J. Conteduca - Academia.edu (original) (raw)

Papers by J. Conteduca

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021

Aim In the scientific literature there are no papers that clarify which method of surgical fixati... more Aim In the scientific literature there are no papers that clarify which method of surgical fixation in transverse metacarpal fractures has the best functional outcomes. The aim of this study was to compare the hand strength obtained using two different methods in the treatment of these fractures. Methods A total of 52 patients who presented a transverse metacarpal fracture were enrolled. They were divided in two groups: 26 patients treated with K-wire (IMN) and 26 patients treated with plate and screws (PW). The evaluation criteria were: fracture healing time, performed force testing collected ultimate tensile strength and grip, the Disability Arm Shoulder and Hand (DASH) score, and the range of motion of the hand. Results In both groups obtained results were comparable in terms of full hand function, healing and total range of motion and DASH. Results in group K were slightly better than group PW in terms of strength and grip pain within 3 months from osteosynthesis. Conclusion Nei...

Injury, 2021

Introduction: Scapular body fractures represent less than 1% of all skeletal fractures. Operative... more Introduction: Scapular body fractures represent less than 1% of all skeletal fractures. Operative criteria and risk factors for scapular fracture instability are well defined. Non-operative management of scapular body fractures show satisfactory results but with shortening and medialization of the scapular body. The aim of this study is to evaluate if surgical treatment will result in an improved quality of life and shoulder function compared to non-operative treatment on patients suffering from a scapular body fracture. Materials and Methods: From a total of 381 retrospectively identified scapular body fractures, we included 45 patients. The enrolled patients were divided into two groups: the surgical treatment (ST, n = 20) group and the non-operative treatment (NOT, n = 25) group. The Non-Union Scoring System (NUSS) was used to assess bone healing on radiographs. The functional evaluation of the two groups during the follow-up were performed using the Constant Shoulder Score (CSS) and the Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH). Complications, reoperation rates, and time until bony union were also documented. The minimum follow-up for this study was designated as 12 months. Results: The ST group had better mean CSS and QuickDASH scores compared to the NOT group at 1, 3 and 6 months of follow-up. No statistically significant difference was detected at 12 months follow-up. ST group also demonstrated improved results in time until bone union, reduction of rehabilitation time, complications and return to work rates. Conclusion: This study suggests that surgical treatment for extraarticular scapular fractures can achieve better short-term functional outcomes (3 to 6 months) compared to conservative treatment.

Anterior Cruciate Ligament Reconstruction, 2014

In this chapter, we describe a reproducible, simple to use method that allows correct femoral tun... more In this chapter, we describe a reproducible, simple to use method that allows correct femoral tunnel placement without the need for aggressive notch debridement. This outside-in technique has a number of advantages over the more conventional in-out femoral tunnel placement via the anteromedial portal. By avoiding the need to place the knee in deep flexion, it allows preservation of the ACL remnant in partial and remnant preserving reconstructions. We propose that this is biologically advantageous. This technique can be applied for single, double-bundle and augmentation procedures.

Anterior Cruciate Ligament Reconstruction, 2014

Anterior Cruciate Ligament Reconstruction, 2014

The American Journal of Sports Medicine, 2014

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal lesion... more Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal lesions. Despite improvements in meniscal repair techniques, failure rates remain significant, especially for the posterior horn of the medial meniscus. Purpose: To determine whether a systematic arthroscopic exploration of the posterior horn of the medial meniscus with an additional posteromedial portal is useful to identify otherwise unrecognized lesions. Study Design: Case series; Level of evidence, 4. Methods: In a consecutive series of 302 ACL reconstructions, a systematic arthroscopic exploration of the posterior horn of the medial meniscus was performed. The first stage of the exploration was achieved through anterior visualization via a standard anterolateral portal. In the second stage, the posterior horn of the medial meniscus was visualized posteriorly via the anterolateral portal with the scope positioned deep in the notch. In the third stage, the posterior horn was probed through ...

