Francesco Falciglia - Academia.edu (original) (raw)
Papers by Francesco Falciglia
Current Therapeutic Research-clinical and Experimental, 1989
Evaluation of the clinical efficacy of short-term antibiotic prophylaxis with multiple doses of m... more Evaluation of the clinical efficacy of short-term antibiotic prophylaxis with multiple doses of mezlocillin, on patients who underwent traumatologic and orthopedic surgery. Clinical and laboratory examinations prior to, during and after surgery were performed
The journal of bone and joint surgery, Jul 1, 2004
Fixation by a single screw is considered the current treatment of choice for a slipped capital fe... more Fixation by a single screw is considered the current treatment of choice for a slipped capital femoral epiphysis. This approach promotes premature physeal closure. The use of a modified, standard, single, cannulated screw designed to maintain epiphyseal fixation without causing premature closure of the physis was reviewed in ten patients. The nine boys and one girl aged between 10.6 and 12.6 years with unilateral slipped capital femoral epiphysis (SCFE), were markedly skeletally immature (Tanner stage I, bone age 10 to 12.6 years). Clinical and radiological review at a mean follow-up of 44.3 months (36 to 76) showed no difference in the time to physeal closure between the involved and uninvolved side. Measurement of epiphyseal and physeal development showed continued growth and remodelling in all patients. Use of this device provided epiphyseal stability and maintained the capacity for physeal recovery and growth following treatment for both unstable and stable slipped capital femoral epiphysis.
Springer eBooks, Nov 20, 2013
Ankle sprains are the most common injury among children and adolescents. The anterior talo-fibula... more Ankle sprains are the most common injury among children and adolescents. The anterior talo-fibular ligament (ATFL) is the first structure to be injured in an inversion sprain. Tears of this ligament can be incomplete, complete, or with avulsion. A capsular lesion is generally present in complete tears and in injuries with avulsed fragments. Effective treatment of these injuries depends on adequate initial assessment. In young patients, avulsions of the chondral or osteochondral fragments are not always revealed by survey radiographs. Therefore, ultrasound examinations should be performed. Management strategies for acute ruptures of the lateral ankle ligaments can be divided into cast immobilization, surgical treatment, and functional treatment. In a number of recent reviews on treatment of acute tears of the lateral ankle ligaments, early mobilization and functional treatment have been advocated. Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains, and stability. Nevertheless, there is still controversy as to whether acute ligament ruptures should be treated non-surgically or with primary surgical repair, followed by immobilization using a plaster cast or brace. Consideration of primary surgical repair must be according to the exigencies and expectations of patients and parents, considering that this treatment is one way to ensure a rapid return to a stable and painless ankle in child athletes with acute tears of the ATFL and extensive capsular involvement with or without avulsed fragments.
Frontiers in Pediatrics, Nov 9, 2022
in all cases of CS with hemivertebra, before considering a surgical approach, conservative treatm... more in all cases of CS with hemivertebra, before considering a surgical approach, conservative treatment should be implemented as early as possible without waiting for the progressive deformation of the adjacent normal vertebrae.
Minerva Ortopedica E Traumatologica, 1991
Orthopedics, Nov 1, 2009
Treatment of anterior cruciate ligament (ACL) injury in skeletally immature patients is controver... more Treatment of anterior cruciate ligament (ACL) injury in skeletally immature patients is controversial. The growth plate could be damaged if treated with the reconstruction techniques used to treat instability in adults. For this reason, many authors postpone surgical treatment until skeletal maturity, but the acceptable length of time that treatment can be postponed without causing irreversible damage to the articular cartilage in children with ACL injury is unknown. Until now, no studies have described the pathological findings and the evolution of the lesions of the articular cartilage during the growing period. For this reason, an experimental study on 16 6-month-old, skeletally immature goats was performed. A complete ACL lesion was achieved by removing the ligament. Two animals per group were sacrificed at intervals of 1, 3, 6, and 9 months postoperatively, and macroscopic and microscopic evaluations were performed. The presence of meniscal injury and articular cartilage lesions with progressive aspects were hystologically underlined. The hystological observations showed that the complete ACL lesion causes irreversible articular cartilage alterations in growing goats 3 months after injury. These experimental data suggest that ACL reconstruction in growing patients with ACL injury and instability should be indicated without waiting until skeletal maturity.
the screening able to lower morbidity in the territory?
