma lesions.Sirolimus inhibits the progression of dermal Kaposi's sarcoma in kidney-transplant recipients while providing effective immunosuppression.
Published: 2005

3. Severe bicompartmental bone bruise is associated with rotatory instability in anterior cruciate ligament injury

Author: Gian Andrea Lucidi, Giacomo Dal Fabbro, Piero Agostinone, Alberto Grassi, Stefano Zaffagnini, Stefano Di Paolo, Agostinone P., Di Paolo S., Lucidi G.A., Dal Fabbro G., Grassi A., and Zaffagnini S.
Subjects: Joint Instability, medicine.medical_specialty, Knee Joint, Sports medicine, Contusions, Anterior cruciate ligament, Pivot shift, Context (language use), Bone bruise, medicine, Humans, Surgical navigation, Orthopedics and Sports Medicine, Orthodontics, Hematoma, ACL injury, Tibia, business.industry, Anterior Cruciate Ligament Injuries, medicine.disease, Biomechanical Phenomena, Bruise, medicine.anatomical_structure, Rotatory instability, Orthopedic surgery, Surgery, medicine.symptom, business
Abstract: Purpose The presence and severity of bone bruise is more and more investigated in the non-contact anterior cruciate ligament (ACL) injury context. Recent studies have advocated a correlation between bone bruise and preoperative knee laxity. The aim of the present study was to investigate the correlation between bone bruise and preoperative rotatory knee laxity. Methods Twenty-nine patients (29.1 ± 9.8 years) with MRI images at a maximum of 3 months after ACL injury (1.6 ± 0.8 months) were included. The bone bruise severity was evaluated according to the International Cartilage Repair Society (ICRS) scale for lateral femoral condyle, lateral tibial plateau, medial femoral condyle, and medial tibial plateau. The intraoperative rotational knee laxity was evaluated through a surgical navigation system in terms of internal–external rotation at 30° and 90° of knee flexion (IE30, IE90) and internal–external rotation and acceleration during pivot-shift test (PS IE, PS ACC). The KOOS score was also collected. The association between ICRS grade of bone bruise and rotational laxity or KOOS was investigated. Results Significant correlation (p 2 mm (very strong odds ratio). No kinematical differences were found between none-to-deep and extensive-generalized lateral bone bruise, while higher IE30 and IE90 were found in extensive-generalized bicompartmental bone bruise than isolated extensive-generalized lateral bone bruise. Conclusion A severe bicompartmental bone bruise was related to higher rotatory instability in the intraoperative evaluation of ACL deficient knees. The severity of edema on the medial tibial plateau was directly correlated with higher intraoperative pivot shift, and the size of edema on the lateral femoral condyle was associated with lower preoperative clinical scores. Level of evidence Level II.
Published: 2021

4. A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading

Author: Stefano Di Paolo, Francesco Della Villa, Filippo Tosarelli, Fabrizio Aggio, Stefano Zaffagnini, Alberto Grassi, Laura Bragonzoni, Di Paolo S., Zaffagnini S., Tosarelli F., Aggio F., Bragonzoni L., Grassi A., and Della Villa F.
Subjects: medicine.medical_specialty, Sports medicine, Knee Joint, Anterior cruciate ligament, Deceleration, Movement, Football, Reproducibility of Result, Return to sport, Sports Medicine, Movement assessment, Physical medicine and rehabilitation, ACL injury prevention, Soccer, Medicine, Humans, Orthopedics and Sports Medicine, Force platform, Rank correlation, business.industry, Anterior Cruciate Ligament Injurie, ACL, Anterior Cruciate Ligament Injuries, Reproducibility of Results, medicine.disease, ACL injury, Biomechanical Phenomena, 2D video analysis, medicine.anatomical_structure, Coronal plane, Surgery, Female, business, human activities, 2D video analysi, Human
Abstract: Purpose The deceleration (pressing) is a common situational pattern leading to anterior cruciate ligament (ACL) injury in football. Although mainly assessed for performance purposes, a stronger focus on movement quality might support the screening of at-risk athletes. The aim of the present study was to describe a 2D scoring system for the assessment of the deceleration task and to associate it with the knee joint loading (knee abduction moment) evaluated through the gold standard 3D motion capture. The hypothesis was that lower 2D scores would be associated with higher knee joint loading. Methods Thirty-four competitive football (soccer) players (age 22.8 ± 4.1, 16 females) performed a series of deceleration tasks. 3D motion analysis was recorded using ten stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D qualitative assessment was performed via a scoring system based on the video analysis of frontal and lateral planes joint kinematics for five scoring criteria. The intra- and inter-rater reliabilities were calculated for each 2D scoring criteria. The peak knee abduction moment was extracted and grouped according to the results of the 2D evaluation. Results An ICC > 0.94 was found for all the 2D scoring criteria, both for intra-rater and inter-rater reliability. The players with low 2D frontal plane scores and low total scores (0–4) showed significantly higher peak knee abduction moment values (p ρ = − 0.25, p Conclusions The qualitative 2D scoring system described successfully discerned between athletes with high and low knee joint loading during a deceleration task. The application of this qualitative movement assessment based on a detailed and accurate scoring system is suitable to identify players and patients with high knee joint loading (high knee abduction moments) and target additional training in the scenario of the primary and secondary ACL injury risk reduction. Level of evidence Level IV.
Published: 2021

5. Post-operative complications of tibial plateau fractures treated with screws or hybrid external fixation

Author: Nicola Pizza, Federico Raggi, M. Romagnoli, Ilaria Cucurnia, Alberto Grassi, S. Di Paolo, M. Casali, Federico Stefanelli, Stefano Zaffagnini, Stefanelli F., Cucurnia I., Grassi A., Pizza N., Di Paolo S., Casali M., Raggi F., Romagnoli M., and Zaffagnini S.
Subjects: medicine.medical_specialty, External Fixators, medicine.medical_treatment, Fracture Fixation, Internal, External fixation, Postoperative Complications, Fracture Fixation, Tibial plateau fractures, medicine, Humans, Minimally Invasive Surgical Procedures, Hybrid fixation, Orthopedics and Sports Medicine, Malunion, Post operative, Fixation (histology), Minimally invasive fixation, business.industry, Wound dehiscence, Significant difference, musculoskeletal system, medicine.disease, Surgery, Tibial Fractures, Orthopedic surgery, business, Complication
Abstract: Purpose: To assess the complications and second surgeries rates at 1year follow-up in a group of patients underwent minimally invasive fixation with screws or hybrid external fixation (HEF) for tibial plateau fractures (TPF). The hypothesis was that low Schatzker (I–IV) TPF would have shown a lower complication rate with respect to high Schatzker (V–VI) TPF. Methods: 148 patients who underwent minimally invasive surgery with screws or HEF for TPF were included and pooled in two groups: mono-condylar (Schatzker I–IV) and bi-condylar (Schatzker V–VI). The rate of second surgeries and complications, such as stiffness, infection, wound dehiscence and malunion occurred within 1year, were reported. Results: Statistically significant difference between mono-condylar and bi-condylar groups was found in terms of stiffness (18% vs. 37%, p = 0.01), malunion (4% vs 21%, p = 0.004) and second surgeries (32% vs. 48%, p = 0.049). Associated procedures performed during TPF fixation increased risk of second surgeries (OR 2.1, p < 0.001). No differences in terms of second surgeries and complications were found in bi-condylar group treated with screws and HEF. Conclusion: Bi-condylar TPF treated with minimally invasive surgery developed a significantly higher rates of stiffness, malunion and second surgeries within 1year compared to mono-condylar fractures. Moreover, when an associated procedure was performed, the risk of a reoperation was nearly doubled. Trial registration number PG 0012506 CE AVEC 620/2018/Oss/IOR.
Published: 2021

