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Giuseppe PORCELLINI
Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
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Pubblicazioni
2023
- Acute elbow dislocations: current concepts
[Articolo su rivista]
Tarallo, Luigi; Bonfatti, Rocco; Donà, Alessandro; Micheloni, Gian M.; Catani, Fabio; Porcellini, Giuseppe
abstract
2023
- Navigation in reverse shoulder arthroplasty: how the lateralization of glenosphere can affect the clinical outcome
[Articolo su rivista]
Tarallo, Luigi; Giorgini, Andrea; Micheloni, Gianmario; Montanari, Marta; Porcellini, Giuseppe; Catani, Fabio
abstract
IntroductionOne of the main causes of RSA failure is attributable to the malpositioning of the glenoid component. Initial experiences with computer-assisted surgery have shown promising results in increasing the accuracy and repeatability of placement of the glenoid component and screws. The aim of this study was to evaluate the functional clinical results, in terms of joint mobility and pain, by correlating them with intraoperative data regarding the positioning of the glenoid component. The hypothesis was that the lateralization more than 25 mm of the glenosphere can led to better stability of the prosthesis but should pay in term of a reduced range of movement and increased pain.Materials and methods50 patients were enrolled between October 2018 and May 2022; they underwent RSA implantation assisted by GPS navigation system. Active ROM, ASES score and VAS pain scale were recorded before surgery. Preoperative data about glenoid inclination and version were collected by pre-op X-Rays an CT. Intraoperative data-inclination, version, medialization and lateralization of the glenoid component-were recorded using computer-assisted surgery. 46 patients had been further clinically and radiographically re-evaluated at 3-months, 6-months, 1-year, and 2-years follow-up.ResultsWe found a statistically significant correlation between anteposition and glenosphere lateralization value (DM - 6.057 mm; p = 0.043). Furthermore a statistically significant correlation has been shown between abduction movement and the lateralization value (DM - 7.723 mm; p = 0.015). No other statistically significant associations were found when comparing the values of glenoid inclination and version with the range of motion achieved by the patients after reverse shoulder arthroplasty.ConclusionWe observed that the patients with the best anteposition and abduction results had a glenosphere lateralization between 18 and 22 mm. When increasing the lateralization above 22 mm or reducing it below 18 mm, on the other hand, both movements considered decreased their range.
2023
- Single approach versus double-incision technique for the repair of distal biceps tendon ruptures
[Articolo su rivista]
Micheloni, Gian M.; Delvecchio, Matilde; Giorgini, Andrea; Porcellini, Giuseppe; Tarallo, Luigi
abstract
2023
- Study of a constrained finite element elbow prosthesis: the influence of the implant placement
[Articolo su rivista]
Nalbone, Lorenzo; Monac, Francesco; Nalbone, Luca; Ingrassia, Tommaso; Ricotta, Vito; Nigrelli, Vincenzo; Ferruzza, Massimo; Tarallo, Luigi; Porcellini, Giuseppe; Camarda, Lawrence
abstract
BackgroundThe functional results of total elbow arthroplasty (TEA) are controversial and the medium- to long-term revision rates are relatively high. The aim of the present study was to analyze the stresses of TEA in its classic configuration, identify the areas of greatest stress in the prosthesis-bone-cement interface, and evaluate the most wearing working conditions.Materials and methodsBy means of a reverse engineering process and using a 3D laser scanner, CAD (computer-aided drafting) models of a constrained elbow prosthesis were acquired. These CAD models were developed and their elastic properties, resistance, and stresses were studied through finite element analysis (finite element method-FEM). The obtained 3D elbow-prosthesis model was then evaluated in cyclic flexion-extension movements (> 10 million cycles). We highlighted the configuration of the angle at which the highest stresses and the areas most at risk of implant mobilization develop. Finally, we performed a quantitative study of the stress state after varying the positioning of the stem of the ulnar component in the sagittal plane by +/- 3 degrees.ResultsThe greatest von Mises stress state in the bone component for the 90 degrees working configuration was 3.1635 MPa, which occurred in the most proximal portion of the humeral blade and in the proximal middle third of the shaft. At the ulnar level, peaks of 4.1763 MPa were recorded at the proximal coronoid/metaepiphysis level. The minimum elastic resistance and therefore the greatest stress states were recorded in the bone region at the apex of the ulnar stem (0.001967 MPa). The results of the analysis for the working configurations at 0 degrees and 145 degrees showed significant reductions in the stress states for both prosthetic components; similarly, varying the positioning of the ulnar component at 90 degrees (- 3 degrees in the sagittal plane, 0 degrees in the frontal plane) resulted in better working conditions with a greater resulting developed force and a lower stress peak in the ulnar cement.ConclusionThe areas of greatest stress occur in specific regions of the ulnar and humeral components at the bone-cement-prosthesis interface. The heaviest configuration in terms of stresses was when the elbow was flexed at 90 degrees. Variations in the positioning in the sagittal plane can mechanically affect the movement, possibly resulting in longer survival of the implant.Level of evidence: 5
2023
- Tailored modular spacers and handmade spacers in periprosthetic shoulder infection: clinical and functional results after 2-year follow-up
[Articolo su rivista]
Porcellini, G.; Montanari, M.; Selleri, F.; Giorgini, A.; Paladini, P.; Padolino, A.; Tarallo, L.
abstract
2022
- Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures
[Articolo su rivista]
Tarallo, Luigi; Micheloni, Gian Mario; Giorgini, Andrea; Lombardi, Martina; Limone, Beatrice; Catani, Fabio; Porcellini, Giuseppe
abstract
Background Proximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age. Methods This is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant-Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered. Results In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery. Conclusion Anatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study.
2022
- Correction to: Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up (Journal of Orthopaedics and Traumatology, (2021), 22, 1, (55), 10.1186/s10195-021-00619-2)
[Articolo su rivista]
Micheloni, G. M.; Tarallo, L.; Negri, A.; Giorgini, A.; Merolla, G.; Porcellini, G.
abstract
Following publication of the original article [1], the authors identified an error in the author names. The given name and family name were erroneously transposed. The incorrect author names: Micheloni Gian Mario, Tarallo Luigi, Negri Alberto, Giorgini Andrea, Merolla Giovanni and Porcellini Giuseppe. The correct author names: Gian Mario Micheloni, Luigi Tarallo, Alberto Negri, Andrea Giorgini, Giovanni Merolla, Giuseppe Porcellini. The author group has been updated above and the original article [1] has been corrected.
2022
- Current concepts in management of coronal shear fractures of the elbow
[Articolo su rivista]
Novi, M.; Tarallo, L.; Dona, A.; Micheloni, G.; Giorgini, A.; Porcellini, G.
abstract
Coronal shear fracture of the capitellum is a rare articular injury of the distal humerus and could be burdened by high complications if an accurate reduction is not achieved. This complex lesion is usually displaced and requires open reduction and internal fixation for a better outcome. Better results are reported in isolated radiocapitellar joint fracture, while lower results are associated with trochlear involvement and articular comminution. CT scan is helpful to understand the fracture pattern and for a surgical planning. Several classifications have been proposed, mainly based on topography of the lesion or more management oriented such as Dubberly's classification. Headless screws guarantee a stable fixation but when medial extension of the fracture or comminution are present, an extensible approach and supplemental fixation with cannulated screws or plate are indicated. Fragment excision can be attempted for small fragments difficult to fix, with a higher risk of elbow instability especially if associated lesions are present. Arthroscopic reduction and elbow arthroplasty are also described for selected cases. Anatomical reduction provides high union rates and good elbow function. Complications' rate is approximately 30%, mostly elbow stiffness, and in a minor part pseudoarthrosis and osteonecrosis.
2022
- Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice?
[Articolo su rivista]
Tarallo, L.; Novi, M.; Porcellini, G.; Schenetti, C.; Micheloni, G. M.; Maniscalco, P.; Catani, F.
abstract
Background: Type III supracondylar fractures represent a difficult injury to treat and there is no universal consensus regarding the best treatment. The purpose of this study is to assess the incidence of complication associated with open reduction and compare open reduction vs closed reduction, in order to determine which treatment lead to better clinical and radiological outcomes. Is open reduction really associated with a higher number of iatrogenic complication and worse clinical outcomes in comparison to closed reduction? Methods: A total of 55 patients, affected by type III supracondylar humerus fracture, were retrospectively selected and divided into two groups according to which type of treatment they received (open reduction or closed reduction). Major complications correlated with surgical procedure, such as infections, neurovascular iatrogenic lesions, elbow stiffness and painful scarring were assessed. The treatment outcomes and clinical features were compared among the two groups. A statistical analysis to find association between the type of reduction, the restored elbow anatomy and the clinical outcomes were performed. The follow-up varies between 1 year and 7 years. Results: No major complications occurred in our series of patients. Excellent and good outcomes were reported among all 26 patients that underwent an open reduction surgery and in 23 out of the 29 patients who received a closed reduction surgery. A higher number of patients in the open reduction group presented angles with normal values; moreover 3 out of the 6 patients with unsatisfactory outcomes presented with angles not in range, underlying the presence of a connection between the restored elbow anatomy and the clinical outcomes. There were no differences among the two groups regarding the presence of complications. Discussion: open reduction should not be considered as a first line option of treatment in any pediatric patient with a type III supracondylar humerus fracture, but in several cases open surgery must be viewed as the choice with the best outcomes not only in presence of neurovascular lesion but also in case of irreducible fracture.
2022
- Locked anterior glenohumeral dislocation: is it always recommendable a conservative treatment?
[Articolo su rivista]
Novi, M.; Tarallo, L.; Colozza, A.; Paladini, P.; Micheloni, G.; Catani, F.; Porcellini, G.
abstract
Purpose: Chronic anterior shoulder dislocation represents a rare condition, and there is still lack of consensus in its treatment. Purpose of this study is to evaluate the clinical and radiological outcome of painful locked dislocation underwent shoulder replacement, with a minimum follow-up of two years. Second endpoint is to assess the glenoid bone graft, harvested from the humeral head. Methods: Eight patients underwent shoulder replacement for locked anterior shoulder dislocation. Four patients with a mean age of 23 y.o. were treated with Pyrocarbon-hemiarthroplasty and four patients with a mean age of 76 y.o. were treated with reverse shoulder arthroplasty. Glenoid single stage reconstruction was performed with a bone autograft harvested from the resected humeral head. Patients were observed for a clinical and radiological follow-up for a minimum period of 2 years; ASES and Constant score were assessed. Results: Pain and ROM improvement was reported in all the patients. In one case, postoperative recurrent RSA instability was found. Glenoid reconstruction was performed in seven cases, showing a good integration and no reabsorption issues in all but one cases. ASES and Constant-Murley functional outcomes were rated as excellent by 1 patient with pyrocarbon HA and 1 patient with RSA, good by 3 patients with RSA and 2 patients with HA, fair by 1 patient with HA and poor by one patient with RSA. Conclusion: The treatment of locked anterior glenohumeral dislocation still represents a challenge in symptomatic patients. Shoulder replacement showed good results in young and older patients, with HA and RSA, respectively. Autograft from the humeral head is reliable for glenoid defect, even in ream and run procedure. Locked dislocation lasting more than one year, surgery is debatable for higher risk of a poor outcome and recurrent instability.
2022
- Radial head fractures: review of current evidence about assessment, classification and management
[Articolo su rivista]
Tarallo, L.; Negri, A.; Novi, M.; Micheloni, G.; Keeling, E.; Porcellini, G.
abstract
The radial head fractures are frequent elbow injuries with several fracture patterns and associated lesions. The literature highlights the importance of correct patient management right from the earliest stages to achieve the best results and to avoid complications. The purpose of this article was to provide an overview of current concepts of the management of radial head fractures. The main goal of each treatment should be to restore elbow biomechanics, kinematics and stability to achieve a complete range of motion and to early begin rehabilitation programs. For Mason type 1 fractures the nonoperative management is the best choice providing good or excellent results in most patients. There is less agreement regarding Mason type 2 fractures, in term of nonoperative or surgical treatment. When surgical treatment is chosen, open reduction and internal fixation seems to guarantee the best clinical outcomes with excellent results reported. The Mason type 3 or 4 fractures are managed with surgical treatment. However, the best method of treatment remains controversial in literature between open reduction and internal fixation, radial head arthroplasty and radial head excision. In the last years, arthroscopy is going to assume an important role in the management of elbow diseases, not only as diagnostic tool but also as surgical solution and probably in the future its role will become more and more relevant. Further studies with long-term follow-up are needed to determine the best form of treatment of these complex injuries. (Cite this article as: Tarallo L, Negri A, Novi M, Micheloni G, Keeling E, Porcellini G. Radial head fractures: review of current evidence about assessment, classification and management.
2022
- Replacement of radial head
[Articolo su rivista]
Porcellini, G.; Micheloni, G. M.; Negri, A.; Novi, M.; Keeling, E.; Tarallo, L.
abstract
Radial head prosthesis (RHP) is the primary solution for the treatment of unfixable radial head fractures, especially if also associated with complex elbow instability. The aim of the implant is to replicate the physiological tracking, reproducing the mechanical function of a native radial head. In this review we analyzed indications and types of implants. The surgical technique is also accurately discussed, considering this implantation with the same attention and precision used for the replacement of all the other joints. The most common complications after RHP are loosening, overstuffing, stiffness and heterotopic ossifications. However recent studies reported good clinical results in particular where correct rehabilitation programs were followed. Studies with high level of clinical evidence are necessary to provide definitive evidence to support the widespread use of this implant.
2021
- A kinematic and electromyographic comparison of a Grammont-style reverse arthroplasty combined with a l’Episcopo transfer compared to a lateralized humeral component reverse for restoration of active external rotation
[Articolo su rivista]
Merolla, G.; Cuoghi, F.; Athwal, G. S.; Parel, I.; Filippi, M. V.; Cutti, A. G.; Fabbri, E.; Padolino, A.; Paladini, P.; Catani, F.; Porcellini, G.
abstract
Purpose: To assess kinematic and electromyographic findings of two designs of reverse total shoulder arthroplasty (RTSA). We tested two hypotheses: (H1) Grammont-style (RTSA) with l’Episcopo tendon transfer gains similar postoperative kinematic findings of a lateralized humeral component RTSA without a tendon transfer; (H2) RTSA with lateralized humeral component induces earlier shoulder muscle activation during shoulder motion compared with standard Grammont prosthesis with l’Episcopo transfer. Methods: Twenty-five patients with a cuff tear arthropathy, pseudoparalysis, and a positive dropping sign were sequentially included. A Grammont-style RTSA with a l’Episcopo tendon transfer was implanted in 13 patients (medialized humerus and transfer group) and an on-lay curved-stem RTSA in 12 (lateralized humerus group). Constant score; the disabilities of the arm, shoulder, and hand (DASH) score; and active shoulder range of motion (flexion, abduction, external rotation, and internal rotation) were measured pre- and postoperatively. Upper limb kinematic and surface electromyography (EMG) (anterior and posterior deltoid; upper, middle, and lower trapezius; and the upper and lower latissimus dorsi muscles) were recorded during active range of motion. Results: At > 24 months of follow-up, the Constant and DASH scores and active shoulder range of motion improved in both groups (p < 0.0001). Internal rotation was significantly higher in the lateralized humerus group than in the medialized humerus and transfer group (p = 0.004). The dropping sign was found in 0/12 patients in the lateralized humerus group and in 5/13 patients in the medialized humerus and transfer group (p < 0.001). Kinematic findings were similar between groups (p = 0.286). A pattern of earlier muscle activation in the lateralized humerus group was found as compared to the transfer group as follows: (i) posterior deltoid during external rotation (p = 0.004); (ii) upper latissimus dorsi and middle and lower trapezius during flexion (p = 0.004, p = 0.005, and p = 0.042, respectively); (iii) lower latissimus dorsi during abduction (p = 0.016). Conclusion: RTSA with a lateralized humeral component provided similar active external rotation restoration to a Grammont-style RTSA with a l’Episcopo procedure in patients with a dropping sign. The posterior deltoid muscle underwent earlier activation during active external rotation in the lateralized humerus RTSA group as compared to the tendon transfer group. Our findings demonstrated the H1 and only partially demonstrated the H2 of the study.