Brace treatment in juvenile idiopathic scoliosis: cordance with the SRS have achieved curve corre... more Brace treatment in juvenile idiopathic scoliosis: cordance with the SRS have achieved curve correction in 19 cases (70.0%), stabilization in 5 cases (19%) and progression in 3 cases (11%). Aulisa et al. Scoliosis 2014, 9:3
Journal of Clinical Medicine
Background: An algorithm for managing open fractures in children is still being debated; the pres... more Background: An algorithm for managing open fractures in children is still being debated; the present study suggests an evidence-based way to manage these patients in the emergency department. Methods: The literature on “Open fractures in children” was carefully analyzed using keywords. The primary sources were The Cochrane Library, PubMed, and Researchgate. Conclusion: We proposed an evidence-based algorithm for managing open fractures in children to standardize clinical practice and improve the care of these patients.
PubMed, 1991
The authors clinically and radiographically review 42 of 53 children between the ages of 5 months... more The authors clinically and radiographically review 42 of 53 children between the ages of 5 months and 3 years treated by closed means from 1983 to 1987 for femoral fracture (average follow-up, 4 years). Evaluation of a large number of patients in this particular age group offers several advantages: a) it regards a phase of evolution in which the modalities of growth do not affect in any significant way the metabolic balance of the growth plate chondrocyte, as occurs in periods of rapid growth. This makes the sample group statistically homogeneous; b) it eliminates the age variable in the search for the factors which may contribute to limb-length discrepancy. The importance of the following factors was statistically analyzed: location, type, and initial displacement of the fracture, accuracy of reduction, and characteristics of the traumatic event. There was a significant correlation between a large degree of limb lengthening and further reduction or corrective procedures under general anesthesia. Overlapping reduction and limb shortening were also closely related. A highly significant correlation was also found between limb lengthening exceeding 15 mm. (range, 15-22 mm.) and the time of day at which the trauma occurred (9-10 pm). The results of treatment suggest the need for a reevaluation, using recently gained knowledge, of Lacroix's theory of the pathogenesis of this disorder as well as the need to examine more thoroughly, with further clinical and experimental studies, the hormonal changes following the trauma.
Scoliosis, Sep 1, 2013
Although several procedures for treating scoliosis have evolved, the most effective treatment is ... more Although several procedures for treating scoliosis have evolved, the most effective treatment is still based on early detection. For early diagnosis of idiopathic scoliosis, many authors proposed methods of school screening; however, a standardized screening program does not yet exist.
PubMed, 1991
Various conventional roentgenographic methods have been proposed to determine the severity of chr... more Various conventional roentgenographic methods have been proposed to determine the severity of chronic slipped capital femoral epiphysis (SCFE) on the sagittal plane, with some maintaining that computed tomography (CT) is more accurate and reproduces better than roentgenography. We used a modified Dunlap's technique and angular measurement to determine slip severity. Three orthopaedists obtained data from roentgenograms and CT of 20 hips with chronic SCFE. Statistical analysis showed concordance between our method and the measurements and reproducibility produced with CT. The results suggest that our method is as effective as and less expensive than CT.
Scoliosis, Feb 23, 2012
Background: The Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orth... more Background: The Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orthosis (TLSO),
BMC Musculoskeletal Disorders, Oct 24, 2015
Background: The Lyon brace is commonly prescribed in many European countries to patients with tho... more Background: The Lyon brace is commonly prescribed in many European countries to patients with thoracic curves and is based on the three-point pressure system. The purpose of this study was to evaluate the efficacy of Lyon bracing for the conservative treatment of adolescent females with idiopathic thoracic curves in a case series selected on the basis of the Scoliosis Research Society (SRS) Committee on Bracing and Nonoperative Management Standardization Criteria and followed the guidelines on management of idiopathic scoliosis with corrective braces, proposed by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Methods: Prospective study based on an ongoing database. From 1297 patients treated for idiopathic scoliosis between 1995 and 2014 fulfill the inclusion criteria 102 patients treated with Lyon brace. Of these, 69 patients had a definite outcome, 17 have abandoned treatment e 16 are still in treatment. The 104 patients were adolescent females with curvatures in the thoracic spine and a pre-treatment Risser score ranging from 0 to 2. All patients were prescribed with full-time Lyon bracing. The minimum duration of follow-up was 24 months after the end of weaning (mean: 41.64 ± 31.45 months). Anteroposterior radiographs were used to estimate the curve magnitude (C M) at 5 time points: beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-year minimum follow-up from t4 (t5). Three outcomes were distinguished: curve correction, curve stabilization and curve progression. Results: The results from our study showed that of the 69 patients with a definite outcome the C M mean value was 31.51°± 4.34 SD at t1 and 20°± 7.6 SD at t5. Curve correction was accomplished in 85.5 % of patients, curve stabilization was obtained in 13 % of patients and curve progression was evident in only 1.5 %. None of the patients were recommended surgery post-bracing. Of 17 patients who abandoned the treatment, at the time of abandonment (14.4 age) have achieved curve correction in 13 cases (77 %), stabilization in 53 cases (18 %) and progression in 1 case (5 %). Conclusion: The Lyon brace, through its biomechanical action on vertebral modeling, is highly effective in correcting thoracic curves in particularly when the SOSORT guidelines were adopted in addition to the SRS criteria.