6. Causes of stiffness after total knee arthroplasty: a systematic review

Author: Amit Meena, Domenico Alesi, Stefano Zaffagnini, Raffaele Zinno, Laura Bragonzoni, Giuseppe Barone, Nicola Pizza, Stefano Di Paolo, Zaffagnini S., Di Paolo S., Meena A., Alesi D., Zinno R., Barone G., Pizza N., and Bragonzoni L.
Subjects: Male, musculoskeletal diseases, medicine.medical_specialty, Total knee arthroplasty, Pain, 03 medical and health sciences, Strength of evidence, 0302 clinical medicine, Humans, Medicine, Orthopedics and Sports Medicine, Clinical significance, Arthroplasty, Replacement, Knee, Male gender, 030203 arthritis & rheumatology, 030222 orthopedics, business.industry, Stiffness, musculoskeletal system, Systematic review, Orthopedic surgery, Stiffne, Physical therapy, Surgery, medicine.symptom, business, Surgical robot
Abstract: Background: Knee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients’ expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically review the literature regarding the main causes of stiffness after TKA. Methods: Pubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for studies on stiffness and pain or discomfort after TKA through November 2020. Overall, 25 articles matched the selection criteria and were included in the study. Clinical relevance and strength of evidence of the included studies were graded using the risk of bias and the methodological index for non-randomized studies quality assessment tools. Results: The main causes of pain and discomfort due to stiffness were surgery-related issues, i.e., component malpositioning and over-voluming, implant loosening, psychological distress, and obesity, which could be considered “modifiable” factors, and expression of profibrotic markers, high material hypersensitivity-related cytokines level, male gender, previous contralateral TKA, and high pre-operative pain, which could be considered “non-modifiable” factors. Conclusion: The use of alternative technologies such as surgical robots, anatomy-based devices, and more inert and less stiff component materials could help in reducing stiffness caused by both modifiable and even some non-modifiable factors. Furthermore, early diagnostic detection of stiffness onset could consistently support surgeons in patient-specific decision-making.
Published: 2021

7. Knee position at the moment of bone bruise could reflect the late phase of non-contact anterior cruciate ligament injury rather than the mechanisms leading to ligament failure

Author: Alberto Grassi, Stefano Zaffagnini, Laura Bragonzoni, Luca Macchiarola, Piero Agostinone, Gian Andrea Lucidi, Gregorio Marchiori, Marco Bontempi, Stefano Di Paolo, Grassi A., Agostinone P., Di Paolo S., Lucidi G.A., Macchiarola L., Bontempi M., Marchiori G., Bragonzoni L., and Zaffagnini S.
Subjects: musculoskeletal diseases, Bone edema, Knee Joint, Contusions, Anterior cruciate ligament, Biomechanic, Squat, In-vivo kinematic, Bone bruise, Injury mechanism, 03 medical and health sciences, 0302 clinical medicine, RSA, Cadaver, medicine, Humans, Knee, Biomechanics, Orthopedics and Sports Medicine, Tibia, Anterior Cruciate Ligament, Range of Motion, Articular, Orthodontics, Subluxation, ACL injury, 030222 orthopedics, biology, business.industry, Anterior Cruciate Ligament Injurie, Anterior Cruciate Ligament Injuries, 030229 sport sciences, musculoskeletal system, biology.organism_classification, medicine.disease, Biomechanical Phenomena, body regions, Valgus, medicine.anatomical_structure, Ligament, In-vivo kinematics, Surgery, Range of motion, business, human activities, Human
Abstract: Purpose The aim of the present study was to trace knee position at the time of bone bruise (BB) and investigate how much this position departed from the knee biomechanics of an in vivo flexion–extension. Methods From an original cohort of 62 patients, seven (11%) presented bicompartmental edemas and were included in the study. 3D models of bones and BB were obtained from MRI. Matching bone edemas, a reconstruction of the knee at the moment of BB was obtained. For the same patients, knee kinematics of a squat was calculated using dynamic Roentgen sterephotogrammetric analysis (RSA). Data describing knee position at the moment of BB were compared to kinematics of the same knee extrapolated from RSA system. Results Knee positions at the moment of BB was significantly different from the kinematics of the squat. In particular, all the patients’ positions were out of squat range for both anterior and proximal tibial translation, varus–valgus rotation (five in valgus and two in varus), tibial internal–external rotation (all but one, five externally and one internally). A direct comparison at same flexion angle between knee at the moment of BB (average 46.1° ± 3.8°) and knee during squat confirmed that tibia in the former was significantly more anterior (p p = 0.04), and valgus (4.1 ± 2.4°, p = 0.03). Conclusion Knee position at the moment of Bone bruise position was out of physiological in-vivo knee range of motion and could reflect a locked anterior subluxation occurring in the late phase of ACL injury rather than the mechanism leading to ligament failure. Level of evidence Level IV
Published: 2021

8. Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors

Author: Massimiliano Mosca, Federico Raggi, Tommaso Bonanzinga, Stefano Zaffagnini, Tommaso Roberti di Sarsina, Cecilia Signorelli, Alberto Grassi, Stefano Di Paolo, Grassi A., Roberti Di Sarsina T., Di Paolo S., Signorelli C., Bonanzinga T., Raggi F., Mosca M., and Zaffagnini S.
Subjects: Anterolateral ligament, Joint Instability, Male, Article Subject, Knee Joint, Rotation, Anterior cruciate ligament, General Biochemistry, Genetics and Molecular Biology, Lesion, 03 medical and health sciences, 0302 clinical medicine, Accelerometry, medicine, Cadaver, Humans, Range of Motion, Articular, Aged, Orthodontics, Acl deficient, Aged, 80 and over, 030222 orthopedics, General Immunology and Microbiology, business.industry, Anterior Cruciate Ligament Injurie, Anterior Cruciate Ligament Injuries, Triaxial accelerometer, 030229 sport sciences, General Medicine, musculoskeletal system, medicine.anatomical_structure, surgical procedures, operative, Medicine, medicine.symptom, business, Cadaveric spasm, human activities, Human, Research Article
Abstract: The anterolateral ligament (ALL) has been suggested as an important secondary knee restrain on the dynamic laxity in anterior cruciate ligament- (ACL-) deficient knees. Nevertheless, its kinematical contribution to the pivot-shift (PS) phenomenon has not been clearly and objectively defined, and noninvasive sensor technology could give a crucial contribution in this direction. The aim of the present study was to quantify in vitro the PS phenomenon in order to investigate the differences between an ACL-deficient knee and an ACL+ALL-deficient knee. Ten fresh-frozen paired human cadaveric knees ( n = 20 ) were included in this controlled laboratory study. Intact, ACL-deficient, and ACL+ALL-deficient knees were subjected to a manual PS test quantified by a noninvasive triaxial accelerometer (KiRA, OrthoKey). Kinematic data (i.e., posterior acceleration of the tibial lateral compartment) were recorded and compared among the three statuses. Pairwise Student’s t -test was used to compare the single groups ( p < 0.05 ). Intact knees, ACL-deficient knees, and ACL+ALL-deficient knees showed an acceleration of 5.3 ± 2.1 m/s2, 6.3 ± 2.3 m/s2, and 7.8 ± 2.1 m/s2, respectively. Combined sectioning of ACL and ALL resulted in a statistically significant acceleration increase compared to both the intact state ( p < 0.01 ) and the ACL-deficient state ( p < 0.01 ). The acceleration increase determined by isolated ACL resection compared to the intact state was not statistically significant ( p > 0.05 ). The ALL sectioning increased the rotatory laxity during the PS after ACL sectioning as measured through a user-friendly, noninvasive triaxial accelerometer.
Published: 2021