2021
- A Long-Term Follow-Up of Post-Operative Periprosthetic Humeral Fracture in Shoulder Arthroplasty
[Articolo su rivista]
Novi, M.; Porcellini, G.; Dona, A.; Tarallo, L.; Micheloni, G.; Giorgini, A.; Paladini, P.; Catani, F.
abstract
Background: During the last decades, the growing number of shoulder replacement has increased the associated complications. Periprosthetic fractures have a low incidence but can be a severe clinical condition, especially in elderly population. There are still no guidelines to define the best treatment protocol for post-operative periprosthetic humeral fractures. Factors associated to these fractures and consequently the decision-making for the best treatment seem to be patient-related but also correlated with the type of implant. The aim of this study is to analyze the patient’s risk factors, fracture pattern, implant type and treatment, evaluating the outcome with a long-term follow-up. Methods: A retrospective study was performed on more than 2700 shoulder prostheses implanted over 10 years in two specialized centers, identifying 19 patients who underwent surgery for post-operative periprosthetic fracture. Gender, age, comorbidities, type of prosthetic implant, type of fracture, and cortical index of each patient were evaluated. All patients underwent surgery and were evaluated with a mean follow-up of 5 years with radiographic controls and functional assessment with the Constant–Murley score. Results: Complete healing was achieved in 18 of 19 patients. All patients presented a lower Constant–Murley score than the pre-fracture score, there were no significant differences between prosthetic implants, and the cortical index was lower than the threshold level in more than 60% of cases. Conclusion: The results of this study showed that a correct preoperative planning is essential to evaluate the type of implant and possible signs of stem mobilization. With a stable stem, it is preferable to maintain it and proceed to a synthesis. The decision process is more complex in periprosthetic fractures with a reduced cortical index, when some radiolucency lines are present in stems with high primary stability, because it is not always indicative of an unstable stem. Level of Evidence: Therapeutic III
2021
- Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury
[Articolo su rivista]
Tarallo, L.; Merolla, G.; Porcellini, G.; Amorico, M. G.; Micheloni, G.; Novi, M.; Di Giovine, E.; Catani, F.
abstract
Purpose: The aim of this current study was to assess elbow ligament tears after dislocation using magnetic resonance imaging (MRI) and to correlate any pre-operative imaging with intra-operative findings of elbow ligament tears. Methods: We prospectively included 32 patients with acute elbow dislocation investigated by MRI at a means of five days from dislocation. A simple elbow dislocation was diagnosed in 14 patients (44%); associated bone injuries were identified in 18 elbows (56%). Surgical repair of elbow ligaments was carried out in 23 patients, and nine cases were treated non-operatively. A blinded MRI evaluation of all 32 elbows was performed by an orthopaedic surgeon (rater 1) and a musculoskeletal radiologist (rater 2). Results: Inter-rater agreement for MRI evaluation of 32 was poor for lateral ulnar collateral ligament (LUCL) tears, fair for radial collateral ligament (RCL), moderate for annular ligament (AL), and fair for ulnar collateral ligament (UCL). All tears were reported as complete by rater 1; 13/32 partial tears were identified by rater 2 (LUCL = 2, RCL = 2, UCL = 9). Correlation between surgical and MRI findings showed good inter-rater agreement for LUCL and AL tears in both raters. Agreement for RCL tear was poor for rater 1 and fair for rater 2; agreement for UCL tear was fair for rater 1 and poor for rater 2. Intra-operative findings showed ten radial head fractures (RHFs) and ten coronoid fractures (CFs). LUCL tears were found in the four cases of type II RHFs and in 3/4 cases of CFs. Bone injuries and ligament tears were not significantly associated. Conclusion: MRI scan supported surgeons to identify soft tissue injuries and to address the most suitable surgical approach after acute elbow dislocation. Inter-observer agreement for intra-operative findings was high for LCL complex injuries and poor for UCL.
2021
- Computer-Assisted Surgery in Reverse Shoulder Arthroplasty: Early Experience
[Articolo su rivista]
Giorgini, A.; Tarallo, L.; Novi, M.; Porcellini, G.
abstract
Background: In the last decade, new technologies have been applied to shoulder arthroplasty. The aim of this work was to show that navigated RSA allows the surgeon to reach the planned version/inclination in all cases. In this article are shown preliminary data, advantages, disadvantages and limits of the technique. Methods: Eighteen computer-assisted reverse shoulder arthroplasty were performed. Preoperative glenoid version and inclination were evaluated with preoperative CT scan using Orthoblue® (Exactech, Gainesville, FL,USA) software, as well as baseplate type, planned glenoid component seating, planned postoperative version, planned postoperative inclination, intraoperative glenoid version/inclination, screw length and surgical time. A senior shoulder surgeon has analyzed the advantages, disadvantages and limitation of this kind of surgery. Results: Mean surgical time of the primary implants was 92 ± 12 min (min 75–max 110). Mean preoperative inclination was + 2.6° ± 6.4, mean preoperative version was − 7.6° ± 8.4. Mean planned postoperative inclination was − 2.7° ± 2.3, mean planned postoperative version was − 1.6° ± 2.9 and mean planned glenoid seating was 89% ± 8%. Planned settings were reached in all cases during surgery. Baseplate implanted were in nine cases 8° posterior augmented, in six cases standard and in three cases 10° superior augmented. Mean screw length was 33.5 mm ± 4.2 mm. No GPS system failure has been recorded. One coracoid fracture occurred during the first case. Discussion: Intraoperative navigation system is a reliable and user-friendly technology that allows the surgeon to reach planned glenoid positioning during surgery. Furthermore, this technology will allow the surgeon to compare clinical outcomes to component positioning data. The lack of humeral implant navigation is the main limit of this technique.
2021
- Current concepts of acute scaphoid fractures
[Articolo su rivista]
Tarallo, L.; Novi, M.; Giorgini, A.; Dona, A.; Porcellini, G.
abstract
Scaphoid fractures represent a common injury, but diagnosis sometimes can be challenging, and a delayed treatment is burdened by severe complication such as avascular necrosis, delayed union or nonunion, with consequent degenerative conditions of the wrist. An early diagnosis and an appropriate treating algorithm are necessary for a good outcome. Clinical suspicion and specific clinical tests help in the diagnosis, but up to 25% of scaphoid fractures remain not detected on initial radiographs. MRI has a high sensitivity for early fractures and CT scan is more indicated to assess the healing process. Conservative treatment with 6 weeks long arm cast is indicated for undisplaced distal third or waist fracture in children or low demanding patients, while proximal pole of the scaphoid usually requires a surgical treatment. Several techniques and implants are proposed, especially percutaneous or minimally invasive fixation, but the surgical approach needs to be considered according to the fracture pattern in order to minimize secondary displacement and increase compression of the fragments. If a proper planning and indications are respected, vascularity is preserved and shear forces on the fragment are reduced, high union rates are achieved.
2021
- Custom-made reverse shoulder arthroplasty for severe glenoid bone loss: review of the literature and our preliminary results
[Articolo su rivista]
Porcellini, G.; Micheloni, G. M.; Tarallo, L.; Paladini, P.; Merolla, G.; Catani, F.
abstract
The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and the results of current prosthetic designs with only glenoid fixation still remain unsatisfactory. In the past decade, customized glenoid prostheses have been developed to address severe glenoid arthritis and in the revision setting. In this review, we analyzed the current surgical options, the classification limits, past literature evidence, and our preliminary results of 6 patients (3 male, 3 female) treated with a reverse implant and custom-made glenoid implant (ProMade; LimaCorporate, Italy). Computer analysis of the residual shape and the amount of glenoid bone stock in association with new classifications could help the surgeon to obtain good clinical and radiological outcomes. The development of navigation systems could improve the adequacy of the implant and, thus, the reliability and longevity of the implant itself.
2021
- Delphi survey on conventional conservative treatment of functional posterior shoulder instability
[Articolo su rivista]
Festbaum, C.; Danzinger, V.; Kibler, W.; Boileau, P.; Lambert, S.; Porcellini, G.; Gerhardt, C.; Scheibel, M.; Tauber, M.; Wellmann, M.; Adamczewski, C.; Vital-Schmid, S.; Moroder, P.
abstract
Background: Posterior shoulder instability is caused by structural or functional defects. While the former are mostly treated surgically, physiotherapy is considered the treatment of choice in functional shoulder instability. However, it often has limited success unless very specific and intensive training programs are applied by trained experts. Currently, there is no consensus on the treatment of functional posterior shoulder instability. Objective: To improve treatment of this pathology, a standardized treatment recommendation is required to serve as a guideline for physiotherapy. The aim of this study was to establish expert consensus for treatment recommendations for functional posterior shoulder instability. Design: The Delphi survey technique was employed. Methods: A standardized training program for treatment of functional posterior shoulder instability was developed by a local expert committee. Two rounds of an online Delphi survey were then conducted. The panel of the Delphi survey comprised nine leading scientific experts in the field of functional shoulder instability who treat patients with shoulder-related problems conservatively and operatively. Results: The response rate was 100% and there were no dropouts. The final program consists of three groups of exercises with increasing difficulty. The exercises are mostly easy to perform and focus on the scapula-retracting muscles and the muscles responsible for external rotation of the shoulder. The treatment program should be executed under the supervision of a therapist at the beginning and later may be performed by the patients themselves. Conclusion: Consensus on a new exercise guideline dedicated to the treatment of functional posterior shoulder instability was achieved. This guideline should not only help to treat this challenging pathology but also provide a starting point for further scientific research and ongoing improvement.
2021
- Implant sonication versus intraoperative tissue sample cultures for periprosthetic joint infection (PJI) of shoulder arthroplasty
[Articolo su rivista]
Padolino, Antonio; Cataldo, Giacomo; Tarallo, Luigi; Fabbri, Elisabetta; Merolla, Giovanni; Mario Micheloni, Gian; Paladini, Paolo; Porcellini, Giuseppe
abstract
Introduction: Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods: From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI. Sixty-five patients respected the criteria for admission to the study and were enrolled. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results: Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty-four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty-seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5% and 93,1% (P < 0.01) respectively. Conclusion: Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it’s a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with tissue cultures. (www.actabiomedica.it).
2021
- Injury analysis of a professional female soccer team in first division Italian season
[Articolo su rivista]
Pellegrini, A.; Lombardi, M.; Riva, N.; Combi, F.; Pecci, C.; Porcellini, G.
abstract
BACKGROUND: Soccer, the most popular sport worldwide, has seen an exponential increase in women's participation at the elite level in the last few years. The main purpose of the current epidemiological study was to analyze the injury incidence, characteristics, and burden among elite female soccer players during a regular season. METHODS: We recorded all injuries that occurred throughout the 2018-2019 competitive soccer season (August-April). The studied group consisted of 22 elite players, who were militant in the first national leagues from the first team of the same soccer club in the north of Italy. The 2006 FIFAconsensus statement was used to design the injury registration form. RESULTS: Throughout the 2018-2019 season, medical staff treated 35 injuries in 22 females. Of the total number of injuries reported in 9 months (5.8 injuries per 1000 hours of exposure), 7 (20%) occurred during matches and 28 (80%) during training sessions. The most common injury was represented by muscular disorders (18; 51.43%) which affected the thigh in 16 cases, and the lower leg and trunk in one case each. According to an anatomic site, most injuries occurred in the lower limbs (94,28%), with the majority affecting thighs (16; 45%), ankles (8; 23%), and knees (5; 14%). CONCLUSIONS: Non-contact injuries are shown to be more frequent than contact injuries, which may be connected to the increasing athletic burden among athletes. Further prospective investigations are needed with a focus on prevention protocols. ,,
2021
- Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up
[Articolo su rivista]
M., Gian Mario; Tarallo, Luigi; N., Alberto; G., Andrea; M., Giovanni; Porcellini, Giuseppe
abstract
Background: Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up. Materials and methods: In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated. Results: In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected. Conclusions: Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries. Level of evidence: Level IV—case series.
2021
- Surgical tips and tricks for coronal shear fractures of the elbow
[Articolo su rivista]
Tarallo, L.; Novi, M.; Porcellini, G.; Giorgini, A.; Micheloni, G.; Catani, F.
abstract
Introduction: Coronal shear fractures of the distal humerus represent an uncommon lesion and could be burdened by high complications. This complex lesion requires an accurate reduction and surgical fixation for a better outcome. Different techniques have been described, however no standard protocol have been proposed. Purpose of this retrospective study, is to evaluate the clinical and radiological outcome with posterior cannulated self-tapping headless screws followed by an early-active-motion protocol and to outline the surgical tips and tricks for different fracture patterns. Materials and methods: From 2013 to 2019, a consecutive series of 24 patients with coronal shear fracture undergoing ORIF were included in the study. Fractures were classified according to Dubberley’s classification. Cannulated self-tapping headless screws were used to fix the fragments. When necessary, additional cannulated half-threaded screws on the lateral edge of the humerus were used, as well as bone chips and fibrin sealant on severe comminution. All patients underwent an assisted early-active-motion rehabilitation protocol. Mean follow-up was 30 months; patients underwent standard X-rays and clinical outcome assessment with range of motion, Broberg and Morrey score and MEPI score. Results: Surgical fixation with headless screw guaranteed complete healing of all shear fractures examined, no loss of reduction were reported. ROM assessment showed good results with an average arc of 113.1°. Excellent to good Broberg-Morrey and MEPI score were reported. No cases of avascular necrosis nor post-traumatic osteoarthritis resulted in our series. Complications occurred in 16.6% of the patients. Conclusion: Coronal shear fracture represents a challenging injury to treat. Anatomical reduction and the use of cannulated self-tapping headless screws from posterior provide a stable fixation, high union rates and good elbow function, with a low cartilage damage and risks of necrosis over 2 years of follow-up. Level of evidence: Therapeutic III.
2021
- 3-dimensional printing in shoulder surgery: Current literature and state of the art
[Articolo su rivista]
Novi, M.; Tarallo, L.; Giorgini, A.; Micheloni, G.; Porcellini, G.
abstract
3D printing technologies provide physical models of patient-specific anatomy for preoperative study, training and patient-specific instruments to improve accuracy and reproducibility during surgery. A literature review has been performed on principal fields of application of this technology in shoulder surgery. Anatomic models in shoulder surgery can improve understanding the spatial orientation in trauma surgery, and shoulder replacement, especially when degenerative conditions alter normal anatomy. Patient-specific models ensure a better understanding of anatomy by haptic feedback of the surgeon during the preoperative planning. In shoulder arthroplasty patient-specific guides seems to ensure high accuracy in the placement of glenoid component. Patient specific instruments improve reliability of components alignment and a good correlation with the preoperative planning. However, surgeon's double check remains essential for the whole procedure. Drawbacks of 3DP technologies remain limited access to 3D printers, long time to produce the models, and the absence of surrounding soft tissues. Anatomical models and patient-specific instruments seem to improve accuracy and reliability, improve preoperative planning and reduce intraoperative time, but whether this is correlated to a clinical benefit is unconfirmed and further clinical studies with long follow-up are necessary.
2020
- Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)
[Articolo su rivista]
Baldelli, I.; Baccarani, A.; Barone, C.; Bedeschi, F.; Bianca, S.; Calabrese, O.; Castori, M.; Catena, N.; Corain, M.; Costanzo, S.; Barbato, G. D. P.; De Stefano, S.; Divizia, M. T.; Feletti, F.; Formica, M.; Lando, M.; Lerone, M.; Lorenzetti, F.; Martinoli, C.; Mellini, L.; Nava, M. B.; Porcellini, G.; Puliti, A.; Romanini, M. V.; Rondoni, F.; Santi, P.; Sartini, S.; Senes, F.; Spada, L.; Tarani, L.; Valle, M.; Venturino, C.; Zaottini, F.; Torre, M.; Crimi, M.
abstract
Background: Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals. Main body: The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conclusion: Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts.
2020
- Isolate and irreducible radial head dislocation in children: A rare case of capsular interposition
[Articolo su rivista]
Tarallo, L.; Novi, M.; Porcellini, G.; Catani, F.
abstract
Background: Radial head dislocation with no associated lesions, is a relatively uncommon injury in children. In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury. Case presentation: An 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. An isolated radio-capitellar dislocation was identified with no other fractures or neurovascular injuries associated. Elbow presented an extension-flexion arc limited (0°-90°), and the prono-supination during general anesthesia shows "a sling effect"from maximal pronation (+ 55°) and supination (+ 90°) to neutral position of forearm. The radial head dislocation was impossible to reduce and an open reduction was performed using lateral Kocher approach. The radial head was found "button-holed"through the anterior capsule. The lateral soft tissues were severely disrupted and the annular ligament was not identifiable. Only by cutting the lateral bundle of the capsule was possible to reduce the joint. At 50 moths follow-up, patient presented a complete Range of motion (ROM), complete functionality and no discomfort or instability even during sport activities. Discussion and conclusion: It is important to understand the pathogenic mechanisms of locked radial head dislocation in children. Some mechanism described are the distal biceps tendon or the brachialis tendon interposition. However even the anterior capsule can hinder reduction. A characteristic "sling-effect"of the forearm could be pathognomonic for capsular button-holing. Surgical release of the capsular bundle sometimes is the only way to reduce the dislocation and obtain a good outcome.
2020
- Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear.
[Articolo su rivista]
Tarallo, L; Porcellini, G; Merolla, G; Pellegrini, A; Giorgini, A; Catani, F.
abstract
.
2020
- Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older
[Articolo su rivista]
Merolla, G.; De Cupis, M.; Walch, G.; De Cupis, V.; Fabbri, E.; Franceschi, F.; Ascani, C.; Paladini, P.; Porcellini, G.
abstract
Background: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. Methods: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant–Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. Results: RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). Conclusion: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.
2020
- Reinsertion of distal biceps ruptures with a single anterior approach: analysis of 14 cases using tension-slide technique and interference screw
[Articolo su rivista]
Micheloni, G. M.; Tarallo, L.; Porcellini, G.; Novi, M.; Catani, F.
abstract
BACKGROUND: Several techniques of surgical repair of biceps tendon ruptures are described in literature. Cortical button repair have shown minimal loss of elbow flexion, supination and strength. In this retrospective study we report the outcomes in terms of elbow function and complications of tension-slide technique and interference screw. Matherials and methods: 14 patients with complete distal biceps tendon rupture were included in the retrospective study and treated with the same tension-slide technique (BicepsButton® - Arthrex, Inc, Naples, Florida) evaluating the clinical and functional outcomes and the complication rate with a follow-up average of 18 months. RESULTS: The flexion recovered compare to the healthy contralateral was 96% (min 115° - max 135°; average 128°), the extension was 97% (min: -2° - max 15°; average 4°), the supination was 90% (min 20° - max 90°; average 75°), the pronation was 95% (min 15° - max 90°; average 76°). The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 8.1 ± 10.5 and Mayo Elbow Performance Score overall (MEPS) score was 97.6 ± 8.2. Two patients had LABCN paresthesia, one case, treated 2 months after injury, had posterior interosseus nerve palsy. One patient had heterotopic ossification at the radiological examination without consequences for the clinical performances. No case of non-traumatic tendon re-rupture and no case of ROM deficiency > 20%. In all case the cortical button remains well positioned and no case of osteolysis were reported. CONCLUSIONS: Distal biceps tendon repair with BicepsButton® system seems to be a safe, relyable and reproducible technique providing excellent clinical, functional and radiological outcomes. Comparing with other techniques the BicepsButton® system has the advantages of the single approach procedures, the reduction of surgical time and risk of heterotopic ossifications. (www.actabiomedica.it).
2020
- Shoulder arthroplasty to address the sequelae of anterior instability arthropathy and stabilization procedures: systematic review and meta-analysis
[Articolo su rivista]
Cerciello, S.; Corona, K.; Morris, B. J.; Paladini, P.; Porcellini, G.; Merolla, G.
abstract
Purpose: Chronic anterior glenohumeral joint instability is a common situation and can lead to progressive cartilage deterioration and ultimately instability arthopathy. Progressive cartilage deterioration can occur despite conservative or surgical treatment and the sequelae of these conditions are often addressed with total shoulder arthroplasty. Aims of the present study were to analyze the available literature to describe the technical aspects of this particular operation and to report outcomes and complication rates. The hypothesis was that shoulder arthropalsty in the sequelae of instability had lower outcomes and higher complication rates than arthroplasties for primary arthritis. Methods: A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Ovid, Cochrane Reviews, and Google Scholar were comprehensively searched using a combination of the following keywords: shoulder arthroplasty, reverse shoulder arthroplasty, dislocation arthropathy, capsulorrhaphy arthropathy and stabilization procedures. Results: Thirteen studies with 365 patients met inclusion criteria. Since 13 patients were lost to follow-up, 352 were reviewed at an average follow-up of 53.4 months. The average Constant–Murley (CM) and American Shoulder and Elbow Society (ASES) scores improved from 35.6 and 35.7 to 72.7 and 77, respectively. The overall complication rate was 25.7% and the reoperation rate was 18.5%. Radiographs at follow-up revealed radiolucent lines on the humerus in 12.4% of cases and radiolucent lines or notching on the glenoid side in 22.7% of cases. The average Methodological Index for Non-randomized Studies Score (MINORS) was 12.9 for non-comparative studies and 21.3 for comparative studies. Conclusion: Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology. Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis; however, the difference is not statistically significant. When reverse shoulder arthroplasties (RSA) were considered as a subgroup and compared to anatomic shoulder replacements (total shoulders and hemiarthroplasties), they showed a lower revision rate.
2020
- Shoulder Function After Cardioverter-Defibrillator Implantation: 5-Year Follow-up
[Articolo su rivista]
Martignani, Cristian; Massaro, Giulia; Mazzotti, Andrea; Pegreffi, Francesco; Ziacchi, Matteo; Biffi, Mauro; Porcellini, Giuseppe; Boriani, Giuseppe; Diemberger, Igor
abstract
2020
- The glad lesion: Are the definition, diagnosis and treatment up to date? A systematic review
[Articolo su rivista]
Porcellini, G.; Cecere, A. B.; Giorgini, A.; Micheloni, G. M.; Tarallo, L.
abstract
Introduction: Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a start-ing point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. Methods: A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: “GlenoLabral Articular Disruption” OR “GLAD” AND “shoulder” AND “cartilage, articular”. Results: Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of gleno-humeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. Conclusions: The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser’s original definition described stable shoulders following a trauma in adduction.(www.actabiomedica.it).
2020
- Two rotator cuff tear repair techniques for sovraspinatus tendon tear: transosseous sharc-ft vs single row repair
[Articolo su rivista]
Pellegrini, A.; Baudi, P.; Rebuzzi, M.; Gialdini, M.; Tarallo, L.; Porcellini, G.
abstract
BACKGROUND: Despite rotator cuff repair techniques have developed significantly in last decade, pushed by the progress in technology and materials, the treatment of rotator cuff tears and re-tears is still a big challenge for shoulder surgeons. The aim of this study is to perform clinical and radiological evaluation (ultrasound and MRI) of patients treated with transosseous sharc-ft, and single row techniques for sovraspinatus rotator cuff tear at 6, 12 and 24 months follow up. METHODS: Twenty-eight consecutive patients who underwent arthroscopic repair for rotator cuff tear were enrolled in the study and divided in two different groups: group A (14 patients) underwent a single row technique repair; group B (14 patients) underwent a transosseous sharc-ft technique repair. All participants had MRI or ultrasound examination confirmed fullthickness tears of sovraspinatus tendon before surgery. All the patients underwent clinical evaluation at 45 days, 3 months, 6 months, 12 and 24 months post-operatively with VAS, Dash, Constant and ASES score. Diagnostic ultrasound examination was performed at 6 months follow up while the MRI examination at 1 and 2 year follow up. RESULTS: The whole primary variables didn't show any significant difference and the groups were homogenous (age, Goutallier fatty infiltration, VAS, DASH, Constant, ASES). Some statistically significant differences are visible at discrete variables in a specific time: Dash at 12 months and Constant at 24 months show a significant improvement versus single-row technique. CONCLUSION: The arthroscopic transosseous repair technique with sharc-ft showed excellent results with little significant statically difference between this technique and the single row for this kind of lesion after 1 year of follow-up. Clinical data from this study confirmed, with the help of ultrasound examination and MRI, the excellent clinical outcome obtained by the patients. Further studies are needed to find differences between these techniques in the repair of large and massive rotator cuff lesions. (www.actabiomedica.it).
2020
- Volar PEEK plate for distal radius fracture: analysis of adverse events
[Articolo su rivista]
Tarallo, L.; Giorgini, A.; Novi, M.; Zambianchi, F.; Porcellini, G.; Catani, F.
abstract
Background: The aim of the present retrospective study was to evaluate complications following carbon-fiber-reinforced polyetheretherketon (CFR-PEEK) volar plating in distal radius fracture in a large cohort of patients. As an alternative to conventional metallic devices, CFR-PEEK plates have been introduced over the last few years. Methods: We performed a retrospective study including all patients who were treated for distal radius fracture using a volar fixed-angle plate DiPHOS-RM (Lima Corporate, Udine, Italy). All CFR-PEEK plates implanted were reviewed between May 2012 and December 2017. Plate removal, second surgery and adverse events were collected by reviewing medical records. A total of 110 patients were included with a mean follow-up of 4 years. Results: Adverse side effects were observed in 9 cases (8%), developed during or after treatment. The most frequent complication was represented by intraoperative plate rupture (4%). Infection was reported in one case. Discussion: The rate of complications of PEEK volar plates seems to be similar to those occurring with plates of different materials. Advantages of PEEK plates are the absence of the cold-welding phenomenon and the absence of exuberant bone callus on the plate, ensuring an easy hardware removal. Intraoperative rupture remains the main complication correlated with PEEK material. These complications can be reduced with an accurate surgical technique, especially at the beginning of the learning curve. Level of evidence: Therapeutic IV.
2019
- A new method to evaluate the influence of the glenosphere positioning on stability and range of motion of a reverse shoulder prosthesis
[Articolo su rivista]
Ingrassia, T.; Nigrelli, V.; Ricotta, V.; Nalbone, L.; D'Arienzo, A.; D'Arienzo, M.; Porcellini, G.
abstract
Purpose: Shoulder instability and reduced range of motion are two common complications of a total reverse shoulder arthroplasty. In this work, a new approach is proposed to estimate how the glenoid component positioning can influence the stability and the range of motion of a reverse shoulder prosthesis. Materials and methods: A standard reverse shoulder prosthesis has been analysed. To perform virtual simulation of the shoulder-prosthesis assembly, all the components of the prosthesis have been acquired via a 3D laser scanner and the solid models of the shoulder bones have been reconstructed through CT images. Loads on the shoulder joint have been estimated using anatomical models database. A new virtual/numerical procedure has been implemented using a 3D parametric modelling software to find the optimal position of the glenosphere. Results: Several analyses have been performed using different configurations obtained by changing the glenoid component tilt and the lateral position of the glenosphere, modified through the insertion of a cylindrical spacer. For the analysed case study, it was found that the interposition of a spacer (between the baseplate and the glenoid) and 15° inferior tilt of the glenosphere allow improving the range of motion and the stability of the shoulder. Conclusions: Some common complications of the reverse shoulder arthroplasty could be effectively reduced by a suitable positioning of the prosthesis components. In this work, using a new method based on virtual simulations, the influence of the glenosphere positioning has been investigated. An optimal configuration for the analysed case study has been found. The proposed approach could be used to find, with no in vivo experiments, the optimal position of a reverse shoulder prosthesis depending on the different dimensions and shape of the bones of each patient.
2019
- A new plate design to treat displaced 3-4 parts proximal humeral fractures in comparison to the most tested and used plate: Clinical and radiographic study
[Articolo su rivista]
Rollo, G.; Porcellini, G.; Rotini, R.; Bisaccia, M.; Pichierri, P.; Paladini, P.; Guerra, E.; Cruto, E. D.; Franzese, R.; Grubor, P.; Pace, V.; Meccariello, L.
abstract
Aim Proximal humeral fractures are common and most complex patterns currently represent a challenge for surgeons. Difficulties in obtaining good anatomical reduction (particularly of great tuberosity) often lead to unsatisfactory results; choices often fall onto prosthesis implantation against fixation options. The aim of this study was to compare a new design of proximal humeral plate with the most used plates in the treatment of these injures by analysing outcomes and complications. Methods Two hundred patients with proximal 3 or 4 parts humeral fracture were enrolled (Neer 3-4). First group treated with PGR Plate composed of 98 patients. Second group treated with Philos Plate composed of 102 patients. Evaluation criteria were Non-Union Scoring System, duration of surgery, complications, objective quality of life and elbow function (Constant Shoulder Score), subjective quality of life and elbow function (Oxford Shoulder Score), post-op radiographs, centrum collum diaphyseal angle. Evaluation endpoint was 12 months. Results There was no statistically significant difference between the groups with regard to the selected evaluation parameters. Achievement of good shoulder range of motion and ability to perform normal daily living activities was obtained in both groups. The PGR had a positive impact on treatment results of varuspattern of proximal humeral fractures. Conclusions The PGR allowed good clinical and radiographic results in the treatment of proximal humeral fractures, comparable to those obtained with Philos. Also, PGR had the advantage to aid and keep the anatomical reduction of patterns of fracture involving the greater tuberosity.
2019
- Assessment of anatomical and reverse total shoulder arthroplasty with the scapula-weighted Constant-Murley score
[Articolo su rivista]
Merolla, G Parel I; Cutti, Ag; Filippi, Mv; Paladini, P; Porcellini, G
abstract
Aim of the study: To evaluate total (TSA) and reverse total shoulder arthroplasty (RTSA) using the Constant-Murley score (CMS) and the scapula-weighted (SW) CMS, an integrated outcome measure that takes into account the compensatory movements of the scapula. Methods: Twenty-five consecutive patients, 12 with TSA and 13 with RTSA, underwent kinematic analysis before and after shoulder replacement. Measurements included flexion (FLEX) and abduction (ABD) for the humerus and Protraction-Retraction (PR-RE), Medio-Lateral rotation (ME-LA), and Posterior-Anterior tilting (P-A) for the scapula. They were recorded at baseline (T0) and at six (T1) and 12 months (T2). Reference data were obtained from 31 control shoulders. Results: At T1, differences in CMS and SW-CMS were not significant in either group, whereas values at T2 were significantly lower in RTSA patients (p = 0.310 and p = 0.327, respectively). In TSA shoulders, the compensatory scapular movements in FLEX were all reduced from T0 to T2, whereas P-A was increased in ABD. In RTSA patients, the compensatory scapular movements in FLEX showed a general reduction at T1, with an increase in P-A at T2, whereas in ABD, all increased at T1 and decreased at T2 except for P-A, which did not decrease. Discussion: The SW-CMS showed that the physiological scapulothoracic motion was not restored in TSA and RTSA patients; it may be used as a reference for the gradual progression of deltoid and scapular muscle rehabilitation. Conclusions: The worse CMS and SW-CMS scores found in RTSA patients at six months may be due to the biomechanics of the reverse prosthesis and to the weakness of deltoid and periscapular muscles.
2019
- Comparison between conservative treatment and plate fixation for displaced middle third clavicle fracture: clinical outcomes and complications.
[Articolo su rivista]
Micheloni, Gm; Tarallo, L; Porcellini, G; Catani, F.
abstract
2019
- Indications for radial head arthroplasty and classification of current implants
[Capitolo/Saggio]
Merolla, G.; Padolino, A.; Paladini, P.; Porcellini, G.
abstract
2019
- Influence of sutures configuration on the strength of tendon-patch joints for rotator cuff tears treatment
[Articolo su rivista]
Ingrassia, T.; Lombardo, B.; Nigrelli, V.; Ricotta, V.; Nalbone, L.; D'Arienzo, A.; D'Arienzo, M.; Porcellini, G.
abstract
Purpose: Massive rotator cuff tears are common in the aging population. The incidence of failed rotator cuff repairs is still quite high, especially in the treatment of full-thickness tears or revision repairs. In this context, natural and synthetic meshes can be used as augmentation scaffolds or as devices to close the gap between a retracted tendon and the bone. The purpose of this work is to evaluate the ultimate tensile strength of different tendon-patch joints in order to consider their use in the treatment of massive cuff tears. Materials and methods: Porcine tendons and a synthetic low-density polypropylene mesh have been used. A preliminary study on the tensile strength of tendons and patches has been performed. Different patch-tendon joints have been studied by modifying the number and the layout of the sutures. For every joint, the tensile test, performed through an electromechanical machine, has been repeated at least twice to obtain reliable data. Results: Experimental tensile tests on tendons and patches have given good results with very low dispersion data. Mean values of the calculated ultimate tensile stresses are, respectively, about 34 MPa and 16 MPa for tendons and patches. As regards the sutures arrangement, the staggered layout gave, for all joints, a higher tensile strength than the regular (aligned) one. Different ultimate tensile stress values, depending on the sutures number and layout, have been calculated for the joints. Conclusion: Synthetic patches could be an interesting option to repair massive cuff tears and to improve, in a significant way, pain, range of motion and strength at time 0, so reducing the rehabilitation time. Obtained results demonstrated that joints with a suitable number and layout of sutures could ensure very good mechanical performances. The failure load of the tendon-patch joint, in fact, is higher than the working load on a healthy tendon.
2019
- One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers
[Articolo su rivista]
Matsen, F. A.; Iannotti, J. P.; Churchill, R. S.; De Wilde, L.; Edwards, T. B.; Evans, M. C.; Fehringer, E. V.; Groh, G. I.; Kelly, J. D.; Kilian, C. M.; Merolla, G.; Norris, T. R.; Porcellini, G.; Spencer, E. E.; Vidil, A.; Wirth, M. A.; Russ, S. M.; Neradilek, M.; Somerson, J. S.
abstract
Purpose: Clinical shoulder science lacks a benchmark against which the early clinical value of new glenoid components can be compared; such a benchmark may be derived from a multicenter study of patients receiving an established, internationally used design of glenoid component. Methods: We obtained data from 11 centers on 1270 patients having total shoulder arthroplasty using an all-polyethylene component with a fluted central peg. We analyzed individual patient outcomes at 1 and 2 years after surgery. We compared the improvement for each patient to the minimal clinically important difference (MCID) and calculated each patient’s improvement as a percent of maximal possible improvement (MPI). Results: The preoperative scores improved from SST 3 ± 2, ASES 37 ± 15, Constant score 36 ± 16, and Penn score 30 ± 19 to SST 10 ± 2, ASES 90 ± 12, Constant 76 ± 13, and Penn 80 ± 24 (p < 0.001 for each). A high percentage of patients improved by more than the MCID (SST 96%, ASES 98%, Constant 94%, Penn 93%) and obtained improvement of at least 30% of the MPI (SST 95%, ASES 98%, Constant 91%, Penn 87%). The clinical outcomes realized with this glenoid design were not worse for the 41% of shoulders with preoperative type B glenoids or for the 30% of shoulders with more than 15 degrees of glenoid retroversion. Conclusions: Individual patients from 11 international practices having total shoulder arthroplasty using a basic glenoid component design obtained highly significant clinical outcomes, providing a benchmark against which the early outcomes of new designs can be compared to determine whether they provide increased clinical value.
2019
- Technology applications in shoulder replacement
[Articolo su rivista]
Porcellini, G; Tarallo, L; Novi, M; Spiezia, F; Catani, F
abstract
The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative guidance and post-operative follow-up. The request for greater accuracy, predictable results and fewer complications, is the engine of digital evolution in pre-operative planning and computer-assisted surgery (CAS). It is an evolution rather than a revolution, and in the last few years these developments have begun to involve shoulder replacement surgery, too.
2018
- Age-related changes of elastic fibers in shoulder capsule of patients with glenohumeral instability: A pilot study
[Articolo su rivista]
Castagna, A; Cesari, E; Gigante, A; Di Matteo, B; Garofalo, R; Porcellini, G.
abstract
Background. Recurrent shoulder dislocations occur much more frequently in adolescents than in the older population but a clear explanation of this incidence does not exist. The aim of the present study was to define the age-related distribution of the elastic fibers (EFs) in the shoulder capsule's extracellular matrix as a factor influencing shoulder instability. Materials and Methods. Biopsy specimens were obtained from the shoulder capsule of patients divided preoperatively into three groups: Group 1 consisted of 10 male patients undergoing surgery for unidirectional traumatic anterior instability (TUBS); Group 2 consisted of 10 male patients undergoing surgery for multidirectional instability (MDI); Group 3 represents the control, including 10 patients with no history of instability. In addition to the group as a whole, specific subgroups were analyzed separately on the basis of the age of subjects: > 22 or < to 22 years. All the samples were analyzed by histochemical (Weigert's resorcinol fuchsin and Verhoeff's iron hematoxylin), immunohistochemical (monoclonal antielastin antibody), and histomorphometric methods. Results. Both the elastin density and the percentage of area covered by EFs were significantly higher in younger subjects (<22 years old). Furthermore, the elastin density and the percentage of area covered by EFs were significantly higher in specimens of group of patients affected by multidirectional shoulder instability in comparison to the other two groups. Conclusion. Data of the present study confirmed the presence of an age-related distribution of EFs in the human shoulder capsule. The greater amount of EFs observed in younger subjects and in unstable shoulders could play an important role in predisposing the joint to first dislocation and recurrence.
2018
- Assessment of return to play in professional overhead athletes subjected to arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow score
[Articolo su rivista]
Merolla, G.; Paladini, P.; Porcellini, G.
abstract
Background: The self-administered Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow questionnaire is a reliable and sensitive outcome tool to assess upper extremity athletic performance and functional changes affecting return to play in overhead athletes. We report the results of a study of return to sport in professional overhead athletes at a mean follow-up of 2 years after arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the score. Materials and methods: A total number of 38 patients completed the 10-item questionnaire before and after surgery. They were also asked (1) whether they had returned to play; (2) how many months after the operation they had done so; (3) the level of postoperative performance (preinjury or less); and (4) whether they had had to change sport due to their shoulder problems. Results: Significant differences were found (1) between preoperative and postoperative scores; (2) between the scores of patients who returned to play at preinjury level and those who merely returned to competition; and (3) between the postoperative subscores of 8/10 items, which were higher in the patients who returned to preinjury performance than in those who merely returned to play; the two items that were not significantly different between these subgroups concerned pain and joint stability. Even though item analysis highlighted a major role for athletic performance in recovery of preinjury performance, it also stressed that the athlete’s relationship with coach, agent, and staff and his/her feeling of the extent to which the arm affects current performance significantly contribute to the final score. Conclusions: The KJOC Shoulder and Elbow score provides an accurate and exhaustive assessment of the recovery of the athlete’s shoulder in relation to preinjury performance and provides the surgeon with key information on the pros and cons of surgical management.
2018
- Comparison of CFR-PEEK and conventional titanium locking plates for proximal humeral fractures: a retrospective controlled study of patient outcomes
[Articolo su rivista]
Padolino, A.; Porcellini, G.; Guollo, B.; Fabbri, E.; Kiran Kumar, G. N.; Paladini, P.; Merolla, G.
abstract
Background: Metal plates are the fixation devices used most frequently to proximal humeral fractures (PHFs). However, in recent years carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates have become increasingly common. This study compares the clinical and radiographic outcomes of 42 Neer three- and four-part PHFs treated with CFR-PEEK or metal (titanium) plates. Materials and methods: Forty-two PHF patients were managed with CFR-PEEK plates (n = 21, males/females 9/12; mean age 57.4 years; mean follow-up 30.7 months; CFR-PEEK group) or metal plates (n = 21; males/females 7/14; mean age 55.8 years; mean follow-up 52.7 months; Metal group). Active shoulder mobility (anterior elevation, lateral elevation, external rotation, and internal rotation), the Constant–Murley Score, the Simple Shoulder Test Score, and the pain score were recorded. Preoperative computed tomography scans and X-rays were obtained. Postoperative fracture healing and displacement, tuberosity resorption and/or malposition, hardware position, and cortical thinning (CT) under the plate were assessed radiographically. Results: Shoulder mobility, clinical, and pain scores were similar in both patient groups. CT was significantly greater in CFR-PEEK patients (mean difference, 1.14 mm; p = 0.0003). In both groups, incomplete or poor calcar reduction was associated to a significantly higher complication rate, especially stiffness and muscle weakness (p = 0.016). The rate of tuberosity resorption was significantly higher in the Metal group (p = 0.040). Two patients required revision to a hemiarthroplasty (CFR-PEEK) and reverse arthroplasty (Metal group). Conclusions: CFR-PEEK plates provide a viable alternative to conventional titanium plates in PHFs, ensuring similar clinical outcomes and a lower rate of tuberosity resorption, but they involve higher stress shielding under the plate.
2018
- Comparison of shoulder replacement to treat osteoarthritis secondary to instability surgery and primary osteoarthritis: a retrospective controlled study of patient outcomes
[Articolo su rivista]
Merolla, G Cerciello S; Marenco, S; Fabbri, E; Paladini, P; Porcellini, G
abstract
Purpose: We hypothesized that osteoarthritis developing after instability surgery is radiographically similar to primary arthritis and that arthroplasty provides comparable outcomes in patients with these two types of osteoarthritis. Methods: Patients with osteoarthritis due to instability surgery (group I) and with primary osteoarthritis (group II) were included. Mean follow-up was 52.6 and 41.6 months, respectively. Hemiarthroplasties (HA) were 32% in group I and 27% in group II; total shoulder arthroplasties (TSA) were 68 and 73% respectively. Outcome measures included active shoulder mobility (anterior elevation [AAE], lateral elevation [ALE], external rotation [ER], and internal rotation [IR]), pain, Constant-Murley score, and Simple Shoulder Test. Pre-operative and post-operative radiographs were taken. Glenoid arthritis was assessed by computed tomography. Results: Participants were 19 in the group I (mean age 44.5 years, 12 males, 7 females) and 30 in the group II (mean age 48.2 years, 28 males, 12 females). Both patient groups had pre-operative concentric arthritis. Group II had higher rates of A2 and B1 glenoids (p = 0.003). A longer interval from stabilization to replacement was associated with lower post-operative IR (p = 0.017) and ALE (p = 0.035). Post-operative ER and IR were higher in group I (p < 0.001 and p = 0.001, respectively). In group I, AFE and ALE were higher in HA than TSA patients (both p = 0.009). The CS and SST score increased significantly in both groups (both p < 0.001). Group II showed significantly greater humeral radiolucency (p = 0.025) and a higher rate of TSA revision to reverse prostheses compared with group I. Conclusions: Shoulder replacement provides similar clinical and radiographic outcomes in arthritis secondary to instability surgery and in primary osteoarthritis. Posterior glenoid wear is more common in primary osteoarthritis.
2018
- First episode of dislocation and simple instability: Management and rehabilitation
[Capitolo/Saggio]
Di Giacomo, S.; Augusti, C. A.; Gogna, P.; Porcellini, G.
abstract
2018
- Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference?
[Articolo su rivista]
Porcellini, G; Palladini, P; Congia, S; Palmas, A; Merolla, G; Capone, A
abstract
Background: Surgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness. The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture. Patients and methods: 20 cases with scapular neck and body fracture treated with posterior approach for lateral border plate fixation were reviewed. In 11 of 20 cases, we used the modified Judet approach (MJ group), and in 9 cases we used the classic Judet approach (CJ group). All fractures were classified according to the AO classification system. At follow-up examinations, patients had X-ray assessment with acromiohumeral distance (AHD) measurement, clinical evaluation, active range of motion (ROM) examination, Constant Shoulder Score, and Disability of the Arm, Shoulder and Hand (DASH) Score. Infraspinatus strength assessment was measured using a dynamometer during infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT). Results: Demographic data did not significantly differ between the CJ group and MJ group, except for mean follow-up, which was 4.15 years in the CJ group and 2.33 in the MJ group (p < 0.001). All X-ray examinations showed fracture healing. AHD was significantly decreased in the CJ group (p = 0.006). We did not find significant differences in active ROM between the MJ and CJ groups in the injured arm (p < 0.05). The Constant Score was 75.83 (±14.03) in the CJ group and 82.75 (±10.72) in the MJ group (p = 0.31); DASH Score was 10.16 in the CJ group and 6.25 in the MJ group (p = 0.49). IST showed mean strength of 8.38 kg (±1.75) in the MJ group and 4.61 kg (±1.98) in the CJ group (p = 0.002), ISRT test was 8.7 (±1.64) in the MJ group and 4.95 (±2.1) in the CJ group (p = 0.002). Infraspinatus hypotrophy was detected during inspection in six patients (five in the CJ group and one in the MJ group); it was related to infraspinatus strength weakness in IST and ISRT (p < 0.001). Conclusions: Infraspinatus-sparing surgical approach for scapular fracture avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not easily reducible with a narrower exposure. Level of evidence: Level IV.
2018
- Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up
[Articolo su rivista]
Merolla, Giovanni; Walch, Gilles; Ascione, Francesco; Paladini, Paolo; Fabbri, Elisabetta; Padolino, Antonio; Porcellini, Giuseppe
abstract
Background: There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs. Methods: Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component. Results: Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P =.002) and lower rates of scapular notching (P =.0003), glenoid radiolucency (P =.016), and humeral bone remodeling (P =.004 and P =.030 for cortical thinning and spot weld, respectively). Conclusions: Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors.
2018
- Irreparable rotator cuff tears: Challenges and solutions
[Articolo su rivista]
Novi, M.; Kumar, A.; Paladini, P.; Porcellini, G.; Merolla, G.
abstract
Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.
2018
- I.S.Mu.L.T. hyaluronic acid injections in musculoskeletal disorders guidelines
[Articolo su rivista]
Frizziero, A.; Oliva, F. V. F.; Berardi, A.; Ceccarelli, F.; Costantino, C.; Faldini, C.; Foti, C.; Masiero, S.; Porcellini, G.; Vulpiani, M. C.; Abatangelo, G.; Mahmoud, A.; Buonocore, D.; Buda, R.; Dossena, M.; Frizziero, L.; Galletti, S.; Via, A. G.; Merolla, G.; Migliore, A.; Nicoletti, S.; Padolino, A.; Terreni, M.; Valent, A.; Vannini, F.; Verri, M.; Vetrano, M.; Bacciu, S.; Bossa, M.; Calderazzi, F.; Carolla, A.; Finotti, P.; Gasparre, G.; Natali, S.; Pellicciari, L.; Piccirilli, E.; Pintus, E.; Romiti, D.; Vertuccio, A.; Maffulli, N.
abstract
Intra-articular and peri-articular hyaluronic acid (HA) injections are widely used to treat several musculoskeletal pathologies. Although clinical outcomes are often positive for different conditions, an holistic consensus on this topic is still lacking. Our work is divided in two main sessions: in the first section we analyzed the preclinical bases for HA treatment in musculoskeletal pathologies, while in the second part we discussed the evidence on the use of HA injections in each district of musculoskeletal system. The aim of this work is to provide to the physician a feasible guideline rapidly to consult in the clinical practice. Level of evidence: Ia.
2018
- Management of epicondylitis and epitrochleitis
[Capitolo/Saggio]
di Giacomo, S.; Porcellini, G.; Tartarone, A.; Paladini, P.; Pellegrini, A.; Ricci, A.; D'Agostino, M. C.; Turoni, R.
abstract
2018
- Osteochondritis dissecans in "Little league" players and gymnast
[Capitolo/Saggio]
Ciaramella, G.; Paladini, P.; Porcellini, G.; Rotini, R.; Guerra, E.; Cavallo, M.; Pederzini, L.
abstract
2018
- Preface
[Prefazione o Postfazione]
Porcellini, G.; Rotini, R.; Kantar, S. S.; Di Giacomo, S.
abstract
2018
- Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants
[Articolo su rivista]
Merolla, Giovanni; Wagner, Eric; Sperling, John W.; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe
abstract
Background There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA. Methods A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation. Results Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P <.0001), with median American Shoulder and Elbow Surgeons and Simple Shoulder Test scores of 60 and 6 points, respectively. There were 11 (7%) repeated revision surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 “at-risk” glenoid components. Conclusion Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes.
2018
- Snapping triceps
[Capitolo/Saggio]
Ciaramella, G.; Saporito, M.; Fauci, F.; Porcellini, G.
abstract
2018
- The elbow of the biker
[Capitolo/Saggio]
Augusti, C. A.; Porcellini, G.
abstract
2018
- The Elbow:Principles of Surgical Treatment and Rehabilitation
[Monografia/Trattato scientifico]
Porcellini, G.; Rotini, R.; Stignani, Kantar; DI GIACOMO, Michelangela
abstract
This book provides readers with detailed guidance on the evaluation, diagnosis, and treatment of injuries and disorders of the elbow, including dislocation, complex instability, articular fractures, epicondylitis and epitrochleitis, distal biceps and triceps tendon injuries, peripheral nerve pathology, snapping triceps syndrome, elbow stiffness, and upper limb compartment syndrome. The choice between conservative and surgical treatment in different settings is clearly explained, and detailed advice offered on selection of surgical technique. A separate section provides a deeper understanding of the most common sports-related elbow pathologies, and their management, based on careful correlation with the movements performed by athletes in particular sports. Extensive consideration is also given to rehabilitation and physiotherapy protocols. This book will be of value for all orthopedic surgeons and other specialists who care for patients with elbow injuries, which can represent a challenge even to the more experienced.
2018
- The experience of the RIPO, a shoulder prosthesis registry with 6-year follow-up
[Articolo su rivista]
Porcellini, G; Combi, A; Merolla, G; Bordini, B; Stea, S; Zanoli, G; Paladini, P
abstract
Implant registries have proved valuable in assessing the outcomes of arthroplasty procedures. Moreover, by identifying lesser quality implants they have indirectly improved the quality of care. The registry of prosthetic shoulder implants was established in 2008.
2017
- Anterior shoulder instability
[Capitolo/Saggio]
Bailey, L. C. D. R. J. R.; Little, B. A.; Dale, K. M.; Taylor, D. C.; Provencher, M. T.; Vutescu, E. S.; Sanchez, G.; Fabricant, P. D.; Cordasco, F. A.; Roberson, T. A.; Bentley, J. C.; Hawkins, R. J.; Provencher, M. T.; Sanchez, A.; Sanchez, G.; Gaston, T.; Lafosse, L.; Plath, J. E.; Provencher, M. T.; Sanchez, A.; Sanchez, G.; Schantz, K.; Tokish, J. M.; Kwapisz, A.; Choate, W. S.; Taverna, E.; Guarrella, V.; Matsuki, K.; Sugaya, H.; Savoie, F. H.; Heffernan, J. T.; Miniaci, A.; Patel, R. M.; Elbanna, A. M.; Dukas, A. G.; Arciero, R. A.; Meadows, M. C.; Gregory, B. P.; Thorsness, R. J.; Romeo, A. A.; Gendre, P.; Bessiere, C.; Boileau, P.; Pelligrini, A.; Paladini, P.; Merolla, G.; Porcellini, G.; Yamamoto, N.; Itoi, E.; Dare, D. M.; Warren, R. F.
abstract
2017
- Arthroscopic Debridement Versus Platelet-Rich Plasma Injection: A Prospective, Randomized, Comparative Study of Chronic Lateral Epicondylitis With a Nearly 2-Year Follow-Up
[Articolo su rivista]
Merolla, G.; Dellabiancia, F.; Ricci, A.; Mussoni, M. P.; Nucci, S.; Zanoli, G.; Paladini, P.; Porcellini, G.
abstract
Purpose The purpose of this prospective, randomized study was to compare the efficacy of autologous platelet-rich plasma (PRP) injections and arthroscopic lateral release in treating chronic lateral epicondylitis (LE). Methods Patients who had a clinical diagnosis of LE confirmed by ultrasound (US) were included in this study. A total of 101 patients received arthroscopic release (n = 50) or US-guided PRP injections (n = 51). Outcomes were assessed using a visual analog scale for pain, the Patient-Rated Tennis Elbow Evaluation (PRTEE), and a calibrated hand dynamometer for grip strength. Results Both patient groups experienced significant improvement in all measures. Between-group comparisons showed a significantly higher value in the PRP group only for grip strength at week 8 (P =.0073); all other significant differences were in favor of arthroscopy: overall pain (P =.0021), night pain (P =.0013), and PRTEE score (P =.0013) at week 104 and grip strength at weeks 24, 52, and 104 (all P <.0001). Consumption of rescue pain medication was not significantly different between the groups. Conclusions The present findings suggest that (1) PRP injections and arthroscopic extensor carpi radialis brevis release are both effective in the short and medium term; (2) PRP patients experienced a significant worsening of pain at 2 years; (3) arthroscopic release ensured better long-term outcomes in terms of pain relief and grip strength recovery; and (4) both procedures were safe and well accepted by patients. Level of Evidence Level II, prospective comparative study.
2017
- Cross-cultural adaptation and validation of the Italian version of the Kerlan–Jobe Orthopaedic Clinic Shoulder and Elbow score
[Articolo su rivista]
Merolla, Giovanni; Corona, Katia; Zanoli, Gustavo; Cerciello, Simone; Giannotti, Stefano; Porcellini, Giuseppe
abstract
Background: The Kerlan–Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a reliable and sensitive tool to measure the performance of overhead athletes. The purpose of this study was to carry out a cross-cultural adaptation and validation of the KJOC questionnaire in Italian and to assess its reliability, validity, and responsiveness. Materials and methods: Ninety professional athletes with a painful shoulder were included in this study and were assigned to the “injury group” (n = 32) or the “overuse group” (n = 58); 65 were managed conservatively and 25 were treated by arthroscopic surgery. To assess the reliability of the KJOC score, patients were asked to fill in the questionnaire at baseline and after 2 weeks. To test the construct validity, KJOC scores were compared to those obtained with the Italian version of the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, and with the DASH sports/performing arts module. To test KJOC score responsiveness, the follow-up KJOC scores of the participants treated conservatively were compared to those of the patients treated by arthroscopic surgery. Results: Statistical analysis demonstrated that the KJOC questionnaire is reliable in terms of the single items and the overall score (ICC 0.95–0.99); that it has high construct validity (rs = −0.697; p < 0.01); and that it is responsive to clinical differences in shoulder function (p < 0.0001). Conclusions: The Italian version of the KJOC Shoulder and Elbow score performed in a similar way to the English version and demonstrated good validity, reliability, and responsiveness after conservative and surgical treatment. Level of evidence: II.
2017
- Deltoid muscle activity in patients with reverse shoulder prosthesis at 2-year follow-up
[Articolo su rivista]
Pegreffi, F.; Pellegrini, A.; Paladini, P.; Merolla, G.; Belli, Giorgia; Velarde, P. U.; Porcellini, G.
abstract
Purpose: The reverse shoulder prosthesis (RSP) was developed to relieve pain and improve functional outcomes in patients with glenohumeral arthritis and deficiency of the rotator cuff. Even if clinical and functional outcomes regarding the use of the RSP were reported by literature, data concerning progressive deltoid adaptation to this non-anatomic implant are still missing. The purpose of our study was to correlate clinical and functional outcomes with deltoid fibers activity and muscle fatigability in patients with reverse shoulder prosthesis at 2 years follow-up. Methods: Twenty patients with reverse shoulder prosthesis due to symptomatic deficient or nonfunctional rotator cuff associated with osteoarthritis were referred by Cervesi Hospital Shoulder and Elbow Surgery Unit. Exclusion criteria were: axillary nerve palsy, a nonfunctioning deltoid muscle, diabetes, previous trauma, malignancy. Furthermore patients who received the RSP for revision arthroplasty, proximal humerus fractures were excluded. All the patients underwent clinical and functional evaluation with the support of electromyography measurement focused on deltoid activity. Results: RSP surgical treatment in shoulder osteoarthritis confirms his good outcome in terms of pain relief. At 2 years anterior and lateral deltoid electromyographic activity was significantly lower compared with contralateral side (p < 0.001). Posterior deltoid activity was no detectable. Range of motion at 2 years of follow-up decreased in terms of forward flexion (p = 0.045), abduction (p = 0.03) and external rotation (p < 0.001). Conclusions: Our study demonstrates that even if the patients remain pain-free, progressive deterioration of the deltoid activity is unavoidable and may lead to poor functional outcomes overtime.
2017
- Diagnosis and conservative treatment of atraumatic posterior shoulder instability
[Articolo su rivista]
Augusti, C. A.; Jain, N.; Paladini, P.; Inglese, F.; Merolla, G.; Porcellini, G.
abstract
Posterior shoulder instability is an entity of low prevalence. An atraumatic etiology makes its diagnosis more difficult owing to the absence of inciting factors. A specific clinical and diagnostic examination is required to make the correct diagnosis. Scapular dyskinesis offers insight into the pathogenesis and thus helps rationalizing conservative treatment as the first choice in most cases. The rehabilitation protocol should be analyzed and customized to correct the abnormal biomechanics of the shoulder, providing a strengthening program to avoid persistence of symptoms or recurrence. Failure of conservative treatment warrants surgical interventions such as arthroscopic stabilization, posterior bone block, or, rarely, shoulder arthrodesis.
2017
- Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures
[Articolo su rivista]
Merolla, Giovanni; Tartarone, Antonio; Sperling, John W.; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe
abstract
Purpose: The aim of this study was to assess the effectiveness of reverse total shoulder arthroplasty (RTSA) with an all-polyethylene glenosphere in patients with failed hemiarthroplasty (HH) or the sequelae of proximal humeral fractures. Methods: Thirty-six patients were assessed at a mean follow-up of 36 months using clinical scores and recording shoulder range of movement (ROM). Results: Active anterior elevation (p < 0.001), lateral elevation (p < 0.001) and internal rotation (p < 0.0001) improved significantly, whereas improvement in external rotation was not significant. The mean Constant score rose significantly from 8.5 ± 7.6 to 40.7 ± 15.7 (p < 0.001) and the Simple Shoulder Test score from 0.42 ± 0.85 to 5.5 ± 2.6 (p < 0.001). Pain improved significantly from 8.7 ± 0.9 to 2.3 ± 1.2 (p < 0.001). Implant radiographic survivorship was 84.6 %. Scapular notching was detected in 7/36 patients (17.5 %). There were five complications: one (stiffness) among patients with fracture sequelae and four among those with failed HH (instability, n = 2; humeral component disassembly, n = 1; pain, n = 1). The two groups did not exhibit significant differences in pain, clinical scores or ROM. Discussion: RTSA with an all-polyethylene glenosphere may have the potential to reduce the risk of biological notching due to polyethylene osteolysis. Further long-term studies are required to assess its efficacy. Conclusions: The good clinical performance and reasonable rate of notching of the polyethylene glenosphere support its use in primary and revision shoulder arthroplasty. Level of evidence: Level 4, retrospective therapeutic case series.
2017
- Glenohumeral and scapulohumeral kinematic analysis of patients with traumatic anterior instability wearing a shoulder brace: a prospective laboratory study
[Articolo su rivista]
Dellabiancia, F.; Parel, I.; Filippi, M. V.; Porcellini, G.; Merolla, G.
abstract
Purpose: To assess the effectiveness of a novel glenohumeral joint immobilizer, the S2 Shoulder Stabilizer®, by evaluating shoulder kinematics with a stereophotogrammetry system. Methods: Participants in this prospective laboratory study were recruited from patients with anterior traumatic instability awaiting arthroscopic glenohumeral stabilization. Glenohumeral and scapulohumeral kinematic data (arm abduction–adduction and internal–external rotation, and scapular pronation–retraction and mediolateral rotation) were collected twice, without and with the brace, using a VICON™ motion capture system, and processed with MATLAB®software. Results: The tests showed a significantly lower joint angle during abduction–adduction (p = 0.0022) and external rotation (p = 0.0076) and a significantly lower (p = 0.0022) mediolateral scapular rotation angle in the limbs wearing the immobilizer. Humeral head translation during abduction–adduction and internal–external rotation was also lower in the patients wearing the brace. Conclusions: The immobilizer significantly limited joint excursion in all planes of movement except internal rotation. The narrower humeral head translation with respect to the trunk, measured in the tests with the brace, demonstrates that the immobilizer achieves the goal of preserving joint stability in the movements that are at risk of dislocation.
2017
- The Effect of Price on Surgeons’ Choice of Implants: A Randomized Controlled Survey
[Articolo su rivista]
Wasterlain, A. S.; Melamed, E.; Karia, R.; Capo, J. T.; Bello, R.; Adams, J.; Vochteloo, A. J. H.; Powell, A. J.; Marcus, A.; Andreas, P.; Miller, A. N.; Berner, A. B. A.; Altintas, B.; Sears, B. W.; Calfee, R. P.; Ekholm, C.; Fernandes, C. H.; Porcellini, G.; Jones, C.; Moreno-Serrano, C. L.; Manke, C.; Crist, B. D.; Haverkamp, D.; Hanel, D.; Merchant, M.; Rikli, D. A.; Shafi, M.; Patino, J. M.; Duncan, S. F.; Ballas, E. G.; Harvey, E.; Walbeehm, E. T.; Schumer, E. D.; Evans, P. J.; Suarez, F.; Lopez-Gonzalez, F.; Seibert, F. J.; DeSilva, G.; Bayne, G. J.; Guitton, T. G.; Nancollas, M.; Lane, L. B.; Westly, S. K.; Villamizar, H. A.; Pountos, I.; Hofmeister, E.; Biert, J.; Goslings, J. C.; Bishop, J.; Gillespie, J. A.; Grandi Ribeiro Filho, J. E.; Huang, J. I.; Nappi, J. F.; Rubio, J.; Scolaro, J. A.; Yao, J.; Chivers, K.; Jeray, K.; Lee, K.; Rumball, K. M.; Mica, L.; Adolfsson, L. E.; Borris, L. C.; Benson, L.; Austin, L. S.; Richard, M. J.; Kastelec, M.; Costanzo, R. M.; Kessler, M. W.; Palmer, M. J.; Pirpiris, M.; Grafe, M. W.; Akabudike, N. M.; Shortt, N. L.; Kanakaris, N. K.; Wilson, N.; Levy, O.; Althausen, P.; Lygdas, P.; Sancheti, P.; Parnes, N.; Krause, P.; Jebson, P.; Guenter, L.; Peters, R. W.; Ramli, R. M.; Shatford, R.; Rowinski, S.; Gilbert, R. S.; Kamal, R. N.; Zura, R. D.; Rodner, C.; Pesantez, R.; Ruch, D.; Kennedy, S. A.; Hurwit, S.; Kaplan, S.; Kronlage, S.; Meylaerts, S. A.; Omara, T.; Swiontkowski, M.; DeCoster, T.
abstract
Purpose Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons’ knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. Methods We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price (“price-aware” group), or a version without prices (“price-naïve” group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. Results For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). Conclusions Price awareness significantly influences surgeons’ choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons’ cost awareness. Type of study/level of evidence Economic/Decision Analyses I.
2016
- Anterior traumatic instability without glenoid bone loss
[Capitolo/Saggio]
Morey, V. M.; Porcellini, G.; Campi, F.; Paladini, P.; Merolla, G.
abstract
2016
- Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment
[Articolo su rivista]
Merolla, Giovanni; Singh, Sanjay; Paladini, Paolo; Porcellini, Giuseppe
abstract
Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.
2016
- Can posterior capsular stretching rehabilitation protocol change scapula kinematics in asymptomatic baseball pitchers?
[Articolo su rivista]
Pellegrini, A.; Tonino, P.; Salazar, D.; Hendrix, K.; Parel, I.; Cutti, A.; Paladini, P.; Ceccarelli, F.; Porcellini, G.
abstract
Purpose: Scapular dyskinesis is a recognized cause of shoulder pain in the throwing shoulder of baseball pitchers and athletes who participate in overhead sports. Past studies have assessed scapular kinematics using electromagnetic tracking devices and have shown a correlation between posterior shoulder tightness and forward scapular posture. The purpose of our study is to evaluate the scapular kinematics, before and after a 4-week posterior stretching protocol in asymptomatic pitchers. Method: Eleven asymptomatic collegiate baseball pitchers were involved in the study and divided into group A (6 pitchers) underwent 4 weeks of a regimented therapy protocol and group B (5 pitchers) did not receive any treatment. Each pitcher was tested on two separate days: at the first day of the study (S1) and after 4 weeks (S2). Results: The results demonstrate that there are statistically significant differences in the kinematics of several athletes from the “treated group” (group A) between S1 and S2. It is also important to notice that variations in group A occurred in both flexextension and ab/adduction movements, strengthening the conclusion that the variation was real. Conclusion: The results of the study can indicate that, in order to prevent the pathologic cascade linked to these sports activities, this physical training protocol might become integral part of the normal daily exercises of baseball pitchers and overhead athletes. Level of evidence II.
2016
- Clinical and Radiographic Mid-Term Outcomes After Total Shoulder Replacement: A Retrospective Study Protocol Including 400 Anatomical and Reverse Prosthetic Implants
[Articolo su rivista]
Merolla, Giovanni; Tartarone, Antonio; Porcellini, Giuseppe
abstract
To obtain outcomes data on anatomical and reverse total shoulder arthroplasty by analysis of clinical scores and standard radiographs.
2016
- Cross-cultural adaptation and validation of the Italian version of the Western Ontario Osteoarthritis of the Shoulder index (WOOS)
[Articolo su rivista]
Corona, Katia; Cerciello, Simone; Morris, Brent Joseph; Visonà, Enrico; Merolla, Giovanni; Porcellini, Giuseppe
abstract
Background: The Western Ontario Osteoarthritis of the Shoulder index (WOOS) has been introduced as a disease-specific quality of life measurement in patients with glenohumeral arthritis. The aim of the present study was to perform a cross-cultural adaptation of the English version of the WOOS to Italian and to assess its validity, reliability and responsiveness in patients with glenohumeral joint osteoarthritis treated conservatively. Material and methods: The adaptation process was carried out following the simplified Guillemin criteria. The English version was translated into Italian by two bilingual orthopaedic surgeons and then translated back into English by two different bilingual orthopaedic surgeons. The original version was compared with the back-translation. The questionnaire was prospectively administered to 30 patients with glenohumeral osteoarthritis at baseline and again after 5 days for retest reliability. After 6 months of conservative treatment, the responsiveness of the questionnaire was assessed in a subsample of 20 patients. The level of statistical significance was set at 0.05. Results: The interclass correlation coefficient between test and retest of the WOOS was 0.99 (P < 0.001). Pearson’s correlation coefficient between the WOOS and disability of the arm, shoulder and hand (DASH) preoperatively was 0.73 (P < 0.01) and the correlation between the changes of score for the WOOS and DASH was 0.75 (P < 0.01). There were no floor or ceiling effects. Responsiveness, calculated by standardized response mean, was 1.1 and effect size was 1.3. Conclusions: The Italian version of the WOOS questionnaire has shown to be equivalent to its English version and demonstrated good validity, reliability and responsiveness to conservative treatment of glenohumeral osteoarthritis. Level of evidence: Level II.
2016
- Endoscopic approach to cubital tunnel syndrome
[Capitolo/Saggio]
Campi, F.; Merolla, G.; Paladini, P.; Porcellini, G.
abstract
2016
- Evaluation of UCL by ultrasound
[Capitolo/Saggio]
Merolla, G.; Porcellini, G.; Bullitta, G.; Giannicola, G.
abstract
2016
- Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation
[Articolo su rivista]
Claessen, F. M. A. P.; Stoop, N.; Ring, D.; Doornberg, J. N.; Guitton, T. G.; van den Bekerom, M. P. J.; Spoor, A. B.; Chauhan, A.; Wahegaonkar, A. L.; Shafritz, A. B.; Garcia G, A. E.; Miller, A. N.; Barquet, A.; Kristan, A.; Apard, T.; Armstrong, A. D.; Berner, A.; Jubel, A.; Kreis, B. E.; Babis, C. G.; Sutker, B.; Sears, B. W.; Nolan, B. M.; Crist, B. D.; Cross, B. J.; Wills, B. P.; Barreto, C. J.; Ekholm, C.; Swigart, C.; Oliveira Miranda, C. D.; Manke, C.; Zalavras, C.; Goldfarb, C. A.; Cassidy, C.; Walsh, C. J.; Jones, C. M.; Garnavos, C.; Young, C.; Moreno-Serrano, C. L.; Lomita, C.; Klostermann, C.; van Deurzen, D. F.; Rikli, D. A.; Polatsch, D.; Beingessner, D.; Drosdowech, D.; Eygendaal, D.; Patel, M.; Brilej, D.; Walbeehm, E. T.; Ballas, E. G.; Ibrahim, E. F.; Melamed, E.; Stojkovska Pemovska, E.; Hofmeister, E.; Hammerberg, E. M.; Kaplan, F. T.; Suarez, F.; Fernandes, C. H.; Lopez-Gonzalez, F.; Walter, F. L.; Frihagen, F.; Kraan, G. A.; Kontakis, G.; Dyer, G. S.; Kohut, G.; Panagopoulos, G.; Hernandez, G. R.; Porcellini, G.; Bayne, G. J.; Merrell, G.; Desilva, G.; Della Rocca, G. J.; Bamberger, H. B.; Broekhuyse, H.; Durchholz, H.; Kodde, I. F.; Mcgraw, I.; Harris, I.; Pountos, I.; Wiater, J. M.; Choueka, J.; Kazanjian, J. E.; Gillespie, J. A.; Biert, J.; Fanuele, J. C.; Johnson, J. W.; Greenberg, J. A.; Abrams, J.; Hall, J.; Fischer, J.; Scheer, J. H.; Itamura, J.; Capo, J. T.; Braman, J.; Rubio, J.; Ortiz, J. A.; Filho, J. E.; Nolla, J.; Abboud, J.; Conflitti, J. M.; Abzug, J. M.; Patino, J. M.; Rodriguez Roiz, J. M.; Adams, J.; Bishop, J.; Kabir, K.; Chivers, K.; Prommersberger, K.; Egol, K.; Rumball, K. M.; Dickson, K.; Jeray, K.; Poelhekke, L. M.; Campinhos, L. A.; Mica, L.; Borris, L. C.; Adolfsson, L. E.; Schulte, L. M.; Elmans, L.; Lane, L. B.; Paz, L.; Taitsman, L.; Guenter, L.; Austin, L. S.; Waseem, M.; Palmer, M. J.; Abdel-Ghany, M. I.; Richard, M. J.; Rizzo, M.; Pirpiris, M.; Di Micoli, M.; Bonczar, M.; Loebenberg, M. I.; Richardson, M.; Mormino, M.; Menon, M.; Soong, M.; Wood, M. M.; Meylaerts, S. A.; Darowish, M.; Nancollas, M.; Prayson, M.; Grafe, M. W.; Kessler, M. W.; Kaminaris, M. D.; Pirela-Cruz, M. A.; Mckee, M.; Merchant, M.; Tyllianakis, M.; Shafi, M.; Powell, A. J.; Shortt, N. L.; Felipe, N. E.; Parnes, N.; Bijlani, N.; Elias, N.; Akabudike, N. M.; Rossiter, N.; Lasanianos, N. G.; Kanakaris, N. K.; Brink, O.; van Eerten, P. V.; Paladini, P.; Martineau, P. A.; Appleton, P.; Levin, P.; Althausen, P.; Evans, P. J.; Jebson, P.; Krause, P.; Schandelmaier, P.; Peters, A.; Dantuluri, P.; Blazar, P.; Andreas, P.; Inna, P.; Quell, M.; Ramli, R. M.; de Bedout, R.; Ranade, A. B.; Ashish, S.; Smith, R. M.; Babst, R. H.; Omid, R.; Buckley, R.; Jenkinson, R.; Gilbert, R. S.; Page, R. S.; Papandrea, R.; Zura, R. D.; Gray, R. L.; Wagenmakers, R.; Pesantez, R.; van Riet, R.; Calfee, R. P.; van Helden, S. H.; Bouaicha, S.; Kakar, S.; Kaplan, S.; Scott, F. D.; Kaar, S. G.; Mitchell, S.; Rowinski, S.; Dodds, S.; Kennedy, S. A.; Beldner, S.; Schepers, T.; Guitton, T. G.; Gosens, T.; Baxamusa, T.; Taleb, C.; Tosounidis, T.; Wyrick, T.; Begue, T.; Decoster, T.; Dienstknecht, T.; Varecka, T. F.; Mittlmeier, T.; Fischer, T. J.; Chesser, T.; Omara, T.; Bafus, T.; Siff, T.; Havlicek, T.; Sabesan, V. J.; Nikolaou, V. S.; Philippe, V.; Giordano, V.; Vochteloo, A. J.; Batson, W. A.; Hammert, W. C.; Satora, W.; Weil, Y.; Ruch, D.; Marsh, L.; Swiontkowski, M.; Hurwit, S.
abstract
Purpose Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. Methods A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. Results The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. Conclusions When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. Type of study/level of evidence Diagnostic III.
2016
- Latarjet procedure: is the coracoid enough to restore the glenoid surface?
[Articolo su rivista]
Paladini, Paolo; Singla, Rohit; Merolla, Giovanni; Porcellini, Giuseppe
abstract
Purpose: The aim of this study was to establish whether anterior glenoid bone loss in patients with large glenoid rim defects can be restored with a coracoid graft (Latarjet procedure). Methods: A total of 143 consecutive patients with chronic anterior shoulder instability and glenoid bone deficiency were treated in 2013. A pre-operative computed tomography (CT) scan using the PICO method was obtained to estimate anterior glenoid rim erosion. The 23 patients with anterior glenoid deficiency exceeding 20 % were included in the study. A post-operative CT scan was obtained to establish whether coracoid transfer had fully restored the glenoid surface. Results: Mean bone loss was 26 ± 3.9 % of the glenoid surface (range 20–34 %) compared with the contralateral glenoid. Mean coracoid dimensions were 26.3 ± 2.9 mm × 7.6 ± 0.65 mm. The graft successfully restored the glenoid surface in all patients (mean filling, 102.4 ± 0.8 %). Discussion: The Latarjet procedure is a valuable approach to treat patients with chronic shoulder instability and glenoid deficiency. Conclusion: Coracoid transfer restored the glenoid surface even in patients with large defects. The Eden-Hybinette technique seems to be more appropriate for revision surgery and for patients with a failed Latarjet procedure.
2016
- Metallosis in shoulder arthroplasty: an integrative review of literature
[Articolo su rivista]
Gogna, Paritosh; Paladini, Paolo; Merolla, Giovanni; Augusti, Carlo Alberto; Maddalena, De Falco; Porcellini, Giuseppe
abstract
Shoulder arthroplasty has gained popularity as an efficient means of achieving pain relief and improved function in a variety of complex shoulder disorders. Despite promising reports, given the increasing number of shoulder arthroplasty procedures, various causes that may contribute to failure of a well-functioning arthroplasty are being increasingly recognized. One such disastrous condition is metallosis, a subject which has not been much talked off with reference to shoulder arthroplasty. This article besides reviewing the existing literature intends to discuss the possible causes that contribute to metallosis and devise a protocol for its timely diagnosis and management.
2016
- The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure
[Articolo su rivista]
Cutti, Andrea Giovanni; Parel, Ilaria; Pellegrini, Andrea; Paladini, Paolo; Sacchetti, Rinaldo; Porcellini, Giuseppe; Merolla, Giovanni
abstract
The Constant–Murley score (CMS) is a popular measure of shoulder function. However, its ability to monitor the evolution of patients during rehabilitation after rotator-cuff repair is controversial. Moreover, CMS does not account for possible alterations in the scapulo-humeral coordination (SHC, scapula dyskinesis), which are apparent in variety of shoulder pathologies. To address these issues, a new formulation of CMS was firstly proposed, which rates the “affected-to-controlateral side difference in SHC” of a patient with respect to reference values of asymptomatic controls (Scapula-Weighted CMS). Then, 32 patients (53 ± 9 year-old) were evaluated with CMS and SW-CMS at 45, 70, 90-day and >6-month after rotator-cuff repair, to test three hypotheses: (1) CMS and SW-CMS are largely responsive to change; (2) accounting (SW-CMS) or not (CMS) for scapula dyskinesis leads to statistically different scores and SW-CMS cannot be predicted from CMS without clinically relevant differences; (3) 90% of patients recover a side-to-side SHC similar to asymptomatic controls at 90 days. Results supported hypotheses 1 and 2. On the contrary (hypothesis 3), only 10% of patients recovered for SHC alterations at 90 days, and 50% at follow-up. These findings support the use of SW-CMS and the importance of treating scapula dyskinesis after rotator-cuff repair.
2016
- The Porcellini test: a novel test for accurate diagnosis of posterior labral tears of the shoulder: comparative analysis with the established tests
[Articolo su rivista]
Morey, V. M.; Singh, H.; Paladini, P.; Merolla, G.; Phadke, V.; Porcellini, G.
abstract
Questions/purposes: Although the posterior labral tears of the shoulder are known for their disabling clinical course, especially in overhead athletes, no clinical test used in isolation can diagnose it accurately in the preoperative period. We wanted to: (1) introduce “Porcellini test” with its radiological verification furnishing the anatomical basis of its mechanism; (2) determine its accuracy; and (3) compare its accuracy with that of the other established tests for diagnosing posterior labral tears of the shoulder. Methods: To determine the anatomical basis, we initially performed radiological verification of our test. Then, we evaluated its accuracy in a retrospective case-controlled study on 310 consecutive patients who underwent shoulder arthroscopic procedures at our hospital between January 2013 and December 2013. All patients were examined preoperatively for Porcellini test, and the presence of posterior labral tear was confirmed on arthroscopy. Later, in a cohort study on 91 consecutive patients who underwent shoulder arthroscopic procedures, we compared its accuracy with O’Brien’s test, the Kim test, the Jerk test, and the Load and Shift test. The accuracy was interpreted in terms of sensitivity, specificity, and predictive values. Results: The radiological verification conferred the anatomical basis for the mechanism of the Porcellini test. This new test showed high accuracy for posterior labral tears with sensitivity of 100 %, specificity of 99.3 %, the positive and negative predictive values of 92.6 and 100 %, respectively. Also, it had superior accuracy results than every other test. The interexaminer reliability for all test results was found to be >0.80. Conclusions: We propose “Porcellini test” as a simple, accurate, reproducible, and reliable test for the preoperative diagnosis of posterior labral tears of shoulder.
2016
- Total shoulder arthroplasty with a secondgeneration tantalum trabecular metal-backed glenoid component
[Articolo su rivista]
Merolla, G.; Chin, P.; Sasyniuk, T. M.; Paladini, P.; Porcellini, G.
abstract
Aims We evaluated clinical and radiographic outcomes of total shoulder arthroplasty (TSA) using the second-generation Trabecular Metal (TM) Glenoid component. The first generation component was withdrawn in 2005 after a series of failures were reported. Between 2009 and 2012, 40 consecutive patients with unilateral TSA using the second-generation component were enrolled in this clinical study. The mean age of the patients was 63.8 years (40 to 75) and the mean follow-up was 38 months (24 to 42). Methods Patients were evaluated using the Constant score (CS), the American Shoulder and Elbow Surg.s (ASES) score and routine radiographs. Results Significant differences were found between the pre-And post-operative CS (p = 0.003), ASES (p = 0.009) scores and CS subscores of pain (p < 0.001), strength (p < 0.001) and mobility items (p < 0.05). No glenoid or humeral components migrated. Posterior thinning of the keel and slight wear at the polyethylene-TM interface was observed in one patient but was asymptomatic. Radiolucent lines were found around three humeral (< 1.5 mm) and two glenoid components (< 1 mm) and all were asymptomatic. Discussion TSA with the second-generation TM Glenoid component results in satisfactory to excellent clinical performance, function, and subjective satisfaction at a mean follow-up of about three years. Radiographic changes were few and did not affect the outcome. Take home message: This paper highlights that the second generation Trabecular Metal Glenoid has better outcomes than those reported with the first-generation component.
2016
- Total shoulder replacement using a bone ingrowth central peg polyethylene glenoid component: a prospective clinical and computed tomography study with short- to mid-term follow-up
[Articolo su rivista]
Merolla, Giovanni; Ciaramella, Giovanni; Fabbri, Elisabetta; Walch, Gilles; Paladini, Paolo; Porcellini, Giuseppe
abstract
Aim of the study: To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC). Methods: Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45–75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24–39). Early and late follow-up CT scans were available for 21/30 shoulders. Results: Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p < 0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p < 0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p < 0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05). Discussion: The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth. Conclusions: The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.
2016
- Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review
[Articolo su rivista]
Colzani, Giulia; Tos, Pierluigi; Battiston, Bruno; Merolla, Giovanni; Porcellini, Giuseppe; Artiaco, Stefano
abstract
The extensor apparatus is a complex muscle-tendon system that requires integrity or optimal reconstruction to preserve hand function. Anatomical knowledge and the understanding of physiopathology of extensor tendons are essential for an accurate diagnosis of extensor tendon injuries (ETIs) of the hand and wrist, because these lesions are complex and commonly observed in clinical practice. A careful clinical history and assessment still remain the first step for the diagnosis, followed by US and MR to confirm the suspect of ETI or to investigate some doubtful conditions and rule out associate lesions. During last decades the evolution of surgical techniques and rehabilitative treatment protocol led to gradual improvement in clinical results of ETI treatment and surgical repair. Injury classification into anatomical zones and the evaluation of the characteristics of the lesions are considered key points to select the appropriate treatment for ETI. Both conservative and surgical management can be indicated in ETI, depending on the anatomical zone and on the characteristics of the injuries. As a general rule, an attempt of conservative treatment should be performed when the lesion is expected to have favorable result with nonoperative procedure. Many surgical techniques have been proposed over the time and with favorable results if the tendon injury is not underestimated and adequately treated. Despite recent research findings, a lack of evidence-based knowledge is still observed in surgical treatment and postoperative management of ETI. Further clinical and biomechanical investigations would be advisable to clarify this complex issue.
2016
- Triceps repair
[Capitolo/Saggio]
Giannicola, G.; Bullitta, G.; Sacchetti, F. M.; Scacchi, M.; Merolla, G.; Porcellini, G.
abstract
2015
- Anterior Glenoid Rim Fracture Following Use of Resorbable Devices for Glenohumeral Stabilization
[Articolo su rivista]
Augusti, Carlo Alberto; Paladini, Paolo; Campi, Fabrizio; Merolla, Giovanni; Bigoni, Marco; Porcellini, Giuseppe
abstract
Background Resorbable anchors are widely used in arthroscopic stabilization of the shoulder as a means of soft tissue fixation to bone. Their function is to ensure repair stability until they are replaced by host tissue. Complications include inflammatory soft tissue reactions, cyst formation, screw fragmentation in the joint, osteolytic reactions, and enhanced glenoid rim susceptibility to fracture. Purpose To evaluate resorption of biodegradable screws and determine whether they induce formation of areas with poor bone strength that may lead to glenoid rim fracture even with minor trauma. Study Design Case series; Level of evidence, 4. Methods This study evaluated 12 patients with anterior shoulder instability who had undergone arthroscopic stabilization with the Bankart technique and various resorbable anchors and subsequently experienced redislocation. The maximum interval between arthroscopic stabilization and the new dislocation was 52 months (mean, 22.16 months; range, 12-52 months). The mean patient age was 31.6 years (range, 17-61 years). The persistence or resorption of anchor holes; the number, area, and volume of osteolytic lesions; and glenoid erosion/fracture were assessed using computed tomography scans taken after redislocation occurred. Results Complete screw resorption was never documented. Osteolytic lesions were found at all sites (mean diameter, 5.64 mm; mean depth, 8.09 mm; mean area, 0.342 cm2; mean volume, 0.345 cm3), and all exceeded anchor size. Anterior glenoid rim fracture was seen in 9 patients, even without high-energy traumas (75% of all recurrences). Conclusion Arthroscopic stabilization with resorbable devices is a highly reliable procedure that is, however, not devoid of complications. In all 12 patients, none of the different implanted anchors had degraded completely, even in patients with longer follow-up, and all induced formation of osteolytic areas. Such reaction may lead to anterior glenoid rim fracture according to the literature and as found in 75% of the study patients with local osteolysis (9/12). Reducing anchor number and/or size may reduce the risk of osteolytic areas and anterior glenoid rim fracture.
2015
- Apixaban versus enoxaparin in elective major orthopedic surgery: A clinical review
[Articolo su rivista]
Maniscalco, P.; Caforio, M.; Imberti, D.; Porcellini, G.; Benedetti, R.
abstract
Despite current guidelines recommendations about anticoagulant prophylaxis, many studies have shown an high venous thromboembolism (VTE) incidence in patients undergoing total hip and knee arthroplasty. A number of anticoagulants are currently available, but they have some limitations that affect their applicability and consequently their effectiveness. Several new oral anticoagulants (NOACs) have been developed in an attempt to overcome these limitations. Apixaban is a NOAC that selectively inhibits the coagulation factor Xa; it is approved for the prevention of VTE after total hip replacement and total knee replacement surgery. This review examines the results of main trials designed to test efficacy and safety of apixaban in major elective orthopedic surgery.
2015
- Arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis: a retrospective blinded cohort study with minimum 24-month follow-up
[Articolo su rivista]
Merolla, G.; Buononato, C.; Chillemi, C.; Paladini, P.; Porcellini, G.
abstract
Background: Elbow osteoarthritis (OA) is a degenerative condition which in the advanced stage can severely impair joint mobility. Conservative treatment remains the first choice; surgery should be considered in case of failure in patients prepared to adhere to a demanding rehabilitation protocol. We assess the effectiveness of arthroscopic joint debridement and capsular release in a series of patients with primary and post-traumatic elbow arthritis. Materials and methods: Forty-eight subjects (40 males, eight females; mean age 48 years) with a preoperative diagnosis of primary (19, 40 %) or post-traumatic OA (29, 60 %) were evaluated at a mean follow-up of 44 months. Outcome measures were active range of motion (ROM), pain score, Oxford elbow score (OES), and Mayo elbow performance score (MEPS). OA severity was graded into three classes (I–III) based on X-ray findings. Statistical significance was set at 5 %. Results: At the final follow-up evaluation, active flexion/extension increased significantly (p < 0.01); pronation and supination improved, but the difference was not significant (p > 0.05). The pain score improved from 7.2 to 4.3 (p < 0.01). Both OES and MEPS improved significantly (p < 0.001). Patients with post-traumatic OA had better ROM (p = 0.0391) and clinical scores (OES, p = 0.011; MEPS, p = 0.010). ROM and clinical scores were lower but not significantly so in class II than in class I patients. A smooth coronoid and olecranon fossa was found in 38 (79 %) patients and a preserved ulnotrochlear joint space in 40 (80 %). Conclusions: Elbow OA has become more common as a result of earlier diagnosis and an increased number of acute injuries involving the joint. Arthroscopy is an effective technique to treat OA which provides the best results with the correct indications. Prospective studies are needed to help develop guidelines enabling selection of the best treatment option.
2015
- Co-analgesic therapy for arthroscopic supraspinatus tendon repair pain using a dietary supplement containing Boswellia serrata and Curcuma longa: a prospective randomized placebo-controlled study
[Articolo su rivista]
Merolla, G.; Dellabiancia, F.; Ingardia, A.; Paladini, P.; Porcellini, G.
abstract
Background: The cuff tendon that is most prone to full-thickness rotator cuff tears is the supraspinatus (SSP). Arthroscopic SSP repair ensures good to satisfactory mid- to long-term clinical outcomes. However, the intense postoperative pain reduces rehabilitation compliance and is cause of patient dissatisfaction. Many natural compounds act by inhibiting inflammatory pathways in a similar way to anti-inflammatory drugs Materials and methods: This was a prospective randomized trial designed to assess the analgesic effect of a dietary supplement (DS) containing Boswellia serrata and Curcuma longa in a population of subjects with full-thickness SSP tendon tear treated by arthroscopy. Three weeks before surgery, patients were randomized to receive Tendisulfur® (group T) or a placebo (group P) for 2 months. The primary outcome measure was subjective VAS pain. Secondary outcomes measures were Constant–Murley score simple shoulder test, and patient global assessment (PGA) scores. Patients were assessed immediately at baseline and subsequently at 1, 2, 4, 6, 8, 12, and 24 weeks. Results: Stratification of pain scores and subscores demonstrated significantly lower overall pain scores in group T versus group P at 1 week (p = 0.0477), and lower but not significantly different scores on week 2 (p = 0.0988); at subsequent time points, differences were not significant (p > 0.05). PGA scores were good in all subjects. Conclusions: In conclusion, this study provides objective data on the effect of a DS containing natural substances, added to standard analgesics, on postoperative RC pain. DS alleviated short and partially mid-term pain, while long-term pain was unchanged. This limitation can probably be addressed by a dosage increase over the first 4 weeks and by extending treatment by 1 or 2 months.
2015
- Complications of calcific tendinitis of the shoulder: a concise review
[Articolo su rivista]
Merolla, Giovanni; Bhat, Mahendar G.; Paladini, Paolo; Porcellini, Giuseppe
abstract
Abstract: Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient. Level of evidence: 5.
2015
- Do surgeons treat their patients like they would treat themselves?
[Articolo su rivista]
Janssen, S. J.; Teunis, T.; Guitton, T. G.; Ring, D.; Spoor, A. B.; Chauhan, A.; Shafritz, A. B.; Wasterlain, A.; Terrono, A. L.; Neviaser, A. S.; Schmidt, A.; Nelson, A.; Miller, A. N.; Kristan, A.; Apard, T.; Berner, A.; Ilyas, A.; Jubel, A.; Jost, B.; Babis, G.; Watkins, B.; Kreis, B.; Sears, B. W.; Nolan, B. M.; Crist, B. D.; Cross, B. J.; Wills, B. P. D.; Barreto, C. J. R.; Ekholm, C.; Swigart, C.; Spath, C.; Zalavras, C.; Cassidy, C.; Garnavos, C.; Young, C.; Moreno-Serrano, C. L.; Rodner, C.; Klostermann, C.; Osei, D. A.; Rikli, D. A.; Haverkamp, D.; Polatsch, D.; Drosdowech, D.; Edelstein, D. M.; Eygendaal, D.; Mckee, D. M.; Van Deurzen, D.; Verbeek, D. O. F.; Patel, M.; Brilej, D.; Walbeehm, E. T.; Pemovska, E. S.; Hofmeister, E.; Twiss, E. L. L.; Hammerberg, E. M.; Schumer, E. D.; Kaplan, F. T. D.; Suarez, F.; Fernandes, C. H.; Lopez-Gonzalez, F.; Walter, F. L.; Seibert, F. J.; Frihagen, F.; Kraan, G.; Gadbled, G.; Huemer, G. M.; Kohut, G.; Porcellini, G.; Garrigues, G.; Bayne, G. J.; Desilva, G.; Bamberger, H. B.; Grunwald, H. W.; Goost, H.; Broekhuyse, H.; Durchholz, H.; Routman, H. D.; Kodde, I. F.; Mcgraw, I.; Harris, I.; Lin, I. C.; Choueka, J.; Kazanjian, J. E.; Gillespie, J. A.; Biert, J.; Greenberg, J. A.; Abrams, J.; Wint, J.; Giuffre, J. L.; Wolf, J. M.; Overbeck, J. P.; Doornberg, J. N.; Scheer, J. H.; Itamura, J.; Erickson, J. M.; Mcauliffe, J.; Capo, J. T.; Taras, J.; Braman, J.; Rubio, J.; Filho, J. E. G. R.; Abboud, J.; Conflitti, J. M.; Abzug, J. M.; Patino, J. M.; Roiz, J. M. R.; Adams, J.; Bishop, J.; Kabir, K.; Zyto, K.; Lee, K.; Eng, K.; Rumball, K. M.; Erol, K.; Dickson, K.; Jeray, K.; Bainbridge, C.; Poelhekke, L.; Van Minnen, P.; Mica, L.; Borris, L. C.; Adolfsson, L. E.; Weiss, L.; Schulte, L. M.; Lane, L. B.; Paz, L.; Taitsman, L.; Guenter, L.; Catalano, L.; Campinhos, L. A. B.; Austin, L. S.; Lygdas, P.; Waseem, M.; Palmer, M. J.; Krijnen, M. R.; Abdel-Ghany, M. I.; Swiontkowski, M.; Rizzo, M.; Oidtmann, M.; Pirpiris, M.; Bonczar, M.; Loebenberg, M. I.; Boyer, M.; Richardson, M.; Mormino, M.; Menon, M.; Calcagni, M.; Beaumont-Courteau, M.; Soong, M.; Wood, M. M.; Meylaerts, S. A.; Darowish, M.; Nancollas, M.; Prayson, M.; Quinn, M.; Grafe, M. W.; Kessler, M. W.; Van Den Bekerom, M. P. J.; Ruiz-Suarez, M.; Pirela-Cruz, M. A.; Mckee, M.; Merchant, M.; Tyllianakis, M.; Shafi, M.; Felipe, N. E. L.; Parnes, N.; Chen, N. C.; Wilson, N.; Elias, N.; Akabudike, N. M.; Horangic, N. J.; Shortt, N. L.; Schep, N.; Rossiter, N.; Kanakaris, N. K.; Brink, O.; Van Eerten, P. V.; Paladini, P.; Melvanki, P.; Sancheti, P.; Althausen, P.; Giannoudis, P.; Hahn, P.; Evans, P. J.; Jebson, P.; Kloen, P.; Krause, P.; Brink, P. R. G.; Schandelmaier, P.; Peters, A.; Dantuluri, P.; Blazar, P.; Muhl, P.; Andreas, P.; Choudhari, P.; Inna, P.; Benhaim, P.; Quell, ; Gaston, R. G.; Haverlag, R.; Mohd Ramli, R.; Costanzo, R. M.; De Bedout, R.; Ranade, A.; Hauck, R.; Smith, R. M.; Babst, R. H.; Jenkinson, R.; Hutchison, R. L.; Gilbert, R. S.; Page, R. S.; Wallensten, R.; Papandrea, R.; Zura, R. D.; Slater, R. R.; Gray, R. R. L.; Wagenmakers, R.; Pesantez, R.; Hackney, R. G.; Van Riet, R.; Calfee, R. P.; Mehta, S.; Bouaicha, S.; Spruijt, S.; Kakar, S.; Kaplan, S.; Duncan, S. F.; Kaar, S. G.; Mitchell, S.; Rowinski, S.; Van Helden, S.; Jacoby, S. M.; Kennedy, S. A.; Westly, S. K.; Beldner, S.; Morgan, S. J.; Sulkers, G.; Schepers, T.; Gosens, T.; Baxamusa, T.; Tosounidis, T.; Wyrick, T.; Begue, T.; Decoster, T.; Dienstknecht, T.; Varecka, T. F.; Higgins, T.; Fischer, T. J.; Mittlmeier, T.; Wright, T.; Chesser, T.; Omara, T.; Siff, T.; Havlifcek, T.; Neuhaus, V.; Sabesan, V. J.; Nikolaou, V. S.; Verhofstad, M.; Giordano, V.; Iyer, V. M.; Vochteloo, A.; Batson, W. A.; Hammert, W. C.; Belangero, W. D.; Satora, W.; Weil, Y.; Balogh, Z.
abstract
Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery.Onewould expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. Questions/purposes (1) Are surgeons more likely to recommend surgery when choosing for a patient than for themselves? (2) Are surgeons less confident in deciding for patients than for themselves? Methods Two hundred fifty-four (32%) of 790 Science of Variation Group (SOVG) members reviewed 21 fictional upper extremity cases (eg, distal radius fracture, De Quervain tendinopathy) for which surgery is optional answering two questions: (1) What treatment would you choose/recommend: operative or nonoperative? (2) On a scale from 0 to 10, how confident are you about this decision? Confidence is the degree that one believes that his or her decision is the right one (ie, most appropriate). Participants were orthopaedic, trauma, and plastic surgeons, all with an interest in treating upper extremity conditions. Half of the participants were randomized to choose for themselves if they had this injury or illness. The other half was randomized to make treatment recommendations for a patient of their age and gender. For the choice of operative or nonoperative, the overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the number of cases they would operate on by the total number of cases (n = 21), where 100% is when every surgeon recommended surgery for every case. For confidence, we calculated the mean confidence for all 21 cases per surgeon; overall score ranges from 0 to 10 with a higher score indicating more confidence in the decision for treatment. Results Surgeons were more likely to recommend surgery for a patient (44.2% ± 14.0%) than they were to choose surgery for themselves (38.5% ± 15.4%) with a mean difference of 6% (95% confidence interval [CI], 2.1%-9.4%; p = 0.002). Surgeons were more confident in deciding for themselves than they were for a patient of similar age and gender (self: 7.9 ± 1.0, patient: 7.5 ± 1.2, mean difference: 0.35 [CI, 0.075-0.62], p = 0.012). Conclusions Surgeons are slightly more likely to recommend surgery for a patient than they are to choose surgery for themselves and they choose for themselves with a little more confidence. Different perspectives, preferences, circumstantial information, and cognitive biases might explain the observed differences. This emphasizes the importance of (1) understanding patients' preferences and their considerations for treatment; (2) being aware that surgeons and patients might weigh various factors differently; (3) giving patients more autonomy by letting them balance risks and benefits themselves (ie, shared decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help inform the patient and influences their decisional conflict.
2015
- Early anchor displacement after arthroscopic rotator cuff repair
[Articolo su rivista]
Skaliczki, Gábor; Paladini, Paolo; Merolla, Giovanni; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Methods: A total of 5,327 patients who had arthroscopic rotator cuff reconstruction for full thickness tear were included in the study. Radiographs taken immediately after surgery were observed and occurrent anchor displacement was recorded. Patient-specific, tendon-specific, bone-specific and implant-specific variables were studied. Any possible relationship between these factors and anchor displacement was investigated.Purpose: Arthroscopic rotator cuff repair is a success and became the mainstream method of reconstruction in recent years. Due to the technical development in shoulder surgery, novel suture anchors and high-strength sutures are widely used providing convincing fixation, however anchor pullout still remains a problem. The aim of our study was to observe early anchor movement on a large patient cohort, and identify clinical, biological and technical variables that can lead to this complication.Results: Early anchor movement occurred in six cases (0.1 %). The involvement of two or more tendons, retraction of the tendon by more than 2 cm and the use of four anchors was associated with higher incidence of anchor displacement, however the difference was not significant.Conclusions: Based on our study, anchor pullout occurring immediately after surgery is a relatively rare complication. Instead of timing the radiologic examination directly after the procedure, assessment of the anchors’ position four to six weeks after surgery should be considered.
2015
- Functional outcome and quality of life after rehabilitation for voluntary posterior shoulder dislocation: a prospective blinded cohort study
[Articolo su rivista]
Merolla, Giovanni; De Santis, Elisa; Cools, Ann M. J.; Porcellini, Giuseppe
abstract
Background: Voluntary posterior instability of the shoulder is a rare condition in which the patient is able to cause a subluxation by voluntary muscle activation. A shoulder rehabilitation program aimed to correct abnormal muscle patterns and restore correct scapular motion may provide good results and improve the quality of life of these patients.Methods: Fifteen subjects (six males, nine females; mean age 19 years) underwent physical examination and clinical tests [Disability of the Arm, Shoulder and Hand (DASH) score, Shoulder Pain and Disability Index (SPADI), and modified Rowe score] and compiled the patient global assessment (PGA). Articular or rotator cuff lesions were excluded by X-rays and MRI. The rehabilitation program included three phases: (1) assessment and correction of abnormal muscle patterns, (2) restoration of correct scapular motion, and (3) strengthening of scapular and posterior glenohumeral muscles. Follow-up was at 3, 6, 12, and 24 months.Results: DASH and SPADI scores improved significantly at 3 (p < 0.01), 6 (p < 0.009), 12 (p < 0.001), and 24 months (p < 0.001). The Rowe score was fair at 3 months and good at 6, 12, and 24 months. Active flexion, abduction, and external rotation increased at all follow-up points (p < 0.01), whereas internal rotation remained unchanged (p > 0.05). PGA values were high. Compliance was good without serious adverse events reported during the treatment. A correlation was found between age and DASH changes (Spearman’s ρ −0.56; p = 0.0455).Conclusions: Our findings stress the value of a rehabilitation program that teaches subjects with voluntary instability how to correct abnormal muscle patterns to restore scapular motion, and the importance of adopting home rehabilitation exercises as a part of the normal lifestyle.
2015
- Intra-articular glenohumeral injections of HYADD®4-G for the treatment of painful shoulder osteoarthritis: A prospective multicenter, open-label trial
[Articolo su rivista]
Porcellini, Giuseppe; Merolla, Giovanni; Giordan, Nicola; Paladini, Paolo; Burini, Andrea; Cesari, Eugenio; Castagna, Alessandro
abstract
Purpose: Numerous experimental and clinical studies in osteoarthritis (oA) have demonstrated that intraarticular (iA) administration of hyaluronic acid can improve the altered rheological properties of the synovial fluid and exert protective and reparative effects on the joint structure. the objective of this study was to evaluate the safety and performance of HYADD®4-G (Hymovis®) in patients with glenohumeral joint oA. Methods: Forty-one patients with shoulder pain and limited shoulder function resulting from concentric glenohumeral joint oA were enrolled in a multicenter clinical trial. Patients received two HYADD®4-G injections administered one week apart. the main outcome measure was improvement in shoulder pain on movement at six months as assessed through a 100-mm visual analog scale (VAs), range of motion (RoM) values, and Constant-Murley shoulder outcome score (CS). Results: Two iA injections of HYADD®4-G (Hy - movis®) significantly decreased pain and improved shoulder function for up to six months from the first injection. the VAs score decreased (from 66.1 mm to 37.7 mm at six months) and improvements were recorded in the total Cs and in the ROM values (rotation decreased from a mean value of 54.2° at baseline to 63.2° at six months and internal rotation from a mean value of 44.0° at baseline to 45.7° at 26 weeks). no serious adverse events occurred. Conclusions: The study results demonstrated that two IA injections of HYADD®4-G (Hymovis®) may be a safe and effective treatment option for shoulder pain associated with glenohumeral OA and that the effects of the injections are still present for up to six months after the treatment. Level of evidence: Level iV, therapeutic case series.
2015
- I.S.Mu.L.T - Rotator cuff tears guidelines
[Articolo su rivista]
Oliva, Francesco; Piccirilli, Eleonora; Bossa, Michela; Giai Via, Alessio; Colombo, Alessandra; Chillemi, Claudio; Gasparre, Giuseppe; Pellicciari, Leonardo; Franceschetti, Edoardo; Rugiero, Clelia; Scialdoni, Alessandro; Vittadini, Filippo; Brancaccio, Paola; Creta, Domenico; del Buono, Angelo; Garofalo, Raffaele; Franceschi, Francesco; Frizziero, Antonio; Mahmoud, Asmaa; Merolla, Giovanni; Nicoletti, Simone; Spoliti, Marco; Osti, Leonardo; Padulo, Johnny; Portinaro, Nicola; Tajana, Gianfranco; Castagna, Alex; Foti, Calogero; Masiero, Stefano; Porcellini, Giuseppe; Tarantino, Umberto; Maffulli, Nicola
abstract
Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.