European Journal of Physical and Rehabilitation Medicine, May 1, 2019
The recent literature showed positive results for bracing of patients with idiopathic scoliosis a... more The recent literature showed positive results for bracing of patients with idiopathic scoliosis above 45° who refused surgery. However, no one has investigated whether other parameters can affect the results. The aim of this study was to evaluate the effectiveness of bracing in idiopathic scoliosis with curves above 40° and to verify the mechanical and biological parameters which go beyond the simple bend value expressed in Cobb degrees. This is an observational controlled cohort study nested in a prospective clinical on-going database including 1,238 patients with idiopathic scoliosis. Inpatients and outpatients in Rome. 160 patients with idiopathic scoliosis with curves above 40°. This is a prospective study based on an ongoing database including 1,238 patients with idiopathic scoliosis. The patients studied had idiopathic scoliosis with curves of 40° or more, Risser grade 0-4, and had refused any surgical treatment. 160 patients met the inclusion criteria. Of these, 104 patients had a definite outcome, 28 abandoned treatment and 28 are currently under treatment. The minimum duration of follow-up was 24 months. X-rays were used to obtain Cobb degrees and torsion of the apical vertebrae (Perdriolle's method). Three outcomes were distinguished according to SRS- SOSORT criteria: correction, stabilization and progression. To achieve the second aim we divided the sample into subgroups according to Cobb degrees (<45°;≥45°), Risser (0-2; 3-4) and rotation (<20; ≥ 20). Furthermore, logistic regression was applied by Stepwise Regression. The results of our study showed that in 104 patients with a definite outcome the Cobb mean value was initially 47 ± 5.25 SD and 34.19 ±8.45 SD at follow-up. Perdriolle was initially 20.04 ± 5.53 SD and 16.76 ± 7.04 at follow-up. Overall, 81 patients (78%) obtained a curve correction, and stabilization was achieved in 14 cases (13%). Nine patients experienced curve progression (9%), 16 patients were recommended for surgery because the curve at follow up was over 45°. The analysis of subgroups shows that with Cobb < 45° at baseline, the average reduction was 11.46° Cobb, while in cases with Cobb ≥ 45 at baseline, the mean correction was 13.74° Cobb. In subgroups with Perdriolle < 20° at baseline, the average reduction was 16.02° Cobb, while in cases with Perdriolle ≥ 20° at baseline, the mean correction was 8.4° Cobb. In subgroups with Risser 0-2 at baseline, the average reduction was 14.7° Cobb, while in cases with Risser 3-4 at baseline, the mean correction was 6.7° Cobb. The logistic regression model shows significance for the initial value of Perdriolle and Risser. Our results indicate that an adequate conservative treatment must definitely be considered for patients with scoliotic curves who refuse surgery; the results will be better particularly if the rotation is lower than 20 and Risser is between 0-2. With the simultaneous evaluation of the Cobb angle, the vertebral rotation and the potential vertebral growth, it was possible to predict the final results at the start of treatment.
American Journal of Sports Medicine, Nov 1, 2003
Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries th... more Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries the risk of adverse sequelae. 1) To provide clinical and radiographic methods to identify skeletally immature patients with significant remaining lower limb growth. 2) To provide a method for calculating the percent area lesion created by a 6-mm distal femoral physeal tunnel. 3) To present a method of partial transphyseal intraarticular anterior cruciate ligament reconstruction with bipolar graft fixation in these patients. 4) To report on clinical, functional, and radiographic results at skeletal maturity. Fourteen adolescents with symptomatic anterior cruciate ligament instability who were identified as being in Tanner stages 2 and 3 underwent partial transphyseal intraarticular anterior cruciate ligament reconstruction with the use of hamstring tendon grafts (transphyseal only in the femur and through the epiphysis in the tibia). At skeletal maturity, 10 patients were asymptomatic and fully active in sports. No patient had significant leg-length inequality or angular deformity after use of a 6-mm femoral physeal tunnel, which represented 1) less than 7% of the frontal plane and 2) less than 1% of the transverse plane cross-sectional femoral physeal areas. The choice of the exposed technique and the method used to select patients permitted us to avoid adverse sequelae.
American Journal of Sports Medicine, Nov 1, 2003
In the very young patient in need of anterior cruciate ligament reconstruction, the option of rec... more In the very young patient in need of anterior cruciate ligament reconstruction, the option of reconstruction with physeal-sparing techniques is valid because it is not known what percentage of physeal transgression causes adverse growth consequences. To report our experience with an intraarticular technique for anterior cruciate ligament reconstruction that spares the open femoral and tibial physes yet allows soft tissue graft fixation in the femoral and tibial tunnels. Eight preadolescents underwent physeal-sparing intraarticular reconstruction for anterior cruciate ligament insufficiency with the use of semitendinosus and gracilis tendon grafts. All eight patients were in Tanner stage 1 with an average chronologic age of 11.15 years and average bone age of 10.9 years. Preoperative prediction of lower limb growth averaged 10.8 cm. Five of the eight patients had reached skeletal maturity at follow-up, which was at an average of 69.2 months postoperatively. For these five, the Orthopadische Arbeitsgruppe Knie (OAK) score averaged 97 and the average KT-2000 arthrometer difference was 1.8 mm. Average growth in total height from surgery to final follow-up was 21.7 cm. No patient had a leg-length discrepancy or angular deformity, as verified by clinical or teleroentgenogram measurements. The technique presented in this study provided graft isometry and stability without adverse physeal consequences. Additional research is needed to determine the threshold percentage of physeal transgression for avoiding growth disturbances in humans.
Knee Surgery, Sports Traumatology, Arthroscopy, Feb 9, 2016
Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stag... more Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stages 2 and 3) is controversial. Conventional reconstruction used in adults can cause iatrogenic growth disturbance due to physeal damage, and studies that report long-term results using a specific technique are scarce. The aim of this study is to evaluate in a large series the mid- and long-term results of a partial transphyseal technique and define the safe percentage of lesions of the femoral growth plate. Between 1989 and 2012, 42 adolescents at risk of growth disturbances (growth prediction of lower limbs >5 cm-Tanner 2, 3) underwent reconstruction of the anterior cruciate ligament using the semitendinosus and gracilis tendons. Growth characteristics of all the patients were assessed preoperatively, and the percentage of damage that would be produced in the femoral physis by the drilling of a 6-mm-diameter tunnel was determined. The technique used achieved graft fixation at both insertion sites, drilling the femoral physis and avoiding the tibial physis. We distinguished two groups: (a) long-term follow-up (mean 13 years 7 months, min 10.9, max 16.2) and (b) medium follow-up (mean 6 years 3 months, min 3.7, max 9.9). All knees were evaluated subjectively by history and objectively by KT2000 testing, and X-rays of both knees were compared for osteoarthritis using the Kellgren-Lawrence classification. In group A (12 patients) one osteoarthritis grade 2, one instability, and ten good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +2.4 mm (range 1-4 mm) between the operated and non-operated sides (p < 0.05). In group B (21 patients) no growth disturbance of the lower limbs, two failures (reinjury while participating in pivoting sports), and 19 good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +1.9 mm (range 1-5 mm) between the operated and non-operated sides (p < 0.05). The average IKDC score of all the patients was 90 (min: 68, max: 97). None of the adolescents had consequences on growth after an eccentric damage passing tendons less than 7 % on the frontal plane and of 1 % on cross-sectional area of the femoral physis, and after an oblique tunnel passing 6-mm-diameter tendons of the tibial epiphyseal nucleus . This study defines the possibility to perform a partial transphyseal intra-articular ACL reconstruction in patients in Tanner stages 2 and 3 that avoids tibial physis, involves the distal femoral physis, and produces good results at mid- and long-term follow-up without causing growth disturbances. IV.
The journal of bone and joint surgery, May 1, 1990
We obtained specimens of growth-plate cartilage from four patients with osteogenesis imperlecta. ... more We obtained specimens of growth-plate cartilage from four patients with osteogenesis imperlecta. Light microscopy showed structural changes in the tissue and morphological changes in chondrocytes and matrix, particularly in the hypertrophic zone. There were changes in the process of calcification in the primary mineralisation zone of the cartilage. We also found histochemical changes in the matrix glycosaminoglycans (GAGs) in the zones where physiological mineralisation was disturbed and where the trabeculae were interrupted and poorly mineralised. In addition to the known molecular defects in collagen, changes in GAGs and non-collagenous proteins are important factors in the pathogenesis of the disease.
Current Therapeutic Research-clinical and Experimental, 1989
Evaluation of the clinical efficacy of short-term antibiotic prophylaxis with multiple doses of m... more Evaluation of the clinical efficacy of short-term antibiotic prophylaxis with multiple doses of mezlocillin, on patients who underwent traumatologic and orthopedic surgery. Clinical and laboratory examinations prior to, during and after surgery were performed
The journal of bone and joint surgery, Jul 1, 2004
Fixation by a single screw is considered the current treatment of choice for a slipped capital fe... more Fixation by a single screw is considered the current treatment of choice for a slipped capital femoral epiphysis. This approach promotes premature physeal closure. The use of a modified, standard, single, cannulated screw designed to maintain epiphyseal fixation without causing premature closure of the physis was reviewed in ten patients. The nine boys and one girl aged between 10.6 and 12.6 years with unilateral slipped capital femoral epiphysis (SCFE), were markedly skeletally immature (Tanner stage I, bone age 10 to 12.6 years). Clinical and radiological review at a mean follow-up of 44.3 months (36 to 76) showed no difference in the time to physeal closure between the involved and uninvolved side. Measurement of epiphyseal and physeal development showed continued growth and remodelling in all patients. Use of this device provided epiphyseal stability and maintained the capacity for physeal recovery and growth following treatment for both unstable and stable slipped capital femoral epiphysis.
Springer eBooks, Nov 20, 2013
Ankle sprains are the most common injury among children and adolescents. The anterior talo-fibula... more Ankle sprains are the most common injury among children and adolescents. The anterior talo-fibular ligament (ATFL) is the first structure to be injured in an inversion sprain. Tears of this ligament can be incomplete, complete, or with avulsion. A capsular lesion is generally present in complete tears and in injuries with avulsed fragments. Effective treatment of these injuries depends on adequate initial assessment. In young patients, avulsions of the chondral or osteochondral fragments are not always revealed by survey radiographs. Therefore, ultrasound examinations should be performed. Management strategies for acute ruptures of the lateral ankle ligaments can be divided into cast immobilization, surgical treatment, and functional treatment. In a number of recent reviews on treatment of acute tears of the lateral ankle ligaments, early mobilization and functional treatment have been advocated. Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains, and stability. Nevertheless, there is still controversy as to whether acute ligament ruptures should be treated non-surgically or with primary surgical repair, followed by immobilization using a plaster cast or brace. Consideration of primary surgical repair must be according to the exigencies and expectations of patients and parents, considering that this treatment is one way to ensure a rapid return to a stable and painless ankle in child athletes with acute tears of the ATFL and extensive capsular involvement with or without avulsed fragments.
Frontiers in Pediatrics, Nov 9, 2022
in all cases of CS with hemivertebra, before considering a surgical approach, conservative treatm... more in all cases of CS with hemivertebra, before considering a surgical approach, conservative treatment should be implemented as early as possible without waiting for the progressive deformation of the adjacent normal vertebrae.
Minerva Ortopedica E Traumatologica, 1991
Orthopedics, Nov 1, 2009
Treatment of anterior cruciate ligament (ACL) injury in skeletally immature patients is controver... more Treatment of anterior cruciate ligament (ACL) injury in skeletally immature patients is controversial. The growth plate could be damaged if treated with the reconstruction techniques used to treat instability in adults. For this reason, many authors postpone surgical treatment until skeletal maturity, but the acceptable length of time that treatment can be postponed without causing irreversible damage to the articular cartilage in children with ACL injury is unknown. Until now, no studies have described the pathological findings and the evolution of the lesions of the articular cartilage during the growing period. For this reason, an experimental study on 16 6-month-old, skeletally immature goats was performed. A complete ACL lesion was achieved by removing the ligament. Two animals per group were sacrificed at intervals of 1, 3, 6, and 9 months postoperatively, and macroscopic and microscopic evaluations were performed. The presence of meniscal injury and articular cartilage lesions with progressive aspects were hystologically underlined. The hystological observations showed that the complete ACL lesion causes irreversible articular cartilage alterations in growing goats 3 months after injury. These experimental data suggest that ACL reconstruction in growing patients with ACL injury and instability should be indicated without waiting until skeletal maturity.
the screening able to lower morbidity in the territory?
Brace treatment in juvenile idiopathic scoliosis: cordance with the SRS have achieved curve corre... more Brace treatment in juvenile idiopathic scoliosis: cordance with the SRS have achieved curve correction in 19 cases (70.0%), stabilization in 5 cases (19%) and progression in 3 cases (11%). Aulisa et al. Scoliosis 2014, 9:3
Journal of Clinical Medicine
Background: An algorithm for managing open fractures in children is still being debated; the pres... more Background: An algorithm for managing open fractures in children is still being debated; the present study suggests an evidence-based way to manage these patients in the emergency department. Methods: The literature on “Open fractures in children” was carefully analyzed using keywords. The primary sources were The Cochrane Library, PubMed, and Researchgate. Conclusion: We proposed an evidence-based algorithm for managing open fractures in children to standardize clinical practice and improve the care of these patients.
PubMed, 1991
The authors clinically and radiographically review 42 of 53 children between the ages of 5 months... more The authors clinically and radiographically review 42 of 53 children between the ages of 5 months and 3 years treated by closed means from 1983 to 1987 for femoral fracture (average follow-up, 4 years). Evaluation of a large number of patients in this particular age group offers several advantages: a) it regards a phase of evolution in which the modalities of growth do not affect in any significant way the metabolic balance of the growth plate chondrocyte, as occurs in periods of rapid growth. This makes the sample group statistically homogeneous; b) it eliminates the age variable in the search for the factors which may contribute to limb-length discrepancy. The importance of the following factors was statistically analyzed: location, type, and initial displacement of the fracture, accuracy of reduction, and characteristics of the traumatic event. There was a significant correlation between a large degree of limb lengthening and further reduction or corrective procedures under general anesthesia. Overlapping reduction and limb shortening were also closely related. A highly significant correlation was also found between limb lengthening exceeding 15 mm. (range, 15-22 mm.) and the time of day at which the trauma occurred (9-10 pm). The results of treatment suggest the need for a reevaluation, using recently gained knowledge, of Lacroix's theory of the pathogenesis of this disorder as well as the need to examine more thoroughly, with further clinical and experimental studies, the hormonal changes following the trauma.
Scoliosis, Sep 1, 2013
Although several procedures for treating scoliosis have evolved, the most effective treatment is ... more Although several procedures for treating scoliosis have evolved, the most effective treatment is still based on early detection. For early diagnosis of idiopathic scoliosis, many authors proposed methods of school screening; however, a standardized screening program does not yet exist.
PubMed, 1991
Various conventional roentgenographic methods have been proposed to determine the severity of chr... more Various conventional roentgenographic methods have been proposed to determine the severity of chronic slipped capital femoral epiphysis (SCFE) on the sagittal plane, with some maintaining that computed tomography (CT) is more accurate and reproduces better than roentgenography. We used a modified Dunlap's technique and angular measurement to determine slip severity. Three orthopaedists obtained data from roentgenograms and CT of 20 hips with chronic SCFE. Statistical analysis showed concordance between our method and the measurements and reproducibility produced with CT. The results suggest that our method is as effective as and less expensive than CT.
Scoliosis, Feb 23, 2012
Background: The Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orth... more Background: The Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orthosis (TLSO),
BMC Musculoskeletal Disorders, Oct 24, 2015
Background: The Lyon brace is commonly prescribed in many European countries to patients with tho... more Background: The Lyon brace is commonly prescribed in many European countries to patients with thoracic curves and is based on the three-point pressure system. The purpose of this study was to evaluate the efficacy of Lyon bracing for the conservative treatment of adolescent females with idiopathic thoracic curves in a case series selected on the basis of the Scoliosis Research Society (SRS) Committee on Bracing and Nonoperative Management Standardization Criteria and followed the guidelines on management of idiopathic scoliosis with corrective braces, proposed by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Methods: Prospective study based on an ongoing database. From 1297 patients treated for idiopathic scoliosis between 1995 and 2014 fulfill the inclusion criteria 102 patients treated with Lyon brace. Of these, 69 patients had a definite outcome, 17 have abandoned treatment e 16 are still in treatment. The 104 patients were adolescent females with curvatures in the thoracic spine and a pre-treatment Risser score ranging from 0 to 2. All patients were prescribed with full-time Lyon bracing. The minimum duration of follow-up was 24 months after the end of weaning (mean: 41.64 ± 31.45 months). Anteroposterior radiographs were used to estimate the curve magnitude (C M) at 5 time points: beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-year minimum follow-up from t4 (t5). Three outcomes were distinguished: curve correction, curve stabilization and curve progression. Results: The results from our study showed that of the 69 patients with a definite outcome the C M mean value was 31.51°± 4.34 SD at t1 and 20°± 7.6 SD at t5. Curve correction was accomplished in 85.5 % of patients, curve stabilization was obtained in 13 % of patients and curve progression was evident in only 1.5 %. None of the patients were recommended surgery post-bracing. Of 17 patients who abandoned the treatment, at the time of abandonment (14.4 age) have achieved curve correction in 13 cases (77 %), stabilization in 53 cases (18 %) and progression in 1 case (5 %). Conclusion: The Lyon brace, through its biomechanical action on vertebral modeling, is highly effective in correcting thoracic curves in particularly when the SOSORT guidelines were adopted in addition to the SRS criteria.
European Journal of Physical and Rehabilitation Medicine, May 1, 2019
The recent literature showed positive results for bracing of patients with idiopathic scoliosis a... more The recent literature showed positive results for bracing of patients with idiopathic scoliosis above 45° who refused surgery. However, no one has investigated whether other parameters can affect the results. The aim of this study was to evaluate the effectiveness of bracing in idiopathic scoliosis with curves above 40° and to verify the mechanical and biological parameters which go beyond the simple bend value expressed in Cobb degrees. This is an observational controlled cohort study nested in a prospective clinical on-going database including 1,238 patients with idiopathic scoliosis. Inpatients and outpatients in Rome. 160 patients with idiopathic scoliosis with curves above 40°. This is a prospective study based on an ongoing database including 1,238 patients with idiopathic scoliosis. The patients studied had idiopathic scoliosis with curves of 40° or more, Risser grade 0-4, and had refused any surgical treatment. 160 patients met the inclusion criteria. Of these, 104 patients had a definite outcome, 28 abandoned treatment and 28 are currently under treatment. The minimum duration of follow-up was 24 months. X-rays were used to obtain Cobb degrees and torsion of the apical vertebrae (Perdriolle's method). Three outcomes were distinguished according to SRS- SOSORT criteria: correction, stabilization and progression. To achieve the second aim we divided the sample into subgroups according to Cobb degrees (<45°;≥45°), Risser (0-2; 3-4) and rotation (<20; ≥ 20). Furthermore, logistic regression was applied by Stepwise Regression. The results of our study showed that in 104 patients with a definite outcome the Cobb mean value was initially 47 ± 5.25 SD and 34.19 ±8.45 SD at follow-up. Perdriolle was initially 20.04 ± 5.53 SD and 16.76 ± 7.04 at follow-up. Overall, 81 patients (78%) obtained a curve correction, and stabilization was achieved in 14 cases (13%). Nine patients experienced curve progression (9%), 16 patients were recommended for surgery because the curve at follow up was over 45°. The analysis of subgroups shows that with Cobb < 45° at baseline, the average reduction was 11.46° Cobb, while in cases with Cobb ≥ 45 at baseline, the mean correction was 13.74° Cobb. In subgroups with Perdriolle < 20° at baseline, the average reduction was 16.02° Cobb, while in cases with Perdriolle ≥ 20° at baseline, the mean correction was 8.4° Cobb. In subgroups with Risser 0-2 at baseline, the average reduction was 14.7° Cobb, while in cases with Risser 3-4 at baseline, the mean correction was 6.7° Cobb. The logistic regression model shows significance for the initial value of Perdriolle and Risser. Our results indicate that an adequate conservative treatment must definitely be considered for patients with scoliotic curves who refuse surgery; the results will be better particularly if the rotation is lower than 20 and Risser is between 0-2. With the simultaneous evaluation of the Cobb angle, the vertebral rotation and the potential vertebral growth, it was possible to predict the final results at the start of treatment.
American Journal of Sports Medicine, Nov 1, 2003
Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries th... more Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries the risk of adverse sequelae. 1) To provide clinical and radiographic methods to identify skeletally immature patients with significant remaining lower limb growth. 2) To provide a method for calculating the percent area lesion created by a 6-mm distal femoral physeal tunnel. 3) To present a method of partial transphyseal intraarticular anterior cruciate ligament reconstruction with bipolar graft fixation in these patients. 4) To report on clinical, functional, and radiographic results at skeletal maturity. Fourteen adolescents with symptomatic anterior cruciate ligament instability who were identified as being in Tanner stages 2 and 3 underwent partial transphyseal intraarticular anterior cruciate ligament reconstruction with the use of hamstring tendon grafts (transphyseal only in the femur and through the epiphysis in the tibia). At skeletal maturity, 10 patients were asymptomatic and fully active in sports. No patient had significant leg-length inequality or angular deformity after use of a 6-mm femoral physeal tunnel, which represented 1) less than 7% of the frontal plane and 2) less than 1% of the transverse plane cross-sectional femoral physeal areas. The choice of the exposed technique and the method used to select patients permitted us to avoid adverse sequelae.