9. Anterior cruciate ligament reconstruction with lateral plasty restores anterior-posterior laxity in the case of concurrent partial medial meniscectomy

Author: Luca Macchiarola, Stefano Di Paolo, Giacomo Dal Fabbro, Gian Andrea Lucidi, Nicola Pizza, Stefano Zaffagnini, Alberto Grassi, Di Paolo S., Grassi A., Pizza N., Lucidi G.A., Dal Fabbro G., Macchiarola L., and Zaffagnini S.
Subjects: Joint Instability, medicine.medical_specialty, Laxity, Anterior cruciate ligament reconstruction, Sports medicine, Meniscu, Knee Joint, medicine.medical_treatment, Context (language use), Meniscus (anatomy), Lateral plasty, medicine, Humans, Orthopedics and Sports Medicine, Anterior posterior, Navigation system, Anterior Cruciate Ligament, Range of Motion, Articular, Meniscectomy, ACL injury, Anterior Cruciate Ligament Reconstruction, business.industry, musculoskeletal, neural, and ocular physiology, Anterior Cruciate Ligament Injuries, medicine.disease, musculoskeletal system, Surgery, Biomechanical Phenomena, medicine.anatomical_structure, surgical procedures, operative, Knee laxity, Orthopedic surgery, business, human activities
Abstract: Purpose: To evaluate the in vivo knee laxity in the presence of a partial medial meniscectomy before and after a single-bundle ACL reconstruction with a lateral plasty (SBLP) and to compare it with the knee laxity after a single-bundle ACL reconstruction (SB). Methods: One-hundred and one patients with ACL tear were enrolled in the study and grouped according to the surgical technique and the meniscus treatment: regarding the SBLP technique (n = 55), 31 patients underwent isolated ACL reconstruction (“SBLP Isolated ACL Group”), while 24 patients underwent combined ACL reconstruction and partial medial meniscectomy (“SBLP ACL + MM Group”); regarding the SB technique (n = 46), 33 patients underwent isolated ACL reconstruction (“SB Isolated ACL Group”), while 13 patients underwent combined ACL reconstruction and partial medial meniscectomy (“SB ACL + MM Group”). Anterior–posterior clinical laxity at 30° (AP30) and 90° (AP90) of knee flexion was quantified before and after surgery through a surgical navigation system dedicated to kinematic assessment. Results: In the ACL-deficient status, the antero-posterior laxity was significantly higher in the presence of a combined MM in both the AP30 and the AP90, with no differences between the two surgical techniques. After the ACL reconstruction, both AP30 and AP90 translations decreased significantly (p < 0.0001) compared to the ACL-deficient status. No differences were found for AP30 and AP90 between SBLP Isolated ACL and SBLP + MM groups, while a significantly higher AP90 translation was found for the SB + MM group compared to the SB Isolated ACL group. Moreover, the AP90 translation in the SB ACL + MM group was significantly higher than the one of the other three groups, i.e., SBLP ACL + MM, SB, and SBLP Isolated ACL group. Conclusion: The ACL reconstruction with lateral plasty reduced the AP knee laxity caused by the medial meniscectomy in the context of an ACL surgery. Level of evidence: Level II.
Published: 2021

10. Poor Motor Coordination Elicits Altered Lower Limb Biomechanics in Young Football (Soccer) Players: Implications for Injury Prevention through Wearable Sensors

Author: Stefano Zaffagnini, Stefano Di Paolo, Alberto Grassi, Nicola Pizza, Laura Bragonzoni, Di Paolo S., Zaffagnini S., Pizza N., Grassi A., and Bragonzoni L.
Subjects: medicine.medical_specialty, football, Anterior cruciate ligament, injury prevention, TP1-1185, Football, Knee Joint, Biochemistry, joint kinematics, Analytical Chemistry, 03 medical and health sciences, Vertical jump, Wearable Electronic Devices, 0302 clinical medicine, Physical medicine and rehabilitation, Soccer, Medicine, Electrical and Electronic Engineering, motor coordination, Wearable sensor, Instrumentation, 030222 orthopedics, biology, business.industry, Chemical technology, Communication, wearable sensors, ACL, Biomechanics, 030229 sport sciences, medicine.disease, biology.organism_classification, ACL injury, Atomic and Molecular Physics, and Optics, Motor coordination, Biomechanical Phenomena, Valgus, medicine.anatomical_structure, Lower Extremity, Joint kinematic, business, human activities
Abstract: Motor coordination and lower limb biomechanics are crucial aspects of anterior cruciate ligament (ACL) injury prevention strategies in football. These two aspects have never been assessed together in real scenarios in the young population. The present study aimed to investigate the influence of motor coordination on lower limb biomechanics in young footballers during an on-the-pitch training. Eighteen juvenile football players (10 y ± 2 m) were enrolled. Each player performed a training drill with sport-specific movements (vertical jump, agility ladders, change of direction) and the Harre circuit test (HCT) to evaluate players’ motor coordination. Wearable inertial sensors (MTw Awinda, Xsens) were used to assess lower limb joint angles and accelerations. Based on the results of the HCT, players were divided into poorly coordinated (PC) and well-coordinated (WC) on the basis of the literature benchmark. The PC group showed a stiffer hip biomechanics strategy (up to 40% lower flexion angle, ES = 2.0) and higher internal-external hip rotation and knee valgus (p < 0.05). Significant biomechanical limb asymmetries were found only in the PC group for the knee joint (31–39% difference between dominant and non-dominant limb, ES 1.6–2.3). Poor motor coordination elicited altered hip and knee biomechanics during sport-specific dynamic movements. The monitoring of motor coordination and on-field biomechanics might enhance the targeted trainings for ACL injury prevention.
Published: 2021

11. Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

Author: Laura Bragonzoni, Stefano Zaffagnini, Alberto Grassi, Nicola Lopomo, Giulio Figari, Francesco Della Villa, Stefano Di Paolo, Gabriele Paolini, Di Paolo S., Lopomo N.F., Villa F.D., Paolini G., Figari G., Bragonzoni L., Grassi A., and Zaffagnini S.
Subjects: medicine.medical_specialty, Wearable inertial sensor, ACL, Kinematics, Marker‐based optoelectronic system, Motion capture validation, Rehabilitation, Wearable inertial sensors, Knee Joint, Computer science, Anterior cruciate ligament, medicine.medical_treatment, Wearable computer, lcsh:Chemical technology, Biochemistry, Analytical Chemistry, rehabilitation, 03 medical and health sciences, Wearable Electronic Devices, marker-based optoelectronic system, 0302 clinical medicine, Physical medicine and rehabilitation, medicine, Humans, lcsh:TP1-1185, Electrical and Electronic Engineering, Anterior Cruciate Ligament, Instrumentation, Wearable technology, motion capture validation, 030222 orthopedics, Anterior Cruciate Ligament Reconstruction, business.industry, Communication, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Injurie, 030229 sport sciences, wearable inertial sensors, medicine.disease, Kinematic, ACL injury, Atomic and Molecular Physics, and Optics, Sagittal plane, Biomechanical Phenomena, Return to Sport, medicine.anatomical_structure, Sprint, kinematics, business, Human
Abstract: The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.
Published: 2021

12. ACL deficiency influences medio-lateral tibial alignment and knee varus–valgus during in vivo activities

Author: Stefano Zaffagnini, Marco Bontempi, Laura Bragonzoni, Alberto Grassi, Piero Agostinone, Stefano Di Paolo, Erika Pinelli, Agostinone P., Di Paolo S., Grassi A., Pinelli E., Bontempi M., Bragonzoni L., and Zaffagnini S.
Subjects: Adult, Joint Instability, Male, musculoskeletal diseases, medicine.medical_specialty, Adolescent, Knee Joint, Radiography, Anterior cruciate ligament, Posture, Acl deficiency, Weight-Bearing, 03 medical and health sciences, Motion, Young Adult, 0302 clinical medicine, Biplane radiography, Knee kinematic, Osteoarthritis, In vivo, medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, Orthodontics, 030222 orthopedics, biology, Tibia, business.industry, Anterior Cruciate Ligament Injuries, 030229 sport sciences, biology.organism_classification, medicine.disease, musculoskeletal system, ACL injury, Magnetic Resonance Imaging, Biomechanical Phenomena, Valgus, medicine.anatomical_structure, Single leg squat, Coronal plane, Orthopedic surgery, Surgery, Female, business, human activities
Abstract: Purpose: The role of the anterior cruciate ligament (ACL) in knee biomechanics in vivo and under weight-bearing is still unclear. The purpose of this study was to compare the tibiofemoral kinematics of ACL-deficient knees to healthy contralateral ones during the execution of weight-bearing activities. Methods: Eight patients with isolated ACL injury and healthy contralateral knees were included in the study. Patients were asked to perform a single step forward and a single leg squat first with the injured knee and then with the contralateral one. Knee motion was determined using a validated model-based tracking process that matched subject-specific MRI bone models to dynamic biplane radiographic images, under the principles of Roentgen stereophotogrammetric analysis (RSA). Data processing was performed in a specific software developed in Matlab. Results: Statistically significant differences (p < 0.05) were found for single leg squat along the frontal plane: ACL-deficient knees showed a more varus angle, especially at the highest knee flexion angles (40°–50° on average), compared to the contralateral knees. Furthermore, ACL-deficient knees showed tibial medialization along the entire task, while contralateral knees were always laterally aligned. This difference became statistically relevant (p < 0.05) for knee flexion angles included between 0° and about 30°. Conclusion: ACL-deficient knees showed an abnormal tibial medialization and increased varus angle during single leg squat when compared to the contralateral knees. These biomechanical anomalies could cause a different force distribution on tibial plateau, explaining the higher risk of early osteoarthritis in ACL deficiency. The clinical relevance of this study is that also safe activities used in ACL rehabilitation protocols are significantly altered in ACL deficiency. Level of evidence: III.
Published: 2021

13. A 2D video-analysis scoring system of 90° change of direction technique identifies football players with high knee abduction moment

Author: Stefano Zaffagnini, Alberto Grassi, Stefano Di Paolo, Edoardo Della Croce, Francesco Della Villa, Dario Santagati, Nicola Lopomo, Della Villa F., Di Paolo S., Santagati D., Della Croce E., Lopomo N.F., Grassi A., and Zaffagnini S.
Subjects: Male, medicine.medical_specialty, Knee Joint, Anterior cruciate ligament, Football, Kinematics, Return to sport, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, ACL injury prevention, Soccer, medicine, Humans, Orthopedics and Sports Medicine, Force platform, 030222 orthopedics, Cut maneuver, business.industry, Anterior Cruciate Ligament Injuries, ACL, Biomechanics, Reproducibility of Results, 030229 sport sciences, Gold standard (test), medicine.disease, ACL injury, Trunk, Sagittal plane, Biomechanical Phenomena, 2D video analysis, medicine.anatomical_structure, Female, Surgery, business, 2D video analysi
Abstract: Purpose Abnormal joint biomechanics and poor neuromuscular control are modifiable risk factors for Anterior Cruciate Ligament (ACL) injury. Although 3D motion capture is the gold standard for the biomechanical evaluation of high-speed multidirectional movements, 2D video analysis is a growing-interest alternative because of its higher cost-effectiveness and interpretability. The aim of the present study was to explore the possible association between a 2D evaluation of a 90° change of direction (COD) and the KAM measured with gold standard 3D motion analysis. Methods Thirty-four competitive football (soccer) players (age 22.8 ± 4.1, 18 male and 16 females) were enrolled. Each athlete performed a series of pre-planned 90° COD at the maximum speed possible in a laboratory equipped with artificial turf. 3D motion analysis was recorded using 10 stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D evaluation was performed through a scoring system based on the video analysis of frontal and sagittal plane joint kinematics. Five scoring criteria were adopted: limb stability (LS), pelvis stability (PS), trunk stability (TS), shock absorption (SA), and movement strategy (MS). For each criterion, a sub-score of 0/2 (non-adequate), 1/2 (partially adequate), or 2/2 (adequate) was attributed to the movement, based on objective measurements. The intra-rater and inter-rater reliability were calculated for each criterion and the total score. The Knee Abduction Moment (KAM) was extracted from the 3D motion analysis and grouped according to the results of the 2D evaluation. Results Excellent intra-rater reliability (ICC > 0.88) and good-to-excellent inter-rater reliability (ICC 0.68–0.92) were found. Significantly higher KAM was found for athletes obtaining a 0/2 score compared to those obtaining a 2/2 score in all the sub-criteria and the total score (20–47% higher, p Conclusion The 2D video-analysis scoring system here described was a simple and effective tool to discriminate athletes with high and low KAM in the assessment of a 90° COD and could be a potential method to identify athletes at high risk of non-contact ACL injury. Level of evidence IV.
Published: 2021

