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Impieri L, Pezzi A, Hadad H, Peretti GM, Mangiavini L, Rossi N. Orthobiologics in delayed union and non-union of adult long bones fractures: A systematic review. Bone Rep 2024; 21:101760. [PMID: 38618008 PMCID: PMC11010966 DOI: 10.1016/j.bonr.2024.101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
Background Fracture healing poses a significant challenge in orthopedics. Successful regeneration of bone is provided by mechanical stability and a favorable biological microenvironment. This systematic review aims to explore the clinical application of orthobiologics in treating aseptic delayed union and non-union of long bones in adults. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were explored, with no date restrictions, using keywords related to orthobiologics and delayed union and non-union. Eligible studies included human clinical studies in English, with available full texts, examining orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone morphogenetic protein (BMPs) for treating aseptic delayed unions and non-unions in adults. Animal studies, in vitro research, and studies on non-unions due to congenital defects, tumors or infections were excluded. Results The initial search identified 9417 studies, with 20 ultimately included in the review. These studies involved 493 patients affected by non-union and 256 patients affected by delayed union, with an average age respectively of 40.62 years and 41.7 years. The mean follow-up period was 15.55 months for non-unions and 8.07 months for delayed unions. PRP was the most used orthobiologic, and outcomes were evaluated through time to union, functional scores, and clinical examinations. The results indicated that orthobiologics, especially PRP, tended to yield better outcomes compared to surgical procedures without biological factors. Conclusion This systematic review suggests that orthobiologics, such as PRP, BMPs, and MSCs, can be effective and safe in the management of delayed union and non-union fractures. These biological treatments have the potential to improve union rates, reduce healing times, and enhance functional outcomes in patients with non-union fractures. Further research is essential to refine treatment protocols and determine the most suitable orthobiologic for specific patient populations and fracture types.
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Affiliation(s)
- Lorenzo Impieri
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andrea Pezzi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Henrique Hadad
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), Araçatuba School of Dentistry, São Paulo, Brazil
| | - Giuseppe M. Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Nicolò Rossi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
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D'Ambrosi R, Migliorini F, Di Maria F, Anghilieri FM, Di Feo F, Ursino N, Mangiavini L, Kambhampati SBS. Italian research on anterior cruciate ligament: a bibliometric analysis. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03937-3. [PMID: 38602582 DOI: 10.1007/s00590-024-03937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION This study analysed the trend of publications on anterior cruciate ligament (ACL) in Italy. It was hypothesised that publications on this topic have quickly increased in recent years due to increased knowledge of both clinical and radiological pathology. METHODS PubMed and Scopus were accessed on 29/11/2023. This retrieved 838 articles from PubMed and 1050 from Scopus. We analysed the top 10 authors, and journals in publication numbers, citation numbers, and citations per year. We have also looked at the top 10 institutions publishing on anterior cruciate ligament from Scopus as PubMed does not give this information in the output. Data mining was performed using the Orange software, Mac version 3.32.0 ( https://orangedatamining.com/ ) from the titles of all articles. A word cloud analysis of titles, authors, journals and universities was performed. RESULTS The peak of citations was in 2017 with 1529, whilst the peak of publications was in 2019 with 59 articles published. Analysing the number of publications and citations for the journal, the most impacted journal is Knee Surgery, Sports Traumatology, Arthroscopy with 5472 citations and 183 articles, followed by The American Journal of Sports Medicine, with 2722 citations and 56 articles and Arthroscopy with 1990 citations and 62 articles. Considering also international collaborations, the most cited author is Della Villa F. in 2020 with 43.67 citations per year. The Italian author with the major number of publications is Zaffagnini S. with 39 articles, whilst the author with the higher number of citations is Aglietti P. with 1612 citations. CONCLUSIONS ACL reconstruction has gained growing interest amongst the scientific community. Publications and citations presented a rising trend, the majority of the highly cited papers were contributed by few centres, and clinical trials were the most cited study designs. The long-term outcomes of ACL lesions have attracted interest. The authors hypothesised that shortly there will be an increase in articles analysing the results of ACL revisions, the use of lateral extra-articular tenodesis, and meniscus transplants. LEVEL OF EVIDENCE IV Cross-Sectional Study.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Fabrizio Di Maria
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | | | | | - Nicola Ursino
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Laura Mangiavini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy
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Malvandi AM, Halilaj E, Faraldi M, Mangiavini L, Cristoni S, Leoni V, Lombardi G. Correction: Enhanced molecular release from elderly bone samples using collagenase I: insights into fatty acid metabolism alterations. J Transl Med 2024; 22:303. [PMID: 38523301 PMCID: PMC10962159 DOI: 10.1186/s12967-024-05074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Affiliation(s)
- Amir Mohammad Malvandi
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
| | - Esra Halilaj
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Martina Faraldi
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Valerio Leoni
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale Della Brianza, ASST-Brianza, Desio Hospital, Desio, Italy
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
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Rossi N, Nannini A, Ulivi M, Sirtori P, Banfi G, Tomaiuolo R, de Girolamo L, Mangiavini L, Peretti GM. Men and women undergoing total hip arthroplasty have different clinical presentations before surgery and different outcomes at 1-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38461374 DOI: 10.1002/ksa.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE The purpose of this study was to investigate the influence of sex on patients undergoing total hip arthroplasty (THA) for hip osteoarthritis (HOA), aiming to assess the clinical and functional outcomes using patient-reported outcome measures (PROMs). METHODS A retrospective analysis of patients undergoing THA at Ospedale Galeazzi-Sant'Ambrogio between 2016 and 2022 was conducted. Inclusion criteria encompassed Kellgren-Lawrence grade III or IV HOA, with preoperative and 12-month postoperative PROMs. Enroled patients have been selected from a larger cohort without matching design for confounders. The analyses were performed using R software v4.0.3 (R Core Team) and data distributions were assessed using the Shapiro-Wilk normality test. RESULTS One hundred ninety patients (72 male and 118 female) who had both preoperative and postoperative PROMs have been analysed from our institutional prosthesis registry (Datareg). Baseline and 12-month post-THA PROMs showed significant improvements overall. VAS score dropped notably from baseline to 3 months postsurgery (7.1 ± 2.1 vs. 0.9 ± 1.7). Functional and mental PROMs, including Harris Hip Score-functional (HHS-F), Harris Hip Score-total (HHS-t), SF-12PS and SF-12MS, exhibited substantial improvements post-THA. Stratifying by sex, males had lower baseline VAS, higher HHS-F, SF-12MS and hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS). At 12 months, males displayed significantly better VAS, HHS-F, SF-12PS and HOOS-PS scores. Complication rates were minimal (1.5%), with stable rates across genders, mostly involving dislocation and periprosthetic fractures. Implant survival at 12 months reached an impressive 99%. CONCLUSION THA remains an effective treatment for severe HOA. However, females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. This difference could be attributed to physiological and psychosocial factors associated with sex, including hormonal changes, muscle mass decline and perception of pain. Longer follow-ups and prospective studies are necessary to validate these findings and facilitate personalised approaches in HOA treatment, emphasising the need for careful consideration of sex-related variables in clinical decision-making for THA patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nicolò Rossi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Alessandra Nannini
- Residency Program in Orthopaedics and Traumatology, University of Milan, Milan, Italy
| | | | | | | | - Rossella Tomaiuolo
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, Milano, Italy
| | | | - Laura Mangiavini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Malvandi AM, Halilaj E, Faraldi M, Mangiavini L, Cristoni S, Leoni V, Lombardi G. Enhanced molecular release from elderly bone samples using collagenase I: insights into fatty acid metabolism alterations. J Transl Med 2024; 22:143. [PMID: 38336738 PMCID: PMC10858523 DOI: 10.1186/s12967-024-04948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Bone is a metabolically active tissue containing different cell types acting as endocrine targets and effectors. Further, bone is a dynamic depot for calcium, phosphorous and other essential minerals. The tissue matrix is subjected to a constant turnover in response to mechanical/endocrine stimuli. Bone turnover demands high energy levels, making fatty acids a crucial source for the bone cells. However, the current understanding of bone cell metabolism is poor. This is partly due to bone matrix complexity and difficulty in small molecules extraction from bone samples. This study aimed to evaluate the effect of metabolite sequestering from a protein-dominated matrix to increase the quality and amount of metabolomics data in discovering small molecule patterns in pathological conditions. METHODS Human bone samples were collected from 65 to 85 years old (the elderly age span) patients who underwent hip replacement surgery. Separated cortical and trabecular bone powders were treated with decalcifying, enzymatic (collagenase I and proteinase K) and solvent-based metabolite extraction protocols. The extracted mixtures were analyzed with the high-resolution mass spectrometry (HRMS). Data analysis was performed with XCMS and MetaboAnalystR packages. RESULTS Fast enzymatic treatment of bone samples before solvent addition led to a significantly higher yield of metabolite extraction. Collagenase I and proteinase K rapid digestion showed more effectiveness in cortical and trabecular bone samples, with a significantly higher rate (2.2 folds) for collagenase I. Further analysis showed significant enrichment in pathways like de novo fatty acid biosynthesis, glycosphingolipid metabolism and fatty acid oxidation-peroxisome. CONCLUSION This work presents a novel approach for bone sample preparation for HRMS metabolomics. The disruption of bone matrix conformation at the molecular level helps the molecular release into the extracting solvent and, therefore, can lead to higher quality results and trustable biomarker discovery. Our results showed β-oxidation alteration in the aged bone sample. Future work covering more patients is worthy to identify the effective therapeutics to achieve healthy aging.
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Affiliation(s)
- Amir Mohammad Malvandi
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
| | - Esra Halilaj
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Martina Faraldi
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Valerio Leoni
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale Della Brianza, ASST-Brianza, Desio Hospital, Desio, Italy
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
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Cucchi D, Di Giacomo G, Compagnoni R, Castricini R, Formigoni C, Radici M, Melis B, Brindisino F, De Giorgi S, De Vita A, Lisai A, Mangiavini L, Candela V, Carrozzo A, Pannone A, Menon A, Giudici LD, Klumpp R, Padua R, Carnevale A, Rosa F, Marmotti A, Peretti GM, Berruto M, Milano G, Randelli P, Bonaspetti G, De Girolamo L. A high level of scientific evidence is available to guide treatment of primary shoulder stiffness: The SIAGASCOT consensus. Knee Surg Sports Traumatol Arthrosc 2024; 32:37-46. [PMID: 38226696 DOI: 10.1002/ksa.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Shoulder stiffness (SS) is a condition characterised by active and passive restricted glenohumeral range of motion, which can occur spontaneously in an idiopathic manner or be associated with a known underlying aetiology. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. Herein we present the results of a national consensus on the treatment of primary SS. METHODS The project followed the modified Delphi consensus process, involving a steering, a rating and a peer-review group. Sixteen questions were generated and subsequently answered by the steering group after a thorough literature search. A rating group composed by professionals specialised in the diagnosis and treatment of shoulder pathologies rated the question-answer sets according to the scientific evidence and their clinical experience. RESULTS Recommendations were rated with an average of 8.4 points out of maximum 9 points. None of the 16 answers received a rating of less than 8 and all the answers were considered as appropriate. The majority of responses were assessed as Grade A, signifying a substantial availability of scientific evidence to guide treatment and support recommendations encompassing diagnostics, physiotherapy, electrophysical agents, oral and injective medical therapies, as well as surgical interventions for primary SS. CONCLUSIONS A consensus regarding the conservative and surgical treatment of primary SS could be achieved at a national level. This consensus sets basis for evidence-based clinical practice in the management of primary SS and can serve as a model for similar initiatives and adaptable guidelines in other European countries and potentially on a global scale. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
| | | | - Riccardo Compagnoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Roberto Castricini
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura Villa Verde, Fermo, Italy
| | - Chiara Formigoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- GIDIF-RBM - Italian Group of Information Specialist from Pharmaceutical Company and Biomedical Research Institutes, Milan, Italy
| | - Mattia Radici
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Barbara Melis
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità di Ortopedia e traumatologia dello sport, Casa di cura "Policlinico Città di Quartu", Quartu Sant'Elena, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Silvana De Giorgi
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari, Bari, Italy
| | - Andrea De Vita
- Concordia Hospital Roma, Rome, Italy
- SIAGASCOT "Shoulder" Committee, Rome, Italy
| | - Andrea Lisai
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità Funzionale Chirurgia della Spalla, Humanitas San Pio X, Milan, Italy
| | - Laura Mangiavini
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Candela
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Carrozzo
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Antonello Pannone
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Policlinico "Città di Udine", Udine, Italy
| | - Alessandra Menon
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Dei Giudici
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura "Villa dei Pini", Civitanova Marche, Italy
| | - Raymond Klumpp
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedics and Trauma Surgery, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Arianna Carnevale
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Rosa
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Humanitas Clinical and Research Center -IRCCS, Rozzano, Italy
| | - Antongiulio Marmotti
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Orthopaedics and Traumatology, University of Torino, Turin, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimo Berruto
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Spedali Civili, UOC Clinica Ortopedica, Brescia, Italy
| | - Pietro Randelli
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Bonaspetti
- Department of Orthopaedics and Traumatology, Clinica S. Anna, Brescia, Italy
| | - Laura De Girolamo
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Laboratorio di Biotecnologie applicate all'Ortopedia, Milan, Italy
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Careccia G, Mangiavini L, Cirillo F. Regulation of Satellite Cells Functions during Skeletal Muscle Regeneration: A Critical Step in Physiological and Pathological Conditions. Int J Mol Sci 2023; 25:512. [PMID: 38203683 PMCID: PMC10778731 DOI: 10.3390/ijms25010512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Skeletal muscle regeneration is a complex process involving the generation of new myofibers after trauma, competitive physical activity, or disease. In this context, adult skeletal muscle stem cells, also known as satellite cells (SCs), play a crucial role in regulating muscle tissue homeostasis and activating regeneration. Alterations in their number or function have been associated with various pathological conditions. The main factors involved in the dysregulation of SCs' activity are inflammation, oxidative stress, and fibrosis. This review critically summarizes the current knowledge on the role of SCs in skeletal muscle regeneration. It examines the changes in the activity of SCs in three of the most common and severe muscle disorders: sarcopenia, muscular dystrophy, and cancer cachexia. Understanding the molecular mechanisms involved in their dysregulations is essential for improving current treatments, such as exercise, and developing personalized approaches to reactivate SCs.