Clinical Cases in Mineral and Bone Metabolism, 2010

The aim of this study was to evaluate, through the application of semi-quantitative radiological ... more The aim of this study was to evaluate, through the application of semi-quantitative radiological criteria, the speed of bone repair processes induced by the surgical use of materials based on hydroxyapatite nanoparticles

Background The pathogenesis of bone tunnel enlargement following anterior cruciate ligament (ACL)... more Background The pathogenesis of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction is not yet clearly understood. Mechanical and biological hypotheses have been proposed to describe this short-to-mid term phenomenon which takes place after ACL reconstructions. In this paper we describe clinical and radiological results of studies performed at our Orthopaedic Department, in which we examined the effects on bone tunnel diameters of accelerated post-operative rehabilitation protocols and use of different stiffness graft fixation devices (among mechanical factors) and the effects on bone tunnel diameters of the synovial bathing effect and the presence of high level of proinflammatory cytokines (among biological factors) in patients operated for ACL reconstruction. Methods Along series of patients operated on for ACL reconstruction was prospectively enrolled in these studies and followed-up right before the operation and at a mean time of 10 months post-op. ...

Introduction Recently, much attention has been focused on tunnel enlargement phenomenon following... more Introduction Recently, much attention has been focused on tunnel enlargement phenomenon following Anterior Cruciate Ligament (ACL) reconstruction with hamstrings. The aim of the study was to evaluate the efficacy of the nanohydroxiapatite used as a bone graft in the bone tunnels to prevent this phenomenon possibly allowing a better tendon-to-bone integration. Methods Twenty consecutive male patients operated for ACL reconstruction were enrolled in this prospective study and they were randomly assigned to group A (10 patients, nanohydroxiapatite group) and group B (10 patients, control group). All patients underwent Magnetic Resonance Imaging (MRI) exam ten months after surgery with the aim to evaluate the amount of tunnel enlargement, the signal intensity in the central and in the peripheric part of the graft, and around bone the tunnel. Results Clinical evaluations, KT-1000 arthrometer and knee evaluation scales did not show any difference among the two groups. The mean tibial tunn...

Alpha Lipoic Acid (L.A.) is an effective natural antioxidant discovered in the human body in 1951... more Alpha Lipoic Acid (L.A.) is an effective natural antioxidant discovered in the human body in 1951 from L.J. Reed and I.C. Gunslaus from liver. It is inside broccoli, spinach and red meats, especially liver and spleen. Actually it is largely used as antioxidant in antiaging products according to the low toxicity level of the product. The present study take into consideration the possibility to reduce oxidation of medical irradiated UHMWPE GUR 1050, mixing together polyethylene powder and Alpha Lipoic Acid powder. The study is composed of two parts. Part 1 Thermostability of alpha lipoic acid during polyethylene fusion Part 2 detection of oxygen level in artificially aged irradiated polyethylene Solid pieces were made with Gur 1050 powder (Ticona Inc., Bayport, Tex, USA) and mixed with Alpha Lipoic Acid (Talamonti, Italy, Stock 1050919074) 0, 1% and gamma ray irradiated with 30 kGy (Isomedix, Northborough, MA). An oven (80° Celsius) was used to produce an aging effect for 35 days in t...

Introduction: Mechanical factors are thought to be one of the main reasons in determining tunnel ... more Introduction: Mechanical factors are thought to be one of the main reasons in determining tunnel enlargement after ACL reconstruction with hamstrings. The purpose of this prospective study was to evaluate how the different techniques may affect the bone tunnel enlargement. Material and Method : Forty-five consecutive patients undergoing ACL reconstruction with the use of autologous doubled semitendinosus and gracilis tendons entered this study. They were randomly assigned to enter group A (In-Out technique, with cortical fixation and Interference screw) and group B (Out-In technique, metal cortical fixation on the femour and tibia). At a mean follow-up of 10 months, all the patients underwent clinical evaluation and a CT scan exam to evaluate the post-operative diameters of both femoral and tibial tunnels. Results: The mean femoral tunnel diameter increased significantly from 9.05±0.3 mm (post op) to 10.01±2.3 mm (follow-up) in group A and from 9.04±0.8 mm to 9.3±1,12 mm in group B....

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 8, 2017

Several studies have recently shown better restoration of normal knee kinematics and improvement ... more Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out-in (OI) technique. Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed. In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8....

Revue de Chirurgie Orthopédique et Traumatologique, 2014

Resume La chondrolyse rapide apres menisectomie laterale est une complication rare. Nous rapporto... more Resume La chondrolyse rapide apres menisectomie laterale est une complication rare. Nous rapportons le premier cas de chondrolyse rapide du compartiment lateral apparue 6 mois apres une lesion du menisque lateral non traitee chirurgicalement chez un athlete de 18 ans pratiquant le rugby en pole espoir. Les hypotheses susceptibles d’expliquer cette complication sont presentees en excluant certains facteurs precedemment incrimines (geste chirurgical iatrogene, hyper laxite rotatoire meconnue, chondrotoxicite de la bupivacaine). Les contraintes excessives sur les surfaces cartilagineuses du compartiment lateral provoquees par l’extrusion du menisque pourraient provoquer une necrose cartilagineuse.

Orthopaedics & traumatology, surgery & research : OTSR, 2014

Rapid chondrolysis following a lateral meniscectomy is a rare complication. We present the first ... more Rapid chondrolysis following a lateral meniscectomy is a rare complication. We present the first reported case of rapid chondrolysis of the lateral compartment, which developed 6 months after a meniscus tear that was not surgically treated in a young 18-year-old professional rugby player. The possible hypotheses to explain this complication are presented, and certain previously published causes were excluded (iatrogenic during surgery, undiagnosed increased rotatory instability, chondrotoxicity of bupivacaine). Overloading of the cartilage surface of the lateral compartment from meniscal extrusion can cause cartilage necrosis.

Orthopaedic Journal of Sports Medicine, 2013

Background: Augmentation consisting of a selective reconstruction of the ruptured bundle while pr... more Background: Augmentation consisting of a selective reconstruction of the ruptured bundle while preserving the remnant bundle has been proposed as a treatment option for partial anterior cruciate ligament (ACL) tears. Good clinical outcomes after selective anteromedial (AM) bundle augmentation have been reported, whereas little is known about selective reconstruction of the posterolateral (PL) bundle with preservation of the AM bundle remnant. Purpose: The purpose of this study was to evaluate the clinical outcomes and the magnetic resonance imaging (MRI) characteristics of selective PL bundle reconstruction with a median follow-up of 24 months. Study Design: Case series; Level of evidence, 4. Methods: In a consecutive series of 741 ACL reconstructions, 44 patients underwent a selective PL bundle reconstruction with preservation of the AM remnant. Four patients with contralateral knee ligament surgery and 1 patient who sustained a traumatic rupture of his graft were excluded, leaving...

International Orthopaedics, 2014

Purpose The accelerometer-based system is a portable surgical navigation system for TKA that does... more Purpose The accelerometer-based system is a portable surgical navigation system for TKA that does not require the use of a large computer console for registration and alignment feedback as required in computer-assisted surgery (CAS). The purpose of this prospective study was to determine the accuracy of the accelerometer-based system in the tibial component positioning and also to evaluate clinical outcomes. Methods Between December 2011 and July 2012, a total of 53 consecutive patients with primary gonarthrosis were prospectively enrolled for unilateral TKA using a handheld surgical navigation system to perform the tibial resection. Preoperatively and postoperatively, patients were asked to fill out a visual analogue scale for pain (VAS) and a knee injury and osteoarthritis outcome score (KOOS). Standing anteroposterior (AP) hip-knee-ankle (HKA) and lateral knee-toankle radiographs were performed to determine the varus/ valgus alignment and the posterior slope of the tibial components relative to the mechanical axis. Results The mean duration of follow-up was 23 months. Average preoperative VAS was 8.3±0.67, which significantly improved to a mean 1.2±0.57 at final follow up (P<0.001). All scores significantly increased compared with pre-operative scores, except for the KOOS sport component (P=0.075) and quality of life (P=0.19). Intra-operatively, the average reading provided by the system with regard to varus/valgus alignment before performing the tibial resection was 0.55°±0.43. The average postoperative radiographic alignment of the tibial component in the coronal plane was 0.65°±0.59 of deviation by the ideal alignment (P>0.05). Conclusion This study demonstrates that the OrthAlign navigation system combines the accuracy of the computerassisted surgery systems with the ease of use and familiarity of the traditional instruments while avoiding the drawbacks of the CAS technique and disadvantages of conventional IM femoral alignment systems. The system could demonstrate an improvement in the incidence of outliers in final coronal alignment, as compared with a patient-specific cutting guide.

Knee Surgery, Sports Traumatology, Arthroscopy, 2012

The aim of this study was to evaluate the accuracy of conventional instrumentation for tibial res... more The aim of this study was to evaluate the accuracy of conventional instrumentation for tibial resection in total knee arthroplasty (TKA) as assessed by a computer-based navigation system during each phase of the surgical procedure. The hypothesis is that conventional instrumentation fails to achieve optimal accuracy in final implant positioning, thus leading to surgical errors. Methods Forty primary TKAs were performed. The resection guide was placed using an extramedullary guide. Accurate guide positioning was assessed by the navigation system prior to the osteotomy. The alignment measurement was repeated after resection and after component implantation in order to quantify the deviation caused by the manual positioning of the prosthetic components. A deviation C2°was considered unsatisfactory. Results In the frontal plane, unsatisfactory results observed were as follows: 15 % with reference to manual positioning of the resection guide and 10 % with reference to definition of the resection plane with a tendency towards varus malalignment. In the sagittal plane, unsatisfactory results were as follows: 45 % with reference to manual positioning of the resection guide and 40 % with reference to definition of the resection plane with a trend of decreased tibial slope angle. The deviation between bone resection and subsequent implant placement was C2°in none of the cases. Conclusions The study confirms the hypothesis that conventional instrumentation fails to achieve optimal accuracy in the positioning of the tibial component. During each phase of the surgical procedure, a tendency towards varus malalignment and a decreased tibial slope angle were observed. Levels of evidence II.

Knee Surgery, Sports Traumatology, Arthroscopy, 2013

Purpose To determine the involvement of the posterolateral structures including the lateral colla... more Purpose To determine the involvement of the posterolateral structures including the lateral collateral ligament, the popliteus muscle-tendon unit, the arcuate ligament (popliteofibular ligament, fabellofibular ligament, popliteomeniscal fascicles, capsular arm of short head of the biceps femoris and anterolateral ligament) and the posterior cruciate ligament in providing restraint to excessive recurvatum, tibial posterior translation and external tibial rotation at 90°of flexion. Methods Ten fresh-frozen cadaveric knees were tested with dial test, posterior drawer test and recurvatum test. The values were collected, using a surgical navigation system, on intact knees, following a serial section of the posterolateral corner (lateral collateral ligament, arcuate ligament and popliteus muscle-tendon unit), followed by the additional section of the posterior cruciate ligament. Results The mean tibial external rotation, recurvatum and posterior drawer were, respectively, measured at 9°± 4°, 2°± 3°and 9 ± 1 mm on intact knees. These values increase to 12°± 5°, 3°± 2°and 9 ± 1 mm after cutting the lateral collateral ligament; 17°± 6°(p \ 0.05), 3°± 2°and 10 ± 1 mm after sectioning the arcuate ligament; 18°± 7°, 3°± 2°and 10 ± 1 mm after sectioning the popliteus muscle-tendon unit and 27°± 6°(p \ 0.05), 5°± 3°(p \ 0.05) and 28 ± 2 mm (p \ 0.05) after the additional section of the posterior cruciate ligament. Conclusion Among the different structures of the posterolateral corner, only the arcuate ligament has a significant role in restricting excessive primary and coupled external rotation. The popliteus muscle-tendon unit is not a primary static stabilizer to tibial external rotation at 90°of knee flexion. The posterior cruciate ligament is the primary restraint to excessive recurvatum and posterior tibial translation. The posterior cruciate ligament and the arcuate ligament have predominant role for the posterolateral stability of the knee. The functional restoration of these ligaments is an important part of the surgical treatment of posterolateral ligamentous injuries.

The Knee, 2013

The hypothesis of this study is that computer-aided navigation experience could improve the abili... more The hypothesis of this study is that computer-aided navigation experience could improve the ability to better place components in the coronal plane and to improve visual/spatial awareness based on the ability of navigation to provide instant feedback. The purpose of this study is to demonstrate the educational role of the navigation system to obtain a better alignment of the prosthetic components with standard instrumentation after a computer-aided navigation experience. Materials and methods: One hundred fifty patients were operated by the same surgeon, with more than 5 years experience with TKA. They were equally divided in three groups: group A (operated with non-navigated technique by surgeon without computer-assisted experience); group B (operated with computer-assisted surgery by the same surgeon); group C (operated with non-navigated technique by the same surgeon after the computer-navigated experience). We evaluated by full-length weight-bearing radiographs the overall alignment of the lower limb in the coronal plane. The optimum placement of the components was considered when the angle was within the limits of ±3°v arus/valgus on the coronal x-rays. Comparison between groups was done using one-way ANOVA followed by post hoc Bonferroni test and Pearson chi-square statistics for proportions of optimum placement (P b 0.05). Results: In the group A 34 patients (68%) had the optimum placement on the coronal x-rays; in the group B they were 46 (92%) and in the group 41 (82%). The difference is statistically significant in comparing group A and Group B (b0.001), group A and group C (P =0.04), but not for group B and C (P=0.2). Conclusion: We believe that the navigation system has an educational role to improve the ability of surgeon of positioning prosthetic components precisely in the coronal plane.