14. In Vivo Kinematic Analysis of Lateral Meniscal Allograft Transplantation With Soft Tissue Fixation

Author: Ilaria Cucurnia, Alberto Grassi, Giacomo Dal Fabbro, Gian Andrea Lucidi, Stefano Zaffagnini, Stefano Di Paolo, Luca Macchiarola, Macchiarola L., Di Paolo S., Grassi A., Dal Fabbro G., Lucidi G.A., Cucurnia I., and Zaffagnini S.
Subjects: musculoskeletal diseases, Allograft transplantation, medicine.medical_specialty, kinematic, business.industry, Pivot shift, meniscal allograft transplantation, Kinematics, musculoskeletal system, surgical navigation, Article, Surgery, MAT, In vivo, Soft tissue fixation, kinematics, medicine, Orthopedics and Sports Medicine, business
Abstract: Background: Lateral meniscal deficiency increases the pivot shift in the knee, and although meniscal allograft transplantation (MAT) is a well-established procedure with satisfactory clinical results, biomechanical studies have failed to show whether this procedure is able to restore knee kinematics. Purpose: To assess, in vivo, the kinematic effect of lateral MAT in anterior cruciate ligament–intact knees, with a particular focus on the pivot-shift maneuver. Study Design: Controlled laboratory study. Methods: Enrolled in this study were 10 consecutive patients undergoing lateral MAT. A surgical navigation system was used to acquire and quantify the following variables: anterior-posterior displacement at 30° of flexion (AP30) and 90° of flexion (AP90), varus-valgus rotation at 0° of flexion (VV0) and 30° of flexion, and dynamic laxity on the pivot-shift test, which was determined through anterior displacement of the lateral tibial compartment (APlat) and posterior acceleration of the lateral tibial compartment during tibial reduction (ACC). Data from before and after MAT were compared. Results: From pre- to postoperatively, there was a significant decrease in tibial translation of 2.8 mm (43%; P = .005) for AP30 and 1.9 mm (38%; P = .018) for AP90 as well as a significant difference of 3.6° (64%; P = .001) for VV0. There was also a significant pre- to postoperative reduction in the pivot shift of 7.4 mm (39%; P = .021) for APlat and 302.9 mm/s2 (75%; P = .005) for ACC. Conclusion: Lateral MAT improved knee kinematic parameters at time zero after surgery; the biomechanical effect of MAT was particularly evident during the pivot-shift maneuver.
Published: 2021

15. The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System

Author: Gian Andrea Lucidi, Maria Pia Neri, Stefano Di Paolo, Piero Agostinone, Luca Macchiarola, Giacomo Dal Fabbro, Alberto Grassi, Stefano Zaffagnini, Lucidi G.A., Grassi A., Di Paolo S., Agostinone P., Neri M.P., Macchiarola L., Dal Fabbro G., and Zaffagnini S.
Subjects: Joint Instability, Knee Joint, Rotation, Anterior cruciate ligament, Pivot shift, Physical Therapy, Sports Therapy and Rehabilitation, lateral notch sign, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Orthopedics and Sports Medicine, 030222 orthopedics, anterior cruciate injury, business.industry, Anterior Cruciate Ligament Injuries, ACL, 030229 sport sciences, Anatomy, Surgical Navigation Systems, Cross-Sectional Studies, medicine.anatomical_structure, Lateral femoral condyle, rotatory laxity, business, Sign (mathematics), MRI, pivot shift
Abstract: Background:The lateral femoral notch sign (LNS) is a bony impression on the lateral femoral condyle correlated with anterior cruciate ligament (ACL) injury. Its presence is associated with lateral meniscal injury and higher cartilage degradation on the lateral femoral condyle.Purpose/Hypothesis:The purpose was to investigate the effect of the presence and magnitude of LNS on rotatory instability. The hypothesis was that a positive LNS is correlated with a high-grade pivot shift (PS).Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 90 consecutive patients with complete ACL tears between 2013 and 2017 underwent intraoperative kinematic evaluation with the surgical navigation system and were included in the present study. The same surgeon performed a standardized PS under anesthesia. The PS was quantified through the acceleration of the lateral compartment during tibial reduction (PS ACC) and the internal-external rotation (PS IE). Presence and depth of LNS were evaluated on sagittal magnetic resonance images (1.5-T).Results:In 47 patients, the LNS was absent; in 33, the LNS depth was between 1 mm and 2 mm; and in 10 patients, it was deeper than 2 mm. Patients with a notch deeper than 2 mm showed increased PS ACC and PS IE compared with the group without the LNS. However, no significant differences were present between the group with a notch between 1 and 2 mm and the patients without LNS. Receiver operating characteristic curve analysis showed that 2 mm was the most predictive cutoff value to identify the “high-grade rotatory instability” group, with an accuracy of 77.8% and 74.4% and a specificity of 95.5% and 93.9% referred to the PS ACC and PS IE, respectively.Conclusion:The presence of a lateral LNS deeper than 2 mm could be used for the preoperative identification of patients with a high risk of increased rotatory instability.
Published: 2021

16. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes

Author: Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli, Stefano Di Paolo, Marco Bontempi, Tommaso Roberti di Sarsina, Laura Bragonzoni, Nicola Pizza, Domenico Alesi, Raffaele Zinno, Alesi D., Marcheggiani Muccioli G.M., Roberti di Sarsina T., Bontempi M., Pizza N., Zinno R., Di Paolo S., Zaffagnini S., and Bragonzoni L.
Subjects: Male, medicine.medical_specialty, Medial-stabilized, WOMAC, Knee Joint, Rotation, Movement, Medial pivot, Total knee arthroplasty, Kinematics, 03 medical and health sciences, 0302 clinical medicine, In vivo, medicine, Humans, Orthopedics and Sports Medicine, Femur, Postoperative Period, Post operative, Range of Motion, Articular, Arthroplasty, Replacement, Knee, Aged, Orthodontics, Aged, 80 and over, 030222 orthopedics, business.industry, TKA, 030229 sport sciences, Dynamic RSA, Middle Aged, Osteoarthritis, Knee, Biomechanical Phenomena, Motor task, Orthopedic surgery, Surgery, Female, business, Knee Prosthesis
Abstract: Purpose: To evaluate if there was a correlation between in vivo kinematics of a medial-stabilized (MS) total knee arthroplasty (TKA) and post-operative clinical scores. We hypothesized that (1) a MS-TKA would produce a medial pivot movement and that (2) this specific pattern would be correlated with higher clinical scores. Methods: 18 patients were evaluated through clinical and functional scores evaluation (Knee Society Score clinical and functional, Womac, Oxford), and kinematically through dynamic radiostereometric analysis (RSA) at 9months after MS-TKA, during the execution of a sit-to-stand and a lunge motor task. The anteroposterior (AP) Low Point translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). A correlation analysis between scores and kinematics was performed through the Pearson’s correlation coefficient r. Results: A significantly greater (p < 0.0001) anterior translation of the lateral compartment with respect to the medial one was found in both sit-to-stand (medial 2.9mm ± 0.7mm, lateral 7.1mm ± 0.6mm) and lunge (medial 5.3mm ± 0.9mm, lateral 10.9mm ± 0.7mm) motor tasks, thus resulting in a medial pivot pattern in about 70% of patients. Significant positive correlation in sit-to-stand was found between the peak of AP translation in the lateral compartment and clinical scores (r = 0.59 for Knee Society Score clinical and r = 0.61 for Oxford). Moreover, we found that the higher peak of AP translation of the medial compartment correlated with lower clinical scores (r = − 0.55 for Knee Society Score clinical, r = − 0.61 for Womac and r = − 0.53 for Oxford) in the lunge. A negative correlation was found between Knee Society Score clinical and VV laxity during sit-to-stand (r = − 0.56) and peak of external rotation in the lunge motor task (r = − 0.66). Conclusions: The MS-TKA investigated produced in vivo a medial pivot movement in about 70% of patients in both examined motor tasks. There was a correlation between the presence of medial pivot and higher post-operative scores. Level of evidence: IV.
Published: 2021

17. Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review

Author: Laura Bragonzoni, Giuseppe Barone, Stefano Zaffagnini, Domenico Alesi, Raffaele Zinno, S. Di Paolo, G Ambrosino, Zinno, R., Di Paolo, S., Ambrosino, G., Alesi, D., Zaffagnini, S., Barone, G., and Bragonzoni, L.
Subjects: medicine.medical_specialty, Roentgen stereophotogrammetric analysis, Total knee replacement, Dentistry, Review, Prosthesis Design, 03 medical and health sciences, 0302 clinical medicine, RSA, Femoral component, medicine, Humans, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, Migration, 030222 orthopedics, TKR · Migration · Clinical outcome · RSA · Femoral component · Cobalt-chrome, Tibia, Clinical outcome, business.industry, Cobalt-chrome, Implant failure, 030229 sport sciences, Prosthesis Failure, Surgery, TKR, Orthopedic surgery, Narrative review, Chromium Alloys, Knee Prosthesis, business
Abstract: Loosening is considered as a main cause of implant failure in total knee replacement (TKR). Among the predictive signs of loosening, migration is the most investigated quantitative parameter. Several studies focused on the migration of the tibial component in TKR, while no reviews have been focused on the migration of the femoral component and its influence on patients’ clinical outcomes. The aim of this narrative review was (1) to provide information about of the influence of migration in femoral component of TKR prostheses, (2) to assess how migration may affect patient clinical outcomes and (3) to present alternative solution to the standard cobalt-chrome prostheses. A database search was performed on PubMed Central® according to the PRISMA guidelines for studies about Cobalt-Chrome femoral component migration in people that underwent primary TKR published until May 2020. Overall, 18 articles matched the selection criteria and were included in the study. Few studies investigated the femoral component through the migration, and no clear migration causes emerged. The Roentgen Stereophotogrammetric Analysis has been mostly used to assess the migration for prognostic predictions. An annual migration of 0.10 mm seems compatible with good long-term performance and good clinical and functional outcomes. An alternative solution to cobalt-chrome prostheses is represented by femoral component in PEEK material, although no clinical evaluations have been carried out on humans yet. Further studies are needed to investigate the migration of the femoral component in relation to clinical outcomes and material used.
Published: 2021

18. Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Author: Piero Agostinone, Laura Bragonzoni, Marco Bontempi, Giulio Maria Marcheggiani Muccioli, Nicola Pizza, Stefano Di Paolo, Stefano Zaffagnini, Domenico Alesi, Raffaele Zinno, Pizza N., Di Paolo S., Zinno R., Marcheggiani Muccioli G.M., Agostinone P., Alesi D., Bontempi M., Zaffagnini S., and Bragonzoni L.
Subjects: musculoskeletal diseases, medicine.medical_specialty, Knee Joint, Total knee arthroplasty, Medial pivot, Kinematics, Radiostereometric Analysis, 03 medical and health sciences, 0302 clinical medicine, RSA, medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, Compartment (pharmacokinetics), Lead (electronics), Arthroplasty, Replacement, Knee, 030222 orthopedics, Clinical outcome, business.industry, 030229 sport sciences, Osteoarthritis, Knee, Kinematic, Posterior stabilized, Surgery, Biomechanical Phenomena, Total knee replacement, Motor task, Orthopedic surgery, business, Knee Prosthesis
Abstract: Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p Results Low point AP translation of the medial compartment was significantly lower (p 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS Level of evidence II.
Published: 2020

19. Indications for renal biopsy in patients with diabetes. Joint position statement of the Italian Society of Nephrology and the Italian Diabetes Society

Author: Salvatore Di Paolo, Marco Fiorentino, Gianpaolo Reboldi, Luca De Nicola, Paola Fioretto, Loreto Gesualdo, Giuseppe Pugliese, Andrea Natali, Giuseppe Penno, Federica Barutta, Di Paolo, S., Fiorentino, M., De Nicola, L., Reboldi, G., Gesualdo, L., Barutta, F., Natali, A., Penno, G., Fioretto, P., and Pugliese, G.
Subjects: Nephrology, medicine.medical_specialty, Consensus, Diabetic kidney disease (DKD), Diabetic nephropathy (DN), DKD phenotypes, Non-diabetic renal disease (NDRD), Renal biopsy, Biopsy, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Kidney, urologic and male genital diseases, Severity of Illness Index, Diabetic nephropathy, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Humans, Hypoglycemic Agents, Diabetic Nephropathies, Type 1 diabetes, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Diabetes Mellitus, Type 1, Prognosis, medicine.disease, DKD phenotype, Albuminuria, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Nephrotic syndrome, Type 1, Retinopathy
Abstract: Aims This joint document of the Italian Society of Nephrology and the Italian Diabetes Society reviews the main indications to perform a renal biopsy in diabetic patients, according to the recommendations of a panel of experts based on all available scientific evidence. Data synthesis Renal biopsy has a pivotal role in assessing the nature and severity of renal injury in patients with diabetic kidney disease (DKD). The procedure is mandatory in the presence of one of more of the following features: rapid onset or progression of albuminuria or sudden onset of nephrotic syndrome, rapid GFR decline with or without albuminuria, hematuria, active urine sediment, clinical and/or laboratory suspicion of other systemic diseases, and, in patients with type 1 diabetes, short diabetes duration and absence of retinopathy. Indeed, ~40% of diabetic individuals with kidney injury undergoing renal biopsy are affected by a non-diabetic renal disease (NDRD). Furthermore, the histological evaluation of patients with suspected classical diabetic nephropathy allows to define the extent of glomerular, tubulo-interstitial and vascular lesions, thus providing important prognostic (and potentially therapeutic) data. In the future, the indications for renal biopsy might be extended to the definition of the histological lesions underlying the “nonalbuminuric” DKD phenotypes, as well as to the evaluation of the response to treatment with the new anti-hyperglycemic drugs that provide cardiorenal protection. Conclusions In view of the heterogeneous clinical presentation and course of DKD and of the related heterogeneous histopathological patterns, a more extensive use of renal biopsy may be crucial to provide valuable information with important pathogenic, diagnostic, prognostic, and therapeutic implications.
Published: 2020

20. Dynamic Radiostereometry Evaluation of 2 Different Anterior Cruciate Ligament Reconstruction Techniques During a Single-Leg Squat