American Journal of Sports Medicine, Nov 1, 2003
In the very young patient in need of anterior cruciate ligament reconstruction, the option of rec... more In the very young patient in need of anterior cruciate ligament reconstruction, the option of reconstruction with physeal-sparing techniques is valid because it is not known what percentage of physeal transgression causes adverse growth consequences. To report our experience with an intraarticular technique for anterior cruciate ligament reconstruction that spares the open femoral and tibial physes yet allows soft tissue graft fixation in the femoral and tibial tunnels. Eight preadolescents underwent physeal-sparing intraarticular reconstruction for anterior cruciate ligament insufficiency with the use of semitendinosus and gracilis tendon grafts. All eight patients were in Tanner stage 1 with an average chronologic age of 11.15 years and average bone age of 10.9 years. Preoperative prediction of lower limb growth averaged 10.8 cm. Five of the eight patients had reached skeletal maturity at follow-up, which was at an average of 69.2 months postoperatively. For these five, the Orthopadische Arbeitsgruppe Knie (OAK) score averaged 97 and the average KT-2000 arthrometer difference was 1.8 mm. Average growth in total height from surgery to final follow-up was 21.7 cm. No patient had a leg-length discrepancy or angular deformity, as verified by clinical or teleroentgenogram measurements. The technique presented in this study provided graft isometry and stability without adverse physeal consequences. Additional research is needed to determine the threshold percentage of physeal transgression for avoiding growth disturbances in humans.
Knee Surgery, Sports Traumatology, Arthroscopy, Feb 9, 2016
Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stag... more Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stages 2 and 3) is controversial. Conventional reconstruction used in adults can cause iatrogenic growth disturbance due to physeal damage, and studies that report long-term results using a specific technique are scarce. The aim of this study is to evaluate in a large series the mid- and long-term results of a partial transphyseal technique and define the safe percentage of lesions of the femoral growth plate. Between 1989 and 2012, 42 adolescents at risk of growth disturbances (growth prediction of lower limbs >5 cm-Tanner 2, 3) underwent reconstruction of the anterior cruciate ligament using the semitendinosus and gracilis tendons. Growth characteristics of all the patients were assessed preoperatively, and the percentage of damage that would be produced in the femoral physis by the drilling of a 6-mm-diameter tunnel was determined. The technique used achieved graft fixation at both insertion sites, drilling the femoral physis and avoiding the tibial physis. We distinguished two groups: (a) long-term follow-up (mean 13 years 7 months, min 10.9, max 16.2) and (b) medium follow-up (mean 6 years 3 months, min 3.7, max 9.9). All knees were evaluated subjectively by history and objectively by KT2000 testing, and X-rays of both knees were compared for osteoarthritis using the Kellgren-Lawrence classification. In group A (12 patients) one osteoarthritis grade 2, one instability, and ten good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +2.4 mm (range 1-4 mm) between the operated and non-operated sides (p < 0.05). In group B (21 patients) no growth disturbance of the lower limbs, two failures (reinjury while participating in pivoting sports), and 19 good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +1.9 mm (range 1-5 mm) between the operated and non-operated sides (p < 0.05). The average IKDC score of all the patients was 90 (min: 68, max: 97). None of the adolescents had consequences on growth after an eccentric damage passing tendons less than 7 % on the frontal plane and of 1 % on cross-sectional area of the femoral physis, and after an oblique tunnel passing 6-mm-diameter tendons of the tibial epiphyseal nucleus . This study defines the possibility to perform a partial transphyseal intra-articular ACL reconstruction in patients in Tanner stages 2 and 3 that avoids tibial physis, involves the distal femoral physis, and produces good results at mid- and long-term follow-up without causing growth disturbances. IV.
The journal of bone and joint surgery, May 1, 1990
We obtained specimens of growth-plate cartilage from four patients with osteogenesis imperlecta. ... more We obtained specimens of growth-plate cartilage from four patients with osteogenesis imperlecta. Light microscopy showed structural changes in the tissue and morphological changes in chondrocytes and matrix, particularly in the hypertrophic zone. There were changes in the process of calcification in the primary mineralisation zone of the cartilage. We also found histochemical changes in the matrix glycosaminoglycans (GAGs) in the zones where physiological mineralisation was disturbed and where the trabeculae were interrupted and poorly mineralised. In addition to the known molecular defects in collagen, changes in GAGs and non-collagenous proteins are important factors in the pathogenesis of the disease.