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021

Aim In the scientific literature there are no papers that clarify which method of surgical fixati... more Aim In the scientific literature there are no papers that clarify which method of surgical fixation in transverse metacarpal fractures has the best functional outcomes. The aim of this study was to compare the hand strength obtained using two different methods in the treatment of these fractures. Methods A total of 52 patients who presented a transverse metacarpal fracture were enrolled. They were divided in two groups: 26 patients treated with K-wire (IMN) and 26 patients treated with plate and screws (PW). The evaluation criteria were: fracture healing time, performed force testing collected ultimate tensile strength and grip, the Disability Arm Shoulder and Hand (DASH) score, and the range of motion of the hand. Results In both groups obtained results were comparable in terms of full hand function, healing and total range of motion and DASH. Results in group K were slightly better than group PW in terms of strength and grip pain within 3 months from osteosynthesis. Conclusion Nei...

Injury, 2021

Introduction: Scapular body fractures represent less than 1% of all skeletal fractures. Operative... more Introduction: Scapular body fractures represent less than 1% of all skeletal fractures. Operative criteria and risk factors for scapular fracture instability are well defined. Non-operative management of scapular body fractures show satisfactory results but with shortening and medialization of the scapular body. The aim of this study is to evaluate if surgical treatment will result in an improved quality of life and shoulder function compared to non-operative treatment on patients suffering from a scapular body fracture. Materials and Methods: From a total of 381 retrospectively identified scapular body fractures, we included 45 patients. The enrolled patients were divided into two groups: the surgical treatment (ST, n = 20) group and the non-operative treatment (NOT, n = 25) group. The Non-Union Scoring System (NUSS) was used to assess bone healing on radiographs. The functional evaluation of the two groups during the follow-up were performed using the Constant Shoulder Score (CSS) and the Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH). Complications, reoperation rates, and time until bony union were also documented. The minimum follow-up for this study was designated as 12 months. Results: The ST group had better mean CSS and QuickDASH scores compared to the NOT group at 1, 3 and 6 months of follow-up. No statistically significant difference was detected at 12 months follow-up. ST group also demonstrated improved results in time until bone union, reduction of rehabilitation time, complications and return to work rates. Conclusion: This study suggests that surgical treatment for extraarticular scapular fractures can achieve better short-term functional outcomes (3 to 6 months) compared to conservative treatment.

Anterior Cruciate Ligament Reconstruction, 2014

In this chapter, we describe a reproducible, simple to use method that allows correct femoral tun... more In this chapter, we describe a reproducible, simple to use method that allows correct femoral tunnel placement without the need for aggressive notch debridement. This outside-in technique has a number of advantages over the more conventional in-out femoral tunnel placement via the anteromedial portal. By avoiding the need to place the knee in deep flexion, it allows preservation of the ACL remnant in partial and remnant preserving reconstructions. We propose that this is biologically advantageous. This technique can be applied for single, double-bundle and augmentation procedures.

Anterior Cruciate Ligament Reconstruction, 2014

Anterior Cruciate Ligament Reconstruction, 2014

The American Journal of Sports Medicine, 2014

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal lesion... more Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal lesions. Despite improvements in meniscal repair techniques, failure rates remain significant, especially for the posterior horn of the medial meniscus. Purpose: To determine whether a systematic arthroscopic exploration of the posterior horn of the medial meniscus with an additional posteromedial portal is useful to identify otherwise unrecognized lesions. Study Design: Case series; Level of evidence, 4. Methods: In a consecutive series of 302 ACL reconstructions, a systematic arthroscopic exploration of the posterior horn of the medial meniscus was performed. The first stage of the exploration was achieved through anterior visualization via a standard anterolateral portal. In the second stage, the posterior horn of the medial meniscus was visualized posteriorly via the anterolateral portal with the scope positioned deep in the notch. In the third stage, the posterior horn was probed through ...

Clinical Cases in Mineral and Bone Metabolism, 2010

The aim of this study was to evaluate, through the application of semi-quantitative radiological ... more The aim of this study was to evaluate, through the application of semi-quantitative radiological criteria, the speed of bone repair processes induced by the surgical use of materials based on hydroxyapatite nanoparticles

Background The pathogenesis of bone tunnel enlargement following anterior cruciate ligament (ACL)... more Background The pathogenesis of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction is not yet clearly understood. Mechanical and biological hypotheses have been proposed to describe this short-to-mid term phenomenon which takes place after ACL reconstructions. In this paper we describe clinical and radiological results of studies performed at our Orthopaedic Department, in which we examined the effects on bone tunnel diameters of accelerated post-operative rehabilitation protocols and use of different stiffness graft fixation devices (among mechanical factors) and the effects on bone tunnel diameters of the synovial bathing effect and the presence of high level of proinflammatory cytokines (among biological factors) in patients operated for ACL reconstruction. Methods Along series of patients operated on for ACL reconstruction was prospectively enrolled in these studies and followed-up right before the operation and at a mean time of 10 months post-op. ...