Author: Marco Bontempi, Stefano Zaffagnini, Erika Pinelli, Alberto Grassi, Gian Andrea Lucidi, Laura Bragonzoni, Piero Agostinone, Stefano Di Paolo, Gregorio Marchiori, Di Paolo S., Agostinone P., Grassi A., Lucidi G.A., Pinelli E., Bontempi M., Marchiori G., Bragonzoni L., and Zaffagnini S.
Subjects: musculoskeletal diseases, Anterior cruciate ligament reconstruction, medicine.medical_treatment, Anterior cruciate ligament, Context (language use), single-leg squat, in vivo knee kinematic, Article, 03 medical and health sciences, 0302 clinical medicine, lateral extra-articular tenodesis, medicine, Orthopedics and Sports Medicine, In patient, Orthodontics, 030222 orthopedics, business.industry, anterior cruciate ligament, 030229 sport sciences, musculoskeletal system, medicine.anatomical_structure, Single leg squat, business, lateral extra-articular tenodesi, human activities, Knee instability, biplane radiography, in vivo knee kinematics
Abstract: Background: Lateral extra-articular tenodesis in the context of anterior cruciate ligament (ACL) reconstruction (ACLR) is performed to better control anterolateral knee instability in patients with high-grade preoperative pivot shift. However, some authors believe these procedures may cause lateral compartment overconstraint, affecting knee motion in daily life. Purpose/Hypothesis: The primary aim of the present study was to identify kinematic differences during the execution of an activity under weightbearing conditions between knees having undergone ACLR using anatomic single-bundle (SB) versus single-bundle plus lateral plasty (SBLP) techniques. The secondary aim was to compare the postoperative kinematic data with those from the same knees before ACLR and from the healthy contralateral knees in order to investigate if ACLR was able to restore physiologic knee biomechanics during squat execution. The hypotheses were that (1) the SBLP technique would allow a better restoration of internal-external (IE) knee rotation than would SB and (2) regardless of the technique, ACLR would not fully restore physiologic knee biomechanics. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In total, 32 patients (42 knees) were included in the study. Patients were asked to perform a single-leg squat before surgery (ACL-injured group, n = 32; healthy contralateral group, n = 10) and at minimum 18-month follow-up after ACLR (SB group, n = 9; SBLP group, n = 18). Knee motion was determined using a validated model-based tracking process that matched patient-specific magnetic resonance imaging bone models to dynamic biplane radiographic images under the principles of roentgen stereophotogrammetric analysis. Data processing was performed using specific software. The authors compared IE and varus-valgus rotations and anterior-posterior and medial-lateral translations among the groups. Results: The mean follow-up period was 21.7 ± 4.5 months. No kinematic differences were found between the SB and SBLP groups ( P > .05). A more medial tibial position ( P < .05) of the ACL-injured group was reported during the entire motor task and persisted after ACLR in both the SB and the SBLP groups. Differences in IE and varus-valgus rotations were found between the ACL-injured and healthy groups. Conclusion: There were no relevant kinematic differences between SBLP and anatomic SB ACLR during the execution of a single-leg squat. Regardless of the surgical technique, ACLR failed in restoring knee biomechanics. Registration: NCT02323386 ( ClinicalTrials.gov identifier).
Published: 2021

21. The Italian cross-cultural adaptations of the paediatric International Knee Documentation Committee Score and the Hospital for Special Surgery Paediatric Functional Activity Brief Scale are reliable instruments in paediatric population

Author: Stefano Zaffagnini, Alberto Grassi, Giovanni Trisolino, Luca Macchiarola, Stefano Stilli, Stefano Di Paolo, Nicola Pizza, Stefano Stallone, Macchiarola L., Grassi A., Di Paolo S., Pizza N., Trisolino G., Stallone S., Stilli S., and Zaffagnini S.
Subjects: Cross-Cultural Comparison, Male, medicine.medical_specialty, Adolescent, Psychometrics, Intraclass correlation, Anterior cruciate ligament, Knee Injuries, Italian validation, 03 medical and health sciences, 0302 clinical medicine, Cronbach's alpha, Pedi-FABS, Surveys and Questionnaires, medicine, Criterion validity, Humans, Orthopedics and Sports Medicine, Knee, Translations, Child, Exercise, Protocol (science), PAMI, 030222 orthopedics, business.industry, Pediatric ACL, Reproducibility of Results, 030229 sport sciences, Physical Functional Performance, Pedi-IKDC, Surgery, Patient Outcome Assessment, medicine.anatomical_structure, Standard error, Italy, Scale (social sciences), Orthopedic surgery, Female, business
Abstract: Purpose: The aim of the present study was to translate, cross-culturally adapt, and assess the psychometric properties of the Pedi-IKDC and Pedi-FABS scores in the Italian paediatric population with various knee pathologies. Methods: In accordance with the Paediatric Anterior Cruciate Ligament Monitoring Initiative (PAMI) research protocol, the original English versions of the questionnaires were translated into Italian. All patients aged 8–16 and scheduled for knee surgery were considered eligible in the study. An open-source platform was implemented to collect responses to the surveys which included general patient information, the questionnaires Pedi-IKDC, and Pedi-FABS. Two surveys were sent under stable clinical conditions before surgery (Q1 and Q2); a third survey was sent 3–4months after surgery (Q3). The following properties were calculated: reliability, internal consistency, criterion validity, responsiveness, and floor/ceiling effects. Results: Eighty-nine patients completed Q1, 81 patients completed Q2, and 49 patients completed Q3. Both questionnaires demonstrated acceptable properties. Pedi-IKDC: standard error of measurement (SEM) = 4.4, smallest detectable change (SDC) = 12.3, interclass correlation coefficient (ICC) = 0.96, Cronbach alpha (α) = 0.92, moderate-to-low correlation to Pedi-FABS, effect size (ES) = 0.79, standardized response mean (SRM) = 0.86, floor = 0%, ceiling = 22%. Pedi-FABS: SEM = 2.1, SDC = 5.8, ICC = 0.94, Cronback alpha (α) = 0.93, moderate-to-low correlation to Pedi-IKDK, ES = 0.60, SRM = 0.51, floor = 19%, ceiling = 0%. Conclusions: The Italian version of Pedi-IKDC and Pedi-FABS is valuable tools for patient assessment, by demonstrating good psychometric properties. In clinical setting, these questionnaires can be used to properly evaluate outcomes in Italian pediatric patients with knee pathologies. Level of evidence: II.
Published: 2019

22. The biomechanical role of meniscal allograft transplantation and preliminary in-vivo kinematic evaluation

Author: Alberto Grassi, Luca Macchiarola, Stefano Zaffagnini, Giacomo Dal Fabbro, Stefano Di Paolo, Federico Stefanelli, Gian Andrea Lucidi, Zaffagnini S., Di Paolo S., Stefanelli F., Dal Fabbro G., Macchiarola L., Lucidi G.A., and Grassi A.
Subjects: musculoskeletal diseases, medicine.medical_specialty, Meniscu, Anterior cruciate ligament, medicine.medical_treatment, Meniscus transplant, Review, Kinematics, Meniscus (anatomy), 03 medical and health sciences, 0302 clinical medicine, lcsh:Orthopedic surgery, Medicine, Meniscus, Knee, Orthopedics and Sports Medicine, Reduction (orthopedic surgery), 030222 orthopedics, business.industry, Biomechanical evaluation, 030229 sport sciences, musculoskeletal system, Surgery, Transplantation, lcsh:RD701-811, medicine.anatomical_structure, Orthopedic surgery, Laxity test, business, Cadaveric spasm, human activities, Meniscus allograft transplantation
Abstract: Background Meniscus allograft transplantation (MAT) is a surgical procedure performed in patients complaining post-meniscectomy syndrome. Although the effectiveness of MAT on knee stability has been already demonstrated in cadaveric studies, its biomechanical role has been poorly evaluated in-vivo. Methods A narrative review of the biomechanical effect of meniscectomy and MAT was performed. Furthermore, two cases were presented, of one patient who underwent Medial MAT and Anterior Cruciate Ligament (ACL) reconstruction, and one who underwent Lateral MAT. During the surgery, knee laxity was evaluated using a surgical navigation system. Results AP laxity and IE rotation were reduced of 25% to 50% at both 30° and 90° of knee flexion after MAT transplantation. Discussion In both cases, almost all the tests performed showed a reduction of knee laxity after meniscus transplant, when compared with pre-operative knee laxity. This assessment confirms the insights of previous in-vitro studies and underline a crucial role of MAT in knee biomechanics.
Published: 2019

23. Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on 'The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function'

Author: Salvatore Di Paolo, Giuseppe Penno, Federica Barutta, Loreto Gesualdo, Giuseppe Pugliese, Gianpaolo Reboldi, Andrea Natali, Luca De Nicola, Pugliese, G., Penno, G., Natali, A., Barutta, F., Di Paolo, S., Reboldi, G., Gesualdo, L., De Nicola, L., Pugliese, Giuseppe, Penno, Giuseppe, Natali, Andrea, Barutta, Federica, Di Paolo, Salvatore, Reboldi, Gianpaolo, Gesualdo, Loreto, and De Nicola, Luca
Subjects: Nephrology, Blood Glucose, Endocrinology, Diabetes and Metabolism, Anti-hyperglycemic therapy, Medicine (miscellaneous), Type 2 diabetes, Review, Diabetic nephropathy, Albuminuria, Diabetes mellitus, End-stage kidney disease, Estimated glomerular filtration rate, Biomarkers, Clinical Decision-Making, Consensus, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Disease Progression, Humans, Hypoglycemic Agents, Kidney, Kidney Failure, Chronic, Patient Selection, Risk Factors, Treatment Outcome, Glomerular Filtration Rate, 030204 cardiovascular system & hematology, Kidney Failure, 0302 clinical medicine, Medicine, Chronic, Nutrition and Dietetics, Italy, medicine.symptom, Cardiology and Cardiovascular Medicine, Type 2, Human, medicine.medical_specialty, Diabetes mellitu, Renal function, 030209 endocrinology & metabolism, Consensu, Hypoglycemia, 03 medical and health sciences, Internal medicine, Hypoglycemic Agent, business.industry, Risk Factor, Hyperglycemia, Biomarker, medicine.disease, Diabetic Nephropathie, albuminuria, anti-hyperglycemic therapy, diabetes mellitus, diabetic nephropathy, end-stage kidney disease, estimated glomerular filtration rate, business, Kidney disease
Abstract: Aims This joint document of the Italian Diabetes Society and the Italian Society of Nephrology reviews the natural history of diabetic kidney disease (DKD) in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents. Data Synthesis Recent epidemiological studies have disclosed a wide heterogeneity of DKD. In addition to the classical albuminuric phenotype, two new albuminuria-independent phenotypes have emerged, i.e., “nonalbuminuric renal impairment” and “progressive renal decline”, suggesting that DKD progression toward end-stage kidney disease (ESKD) may occur through two distinct pathways, albuminuric and nonalbuminuric. Several biomarkers have been associated with decline of estimated glomerular filtration rate (eGFR) independent of albuminuria and other clinical variables, thus possibly improving ESKD prediction. However, the pathogenesis and anatomical correlates of these phenotypes are still unclear. Also the management of hyperglycemia in patients with type 2 diabetes and impaired renal function has profoundly changed during the last two decades. New anti-hyperglycemic drugs, which do not cause hypoglycemia and weight gain and, in some cases, seem to provide cardiorenal protection, have become available for treatment of these individuals. In addition, the lowest eGFR safety thresholds for some of the old agents, particularly metformin and insulin secretagogues, have been reconsidered. Conclusions The heterogeneity in the clinical presentation and course of DKD has important implications for the diagnosis, prognosis, and possibly treatment of this complication. The therapeutic options for patients with type 2 diabetes and impaired renal function have substantially increased, thus allowing a better management of these individuals.
Published: 2019

24. The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

Author: Luca Macchiarola, Gian Andrea Lucidi, Federico Raggi, Stefano Zaffagnini, Alberto Grassi, Stefano Di Paolo, Grassi A., Di Paolo S., Lucidi G.A., Macchiarola L., Raggi F., and Zaffagnini S.
Subjects: Adult, Joint Instability, Male, Anterior cruciate ligament reconstruction, Anterior cruciate ligament, medicine.medical_treatment, laxity, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Kinematics, Meniscus (anatomy), Menisci, Tibial, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Double bundle, medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, 030222 orthopedics, ACL injury, Anterior Cruciate Ligament Reconstruction, Tibia, business.industry, Anterior Cruciate Ligament Injuries, 030229 sport sciences, Anatomy, In vivo kinematics, medicine.disease, musculoskeletal system, Biomechanical Phenomena, medicine.anatomical_structure, Cross-Sectional Studies, meniscectomy, navigation system, Female, meniscu, business, anatomic single-bundle
Abstract: Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group ( P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group ( P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm ( P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.
Published: 2019

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources

Refine your results

24 results on '"Di Paolo S"'

1. Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

2. Sirolimus for Kaposi's Sarcoma in Renal-Transplant Recipients

3. Severe bicompartmental bone bruise is associated with rotatory instability in anterior cruciate ligament injury

4. A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading

5. Post-operative complications of tibial plateau fractures treated with screws or hybrid external fixation

6. Causes of stiffness after total knee arthroplasty: a systematic review

7. Knee position at the moment of bone bruise could reflect the late phase of non-contact anterior cruciate ligament injury rather than the mechanisms leading to ligament failure

8. Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors

9. Anterior cruciate ligament reconstruction with lateral plasty restores anterior-posterior laxity in the case of concurrent partial medial meniscectomy

10. Poor Motor Coordination Elicits Altered Lower Limb Biomechanics in Young Football (Soccer) Players: Implications for Injury Prevention through Wearable Sensors

11. Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

12. ACL deficiency influences medio-lateral tibial alignment and knee varus–valgus during in vivo activities

13. A 2D video-analysis scoring system of 90° change of direction technique identifies football players with high knee abduction moment

14. In Vivo Kinematic Analysis of Lateral Meniscal Allograft Transplantation With Soft Tissue Fixation

15. The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System

16. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes

17. Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review

18. Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

19. Indications for renal biopsy in patients with diabetes. Joint position statement of the Italian Society of Nephrology and the Italian Diabetes Society

20. Dynamic Radiostereometry Evaluation of 2 Different Anterior Cruciate Ligament Reconstruction Techniques During a Single-Leg Squat

21. The Italian cross-cultural adaptations of the paediatric International Knee Documentation Committee Score and the Hospital for Special Surgery Paediatric Functional Activity Brief Scale are reliable instruments in paediatric population

22. The biomechanical role of meniscal allograft transplantation and preliminary in-vivo kinematic evaluation

24. The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

Catalog

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Journal

Database

Publisher

24 results on '"Di Paolo S"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources