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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.

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E' estremamente importante preservare il menisco quanto più possibile per evitare la progressione della degenerazione articolare del ginocchio. In effetti, un numero considerevole di pazienti soffre a causa degli effetti in seguito ad una meniscectomia artroscopica anche parziale.Stone, Steadman e Rodkey hanno sviluppato un nuovo tipo di scaffold in collagene I per sostituire il menisco in caso di rotture parziali/subtotali irreparabili: il CMI (Collagen Meniscus Implant). Dopo 13 anni di buoni risultati nell’uso del CMI mediale, nel 2006 abbiamo iniziato uno studio multicentrico europeo per valutarne l'efficacia e l'efficacia di uno scaffol meniscale equivalente appositamente progettato per riparare i difetti parziali/subtotati del menisco laterale (Lateral CMI). In questo articolo si descrivono le indicazioni per l’impianto di uno scaffol meniscale collagenico, l'evoluzione della tecnica chirurgica (da una tecnica di sutura artroscopica “in-out” ad una “all-inside”) nei nostri 13 anni di esperienza e una breve relazione sui nostri risultati clinici.

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.

Purpose: To determine the medium-term implant survivorship, the clinical results and the failure mechanisms of a novel unicompartmental arthroplasty for uncemented resurfacing of the medial tibio-femoral compartment. Methods: Seventy-six consecutive patients were prospectively evaluated with a mean final follow-up of 6 years (SD 5.3 months). In 44 patients, the diagnosis was osteoarthritis, and in 32 patients, it was avascular necrosis of the medial femoral condyle. The Hospital for Special Surgery Score was used for objective clinical evaluation, and a self-administered visual analogue scale was used to quantify residual pain at each observation point. Implant survivorship was determined assuming revision for any reason as endpoint. Results: Nineteen patients were revised (6 with osteoarthritis and 13 with avascular necrosis of the medial femoral condyle). The mean interval time from index surgery to revision was 11.2 months (SD 4.66 months). Implant survivorship was higher in patients with osteoarthritis with respect to those with avascular necrosis of the medial femoral condyle (p = 0.018). Aseptic loosening was the most frequent failure mechanism. Femoral component loosening was reported in five patients and tibial component loosening was reported in other six patients. Assuming revision for any reason as endpoint, an implant survivorship of 74.3 % at 6-year follow-up was determined. In the remaining 57 patients, satisfactory clinical results were obtained. Hospital for Special Surgery Score and visual analogue scale for residual pain showed significant improvements (p

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.

Background: There have been no direct in vivo biomechanical comparisons performed between an anatomic double-bundle (ADB) and a nonanatomic double-bundle (NADB) anterior cruciate ligament (ACL) reconstruction. Hypothesis: There are differences in kinematic outcomes between ADB and NADB ACL reconstruction techniques. Study Design: Controlled laboratory study. Methods: Twenty-six consecutive patients (mean age, 30 years; range, 18-32 years; 23 men, 3 women; 17 right knees, 9 left knees) with an isolated ACL injury were included in the study. The first 13 consecutive patients underwent NADB reconstruction (combination of a single-bundle and an over-the-top reconstruction), and the following 13 consecutive patients were treated with an ADB approach (using 2 tibial tunnels and 2 femoral tunnels placed in the center of the native femoral and tibial insertion sites). Grafts were pretensioned at 80 N and secured with cortical fixation systems under manual maximum force tension. Standard clinical laxity and pivot-shift tests were quantified at time zero before and after ACL reconstruction by means of a surgical navigation system dedicated to kinematic assessment; displacement of the medial and lateral compartments during the tests was also analyzed. Results: The ADB-reconstructed knees showed a larger preoperative-to-postoperative difference in anterior-posterior tibial plateau displacement of the medial and lateral compartments when compared with the NADB-reconstructed knees during the internal-external rotation test at 30° of flexion ( P < .050). No other significant differences in laxity or pivot-shift values were noted. The mean surgical time for ADB reconstruction was significantly higher than that for NABD reconstruction (62 ± 13 and 43 ± 10 minutes, respectively; P < .0001). Conclusion: Results showed a greater anterior-posterior translation of both compartments during the rotational passive laxity test in the ADB reconstruction group or overconstraint caused by the NADB technique. The 2 analyzed double-bundle ACL reconstructions did not show any significant quantitative difference in isolated anterior-posterior laxity and pivot-shift phenomenon at time zero. Clinical Relevance: Nonanatomic double-bundle ACL reconstruction can control anterior-posterior laxity and the pivot-shift phenomenon as well as ABD ACL reconstruction.