Introduction Recently, much attention has been focused on tunnel enlargement phenomenon following... more Introduction Recently, much attention has been focused on tunnel enlargement phenomenon following Anterior Cruciate Ligament (ACL) reconstruction with hamstrings. The aim of the study was to evaluate the efficacy of the nanohydroxiapatite used as a bone graft in the bone tunnels to prevent this phenomenon possibly allowing a better tendon-to-bone integration. Methods Twenty consecutive male patients operated for ACL reconstruction were enrolled in this prospective study and they were randomly assigned to group A (10 patients, nanohydroxiapatite group) and group B (10 patients, control group). All patients underwent Magnetic Resonance Imaging (MRI) exam ten months after surgery with the aim to evaluate the amount of tunnel enlargement, the signal intensity in the central and in the peripheric part of the graft, and around bone the tunnel. Results Clinical evaluations, KT-1000 arthrometer and knee evaluation scales did not show any difference among the two groups. The mean tibial tunn...

Alpha Lipoic Acid (L.A.) is an effective natural antioxidant discovered in the human body in 1951... more Alpha Lipoic Acid (L.A.) is an effective natural antioxidant discovered in the human body in 1951 from L.J. Reed and I.C. Gunslaus from liver. It is inside broccoli, spinach and red meats, especially liver and spleen. Actually it is largely used as antioxidant in antiaging products according to the low toxicity level of the product. The present study take into consideration the possibility to reduce oxidation of medical irradiated UHMWPE GUR 1050, mixing together polyethylene powder and Alpha Lipoic Acid powder. The study is composed of two parts. Part 1 Thermostability of alpha lipoic acid during polyethylene fusion Part 2 detection of oxygen level in artificially aged irradiated polyethylene Solid pieces were made with Gur 1050 powder (Ticona Inc., Bayport, Tex, USA) and mixed with Alpha Lipoic Acid (Talamonti, Italy, Stock 1050919074) 0, 1% and gamma ray irradiated with 30 kGy (Isomedix, Northborough, MA). An oven (80° Celsius) was used to produce an aging effect for 35 days in t...

Introduction: Mechanical factors are thought to be one of the main reasons in determining tunnel ... more Introduction: Mechanical factors are thought to be one of the main reasons in determining tunnel enlargement after ACL reconstruction with hamstrings. The purpose of this prospective study was to evaluate how the different techniques may affect the bone tunnel enlargement. Material and Method : Forty-five consecutive patients undergoing ACL reconstruction with the use of autologous doubled semitendinosus and gracilis tendons entered this study. They were randomly assigned to enter group A (In-Out technique, with cortical fixation and Interference screw) and group B (Out-In technique, metal cortical fixation on the femour and tibia). At a mean follow-up of 10 months, all the patients underwent clinical evaluation and a CT scan exam to evaluate the post-operative diameters of both femoral and tibial tunnels. Results: The mean femoral tunnel diameter increased significantly from 9.05±0.3 mm (post op) to 10.01±2.3 mm (follow-up) in group A and from 9.04±0.8 mm to 9.3±1,12 mm in group B....

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 8, 2017

Several studies have recently shown better restoration of normal knee kinematics and improvement ... more Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out-in (OI) technique. Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed. In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8....

Revue de Chirurgie Orthopédique et Traumatologique, 2014

Resume La chondrolyse rapide apres menisectomie laterale est une complication rare. Nous rapporto... more Resume La chondrolyse rapide apres menisectomie laterale est une complication rare. Nous rapportons le premier cas de chondrolyse rapide du compartiment lateral apparue 6 mois apres une lesion du menisque lateral non traitee chirurgicalement chez un athlete de 18 ans pratiquant le rugby en pole espoir. Les hypotheses susceptibles d’expliquer cette complication sont presentees en excluant certains facteurs precedemment incrimines (geste chirurgical iatrogene, hyper laxite rotatoire meconnue, chondrotoxicite de la bupivacaine). Les contraintes excessives sur les surfaces cartilagineuses du compartiment lateral provoquees par l’extrusion du menisque pourraient provoquer une necrose cartilagineuse.