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Affiliation(s)
- Giorgia Careccia
- Department of Biosciences, University of Milan, 20133 Milan, Italy;
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Federica Cirillo
- IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy
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Nannini A, Giorgino R, Bianco Prevot L, Bobba A, Curci D, Cecchinato R, Peretti GM, Verdoni F, Mangiavini L. Septic arthritis in the pediatric hip joint: a systematic review of diagnosis, management, and outcomes. Front Pediatr 2023; 11:1311862. [PMID: 38188916 PMCID: PMC10771295 DOI: 10.3389/fped.2023.1311862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Septic arthritis of the pediatric hip joint (SAH) is a rare but serious orthopedic emergency requiring immediate diagnosis and management. Delayed recognition can lead to severe complications, emphasizing the need for timely intervention. This systematic review aims to provide a comprehensive analysis of SAH in the pediatric population, focusing on its diagnosis, management, and outcomes. The review included 11 studies involving 391 patients with SAH, aged between three months and 12 years. Staphylococcus aureus was identified as the most common causative pathogen, with increasing cases of methicillin-resistant strains. Diagnosis is challenging due to nonspecific clinical presentations, necessitating validated criteria and a multidisciplinary approach. Ultrasound emerged as a valuable tool for early detection, and MRI was used in challenging cases. Treatment options include hip aspiration, arthrotomy, and arthroscopy, often combined with appropriate antibiotic therapy. Success rates were comparable among different surgical procedures. Early intervention is vital for optimal outcomes. However, the review highlights the need for standardized protocols and further prospective studies to address limitations and improve understanding and management of SAH in the pediatric hip joint.
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Affiliation(s)
- Alessandra Nannini
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Luca Bianco Prevot
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Andrea Bobba
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | - Giuseppe M. Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | | | - Laura Mangiavini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
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Rossi N, Sciancalepore F, Daolio PA, Verdoni F, Mangiavini L. Huntington procedure for the treatment of tibial nonunion in a 17-years old male: A case report. Int J Surg Case Rep 2023; 113:109084. [PMID: 37988988 PMCID: PMC10667759 DOI: 10.1016/j.ijscr.2023.109084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Bone is considered a tissue with good healing properties, and many bone defects can heal spontaneously under appropriate conditions. Extreme bone loss can hinder remodeling and regenerative processes, leading to bone nonunion. This condition negatively impacts the patient's quality of life with a severe socioeconomic burden. Many treatment options have been proposed, but none can be defined as a gold standard, mainly due to the variety of clinical presentation, bone loss, and quality. PRESENTATION OF CASE We present a 15-year-old case of tibial nonunion following multiple traumas. The patient was treated non-surgically at the beginning, but the external fixator positioning was required due to a delay in the healing process. Following further trauma, the patient showed progressive anterolateral angulation, severe lateral procurvation, and a progressive worsening of the pseudoarthrosis. The severe bone loss and poor quality of the bone surrounding the defect required a special technique called Huntington procedure that consists in a vascularized bone autograft from the ipsilateral fibula to achieve mechanical and biological healing of the pseudoarthrosis. The patient recovered well and returned to full weight bearing without a mobility aid. DISCUSSION We report this case of complex tibial nonunion and malalignment, developed after subsequent traumas. Due to the multiple complications, and the poor biology a Huntington procedure was required to provide mechanical stability and a biological boost to the bone defect. CONCLUSION This case report shows a complicated case requiring several surgeries and treatment options and confirms the potential benefit of the Huntington procedure for treating a tibial severe bone loss.
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Affiliation(s)
- Nicolò Rossi
- Residency Program in Orthopaedics and Traumatology, University of Milan, Milano, Italy.
| | | | | | - Fabio Verdoni
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milano, Italy
| | - Laura Mangiavini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milano, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Briguglio M, Sirtori P, Mangiavini L, Buzzi S, Cordani C, Zerni MF, Wainwright TW, Ursino N, Peretti GM, Banfi G. How Do Older Patients with End-Stage Osteoarthritis of the Hip Eat Prior to Hip Replacement? A Preliminary Snapshot That Highlights a Poor Diet. Nutrients 2023; 15:4868. [PMID: 38068726 PMCID: PMC10708412 DOI: 10.3390/nu15234868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Diet quantity and quality in older adults is critical for the proper functioning of the musculoskeletal system. In view of hip surgery, old patients should consume 1.2-1.5 g of proteins and 27-30 kcal per kilo of body weight daily, and adhere to healthy eating habits. In this analytical study, we studied diet quantity and quality in relation to the clinical chemistry and functional status of 57 older adults undergoing elective hip replacement. Nine in ten patients did not meet suggested protein and energy intakes and only one in ten patients exhibited high adherence to the Mediterranean diet. Legume consumption adjusted for sex, age, body mass index, and health status successfully forecasted haemoglobin levels (p < 0.05), and patients regularly consuming olive oil reported minor hip disability compared to those using it less frequently (p < 0.05). Patients who reported daily ingestion of <1 serving of meat versus those consuming >1.5 servings had greater cumulative comorbidity (p < 0.05), with meat consumption independently predicting walking ability, mobility, and balance in the fully adjusted model (p < 0.01). In conclusion, our patients seem to eat poorly. There is room for improvement in pre-operative pathways to make older adults eat better, but there is a need to plan an interventional study to fully understand the cause-effect of a dietary pattern or specific food in enhancing recovery after surgery.
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Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Paolo Sirtori
- E.U.O.R.R. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (G.M.P.)
| | - Laura Mangiavini
- E.U.O.R.R. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (G.M.P.)
- Department of Biomedical Sciences for Health, University “La Statale” of Milan, 20133 Milan, Italy
| | - Sara Buzzi
- Department of Biomedical Sciences for Health, University “La Statale” of Milan, 20133 Milan, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical, and Dental Sciences, University “La Statale” of Milan, 20141 Milan, Italy;
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Maria Francesca Zerni
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8FT, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Nicola Ursino
- C.A.S.C.O. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe M. Peretti
- E.U.O.R.R. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (G.M.P.)
- Department of Biomedical Sciences for Health, University “La Statale” of Milan, 20133 Milan, Italy
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
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11
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Verdoni F, Giorgino R, Virgilio C, Nannini A, Viganò M, Curci D, Peretti GM, Mangiavini L. Results and complications of bilateral limb lengthening in achondroplasia: a retrospective analysis. Front Pediatr 2023; 11:1281099. [PMID: 38027309 PMCID: PMC10655023 DOI: 10.3389/fped.2023.1281099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Achondroplasia is one of the main causes of disharmonic dwarfism. Patients with achondroplasia might have physical and psychological limitations due to their disproportionate stature. Surgical limb lengthening is the only practical option available to achieve a stature comparable to normal population range. The purpose of this study is to analyze results and complications of our lengthening protocol. Methods A retrospective analysis was performed on 33 patients with achondroplasia (21 females and 12 males) undergoing simultaneous bilateral tibia or femur lengthening in four surgical stages from 2017 to 2021 (46 lengthening procedures, with a total of 56 tibias and 36 femurs). For each patient, patients' characteristics and antero-posterior and lateral radiographs were obtained. The following parameters were analyzed: duration of lengthening with external fixator, amount of lengthening, complications or events that influenced outcomes and the healing index (HI). Results The average tibial and femoral gain was 7.9 cm and 6.9 cm, respectively. The tibiae achieved better results than the femurs (p = 0.005). Nineteen complications were reported for 92 segments (20.7%), and the variables influencing complications were: step (p = 0.002) and fixation duration (p = 0.061). Conclusions Bilateral parallel lower limb lengthening in four surgical steps may be a viable technique in patients with achondroplasia.
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Affiliation(s)
| | - Riccardo Giorgino
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Camilla Virgilio
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Alessandra Nannini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Giuseppe Michele Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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12
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Giorgino R, Alessandri-Bonetti M, Luca A, Migliorini F, Rossi N, Peretti GM, Mangiavini L. ChatGPT in orthopedics: a narrative review exploring the potential of artificial intelligence in orthopedic practice. Front Surg 2023; 10:1284015. [PMID: 38026475 PMCID: PMC10654618 DOI: 10.3389/fsurg.2023.1284015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
The field of orthopedics faces complex challenges requiring quick and intricate decisions, with patient education and compliance playing crucial roles in treatment outcomes. Technological advancements in artificial intelligence (AI) can potentially enhance orthopedic care. ChatGPT, a natural language processing technology developed by OpenAI, has shown promise in various sectors, including healthcare. ChatGPT can facilitate patient information exchange in orthopedics, provide clinical decision support, and improve patient communication and education. It can assist in differential diagnosis, suggest appropriate imaging modalities, and optimize treatment plans based on evidence-based guidelines. However, ChatGPT has limitations, such as insufficient expertise in specialized domains and a lack of contextual understanding. The application of ChatGPT in orthopedics is still evolving, with studies exploring its potential in clinical decision-making, patient education, workflow optimization, and scientific literature. The results indicate both the benefits and limitations of ChatGPT, emphasizing the need for caution, ethical considerations, and human oversight. Addressing training data quality, biases, data privacy, and accountability challenges is crucial for responsible implementation. While ChatGPT has the potential to transform orthopedic healthcare, further research and development are necessary to ensure its reliability, accuracy, and ethical use in patient care.
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Affiliation(s)
- Riccardo Giorgino
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Mario Alessandri-Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Andrea Luca
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Nicolò Rossi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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13
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Guida S, Vitale J, Gianola S, Castellini G, Swinnen E, Beckwée D, Gelfi C, Torretta E, Mangiavini L. Effects of tele-prehabilitation on clinical and muscular recovery in patients awaiting knee replacement: protocol of a randomised controlled trial. BMJ Open 2023; 13:e073163. [PMID: 37793919 PMCID: PMC10551960 DOI: 10.1136/bmjopen-2023-073163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The increasing prevalence of knee osteoarthritis and total knee arthroplasty (TKA) impose a significant socioeconomic burden in developed and developing countries. Prehabilitation (rehabilitation in the weeks immediately before surgery) may be crucial to prepare patients for surgery improving outcomes and reducing assistance costs. Moreover, considering the progress of telemedicine, candidates for TKA could potentially benefit from a tele-prehabilitation programme. We aim to evaluate the effects of a home-based tele-prehabilitation program for patients waiting for total knee replacement. METHODS AND ANALYSIS Forty-eight male patients, aged 65-80, on a waiting list for TKA will be recruited and randomly assigned to the tele-prehabilitation intervention or control groups. Both groups will undergo the same 6-week exercise program (five sessions/week) and the same educational session (one per week). The tele-prehabilitation group will perform asynchronous sessions using a tablet, two accelerometers and a balance board (Khymeia, Padova, Italy), while the control group will use a booklet. The Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire, at the end of the prehabilitation, will be the primary outcome. Secondary outcomes will include self-reported outcomes, performance tests and change in expressions of blood and muscle biomarkers. Ten healthy subjects, aged 18-30, will be also recruited for muscle and blood samples collection. They will not undergo any intervention and their data will be used as benchmarks for the intervention and control groups' analyses. ETHICS AND DISSEMINATION This randomised controlled trial will be conducted in accordance with the ethical principles of the Declaration of Helsinki. This study has been approved by the Ethics Committee of Vita-Salute San Raffaele University (Milan, Italy. No. 50/INT/2022). The research results will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05668312.
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Affiliation(s)
- Stefania Guida
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacopo Vitale
- Spine Center, Schulthess Klinik, Zurich, Switzerland
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Eva Swinnen
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Deparment, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - Cecilia Gelfi
- Laboratory of Proteomics and Lipidomics, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Enrica Torretta
- Laboratory of Proteomics and Lipidomics, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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D'Ambrosi R, Valli F, Nuara A, Mariani I, Di Feo F, Ursino N, Formica M, Mangiavini L, Hantes M, Migliorini F. No difference in mobile and fixed bearing partial knee arthroplasty in octogenarians: a clinical trial. Eur J Orthop Surg Traumatol 2023; 33:3081-3088. [PMID: 37017739 PMCID: PMC10074352 DOI: 10.1007/s00590-023-03537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND A clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial partial knee arthroplasty (PKA) in octagenarians has been conducted. The focus of the present study was on PROMs, range of motion (ROM), implant positioning and implants survivorship. The hypothesis of the present study was that MB implants performed better than FB in PKA in octogenarians. METHODS The first group received FB PKA-PPK®; the second received MB PKA-Oxford. Patients were not randomly allocated. The following PROMs were administered at T0 (pre-operatively), T1 (1 year after surgery), and T2 (3 years after surgery): visual analogue scale (VAS), Knee Society Score (KSS) and Oxford Knee Score (OKS). Data regarding the implant survivorship and ROM were also collected. Furthermore, the following radiographic parameters were measured: Femoral component varus/valgus; Tibial component varus/valgus; Anteroposterior slope. RESULTS At T0, 28 patients were included in the FB and 33 in the MB group. The surgical time was shorter in the FB group (p < 0.001). No difference between FB and MB in ROM, VAS, KSS, and OKS at each follow-up (p > 0.05). No difference was found in implant positioning (p > 0.05). At last follow-up, FB group reported three failures caused by aseptic loosening. Four failures were observed in the MB cohort: two for bearing dislocation and two for aseptic loosening. The Kaplan-Meier Curve found no differences in implant survivorship. CONCLUSIONS According to the main findings of the present clinical trial, MB implants performed similar to FB in PKA in octogenarians. The FB group demonstrated shorted surgical time. No difference was found in patient reported outcome measures, ROM, implant positioning, and survivorship. LEVEL OF EVIDENCE Level II, prospective study.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | | | | | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michael Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, University Hospital of Larissa, Larissa, Greece
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
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15
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Modina SC, Aidos L, Millar VRH, Pallaoro M, Polito U, Veronesi MC, Peretti GM, Mangiavini L, Carnevale L, Boschetti F, Abbate F, Di Giancamillo A. Postnatal morpho-functional development of a dog's meniscus. Ann Anat 2023; 250:152141. [PMID: 37499701 DOI: 10.1016/j.aanat.2023.152141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential structures for the knee joint, poor information is available about their morphogenesis, in particular in dog models. Menisci from a group of Dobermann Pinchers aged 0, 10, 30 days, and 4 years (T0, T10, T30, adult, respectively) were analyzed by SEM, histochemistry (Safranin O and Picro Sirius Red Staining analyzed under a polarized light microscope), immunofluorescences (collagen type I and II), biomechanical (compression) and biochemical analyses (glycosaminoglycans, GAGs, and DNA content). SEM analyses revealed that the T0 meniscus is a bulgy structure that during growth tends to flatten, firstly in the inner zone (T10) and then even in the outer zone (T30), until the achievement of the completely smooth adult final shape. These results were further supported by the histochemistry analyses in which the deposition of GAGs started from T30, and the presence of type I birefringent collagen fibers was observed from T0 to T30, while poorly refringent type III collagen fibers were observed in the adult dogs. Double immunofluorescence analyses also evidenced that the neonatal meniscus contains mainly type I collagen fibers, as well as the T10 meniscus, and demonstrated a more evident regionalization and crimping in the T30 and adult meniscus. Young's elastic modulus of the meniscus in T0 and T10 animals was lower than the T30 animals, and this last group was also lower than adult ones (T0-T10 vs T30 vs adult). Biochemical analysis confirmed that cellularity decreases over time from neonatal to adult (p < 0.01). The same decreasing trend was observed in GAGs deposition. These results may suggest that the postnatal development of canine meniscus may be related to the progressive functional locomotory development: after birth, the meniscus acquires its functionality over time, through movement, load, and growth itself.
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Affiliation(s)
- Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | | | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Umberto Polito
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Maria Cristina Veronesi
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Liliana Carnevale
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Federica Boschetti
- IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Polytechnic University of Milan, 20133 Milan, Italy
| | - Francesco Abbate
- Department of Veterinary Sciences, University of Messina, Polo Universitario S.S. Annunziata, 98168 Messina, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy.
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Can Kuzuca B, Nedim Doral M, Mangiavini L, Sapmaz E, Maffulli N, Koken M. Investigation into the effect of epidermal growth factor and hyaluronic acid on fracture healing in a rat femoral fracture model. Acta Orthop Traumatol Turc 2023; 57:229-236. [PMID: 37909682 PMCID: PMC10724737 DOI: 10.5152/j.aott.2023.22163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to investigate the role of an exogenous Epidermal Growth Factor and a hyaluronic acid-based scaffold on fracture healing in a rat femoral fracture model Methods: Forty-eight male Wistar-Albino rats, each weighing a mean 392 grams (range= 350-450 grams) and aged 8.2 months (6-9 months), were used for this experimental study. All surgical procedures were performed on the left femur by a single surgeon. An open femoral fracture was created in all rats. The animals were randomly divided into one of the four groups: Control (12), EGF (12), HA (12) and Combined (12). In the 4th and sixth weeks, samples were processed and analyzed using biomechanical and histological methods. RESULTS Fracture healing was significantly improved in the Combined group compared to the control one, EGF and HA groups in all parameters at both experimental time points. At the fourth and sixth weeks after surgery, fracture healing in the EGF and HA groups was significantly increased at histological evaluation compared to controls. In addition, compared with EGF, HA and Control groups, a significant difference in callus tissue was detected in the Combined group at 4 and 6-week time points in biomechanical features. CONCLUSION This study has shown that combining local EGF and HA scaffold accelerates bone healing and strengthens the bony callus histologically and biomechanically. Using EGF-HA combined scaffolds may represent a possible future strategy in trauma surgery. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Barış Can Kuzuca
- Department Orthopaedics and Traumatology, Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Mahmut Nedim Doral
- Department Orthopaedics and Traumatology, Hacettepe University, Ankara, Turkey
| | | | - Ersin Sapmaz
- Department Thoracic Surgery, Medical Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Italy
| | - Murat Koken
- Department Orthopaedics and Traumatology, Medical Park Hospital, Antalya, Turkey
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Maggioni DM, Giorgino R, Messina C, Albano D, Peretti GM, Mangiavini L. Framing Patellar Instability: From Diagnosis to the Treatment of the First Episode. J Pers Med 2023; 13:1225. [PMID: 37623475 PMCID: PMC10456090 DOI: 10.3390/jpm13081225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
The patellofemoral joint (PFJ) is a complex articulation between the patella and the femur which is involved in the extensor mechanism of the knee. Patellofemoral disorders can be classified into objective patellar instability, potential patellar instability, and patellofemoral pain syndrome. Anatomical factors such as trochlear dysplasia, patella alta, and the tibial tuberosity-trochlear groove (TT-TG) distance contribute to instability. Patellofemoral instability can result in various types of dislocations, and the frequency of dislocation can be categorized as recurrent, habitual, or permanent. Primary patellar dislocation requires diagnostic framing, including physical examination and imaging. Magnetic resonance imaging (MRI) is essential for assessing the extent of damage, such as bone bruises, osteochondral fractures, and medial patellofemoral ligament (MPFL) rupture. Treatment options for primary dislocation include urgent surgery for osteochondral fragments or conservative treatment for cases without lesions. Follow-up after treatment involves imaging screening and assessing principal and secondary factors of instability. Detecting and addressing these factors is crucial for preventing recurrent dislocations and optimizing patient outcomes.
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Affiliation(s)
- Davide Maria Maggioni
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy;
| | - Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Via della Commenda 10, 20122 Milan, Italy
| | - Giuseppe Michele Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
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18
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Bianco Prevot L, Nannini A, Mangiavini L, Bobba A, Buzzi S, Sinigaglia F, Peretti G. What Is the Best Treatment of the Femoral Shaft Nonunion after Intramedullary Nailing? A Systematic Review. Life (Basel) 2023; 13:1508. [PMID: 37511883 PMCID: PMC10381168 DOI: 10.3390/life13071508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Nonunion (NU) is one of the most feared complications of femoral shaft fracture treatment. Femoral shaft fracture treatment is often linked with poor bone stock and reduced bone metabolism. In this paper, the goal is to carefully analyze the best treatment options for patients who developed nonunion after the intramedullary nailing of a femoral shaft fracture. A systematic review of the literature available in the PubMed, EMBASE and Cochran library databases was carried out, and 16 studies were included. Exclusion criteria included case reports and case series that do not have data about clinical outcomes or functional outcomes and included fewer than 10 patients. The reviewed data provide evidence for very good results about the treatment of this pathology with exchanging intramedullary nails or the implantation of a plate and screws (general healing rate of 96.3%). Moreover, the data support the utilization of autologous bone graft in order to stimulate the healing process. In conclusion, the choice between these two types of treatment must be guided by the type of pseudarthrosis that the patient presents. Additionally, bone grafting or growth factors promote bone regenerative processes, especially in patients with oligo-atrophic pseudoarthrosis.
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Affiliation(s)
- Luca Bianco Prevot
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Alessandra Nannini
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Laura Mangiavini
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Andrea Bobba
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Sara Buzzi
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Federico Sinigaglia
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Giuseppe Peretti
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
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19
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Canciani B, Semeraro F, Herrera Millar VR, Gervaso F, Polini A, Stanzione A, Peretti GM, Di Giancamillo A, Mangiavini L. In Vitro and In Vivo Biocompatibility Assessment of a Thermosensitive Injectable Chitosan-Based Hydrogel for Musculoskeletal Tissue Engineering. Int J Mol Sci 2023; 24:10446. [PMID: 37445622 DOI: 10.3390/ijms241310446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Musculoskeletal impairments, especially cartilage and meniscus lesions, are some of the major contributors to disabilities. Thus, novel tissue engineering strategies are being developed to overcome these issues. In this study, the aim was to investigate the biocompatibility, in vitro and in vivo, of a thermosensitive, injectable chitosan-based hydrogel loaded with three different primary mesenchymal stromal cells. The cell types were human adipose-derived mesenchymal stromal cells (hASCs), human bone marrow stem cells (hBMSCs), and neonatal porcine infrapatellar fat-derived cells (IFPCs). For the in vitro study, the cells were encapsulated in sol-phase hydrogel, and then, analyzed via live/dead assay at 1, 4, 7, and 14 days to compare their capacity to survive in the hydrogel. To assess biocompatibility in vivo, cellularized scaffolds were subcutaneously implanted in the dorsal pouches of nude mice and analyzed at 4 and 12 weeks. Our data showed that all the different cell types survived (the live cell percentages were between 60 and 80 at all time points in vitro) and proliferated in the hydrogel (from very few at 4 weeks to up to 30% at 12 weeks in vivo); moreover, the cell-laden hydrogels did not trigger an immune response in vivo. Hence, our hydrogel formulation showed a favorable profile in terms of safety and biocompatibility, and it may be applied in tissue engineering strategies for cartilage and meniscus repair.
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Affiliation(s)
- Barbara Canciani
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, 20161 Milan, Italy
| | - Francesca Semeraro
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | | | - Francesca Gervaso
- CNR NANOTEC-Institute of Nanotechnology, c/o Campus Ecotekne, Via Monteroni, 73100 Lecce, Italy
| | - Alessandro Polini
- CNR NANOTEC-Institute of Nanotechnology, c/o Campus Ecotekne, Via Monteroni, 73100 Lecce, Italy
| | - Antonella Stanzione
- CNR NANOTEC-Institute of Nanotechnology, c/o Campus Ecotekne, Via Monteroni, 73100 Lecce, Italy
| | - Giuseppe Michele Peretti
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Laura Mangiavini
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
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20
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Giorgino R, Nannini A, Scuttari E, Nuara A, Ciliberto R, Sosio C, Sirtori P, Peretti GM, Mangiavini L. Analysis of Short-Term Clinical and Functional Outcomes in Patients Undergoing Total Knee Arthroplasty with Kinematic Alignment Technique. J Clin Med 2023; 12:3978. [PMID: 37373671 DOI: 10.3390/jcm12123978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Surgery remains the best option for more advanced stages of knee osteoarthritis (OA). Kinematic alignment (KA) is an innovative surgical technique that aims to co-align the rotational axes of the femoral, tibial, and patella components with the three kinematic axes of the knee. This study aims to evaluate and analyze short-term clinical, psychological, and functional outcomes in patients undergoing total knee replacement with the KA technique. METHODS Twelve patients who underwent total knee replacement surgery with kinematic alignment from May 2022 until July 2022 were prospectively followed and interviewed. Before surgery, the day after surgery, and postoperative day 14, the following tests were evaluated: VAS, SF-12 PS, SF-12 MS, KSS, KSS-F, PHQ-9, and KOOS-PS. RESULTS The mean BMI value of 30.4 (±3.4) Kg/m2, mean age of 71.8 (±7.2) years. All the scores on the various tests administered consistently showed statistically significant improvement, not only immediately after surgery but also comparing the first to the fourteenth postoperative day. CONCLUSION Kinematic alignment technique as a surgical treatment for KO allows the patient a fast postoperative recovery and good clinical, psychological, and functional results in a short time. Further studies are needed with a larger sample size, and prospective randomized studies are essential to compare these results with mechanical alignment.
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Affiliation(s)
- Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Alessandra Nannini
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Edoardo Scuttari
- Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy
| | - Alessandro Nuara
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | | | - Corrado Sosio
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Paolo Sirtori
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
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21
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Giorgino R, Albano D, Fusco S, Peretti GM, Mangiavini L, Messina C. Knee Osteoarthritis: Epidemiology, Pathogenesis, and Mesenchymal Stem Cells: What Else Is New? An Update. Int J Mol Sci 2023; 24:ijms24076405. [PMID: 37047377 PMCID: PMC10094836 DOI: 10.3390/ijms24076405] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Osteoarthritis (OA) is a chronic disease and the most common orthopedic disorder. A vast majority of the social OA burden is related to hips and knees. The prevalence of knee OA varied across studies and such differences are reflected by the heterogeneity of data reported by studies conducted worldwide. A complete understanding of the pathogenetic mechanisms underlying this pathology is essential. The OA inflammatory process starts in the synovial membrane with the activation of the immune system, involving both humoral and cellular mediators. A crucial role in this process is played by the so-called “damage-associated molecular patterns” (DAMPs). Mesenchymal stem cells (MSCs) may be a promising option among all possible therapeutic options. However, many issues are still debated, such as the best cell source, their nature, and the right amount. Further studies are needed to clarify the remaining doubts. This review provides an overview of the most recent and relevant data on the molecular mechanism of cartilage damage in knee OA, including current therapeutic approaches in regenerative medicine.
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22
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Pironti P, Ambrosanio A, Vismara V, Viganò M, Bucci E, Sirtori P, Peretti GM, Mangiavini L. Correction: One-stage vs two-stage bilateral THA in Lombardy: a cost-effectiveness analysis. Cost Eff Resour Alloc 2023; 21:9. [PMID: 36698188 PMCID: PMC9878758 DOI: 10.1186/s12962-023-00419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Pierluigi Pironti
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andrea Ambrosanio
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Valeria Vismara
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Marco Viganò
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Eugenia Bucci
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Paolo Sirtori
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe M. Peretti
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Mangiavini
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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23
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Pironti P, Ambrosanio A, Vismara V, Viganò M, Bucci E, Sirtori P, Peretti GM, Mangiavini L. One-stage vs two-stage bilateral THA in Lombardy: a cost-effectiveness analysis. Cost Eff Resour Alloc 2023; 21:3. [PMID: 36647163 PMCID: PMC9841130 DOI: 10.1186/s12962-023-00418-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is the most common treatment for primary and secondary end-stage hip osteoarthritis (OA). Almost 20% of all patients undergoing primary THA suffer from bilateral hip OA and, consequently, will need a contralateral procedure to be performed in the following years. The aim of this study is to evaluate the cost-effectiveness and the reliability of one-stage bilateral THA (1-BTHA) compared to two-stage bilateral THA (2-BTHA), in low-risk patients, performed with anterior minimally invasive surgery (AMIS). METHODS Single patient's costs were obtained by dividing the annual costs report by the number of hospitalizations, considering the diagnosis related group (DRG) of the two procedures. Then, 16 patients undergoing 1-BTHA and 8 undergoing 2-BTHA were examined. Hemoglobin (Hb) values before surgery and before discharge, transfusion rate and the occurrence of post-operative complications were observed. RESULTS Procedural costs were divided in different subgroups: pre-hospitalization, operating room, hospital stay, post-operative follow-up and other costs. 1-BTHA total costs amount to 5.754,82€, while performing 2-BTHA costs 7.624,32€. However, considering DRG reimbursement, the hospital's profit margin following 1-BTHA is lower than that following 2-BTHA (6.346,18€ versus 9.261,68€). Surgical time was found not to be significantly different between 1-BTHA and 2-BTHA (141,13 ± 26,1 min vs 164,8 ± 44,3 min; p = 0,111). The two groups showed a statistically significant difference in Hb decrease (4,8 ± 1,3 g/dl vs 3,3 ± 0,9; p = 0,001), despite no variances in transfusion rate. No further complications were observed in either group. CONCLUSIONS This study demonstrates how, in carefully selected patients, 1-BTHA performed with AMIS is a cost-effective and safe technique compared to 2-BTHA, resulting in a shorter OR time, LOS and lower overall costs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pierluigi Pironti
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andrea Ambrosanio
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Valeria Vismara
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Marco Viganò
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Eugenia Bucci
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Paolo Sirtori
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe M Peretti
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Mangiavini
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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24
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D’Ambrosi R, Meena A, Raj A, Giorgino R, Ursino N, Mangiavini L, Karlsson J. Good results after treatment of RAMP lesions in association with ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:358-371. [PMID: 35869982 PMCID: PMC9859864 DOI: 10.1007/s00167-022-07067-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to systematically evaluate the clinical, functional, and radiological outcomes, complications, and rate of return to sports among patients with RAMP lesion of the medial meniscus encountered during anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted based on the PRISMA guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "ACL" or "anterior cruciate ligament," and "RAMP lesion." The outcome measures extracted from the studies were the Short Form-12 (SF-12) in its mental and physical component (MCS and PCS), Lysholm score, Subjective IKDC, Marx Score, WOMAC Score, Tegner, Radiological changes, complications, failures and/or revision surgery, and rate of return to sports. RESULTS The cohort of patients consisted of 1,243 participants with a mean age of 28.6 ± 2.6. The mean postoperative follow-up was 40.9 ± 6.3 months. A total of 1145 (92.1%) RAMP lesions were repaired with concomitant ACL reconstruction, while only 98 (7.9%) lesions were left untreated (or treated with abrasion only). The Lysholm score was used in 6 studies (in one only at final follow-up), with a significant improvement in all the studies (Lysholmpre 60.03 ± 6.12; Lysholmpost 89.9 ± 5.0). Eight studies out of nine reported Subjective IKDC score, and a significant improvement was noted in all cases (IKDCpre 56.2 ± 5.8. IKDCpost 84.9 ± 3.7). Of 18 (1.4%) complications reported, 15 (1.2%) were related to RAMP/ACL surgery, and of the remaining three (0.2%) two (0.2%) were hematomas and one (0.1%) a contralateral ACL lesion. Of the 106 (8.5%) revision surgeries required, 5 (0.4%) were in non-treated lesions [two (0.2%) ACL re-ruptures and three (0.2%) medial meniscus re-injury]. In treated patients, the revision occurred for the following reasons: 75 (6.0%) meniscectomy, 14 (1.1%) meniscal suture revisions, 11 (0.9%) ACL failures and one (0.1%) arthrolysis. CONCLUSIONS It is not yet clear if, in all cases of ACL reconstruction in which a medial meniscal RAMP lesion is encountered, the lesion needs to undergo surgical repair. Accordingly, it is recommended that in the repair of all unstable medial meniscal RAMP lesions during an ACL reconstruction in cases associated with a stable RAMP lesion, the surgeon may decide on repair based on the patient profile. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo D’Ambrosi
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, Milan, Italy
| | - Amit Meena
- grid.487341.dGelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
| | - Akshya Raj
- grid.416888.b0000 0004 1803 7549Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Riccardo Giorgino
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, Milan, Italy
| | - Nicola Ursino
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Laura Mangiavini
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, Milan, Italy
| | - Jon Karlsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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D'Ambrosi R, Migliorini F, Cerciello S, Guerra G, Corona K, Mangiavini L, Ursino N, Vlaic J, Jelic M. Management of the first episode of traumatic patellar dislocation: an international survey. Knee Surg Sports Traumatol Arthrosc 2022; 31:2257-2265. [PMID: 36477349 DOI: 10.1007/s00167-022-07273-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This international survey aimed to evaluate the potential controversies regarding the management of first patellar dislocation amongst experienced knee surgeries in the treatment of the first episode of patellar dislocation without osteochondral fragments. METHODS An online survey was conducted from February 2021 to December 2021 to assess the global trend in the diagnosis and management of first-time patellar dislocation without osteochondral fragments. The online survey was accessible on the homepage of the website of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). The questionnaire consisted of multiple-choice questions and was divided into three sections. The first section consisted of eight questions regarding demographic information, professional activity, and responder experience. The second section consisted of 13 questions regarding the approach to a first patellar dislocation (clinical examination, imaging, and rehabilitation). The third section contained 2 questions concerning the relevance of patient characteristics to the therapeutic algorithm (age, sports, and pathoanatomical predisposing risk factors). RESULTS A total of 438 orthopaedic surgeons worldwide completed the questionnaire. At the first approach to diagnose a first-time patellar dislocation, 251 (57%) of the surgeons requested plain radiographs, and 158 (36%) requested magnetic resonance imaging (MRI). In conservatively treated patients, 368 (84%) of the respondents recommended the use of a knee brace. Amongst them, 14 (3%) advocated its use for one week, 75 (17%) for two weeks, 123 (28%) for three weeks, 105 (24%) for four weeks, and 97 (22%) for six weeks. In conservatively treated patients, 215 (49%) of the surgeons recommended load to tolerance, 148 (34%) recommended 30% to 60% of the bodyweight, and 75 (17%) advised against weight-bearing. More than half of the surgeons considered a patient aged less than 35 years practising contact sports to be a candidate for the medial patello-femoral ligament (MPFL) procedure. In addition, a tibial tuberosity to trochlear groove distance (TT-TG) distance of 15 to > 20 mm (for > 75% of the surgeons) and a trochlea types C and D (for > 70% of the surgeons) were considered possible indications for direct surgical management. CONCLUSION At the first approach to diagnose a first-time patellar dislocation, plain radiographs and MRI should be performed. In conservatively treated patients, most of the surgeons recommend weight-bearing to tolerance and a knee brace during the first four weeks, with range of motion of full extension to 30° during the first 15 days and up to 60° for an additional 15 days. Surgical management should be performed in patients in the second and third decades of life practising contact sports and in those patients who present types C and D trochlea dysplasia and patella alta. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy. .,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Simone Cerciello
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.,Casa di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy
| | - Germano Guerra
- Department of Medicine, Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Katia Corona
- Department of Medicine, Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Mislav Jelic
- Department of Orthopaedic Surgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
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26
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Cecchinato R, Berjano P, Compagnone D, Langella F, Nervi A, Pezzi A, Mangiavini L, Lamartina C. Long spine fusions to the sacrum-pelvis are associated with greater post-operative proximal junctional kyphosis angle in sitting position. Eur Spine J 2022; 31:3573-3579. [PMID: 36227365 DOI: 10.1007/s00586-022-07418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/15/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
STUDY DESIGN A single-centre retrospective study. BACKGROUND AND PURPOSE Although adult patients spend most of their time in sitting positions, the assessment of spinopelvic parameters in adult deformity surgery is commonly performed in standing X-rays. Our study compares the standing and sitting sagittal alignment parameters in subjects who underwent thoracolumbar fusion. METHODS Patients who underwent corrective surgery for adult scoliosis with at least five instrumented vertebra were stratified according to the upper instrumented vertebra (UIV) and pelvic fixation. Group A:UIV proximal to T6 with pelvis fixation. B:UIV lower than T6 and pelvic fixation. Group C: thoracolumbar fusion without pelvic fixation. Post-operative spinopelvic sagittal parameters were measured in both standing and sitting X-rays. RESULTS A total of 51 patients were enrolled in the study (11:Males and 40:Females). The mean age was 52.3 ± 21.7y/o. The comparison of post-operative standing and sitting X-ray within the group A and B showed that a significant change was observed in terms of JA-Junctional Angle-(Group A 6.3 ± 4.3 vs. 8.1 ± 3.3, p value = 0.03) (Group B 8.5 ± 6.4 vs. 10.9 ± 6.4, p value = 0.02). Group C showed statistically significant difference in terms of PT (15.6 ± 11.2 vs. 19.3 ± 9.2, p value = 0.04), AVA-Acetabular Version Angle-(41.1 ± 5.9 vs. 48.3 ± 6.6, p value < 0.01) and LL (- 51.3 ± 16.0 vs. - 42.6 ± 10.7, p value < 0.01). CONCLUSION In our series, the post-operative sagittal alignment showed peculiar behaviours and adaptations in sitting position, depending on the length and the site of the instrumented area. If the pelvis is included, the JA tends to significantly increase in sitting position. These findings can improve the knowledge of pathologies as proximal junctional kyphosis or specific cases of anterior hip impingement. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | | | | | - Andrea Nervi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Pezzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Abstract
During endochondral bone development, a complex process that leads to the formation of the majority of skeletal elements, mesenchymal cells condense, differentiating into chondrocytes and producing the foetal growth plate. Chondrocytes progressively hypertrophy, induce angiogenesis and are then gradually replaced by bone. Epidermal Growth Factor (EGF), one of many growth factors, is the prototype of the EGF-ligand family, which comprises several proteins involved in cell proliferation, migration and survival. In bone, EGF pathway signalling finely tunes the first steps of chondrogenesis by maintaining mesenchymal cells in an undifferentiated stage, and by promoting hypertrophic cartilage replacement. Moreover, EGF signalling modulates bone homeostasis by stimulating osteoblast and osteoclast proliferation, and by regulating osteoblast differentiation under specific spatial and temporal conditions. This evidence-based narrative review describes the EGF pathway in bone metabolism and endochondral bone development. This comprehensive description may be useful in light of possible clinical applications in orthopaedic practice. A deeper knowledge of the role of EGF in bone may be useful in musculoskeletal conditions which may benefit from the modulation of this signalling pathway.Key messagesThe EGF pathway is involved in bone metabolism.EGF signalling is essential in the very early stages of limb development by maintaining cells in an undifferentiated stage.EGF pathway positively regulates chondrocyte proliferation, negatively modulates hypertrophy, and favours cartilage replacement by bone.EGF and EGF-like proteins finely tune the proliferation and differentiation of bone tissue cells, and they also regulate the initial phases of endochondral ossification.
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Affiliation(s)
- L Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - G M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - B Canciani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - N Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, UK
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Yadav AK, Parihar M, Mariani I, Giorgino R, Mangiavini L, Ursino N, D'Ambrosi R. High tibial osteotomy with an external fixator or unicompartmental knee arthroplasty for varus knee in young patients? J Orthop 2022; 34:254-259. [PMID: 36148179 PMCID: PMC9486030 DOI: 10.1016/j.jor.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study compares the functional results and survivorship of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with an external fixator for medial compartment osteoarthritis (OA) of the knee. Methods Two cohorts of patients aged less than 60 years who had undergone either a cemented medial mobile-bearing UKA or an HTO with an external fixator were included in the study. The first cohort included patients undergoing a series of 197 consecutive medial UKA procedures (UKA group). The second cohort consisted of 60 consecutive patients undergoing HTO with an external fixator (HTO group). Each patient was assessed based on the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Subjective International Knee Documentation Committee (IKDC) score/questionnaire. A clinical evaluation was conducted on the day of the surgery (T0) and at the follow-up visit (T1) (minimum follow-up time was 60 months). Complications and failures resulting from the surgery were recorded for each patient. Results Only the age of the patients at the pre-operative time differed significantly between the two groups, with the HTO group being significantly younger (47.7 ± 8.0 versus 55.8 ± 2.2).After the final follow-up visit, all scores improved in both groups (p < 0.05).IKDC and Oxford scores were higher for the UKA group (p < 0.05). In the HTO group, three complications occurred (5%), including two superficial infections and one deep infection. On the other hand, the UKA group reported four complications (2%): three aseptic mobilisations and one infection requiring revision surgery. There was no difference in the complication rate between the two groups (p = 0.208). Conclusions In young patients (<60 years) with an isolated medial knee OA, both HTO and UKA led to good to excellent clinical results with a low rate of complications at mid-term follow-up; both surgical procedures may be considered in this patient population. Level of evidence Level III.
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Affiliation(s)
- Amit Kumar Yadav
- Sir HN Reliance Foundation Hospital and Research Center, Mumbai, India
| | - Mangal Parihar
- Mangal Ananad Hospital, Swastik Park Chembur East, Mumbai, Maharashtra, India
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Riccardo Giorgino
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | | | - Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
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Herrera Millar VR, Canciani B, Mangiavini L, Filipe JFS, Aidos L, Pallaoro M, Peretti GM, Pocar P, Modina SC, Di Giancamillo A. Endostatin in 3D Fibrin Hydrogel Scaffolds Promotes Chondrogenic Differentiation in Swine Neonatal Meniscal Cells. Biomedicines 2022; 10:biomedicines10102415. [PMID: 36289678 PMCID: PMC9598439 DOI: 10.3390/biomedicines10102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
The success of cell-based approaches for the treatment of cartilage or fibro-cartilaginous tissue defects requires an optimal cell source with chondrogenic differentiation ability that maintains its differentiated properties and stability following implantation. For this purpose, the aim of this study was to evaluate the use of endostatin (COL18A1), an anti-angiogenic factor, which is physiologically involved in cell differentiation during meniscus development. Swine neonatal meniscal cells not yet subjected to mechanical stimuli were extracted, cultured in fibrin hydrogel scaffolds, and treated at two different time points (T1 = 9 days and T2 = 21 days) with different concentrations of COL18A1 (10 ng/mL; 100 ng/mL; 200 ng/mL). At the end of the treatments, the scaffolds were examined through biochemical, molecular, and histochemical analyses. The results showed that the higher concentration of COL18A1 promotes a fibro-chondrogenic phenotype and improves cellularity index (DNA content, p < 0.001) and cell efficiency (GAGs/DNA ratio, p < 0.01) after 21 days. These data are supported by the molecular analysis of collagen type I (COL1A1, a marker of fibrous-like tissue, p < 0.001), collagen type II (COL2A1, a marker of cartilaginous-like tissue, p < 0.001) and SRY-Box Transcription Factor 9 (SOX9, an early marker of chondrogenicity, p < 0.001), as well as by histological analysis (Safranin-O staining), laying the foundations for future studies evaluating the involvement of 3D endostatin hydrogel scaffolds in the differentiation of avascular tissues.
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Affiliation(s)
| | - Barbara Canciani
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Joel Fernando Soares Filipe
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Paola Pocar
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- Correspondence:
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Ulivi M, Meroni V, Viganò M, Colombini A, Lombardo MDM, Rossi N, Orlandini L, Messina C, Sconfienza LM, Peretti GM, Mangiavini L, de Girolamo L. Micro-fragmented adipose tissue (mFAT) associated with arthroscopic debridement provides functional improvement in knee osteoarthritis: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07101-4. [PMID: 36040510 PMCID: PMC9424810 DOI: 10.1007/s00167-022-07101-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/30/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Current conservative treatments for knee OA provide limited benefits, with symptoms relief for a short amount of time. Regenerative medicine approaches such as the use of microfragmented adipose tissue (mFAT) showed promising results in terms of durable effects and the possibility to enhance tissue healing and counteract the progression of the pathology. Nevertheless, up to today, the large part of clinical data about mFAT use refers to uncontrolled studies, especially in the surgical setting. The purpose of this study was to evaluate the effectiveness of mFAT applied in association with arthroscopic debridement (AD) for the treatment of knee OA, in terms of symptoms relief and tissue healing. METHODS This study is a prospective, randomized controlled clinical trial. 78 patients affected by knee OA grade 3-4 according to KL classification were randomly assigned to AD or AD + mFAT treatment groups. Clinical, radiological and serological assessments were performed at 6 months after treatment. Additional clinical evaluation was performed at the end of the study with an average follow-up of 26.1 ± 9.5 months. VAS, KOOS, WOMAC and SF-12 were also collected at both timepoints, KSS only at 6 months. RESULTS Treatment with AD + mFAT improved functional scores at both 6 months (KOOS-PS: + 11.7 ± 20.2 vs + 24.4 ± 22.5, in AD and AD + mFAT, respectively, p = 0.024; KSS: + 14.9 ± 15.9 vs + 24.8 ± 23.5, in AD and AD + mFAT, respectively, p = 0.046) and 24-month follow-ups (KOOS-PS Functional subscale: - 2.0 ± 3.5 vs - 4.7 ± 4.2, in AD and AD + mFAT, respectively, p = 0.012). Lower T2-mapping scores were obtained in AD + mFAT-treated group in medial and lateral condyle compartments (p < 0.001). Slight increase was observed in the levels of a serum biomarker of cartilage deposition (PIIINP) in both groups at 6-month follow-up (p = 0.037). CONCLUSION mFAT improves functional outcome and MRI appearance when used in association with AD, therefore supporting its use in the treatment of knee OA in an arthroscopic setting.
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Affiliation(s)
- Michele Ulivi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Valentina Meroni
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | | | - Michele D. M. Lombardo
- Residency Program in Orthopedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy
| | - Nicolò Rossi
- Residency Program in Orthopedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy
| | - Luca Orlandini
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy ,Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli, 31, 20133 Milan, Italy
| | - Luca M. Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy ,Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli, 31, 20133 Milan, Italy
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy ,Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli, 31, 20133 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli, 31, 20133, Milan, Italy.
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
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D’Ambrosi R, Menon PH, Salunke A, Mariani I, Palminteri G, Basile G, Ursino N, Mangiavini L, Hantes M. Octogenarians Are the New Sexagenarians: Cruciate-Retaining Total Knee Arthroplasty Is Not Inferior to Posterior-Stabilized Arthroplasty in Octogenarian Patients. J Clin Med 2022; 11:jcm11133795. [PMID: 35807083 PMCID: PMC9267517 DOI: 10.3390/jcm11133795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. Implant survival was calculated using the Kaplan−Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T1 than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time.
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-339-706-6151
| | - Prem Haridas Menon
- Division of Orthopedics and Traumatology, Government Medical College Trivandrum, Kerala University of Health Sciences, Thiruvananthapuram 695011, India;
| | | | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Giovanni Palminteri
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Giuseppe Basile
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Michael Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, University Hospital of Larissa, University of Thessalia, 41110 Larissa, Greece;
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Cirillo F, Mangiavini L, La Rocca P, Piccoli M, Ghiroldi A, Rota P, Tarantino A, Canciani B, Coviello S, Messina C, Ciconte G, Pappone C, Peretti GM, Anastasia L. Human Sarcopenic Myoblasts Can Be Rescued by Pharmacological Reactivation of HIF-1α. Int J Mol Sci 2022; 23:ijms23137114. [PMID: 35806119 PMCID: PMC9267002 DOI: 10.3390/ijms23137114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia, an age-related decline in muscle mass and strength, is associated with metabolic disease and increased risk of cardiovascular morbidity and mortality. It is associated with decreased tissue vascularization and muscle atrophy. In this work, we investigated the role of the hypoxia inducible factor HIF-1α in sarcopenia. To this end, we obtained skeletal muscle biopsies from elderly sarcopenic patients and compared them with those from young individuals. We found a decrease in the expression of HIF-1α and its target genes in sarcopenia, as well as of PAX7, the major stem cell marker of satellite cells, whereas the atrophy marker MURF1 was increased. We also isolated satellite cells from muscle biopsies and cultured them in vitro. We found that a pharmacological activation of HIF-1α and its target genes caused a reduction in skeletal muscle atrophy and activation of PAX7 gene expression. In conclusion, in this work we found that HIF-1α plays a role in sarcopenia and is involved in satellite cell homeostasis. These results support further studies to test whether pharmacological reactivation of HIF-1α could prevent and counteract sarcopenia.
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Affiliation(s)
- Federica Cirillo
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy; (F.C.); (M.P.); (A.G.); (A.T.); (S.C.)
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy; (L.M.); (C.M.); (G.M.P.)
- IRCCS Istituto Ortopedico Galeazzi, 20100 Milan, Italy;
| | - Paolo La Rocca
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy; (L.M.); (C.M.); (G.M.P.)
| | - Marco Piccoli
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy; (F.C.); (M.P.); (A.G.); (A.T.); (S.C.)
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
| | - Andrea Ghiroldi
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy; (F.C.); (M.P.); (A.G.); (A.T.); (S.C.)
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
| | - Paola Rota
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20133 Milan, Italy
| | - Adriana Tarantino
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy; (F.C.); (M.P.); (A.G.); (A.T.); (S.C.)
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, Via Olgettina 58, 20097 Milan, Italy
| | | | - Simona Coviello
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy; (F.C.); (M.P.); (A.G.); (A.T.); (S.C.)
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy; (L.M.); (C.M.); (G.M.P.)
- IRCCS Istituto Ortopedico Galeazzi, 20100 Milan, Italy;
| | - Giuseppe Ciconte
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy
| | - Carlo Pappone
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, Via Olgettina 58, 20097 Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy; (L.M.); (C.M.); (G.M.P.)
- IRCCS Istituto Ortopedico Galeazzi, 20100 Milan, Italy;
| | - Luigi Anastasia
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy; (F.C.); (M.P.); (A.G.); (A.T.); (S.C.)
- Institute for Molecular and Translational Cardiology (IMTC), 20097 San Donato Milanese, Italy; (P.L.R.); (P.R.); (G.C.); (C.P.)
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, Via Olgettina 58, 20097 Milan, Italy
- Correspondence: ; Tel.: +39-02-2643-7756
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Giannasi C, Mangiavini L, Niada S, Colombo A, Della Morte E, Vismara V, Ambrosanio A, Savadori P, Casati S, Peretti GM, Brini AT. Human Osteochondral Explants as an Ex Vivo Model of Osteoarthritis for the Assessment of a Novel Class of Orthobiologics. Pharmaceutics 2022; 14:pharmaceutics14061231. [PMID: 35745803 PMCID: PMC9229444 DOI: 10.3390/pharmaceutics14061231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Osteoarthritis (OA) is a highly prevalent joint disease still lacking effective treatments. Its multifactorial etiology hampers the development of relevant preclinical models to evaluate innovative therapeutic solutions. In the last decade, the potential of Mesenchymal Stem Cell (MSC) secretome, or conditioned medium (CM), has emerged as an alternative to cell therapy. Here, we investigated the effects of the CM from adipose MSCs (ASCs), accounting for both soluble factors and extracellular vesicles, on human osteochondral explants. Biopsies, isolated from total knee replacement surgery, were cultured without additional treatment or with the CM from 106 ASCs, both in the absence and in the presence of 10 ng/mL TNFα. Tissue viability and several OA-related hallmarks were monitored at 1, 3 and 6 days. Specimen viability was maintained over culture. After 3 days, TNFα induced the enhancement of matrix metalloproteinase activity and glycosaminoglycan release, both efficiently counteracted by CM. The screening of inflammatory lipids, proteases and cytokines outlined interesting modulations, driving the attention to new players in the OA process. Here, we confirmed the promising beneficial action of ASC secretome in the OA context and profiled several bioactive factors involved in its progression, in the perspective of accelerating an answer to its unmet clinical needs.
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Affiliation(s)
- Chiara Giannasi
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20129 Milan, Italy
| | | | - Andrea Colombo
- Residency Program in Orthopedics and Traumatology, University of Milan, 20129 Milan, Italy
| | | | - Valeria Vismara
- Residency Program in Orthopedics and Traumatology, University of Milan, 20129 Milan, Italy
| | - Andrea Ambrosanio
- Residency Program in Orthopedics and Traumatology, University of Milan, 20129 Milan, Italy
| | - Paolo Savadori
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy
| | - Sara Casati
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20129 Milan, Italy
| | - Anna Teresa Brini
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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Cirillo F, Zimmers TA, Mangiavini L. Editorial: Metabolic Adaptation of Muscle Tissue in Diseases Associated With Cachexia. Front Cell Dev Biol 2022; 10:947902. [PMID: 35721487 PMCID: PMC9204193 DOI: 10.3389/fcell.2022.947902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Federica Cirillo
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Institute for Molecular and Translational Cardiology (IMTC), San Donato Milanese, Italy
- *Correspondence: Federica Cirillo,
| | - Teresa A. Zimmers
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, United States
- Indiana Center of Musculoskeletal Health, Indianapolis, IN, United States
- Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, United States
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Bassani R, Morselli C, Cirullo A, Querenghi AM, Mangiavini L. Successful salvage strategy using anterior retroperitoneal approach in failed posterior lumbar interbody fusion. A retrospective analisys on lumbar lordosis and clinical outcome. Eur Spine J 2022; 31:1649-1657. [PMID: 35652952 DOI: 10.1007/s00586-022-07247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are among the most popular surgical options for lumbar interbody fusion. If non-union occurs with consequent pain and reduced quality of life, revision surgery should correct any previous technical errors, avoiding further complications. The aim of this study was to analyze technical advantages, radiological and clinical outcomes of anterior approaches (ALIF) in case of failed PLIF or TLIF. METHODS Retrospective analysis of consecutive patients with persistent low back pain after failed PLIF/TLIF where salvage ALIF through an anterior retroperitoneal miniopen video-assisted technique was performed. Surgical, clinical and radiological data were analysed. Uni and multivariate statistical analysis were applied. RESULTS Thirty-six patients (average age: 47.1 years) were included. Mean follow-up was 34.4 months. In 30 patients (83.3%) a posterior surgical step was necessary. Non-union (86.1%), cage migration (5.5%), infection (8.3%) were the causes of revision surgery. In 22 patients (61.1%) the involved level was L5-S1, in 12 patients (33.4%) L4-L5, in 1 patient (2.7%) L3-L4. One patient (2.7%) had two levels (L4-L5 and L5-S1) involved. No major intraoperative complications were recorded. Significant correlation between clinical and radiological outcomes (L4-S1 and L5-S1 lordosis improvement) were observed (postoperative VAS and L5-S1, p = 0.038). CONCLUSIONS Salvage ALIF is a safe option that can significantly ameliorate residual pain achieving primary interbody stability with an ideal segmental lordosis according to pelvic parameters. The advantages of a naive anterior approach fulfils the main objectives of a revision surgery in order to significantly increase the chances of definitive fusion.
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Affiliation(s)
- Roberto Bassani
- IRCCS Istituto Ortopedico Galeazzi, II Spine Unit, Milan, Italy
| | | | | | | | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, II Spine Unit, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Faraldi M, Mangiavini L, Conte C, Banfi G, Napoli N, Lombardi G. A novel methodological approach to simultaneously extract high-quality total RNA and proteins from cortical and trabecular bone. Open Biol 2022; 12:210387. [PMID: 35506206 PMCID: PMC9065961 DOI: 10.1098/rsob.210387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Molecular differences between cortical and trabecular bone, of relevance to understanding the pathophysiological basis of bone diseases, can be determined only through effective isolation methods for RNA and proteins. Here we present a TRIzol-based method, which combines bone pulverization and homogenization to extract simultaneously total RNA and proteins from human cortical and trabecular bone from the same carrot. RNA integrity and purity were determined as the 260/280 nm and 260/230 nm absorbance ratios and the 28S/18S rRNA ratio. Protein integrity and quality were evaluated by Coomassie blue staining. Reverse transcription quantitative polymerase chain reaction and immunoblotting for bone-specific genes and proteins were performed to verify the suitability of the isolated material in downstream applications. The 260/280 nm and 260/230 nm absorbance ratios were, on average, less than or equal to 1.8. Bands on agarose gel were consistent with intact RNA, with mean 28S/18S ratios of 1.68 ± 0.35 and 1.88 ± 0.10 for cortical and trabecular bone, respectively. Band patterns after Coomassie blue staining confirmed protein integrity. Successful gene and protein expression analysis, with relevant differences between the two compartments, highlighted the suitability of the material in downstream applications. The method presented here is appropriate and effective for the study of human bone.
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Affiliation(s)
- Martina Faraldi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy,Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Banfi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy,Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
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Ulivi M, Orlandini L, Meroni V, Viganò M, D’Errico M, Perrotta R, Nannini A, Peretti GM, Mangiavini L. Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire. Healthcare (Basel) 2022; 10:769. [PMID: 35627906 PMCID: PMC9141051 DOI: 10.3390/healthcare10050769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Patient satisfaction after total joint arthroplasties (TJA) represents a key element for the evaluation of surgery success in relation to subjects' needs and expectations. The assessment tools are applied inconsistently throughout the literature, and thus, it is difficult to compare results among different studies. Goodman et al. proposed a standardized questionnaire with strong psychometric properties for the assessment of satisfaction. The present study aims to translate, adapt, and validate the Goodman questionnaire for the Italian population. After translation and back translation, the questionnaire was administrated to 50 patients. Internal consistency, test-retest reliability, floor and ceiling effects, and construct validity were evaluated (correlation with KOOS/HOOS, SF-12 PCS/MCS, EQ-5D). Responsiveness was evaluated with respect to SF-12 PCS improvements. The Italian version of the Goodman score questionnaire demonstrated psychometric properties similar to those of the original version. The translated questionnaire showed good internal consistency (Cronbach's alpha = 0.836) and test-retest reliability (ICC: 0.507). Moderate/strong correlations were observed between the Italian version of the Goodman score and other scores. The score significantly discriminated patients who improved from those who did not improve in SF-12 PCS after treatment. This study provides an adapted and validated Italian version of the Goodman score questionnaire, with psychometric properties similar to those of its original counterpart.
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Affiliation(s)
- Michele Ulivi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Luca Orlandini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Valentina Meroni
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Mario D’Errico
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Riccardo Perrotta
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Alessandra Nannini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, 20133 Milano, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, 20133 Milano, Italy
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Aidos L, Modina SC, Millar VRH, Peretti GM, Mangiavini L, Ferroni M, Boschetti F, Di Giancamillo A. Meniscus Matrix Structural and Biomechanical Evaluation: Age-Dependent Properties in a Swine Model. Bioengineering (Basel) 2022; 9:bioengineering9030117. [PMID: 35324808 PMCID: PMC8945511 DOI: 10.3390/bioengineering9030117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022] Open
Abstract
The analysis of the morphological, structural, biochemical, and mechanical changes of the Extracellular Matrix (ECM), which occur during meniscus development, represents the goal of the present study. Medial fully developed menisci (FD, 9-month-old pigs), partially developed menisci (PD, 1-month-old piglets), and not developed menisci (ND, from stillbirths) were collected. Cellularity and glycosaminoglycans (GAGs) deposition were evaluated by ELISA, while Collagen 1 and aggrecan were investigated by immunohistochemistry and Western blot analyses in order to be compared to the biomechanical properties of traction and compression tensile forces, respectively. Cellularity decreased from ND to FD and GAGs showed the opposite trend (p < 0.01 both). Collagen 1 decreased from ND to FD, as well as the ability to resist to tensile traction forces (p < 0.01), while aggrecan showed the opposite trend, in accordance with the biomechanics: compression test showed that FD meniscus greatly resists to deformation (p < 0.01). This study demonstrated that in swine meniscus, clear morphological and biomechanical changes follow the meniscal maturation and specialization during growth, starting with an immature pattern (ND) to the mature organized meniscus of the FD, and they could be useful to understand the behavior of this structure in the light of its tissue bioengineering.
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Affiliation(s)
- Lucia Aidos
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milano, Italy; (L.A.); (V.R.H.M.); (G.M.P.); (L.M.)
| | - Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Science, Università degli Studi di Milano, 26900 Lodi, Italy;
| | - Valentina Rafaela Herrera Millar
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milano, Italy; (L.A.); (V.R.H.M.); (G.M.P.); (L.M.)
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milano, Italy; (L.A.); (V.R.H.M.); (G.M.P.); (L.M.)
- IRCCS, Istituto Ortopedico Galeazzi, 20161 Milano, Italy;
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milano, Italy; (L.A.); (V.R.H.M.); (G.M.P.); (L.M.)
- IRCCS, Istituto Ortopedico Galeazzi, 20161 Milano, Italy;
| | - Marco Ferroni
- Department of Chemistry, Material and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy;
| | - Federica Boschetti
- IRCCS, Istituto Ortopedico Galeazzi, 20161 Milano, Italy;
- Department of Chemistry, Material and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy;
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milano, Italy; (L.A.); (V.R.H.M.); (G.M.P.); (L.M.)
- Correspondence: ; Tel.: +39-02503-34606
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Morselli C, Mancini P, Cirullo A, Mangiavini L, Bassani R. “Congenital instability of cervical spine in a pediatric patient with cleft lip and palate”. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2021.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Briguglio M, Wainwright TW, Crespi T, Southern K, Mangiavini L, Craig J, Middleton RG. Oral Hydration Before and After Hip Replacement: The Notion Behind Every Action. Geriatr Orthop Surg Rehabil 2022; 13:21514593221138665. [PMID: 36393900 PMCID: PMC9647305 DOI: 10.1177/21514593221138665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Even though nearly 20 patients undergo hip replacement every hour just in
Italy and the United Kingdom, it is unclear what are the most appropriate
oral hydration practices that patients should follow before and after
surgery. Improper administration can cause postoperative fluid disturbances
or exacerbate pre-existing conditions, which are not an uncommon find in
older subjects. Significance Considering that the number of hip operations is expected to increase in the
next years as well as the age of patients, it is important to recall the
notions behind water balance, especially in light of modern surgical and
anesthetic practices. This technical perspective discusses the perioperative
changes in the hydration status that occur during hip replacement and
provides the concepts that help clinicians to better manage how much water
the patient can drink. Results The points of view of the surgeon, the anesthetist, and the nurse are offered
together with the description of mineral waters intended for human
consumption. Before surgery, water should be always preferred over
caffeinated, sugar-sweetened, and alcoholic beverages. The drinking
requirements on the day of surgery should consider the water output from
urine, feces, respiration, exudation, and bleeding along with the water
input from metabolic production and intravenous administration of fluids and
medications. Healthy eating habits provide water and should be promoted
before and after surgery. Conclusions The judgment on which is the most appropriate approach to oral hydration
practices must be the responsibility of the multidisciplinary perioperative
team. Nevertheless, it is reasonable to argue that, in the presence of a
patient with no relevant illness and who follows a healthy diet, it is more
appropriate to stay closer to dehydration than liberalizing water intake
both prior to surgery and in the early postoperative hours until the
resumption of normal physiological functions.
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Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Thomas W Wainwright
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, United Kingdom
| | - Tiziano Crespi
- IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, Milan, Italy
| | - Kate Southern
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- Nuffield Health Bournemouth Hospital, Bournemouth, United Kingdom
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Regenerative and Reconstructive Unit, Milan, Italy
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - James Craig
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, United Kingdom
| | - Rob G Middleton
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, United Kingdom
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Manta N, Mangiavini L, Balbino C, Colombo A, Pandini EG, Pironti P, Viganò M, D'Anchise R. The role of suction drainage in the management of peri-operative bleeding in Total and Unicomcompartmental knee arthroplasty: a retrospective comparative study. BMC Musculoskelet Disord 2021; 22:1031. [PMID: 34893042 PMCID: PMC8665489 DOI: 10.1186/s12891-021-04868-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Suction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing. However, its efficacy remains controversial; thus, the purpose of this study is to evaluate drainage efficiency in the management of postoperative bleeding in TKA and UKA. Methods The cohort comprised 134 clinical records of patients affected by knee osteoarthritis (OA) who underwent either TKA or UKA. All the patients were subdivided into 2 groups: the first one with drainage and the second one without drainage (respectively 61 and 73 patients). For each group, hemoglobin levels in the preoperative, first, second and third postoperative day were collected. Postoperative complications such as swelling, bleeding from the surgical wound or the need for blood transfusion, were also recorded. Results Our results did not show any significant difference of hemoglobin levels in the first (p = 0.715), second (p = 0.203) and third post-operative day (p = 0.467) between the two groups. Moreover, no significant correlation between knee swelling or transfusion rate and the drainage was observed (p = 0.703 and p = 0.662 respectively). Besides, a significant correlation was found between bleeding from the surgical wound and the absence of drainage (p = 0.006). Conclusions The study demonstrates how the routine use of suction drainage does not provide substantial benefits in the postoperative blood loss management after TKA or UKA. Trial registration ClinicalTrials.gov NCT04508101, 09/08/2020, Retrospectively registered Level of evidence III
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Affiliation(s)
- Nicola Manta
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. .,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | | | - Andrea Colombo
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | | | - Pierluigi Pironti
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Pironti P, Ciliberto P RA, Sirtori P, Mangiavini L. Neglected acetabular fracture with hip dislocation in a 34-year-old subject treated with total hip arthroplasty: our experience. BMJ Case Rep 2021; 14:e245793. [PMID: 34753730 PMCID: PMC8578951 DOI: 10.1136/bcr-2021-245793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/09/2022] Open
Abstract
Neglected hip fracture-dislocations are rare but still possible clinical situations, especially in developing countries. Some authors described skeletal traction and open reduction with internal fixation as a treatment for the abovementioned conditions. Despite the poor literature about this topic, total hip arthroplasty (THA) may be a feasible option in the treatment of neglected hip fracture-dislocations. We present a case of a 34-year-old Moroccan man reporting a 1-year neglected acetabular fracture with hip dislocation successfully treated with THA. The patient showed a significant improvement of pain, range of motion and his quality of life at 45 days. Our experience shows how a neglected acetabular fracture with hip dislocation can be successfully treated with THA. Considering the complexity of these cases, an accurate preoperative planning is mandatory and the prosthetic components' choice must be customised to the patient.
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Affiliation(s)
- Pierluigi Pironti
- Residency Program in Orthopaedics and Traumatology, University of Milan, Milano, Lombardia, Italy
| | - Ricardo A Ciliberto P
- Residency Program in Orthopaedics and Traumatology, University of Milan, Milano, Lombardia, Italy
| | - Paolo Sirtori
- IRCCS Galeazzi Orthopaedic Institute, Milano, Lombardia, Italy
| | - Laura Mangiavini
- IRCCS Galeazzi Orthopaedic Institute, Milano, Lombardia, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milano, Lombardia, Italy
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Giorgino R, Maggioni DM, Viganò M, Verdoni F, Pandini E, Balbino C, Manta N, D'Anchise R, Mangiavini L. Knee Pathology before and after SARS-CoV-2 Pandemic: An Analysis of 1139 Patients. Healthcare (Basel) 2021; 9:1311. [PMID: 34682991 PMCID: PMC8544530 DOI: 10.3390/healthcare9101311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic drastically changed daily life activities and medical practice, leading to a reorganization of healthcare activities. People spent two months in home-isolation, changing their daily habits and undertaking a more sedentary lifestyle. Change in lifestyle is related to important consequences in knee pathologies. The aim of this study was to evaluate the outpatient activity for knee pathologies before and after lockdown in terms of incidence, severity, diagnosis, and treatment. METHODS Medical records of patients with knee pathology in outpatient follow-up at IRCCS Istituto Ortopedico Galeazzi in Milan (Italy) were analyzed in the time frame 4 May-4 September 2020 and compared with patients examined between 4 May and 4 September 2019. RESULTS A significant increase of knee diagnoses associated to patellofemoral disorders in 2020 was found (p = 0.004). In addition, physiotherapy was significantly more prescribed in 2020 than in 2019 (p = 0.012). CONCLUSIONS The SARS-CoV-2 pandemic lockdown did not drastically change knee pathology, but it may have had an impact on it, highlighting a summary worsening of patellofemoral disorders associated with other knee diagnoses. Further studies are required to validate this result.
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Affiliation(s)
- Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
| | - Davide Maria Maggioni
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Fabio Verdoni
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Elisa Pandini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | | | - Nicola Manta
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | | | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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44
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Bassani R, Morselli C, Baschiera R, Brock S, Gavino D, Prandoni L, Cirullo A, Mangiavini L. New Trends in Spinal Surgery: Less Invasive Anatomical Approach to the Spine. The Advantages of the Anterior Approach in Lumbar Spinal Fusion. Turk Neurosurg 2021; 31:484-492. [PMID: 33978225 DOI: 10.5137/1019-5149.jtn.33958-21.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To describe the history of the anterior approach to the lumbar spine from the beginning to the minimal invasive techniques that the authors have developed, and to discuss its advantages and drawbacks. MATERIAL AND METHODS The authors collected published data on the evolution of the anterior approach in the lumbar spine, and described its potential in different pathologies focusing on minimally invasive techniques. RESULTS Several successful techniques of anterior lumbar approach have been developed over the years, leading to a progressive less invasive anatomical exposure of the spine. Anterior approaches of the lumbar spine gained popularity as an alternative to posterior routes in the management of tumors, infections, traumas, degenerative or deformity diseases and as a salvage procedure after posterior surgery. CONCLUSION Advantages of the retroperitoneal anterior approach of the lumbar spine are well accepted: it preserves the anatomical structures of the abdomen and posterior tension band, avoiding muscle dissection. The implantation of lordotic cages with larger footprint improves local lordosis and fusion rate even in revision surgery. Drawbacks of traditional retroperitoneal approaches may be: vascular injury, deep venous thrombosis, risk of retrograde ejaculation in male in case of L5-S1 dissection. Therefore, several minimal invasive techniques have been developed to decrease the risks related to the traditional approaches. However, a long learning curve is required to achieve good skills and to manage possible technical concerns and complications.
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45
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Lombardo MDM, Foppiani A, Peretti GM, Mangiavini L, Battezzati A, Bertoli S, Martinelli Boneschi F, Zuccotti GV. Long-Term Coronavirus Disease 2019 Complications in Inpatients and Outpatients: A One-Year Follow-up Cohort Study. Open Forum Infect Dis 2021; 8:ofab384. [PMID: 34386546 PMCID: PMC8344801 DOI: 10.1093/ofid/ofab384] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Background As the coronavirus pandemic spreads, more and more people are infected with severe acute respiratory syndrome coronavirus 2. The short- and medium-term effects of the infection have been described, but the description of the long-term sequelae is lacking in the literature. Methods Patients healed from coronavirus disease 2019 (COVID-19) from February 2020 to May 2020 were considered for inclusion in this study, regardless of the severity of the disease during the acute phase. Eligible patients were consecutively contacted and a semistructured interview was administered between February and March 2021 by trained medical staff. Results Three hundred three patients were eligible and accepted to participate in the study and were enrolled. Of those surveyed, most patients (81%) reported at least 1 symptom, and the most prevalent symptoms were fatigue (52%), pain (48%), and sleep disorders (47%). Sensory alterations were present in 28% of surveyed patients, but in most of these cases (74% of those affected by sensory alterations or 20% of the overall sample) symptoms reported were either anosmia or dysgeusia. Higher prevalence was generally observed with increasing age, although the most relevant differences were observed when comparing young versus middle-aged adults. Conclusions At 12 months after acute infection, COVID-19 survivors were still suffering from symptoms identified at shorter follow-up, and the most frequent symptoms included fatigue, pain, and sleep disorders. A more severe impairment in the acute phase did not seem to predict more severe complications.
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Affiliation(s)
| | - Andrea Foppiani
- International Center for the Assessment of Nutritional Status, Department of Food Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Giuseppe Michele Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status, Department of Food Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status, Department of Food Environmental and Nutritional Sciences, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, Obesity Unit and Laboratory of Nutrition and Obesity Research, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Italian Auxologic Institute (IAI), Milan, Italy
| | - Filippo Martinelli Boneschi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.,Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences "L. Sacco", Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", University of Milan, Milan, Italy.,Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
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46
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Brayda-Bruno M, Giorgino R, Gallazzi E, Morelli I, Manfroni F, Briguglio M, Accetta R, Mangiavini L, Peretti GM. How SARS-CoV-2 Pandemic Changed Traumatology and Hospital Setting: An Analysis of 498 Fractured Patients. J Clin Med 2021; 10:jcm10122585. [PMID: 34208115 PMCID: PMC8230877 DOI: 10.3390/jcm10122585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background: SARS-CoV-2 pandemic is one of the biggest challenges for many health systems in the world, making lots of them overwhelmed by the enormous pressure to manage patients. We reported our Institutional Experience, with specific aims to describe the distribution and type of treated injuries, and the organizational setup of our hospital. Methods: Data of fractured patients admitted for surgical treatment in the time frames 9 March 2020–4 May 2020 and 1 March 2019–31 May 2019 were collected and compared. Furthermore, surgery duration and some parameters of effectiveness in health management were compared. Results: A total of 498 patients were included. Mean age significantly lower age in 2019 and femoral fractures were significantly more frequent 2020. Mean surgery time was significantly longer in 2020. Mortality rate difference between the two years was found to be statistically significant. Time interval between diagnosis and surgery and between diagnosis and discharge/decease was significantly lower in 2020. In 2020, no patient admitted with a negative swab turned positive in any of the following tests for SARS-CoV-2. Conclusions: The COVID-19 pandemic has modified the epidemiology of hospitalized patients for traumatic reasons, leading to an increased admission of older patients with femoral fractures. Nevertheless, our institutional experience showed that an efficient change in the hospital organization, with an improvement of several parameters of effectiveness in health management, led to a null infection rate between patients.
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Affiliation(s)
- Marco Brayda-Bruno
- IRCCS Orthopedic Institute Galeazzi, 20144 Milan, Italy; (M.B.-B.); (F.M.); (M.B.); (R.A.); (L.M.); (G.M.P.)
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
- Correspondence:
| | - Enrico Gallazzi
- Ortopedia e Traumatologia 3, ASST Centro Specialistico Ortopedico Traumatologico G. Pini–CTO, 20122 Milan, Italy;
| | - Ilaria Morelli
- U.O.C. Ortopedia e Traumatologia Nuovo Ospedale di Legnano ASST Ovest Milanese, 20025 Legnano, Italy;
| | - Francesca Manfroni
- IRCCS Orthopedic Institute Galeazzi, 20144 Milan, Italy; (M.B.-B.); (F.M.); (M.B.); (R.A.); (L.M.); (G.M.P.)
| | - Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, 20144 Milan, Italy; (M.B.-B.); (F.M.); (M.B.); (R.A.); (L.M.); (G.M.P.)
| | - Riccardo Accetta
- IRCCS Orthopedic Institute Galeazzi, 20144 Milan, Italy; (M.B.-B.); (F.M.); (M.B.); (R.A.); (L.M.); (G.M.P.)
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, 20144 Milan, Italy; (M.B.-B.); (F.M.); (M.B.); (R.A.); (L.M.); (G.M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Giuseppe Maria Peretti
- IRCCS Orthopedic Institute Galeazzi, 20144 Milan, Italy; (M.B.-B.); (F.M.); (M.B.); (R.A.); (L.M.); (G.M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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47
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Ulivi M, Orlandini L, Vitale JA, Meroni V, Prandoni L, Mangiavini L, Rossi N, Peretti GM. Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements. Acta Orthop 2021; 92:274-279. [PMID: 33410360 PMCID: PMC8231353 DOI: 10.1080/17453674.2020.1865633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Several surgical approaches are used in primary total hip arthroplasty (THA). In this randomized controlled trial we compared gait, risk of fall, self-reported and clinical measurements between subjects after direct superior approach (DSA) versus posterolateral approach (PL) for THA.Patients and methods - Participants with DSA (n = 22; age 74 [SD 8.9]) and PL (n = 23; age 72 [7.7]) underwent gait analysis, risk of fall assessment and Timed Up and Go Test (TUG) before (PRE), 1 month (T1) and 3 months after (T3) surgery. Data on bleeding and surgical time was collected.Results - DSA resulted in longer surgical times (90 [14] vs. 77 [20] min) but lower blood loss (149 [66] vs. 225 [125] mL) than PL. DSA had lower risk of fall at T3 compared with T1 and higher TUG scores at T3 compared with T1 and PRE. PL improved balance at T3 compared with T1 and PRE. Spatiotemporal gait parameters improved over time for both DSA and PL with no inter-group differences, whereas DSA, regarding hip rotation range of motion, showed lower values at T3 and T1 compared with PRE and, furthermore, this group had lower values at T1 and T3 compared with PL. All foregoing comparisons are statistically signficant (p < 0.05)Interpretation - DSA showed longer surgical time and lower blood loss compared with PL and early improvements in TUG, spatiotemporal, and kinematic gait parameters, highlighting rapid muscle strength recovery.
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Affiliation(s)
| | | | | | | | - Lorenzo Prandoni
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan;
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan; ,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Nicolò Rossi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan;
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan; ,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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48
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Morelli I, Maffulli N, Brambilla L, Agnoletto M, Peretti GM, Mangiavini L. Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update. Br Med Bull 2021; 137:51-69. [PMID: 33517365 DOI: 10.1093/bmb/ldaa041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies). SOURCES OF DATA Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected. AREAS OF AGREEMENT Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals. AREAS OF DISAGREEMENT Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients' optimization protocols before TKA should include standardized nutraceuticals intake.
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Affiliation(s)
- Ilaria Morelli
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Via San Leonardo, 84125 Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, Staffordshire ST5 5BG United Kingdom.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, United Kingdom
| | - Lorenzo Brambilla
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Marco Agnoletto
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giuseppe Maria Peretti
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
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49
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Perazzo P, Giorgino R, Briguglio M, Zuffada M, Accetta R, Mangiavini L, Peretti GM. From Standard to Escalated Anticoagulant Prophylaxis in Fractured Older Adults With SARS-CoV-2 Undergoing Accelerated Orthopedic Surgery. Front Med (Lausanne) 2020; 7:566770. [PMID: 33178713 PMCID: PMC7593394 DOI: 10.3389/fmed.2020.566770] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Proximal femoral fractures in older adults are not uncommon and represent a great challenge for orthopedic surgeons because of the high risks of complications. In the COVID-19 panorama, fractures occurring in infected older adults become an even more intricate task because of concomitant metabolic derangements due to SARS-CoV-2. Multidisciplinary protocols are mandatory and pharmacological treatment in infected patients should be tailored. Regrettably, the spread of the virus in northern Italy, has been faster than scientific progress in characterizing the disease and many hospitals have had to manage the symptoms on a daily clinical bases. Our Italian hospital in the region of Lombardy, which has been the epicenter of the Italian pandemic, has admitted sixteen patients with fractured femurs in March and April 2020. The first seven patients were treated with the antithrombotic prophylaxis of a single daily dose of low-molecular-weight heparin, but we observed the highest prevalence of deaths from cardiovascular complications (four deaths). By doubling the daily dose of anticoagulants in the subsequent patients, we observed a reduction in the incidence of death (one death out of nine). Controversies exist about the surgical treatment of fractures in older adults during this pandemic. However, we have observed an increased survival after fall trauma in infected older adults if treated with high doses of anticoagulant. Although not being statistically significant, our results are in line with the current knowledge of the pathophysiology of SARS-CoV-2 infection, but more studies should be shared about the efficacy and dosage of anticoagulants in traumatic injuries of the elderly.
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Affiliation(s)
- Paolo Perazzo
- Intensive Care Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | | | - Martina Zuffada
- Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Riccardo Accetta
- Traumatology Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Laura Mangiavini
- Regenerative and Reconstructive Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe M Peretti
- Regenerative and Reconstructive Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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50
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Brambilla L, Peretti GM, Sirtori P, Maffulli N, Mangiavini L. Outcome of total hip and total knee arthroplasty and vitamin D homeostasis. Br Med Bull 2020; 135:50-61. [PMID: 32776138 DOI: 10.1093/bmb/ldaa018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Low levels of vitamin D are common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but it is still unclear whether the outcome of such surgery is related to vitamin D levels. SOURCES OF DATA Publicly available electronic databases were systematically reviewed to update knowledge about the role of vitamin D in THA and TKA patients, and to appraise the correlation between vitamin D levels before surgery and post-surgical outcomes. Eight studies were included in our review: six employed prospective observational designs, two reported retrospective database interrogations. Six prospective observational studies and two retrospective database interrogations matched inclusion and exclusion criteria. AREAS OF AGREEMENT Patients undergoing THA and TKA have a high prevalence of hypovitaminosis D. Five of eight studies (62.5%) report a statistically significant association between low vitamin D status and worse outcomes after THA and TKA. AREAS OF CONTROVERSY Different explanations have been proposed for vitamin D insufficiency, but some authors have questioned the correctness of the methods used to measure the vitamin D levels. GROWING POINTS A trial focusing on the role of vitamin D supplementation on safety and outcomes of patients undergoing THA and TKA with low vitamin D status is ongoing. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies should explore the possible causal relationship between vitamin D status and outcomes of THA and TKA and verify the laboratory methods to analyse it.
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Affiliation(s)
- Lorenzo Brambilla
- Residency Program in Orthopaedics and Traumatology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Giuseppe Maria Peretti
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Paolo Sirtori
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D'Aragona Hospital, "Clinica Ortopedica" Department, Hospital of Salerno, Via San Leonardo, 84125 Salerno, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| | - Laura Mangiavini
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
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