Orthopaedics & traumatology, surgery & research : OTSR, 2014

Rapid chondrolysis following a lateral meniscectomy is a rare complication. We present the first ... more Rapid chondrolysis following a lateral meniscectomy is a rare complication. We present the first reported case of rapid chondrolysis of the lateral compartment, which developed 6 months after a meniscus tear that was not surgically treated in a young 18-year-old professional rugby player. The possible hypotheses to explain this complication are presented, and certain previously published causes were excluded (iatrogenic during surgery, undiagnosed increased rotatory instability, chondrotoxicity of bupivacaine). Overloading of the cartilage surface of the lateral compartment from meniscal extrusion can cause cartilage necrosis.

Orthopaedic Journal of Sports Medicine, 2013

Background: Augmentation consisting of a selective reconstruction of the ruptured bundle while pr... more Background: Augmentation consisting of a selective reconstruction of the ruptured bundle while preserving the remnant bundle has been proposed as a treatment option for partial anterior cruciate ligament (ACL) tears. Good clinical outcomes after selective anteromedial (AM) bundle augmentation have been reported, whereas little is known about selective reconstruction of the posterolateral (PL) bundle with preservation of the AM bundle remnant. Purpose: The purpose of this study was to evaluate the clinical outcomes and the magnetic resonance imaging (MRI) characteristics of selective PL bundle reconstruction with a median follow-up of 24 months. Study Design: Case series; Level of evidence, 4. Methods: In a consecutive series of 741 ACL reconstructions, 44 patients underwent a selective PL bundle reconstruction with preservation of the AM remnant. Four patients with contralateral knee ligament surgery and 1 patient who sustained a traumatic rupture of his graft were excluded, leaving...

International Orthopaedics, 2014

Purpose The accelerometer-based system is a portable surgical navigation system for TKA that does... more Purpose The accelerometer-based system is a portable surgical navigation system for TKA that does not require the use of a large computer console for registration and alignment feedback as required in computer-assisted surgery (CAS). The purpose of this prospective study was to determine the accuracy of the accelerometer-based system in the tibial component positioning and also to evaluate clinical outcomes. Methods Between December 2011 and July 2012, a total of 53 consecutive patients with primary gonarthrosis were prospectively enrolled for unilateral TKA using a handheld surgical navigation system to perform the tibial resection. Preoperatively and postoperatively, patients were asked to fill out a visual analogue scale for pain (VAS) and a knee injury and osteoarthritis outcome score (KOOS). Standing anteroposterior (AP) hip-knee-ankle (HKA) and lateral knee-toankle radiographs were performed to determine the varus/ valgus alignment and the posterior slope of the tibial components relative to the mechanical axis. Results The mean duration of follow-up was 23 months. Average preoperative VAS was 8.3±0.67, which significantly improved to a mean 1.2±0.57 at final follow up (P<0.001). All scores significantly increased compared with pre-operative scores, except for the KOOS sport component (P=0.075) and quality of life (P=0.19). Intra-operatively, the average reading provided by the system with regard to varus/valgus alignment before performing the tibial resection was 0.55°±0.43. The average postoperative radiographic alignment of the tibial component in the coronal plane was 0.65°±0.59 of deviation by the ideal alignment (P>0.05). Conclusion This study demonstrates that the OrthAlign navigation system combines the accuracy of the computerassisted surgery systems with the ease of use and familiarity of the traditional instruments while avoiding the drawbacks of the CAS technique and disadvantages of conventional IM femoral alignment systems. The system could demonstrate an improvement in the incidence of outliers in final coronal alignment, as compared with a patient-specific cutting guide.

Knee Surgery, Sports Traumatology, Arthroscopy, 2012

The aim of this study was to evaluate the accuracy of conventional instrumentation for tibial res... more The aim of this study was to evaluate the accuracy of conventional instrumentation for tibial resection in total knee arthroplasty (TKA) as assessed by a computer-based navigation system during each phase of the surgical procedure. The hypothesis is that conventional instrumentation fails to achieve optimal accuracy in final implant positioning, thus leading to surgical errors. Methods Forty primary TKAs were performed. The resection guide was placed using an extramedullary guide. Accurate guide positioning was assessed by the navigation system prior to the osteotomy. The alignment measurement was repeated after resection and after component implantation in order to quantify the deviation caused by the manual positioning of the prosthetic components. A deviation C2°was considered unsatisfactory. Results In the frontal plane, unsatisfactory results observed were as follows: 15 % with reference to manual positioning of the resection guide and 10 % with reference to definition of the resection plane with a tendency towards varus malalignment. In the sagittal plane, unsatisfactory results were as follows: 45 % with reference to manual positioning of the resection guide and 40 % with reference to definition of the resection plane with a trend of decreased tibial slope angle. The deviation between bone resection and subsequent implant placement was C2°in none of the cases. Conclusions The study confirms the hypothesis that conventional instrumentation fails to achieve optimal accuracy in the positioning of the tibial component. During each phase of the surgical procedure, a tendency towards varus malalignment and a decreased tibial slope angle were observed. Levels of evidence II.

Knee Surgery, Sports Traumatology, Arthroscopy, 2013

Purpose To determine the involvement of the posterolateral structures including the lateral colla... more Purpose To determine the involvement of the posterolateral structures including the lateral collateral ligament, the popliteus muscle-tendon unit, the arcuate ligament (popliteofibular ligament, fabellofibular ligament, popliteomeniscal fascicles, capsular arm of short head of the biceps femoris and anterolateral ligament) and the posterior cruciate ligament in providing restraint to excessive recurvatum, tibial posterior translation and external tibial rotation at 90°of flexion. Methods Ten fresh-frozen cadaveric knees were tested with dial test, posterior drawer test and recurvatum test. The values were collected, using a surgical navigation system, on intact knees, following a serial section of the posterolateral corner (lateral collateral ligament, arcuate ligament and popliteus muscle-tendon unit), followed by the additional section of the posterior cruciate ligament. Results The mean tibial external rotation, recurvatum and posterior drawer were, respectively, measured at 9°± 4°, 2°± 3°and 9 ± 1 mm on intact knees. These values increase to 12°± 5°, 3°± 2°and 9 ± 1 mm after cutting the lateral collateral ligament; 17°± 6°(p \ 0.05), 3°± 2°and 10 ± 1 mm after sectioning the arcuate ligament; 18°± 7°, 3°± 2°and 10 ± 1 mm after sectioning the popliteus muscle-tendon unit and 27°± 6°(p \ 0.05), 5°± 3°(p \ 0.05) and 28 ± 2 mm (p \ 0.05) after the additional section of the posterior cruciate ligament. Conclusion Among the different structures of the posterolateral corner, only the arcuate ligament has a significant role in restricting excessive primary and coupled external rotation. The popliteus muscle-tendon unit is not a primary static stabilizer to tibial external rotation at 90°of knee flexion. The posterior cruciate ligament is the primary restraint to excessive recurvatum and posterior tibial translation. The posterior cruciate ligament and the arcuate ligament have predominant role for the posterolateral stability of the knee. The functional restoration of these ligaments is an important part of the surgical treatment of posterolateral ligamentous injuries.

The Knee, 2013

The hypothesis of this study is that computer-aided navigation experience could improve the abili... more The hypothesis of this study is that computer-aided navigation experience could improve the ability to better place components in the coronal plane and to improve visual/spatial awareness based on the ability of navigation to provide instant feedback. The purpose of this study is to demonstrate the educational role of the navigation system to obtain a better alignment of the prosthetic components with standard instrumentation after a computer-aided navigation experience. Materials and methods: One hundred fifty patients were operated by the same surgeon, with more than 5 years experience with TKA. They were equally divided in three groups: group A (operated with non-navigated technique by surgeon without computer-assisted experience); group B (operated with computer-assisted surgery by the same surgeon); group C (operated with non-navigated technique by the same surgeon after the computer-navigated experience). We evaluated by full-length weight-bearing radiographs the overall alignment of the lower limb in the coronal plane. The optimum placement of the components was considered when the angle was within the limits of ±3°v arus/valgus on the coronal x-rays. Comparison between groups was done using one-way ANOVA followed by post hoc Bonferroni test and Pearson chi-square statistics for proportions of optimum placement (P b 0.05). Results: In the group A 34 patients (68%) had the optimum placement on the coronal x-rays; in the group B they were 46 (92%) and in the group 41 (82%). The difference is statistically significant in comparing group A and Group B (b0.001), group A and group C (P =0.04), but not for group B and C (P=0.2). Conclusion: We believe that the navigation system has an educational role to improve the ability of surgeon of positioning prosthetic components precisely in the coronal plane.