2015
- Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies
[Articolo su rivista]
Merolla, Giovanni; Cerciello, Simone; Chillemi, Claudio; Paladini, Paolo; De Santis, Elisa; Porcellini, Giuseppe
abstract
Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. There is general agreement that the initial treatment should be conservative and that surgery should be reserved for patients who have not responded to an ad hoc rehabilitation program. We review the biomechanics, clinical presentation, and treatment strategies of shoulder MDI.
2015
- Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review
[Articolo su rivista]
Merolla, Giovanni; Dave, Arpit C.; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed.
2015
- Osteochondritis dissecans of the humeral capitellum: Reliability of four classification systems using radiographs and computed tomography
[Articolo su rivista]
Claessen, F. M. A. P.; van den Ende, K. I. M.; Doornberg, J. N.; Guitton, T. G.; Eygendaal, D.; van den Bekerom, M. P. J.; van der Lugt, J.; Schep, W. N.; Boerboom, L. A.; van der Pluim, M.; Wagener, M.; Beumer, A.; Kloen, P.; Keijser, M. C.; van Deurzen, D.; Mansat, P.; Somford, P. M.; Jaspars, C. C. J.; Kolovich, P. G.; Cheung, J.; van Tongel, A.; Blokzijl, R.; Heijnk, A.; Alta, T.; Lambers Heerspink, O.; van Deurzen-van Dijk, P.; van Noort, A.; Lisowski, L.; Ekholm, C.; Shafritz, A.; Garrigues, G.; Porcellini, G.; Mazzocca, A. D.; Kaar, G. S.; Duncan, S. F.; Patel, M.; Pati-no, M. J.; Paladini, P.
abstract
Background: The radiographic appearance of osteochondritis dissecans (OCD) of the humeral capitellum varies according to the stage of the lesion. It is important to evaluate the stage of OCD lesion carefully to guide treatment. We compared the interobserver reliability of currently used classification systems for OCD of the humeral capitellum to identify the most reliable classification system. Methods: Thirty-two musculoskeletal radiologists and orthopaedic surgeons specialized in elbow surgery from several countries evaluated anteroposterior and lateral radiographs and corresponding computed tomography (CT) scans of 22 patients to classify the stage of OCD of the humeral capitellum according to the classification systems developed by (1) Minami, (2) Berndt and Harty, (3) Ferkel and Sgaglione, and (4) Anderson on a Web-based study platform including a Digital Imaging and Communications in Medicine viewer. Magnetic resonance imaging was not evaluated as part of this study. We measured agreement among observers using the Siegel and Castellan multirater κ. Results: All OCD classification systems, except for Berndt and Harty, which had poor agreement among observers (κ = 0.20), had fair interobserver agreement: κ was 0.27 for the Minami, 0.23 for Anderson, and 0.22 for Ferkel and Sgaglione classifications. The Minami Classification was significantly more reliable than the other classifications (P < .001). Conclusions: The Minami Classification was the most reliable for classifying different stages of OCD of the humeral capitellum. However, it is unclear whether radiographic evidence of OCD of the humeral capitellum, as categorized by the Minami Classification, guides treatment in clinical practice as a result of this fair agreement.
2015
- Outcomes of Arthroscopic Hill-Sachs Remplissage and Anterior Bankart Repair: A Retrospective Controlled Study Including Ultrasound Evaluation of Posterior Capsulotenodesis and Infraspinatus Strength Assessment
[Articolo su rivista]
Merolla, Giovanni; Paladini, Paolo; di Napoli, Giuseppe; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Hill-Sachs lesions are compression fractures that result from shoulder dislocation. They involve “engaging” the humeral head on the anterior glenoid rim when the arm is abducted and externally rotated. The defect grows as the number of dislocations increases. Arthroscopic remplissage and anterior Bankart repair do not significantly affect infraspinatus strength while ensuring healing of the capsulotenodesis. Cohort study; Level of evidence, 3. Sixty-one patients with traumatic anterior shoulder instability treated by arthroscopic Bankart repair and Hill-Sachs remplissage at least 24 months previously were compared with a control group of 40 healthy participants. Preoperative imaging included magnetic resonance imaging for Bankart lesion identification and computed tomography to quantify the humeral head defect. Active range of motion and clinical scores (Walch-Duplay, Constant-Murley, and Rowe) were assessed. External rotation (ER) and internal rotation (IR) were measured with arm at the side (ER1 and IR1) and abducted at 90° (ER2 and IR2). Infraspinatus strength was assessed with the scapula free (infraspinatus strength test [IST]) and retracted (infraspinatus scapula retraction test [ISRT]). Infraspinatus tenodesis and posterior capsulodesis healing were evaluated by ultrasound (US). The follow-up median was 39.5 months (range, 24-56 months). One patient experienced a recurrence of instability at 34 months. In the remplissage patients, ER1 was significantly lower in the affected compared with the unaffected shoulder (P <.001). Mean IST and ISRT strength values did not show differences between sides. The mean Constant-Murley score rose from 62.9 ± 7.1 to 90 ± 5.2 (P <.0001). The Walch-Duplay and Rowe scores were excellent in 23 (78.6%), good in 6 (17.8%), and poor in 1 patient (both scores). The remplissage group had significantly lower ER1 (P <.001), ER2 (P <.001), and IR2 (P <.01) values compared with the control group. Differences in IST and ISRT between the groups were not significant. Capsulotenodesis healing and filling of the Hill-Sachs defect were confirmed by dynamic US in all subjects. Arthroscopic remplissage is a reliable approach to Hill-Sachs lesions. The ER and IR restriction does not significantly affect quality of life. Infraspinatus strength recovery is satisfactory even compared with healthy subjects. Ultrasound examination allows accurate evaluation of capsulotenodesis healing. © 2014, SAGE Publications. All rights reserved.
2015
- Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series
[Articolo su rivista]
Visonà, E.; Paladini, P.; Merolla, G.; Cerciello, S.; Porcellini, G.
abstract
Purpose: The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. Methods: Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. Results: All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention. Conclusions: Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing. Level of evidence: Level IV, therapeutic case series.
2015
- Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years
[Articolo su rivista]
Merolla, Giovanni; Paladini, Paolo; Artiaco, Stefano; Tos, Pierluigi; Lollino, Nicola; Porcellini, Giuseppe
abstract
Background: Pectoralis major (PM) tendon rupture is an uncommon injury whose incidence has risen in recent decades mainly as a result of the increasing number of sports-practising individuals. This study evaluates clinical and ultrasound (US) outcomes after surgical repair of acute and chronic PM tendon rupture. Materials and methods: Twelve men with PM tendon rupture (9 right and 3 left shoulders) were enrolled. Mean age was 34.6 years, and mean follow-up was 60 months (range 12–108). Rupture was diagnosed by magnetic resonance imaging. Eight patients underwent direct tendon repair (acute group) and 4 had allograft reconstruction (chronic group). Pain, range of motion, strength recovery and return to sports were assessed. Postoperative X-ray and US scans were obtained in all patients. Final outcomes were graded as excellent, good, fair or poor. Isometric strength in adduction/abduction, flexion, internal rotation (IR) and external rotation was recorded. Results: There were 9 excellent and 3 good outcomes. A comparative strength assessment failed to show significant differences in any plane. Mean strength was not significantly different between affected and unaffected arm. Slight but significantly lower strength in IR with the arm adducted (p = 0.0306) was found in chronic patients. On US, all PM tendons appeared to be anatomically intact and continuous with the humerus. Discussion: Prompt surgical repair ensures satisfactory outcomes in patients with complete PM rupture; however, delayed allograft repair provides good results with only slight strength impairment. Fresh insights are provided on the role of US in evaluating PM anatomy and tendon attachment to bone.
2015
- Venous Thromboembolism in Patients Undergoing Shoulder Arthroscopy: Findings From the RECOS Registry
[Articolo su rivista]
Imberti, Davide; Dentali, Francesco; Ivaldo, Nicola; Murena, Luigi; Paladini, Paolo; Castagna, Alessandro; Barillari, Giovanni; Guerra, Enrico; Tonello, Chiara; Castoldi, Filippo; Lazzaro, Fabio; Benedetti, Raffaella; Camporese, Giuseppe; Porcellini, Giuseppe
abstract
N/A
2014
- Arthroscopically assisted shoulder arthrodesis: Is it an effective technique?
[Articolo su rivista]
Porcellini, Giuseppe; Savoie, Felix H.; Campi, Fabrizio; Merolla, Giovanni; Paladini, Paolo
abstract
Purpose: The purpose of this study was to compare clinical and radiographic outcomes of open and mini-open arthroscopic arthrodesis. Methods: Twelve patients underwent arthroscopically assisted glenohumeral arthrodesis over a 5-year period; none were lost to follow-up. Surgery was performed with the patient in the lateral decubitus position, with the arm positioned in 30° each of flexion, internal rotation, and abduction. The articular cartilage was arthroscopically removed from the humerus and glenoid, creating flat opposing surfaces. One to 2 Kirschner wires were inserted percutaneously through the deltoid and across the glenohumeral joint in the center of the articulation; screws were then inserted arthroscopically. The glenohumeral joint was accessed through a mini-open posterior approach beneath the deltoid and was then reassessed before cannulated screws were tightened completely to compress the joint. Two dynamic compression plates were applied to the posterior glenohumeral joint to neutralize rotatory forces. Each patient was immobilized for 6 weeks. Follow-up radiographic imaging was performed at 2, 6, 12, and 24 months after surgery. These patients were then compared with a similar group who underwent a classic open approach. Success of arthrodesis was determined by bone growth across the glenohumeral joint as visualized on axillary radiographs. Results: At 2-year follow-up, complete fusion was achieved in 12 (100%) arthroscopically treated patients, with 2 patients (17%) having early bone grafting (within 6 weeks) through a percutaneous approach. Four patients in the classic open approach group ("open group") required additional grafting. Two patients in the group undergoing arthroscopic surgery ("arthroscopic group") had solid fusion but persisting infection from previously failed operations. Comparison of the 2 groups showed no difference in patient satisfaction or infection rates (2 in each group, all of whom had active infection at the time of the index surgery). One patient in the open group sustained a humeral shaft fracture 5 years after arthrodesis, which required additional surgery. No patient who underwent an arthroscopic procedure required additional surgery other than the 2 early bone grafts. Conclusions: Arthroscopically assisted mini-open glenohumeral arthrodesis provides results that are at least equal to those of open arthrodesis, with a much less invasive approach. Success and complication rates are the same as for the completely open procedure. Level of Evidence: Level IV, therapeutic case series.
2014
- Assessment of the ability of wheelchair subjects with spinal cord injury to perform a specific protocol of shoulder training: a pilot study
[Articolo su rivista]
Merolla, Giovanni; Dellabiancia, Fabio; Filippi, Maria Vittoria; De Santis, Elisa; Alpi, Daniele; Magrini, Paola; Porcellini, Giuseppe
abstract
a regular program of exercises in subjects with spinal cord injury (SCI) can contribute to reduce the risk of upper extremities injuries.
2014
- Computed tomography quantification of bone density adjacent to cemented pegged polyethylene glenoid components in shoulder arthroplasty
[Articolo su rivista]
Merolla, Giovanni; Amore, Barbara; Paladini, Paolo; Cavagna, Enrico; Porcellini, Giuseppe
abstract
Background: Cemented polyethylene devices are the prostheses implanted more frequently, but there is no agreement on the optimal glenoid component design. In this study, bone mineral density (BMD) adjacent to cemented all-polyethylene glenoid components was assessed to gain insights into the characteristics of glenoid bone as a potential risk factor implicated in the failure of shoulder arthroplasty. Patients and methods: Twenty-two subjects were examined at an average follow-up of 31 months using the Constant-Murley score (CS) and multi-detector computed tomography. BMD was measured in 5 regions of interest (ROIs) at the sites where radiolucent lines are usually detected. BMD differences among the ROIs were tested. The relationship between BMD and a number of variables (CS subscores, age, gender, follow-up duration) was explored. Results: There was a significant increase in CS scores (p < 0.05). Significantly different BMD (p = 0.0039) was found in the 5 ROIs, especially between ROIs 2 and 5 (p = 0.016, Bonferroni's test) and between ROIs 3 and 5 (p = 0.005, Bonferroni's test). BMD was lower in ROI 1 than ROI 3 and in ROI 2 than ROI 4, but the difference was not significant. Discussion: The heterogeneous BMD distribution may be related to: (1) an interindividual variability in glenoid BMD; (2) the fixation technique; or (3) the different bone response to eccentric loading of the prosthetic head on the glenoid component. Conclusions: BMD analysis may contribute to extent our knowledge on glenoid component loosening and encourage further techniques of glenoid fixation. © 2013 Springer-Verlag.
2014
- Efficacy, usability and tolerability of a dynamic elbow orthosis after collateral ligament reconstruction: a prospective randomized study
[Articolo su rivista]
Merolla, G.; Bianchi, P.; Porcellini, G.
abstract
Purpose: To assess the efficacy, usability and tolerability of a dynamic orthosis compared with a standard plaster splint after the reconstruction of elbow medial or lateral collateral ligaments (MCL, LCL).Methods: Twenty-six subjects undergoing MCL (n = 23) or LCL (n = 3) reconstruction were randomly assigned to immobilization with an orthosis (n = 13; group A “Innovator X”) or with a plaster splint (n = 13; group B “Plaster splint”). Outcome measures were visual analogue scale pain score, mid-arm (MA) circumference, grip strength, Oxford elbow score (OES) and range of motion (ROM). Patients were assessed at baseline and at 2, 6, 12 and 24 weeks.Results: Significant pain reduction was reported by all patients at 6, 12 and 24 weeks (p < 0.05). Mean MA circumference was significantly higher in group A at all time points (all p < 0.05). Mean grip strength was greater in group A on weeks 2 and 6 (p < 0.05), whereas the difference found on weeks 12 and 24 was not significant. The OES and passive ROM values of the two groups were not significantly different at any time point.Conclusions: The dynamic orthosis and the plaster splint both provided effective and safe elbow immobilization after MCL or LCL reconstruction. The orthosis provided greater pain reduction, faster recovery of muscle trophism and grip strength, and was better tolerated.
2014
- Elbow ulnar collateral ligament reconstruction: Clinical, radiographic, and ultrasound outcomes at a mean 3-year follow-up
[Articolo su rivista]
Merolla, G.; Del Sordo, S.; Paladini, P.; Porcellini, G.
abstract
Background: Ulnar collateral ligament (UCL) has the main function to be stress-resistant to elbow valgus overload. Multilayer tears require a reconstruction with a tendon graft. In this study, we report the clinical, radiographic, and ultrasound outcomes after tendon graft reconstruction for symptomatic UCL insufficiency. Materials and methods: Among twenty-six subjects underwent elbow UCL reconstruction from 2006 to 2012, fifteen were available to be evaluated at a mean follow-up of 36 months. Preoperative assessment included clinical examination and MRI. The outcome measures were the Mayo Elbow Performance Score (MEPS); the Oxford Elbow Score (OES); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Conway-Jobe Scale. Overall population was postoperatively investigated with X-ray and ultrasound (US). Reconstruction was performed with autograft (palmaris longus) in five cases and allograft (semitendinosus) in ten cases using the figure-of-eight configuration (five cases), the docking technique (eight cases), or a fixation with screws (two cases). Results: We found a significant improvement in postoperative MEPS, OES, and DASH scores (p < 0.01). One case was unsatisfied and required an additional procedure of ulnar nerve transposition 12 months after the reconstruction. X-ray showed calcifications along the graft in ten cases. At US examination, all the grafts assessed appeared anatomically intact without structural changes, and the dynamic examination showed a slight medial laxity with the valgus stress maneuver without pain or other sign of medial instability. Conclusions: This study confirms the efficacy of the graft reconstruction for chronic UCL insufficiency and introduces fresh insight on the role of musculoskeletal ultrasound to evaluate the reconstructed UCL. © 2014 Istituto Ortopedico Rizzoli.
2014
- Functional assesment of symptomatic snapping scapula after scapulothoracic arthroscopy: a prospective study protocol
[Articolo su rivista]
Merolla, Giovanni; Cerciello, Simone; Porcellini, Giuseppe
abstract
Giovanni Merolla Co-investigator: Giuseppe Porcellini Investigation performed at Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica - Italy PLAN OF CLINICAL INVESTIGATION (PCI): Version 1.0 of December 10, 2012 Approved by AV/IRST Ethical Committee (Comitato Etico Area Vasta Romagna) Reg. Sperimentazioni 914 Prot. N°: 1785/2013/I.5/46.
2014
- Gap formation in a transosseous rotator cuff repair as a function of bone quality
[Articolo su rivista]
Mantovani, M.; Baudi, P.; Paladini, P.; Pellegrini, A; Verdano, M. A.; Porcellini, G.; Catani, Fabio
abstract
Background The transosseous approach has been well known for a long time as a valid repair approach. Over time, various criticisms have been raised over this technique principally classifiable in two main categories: technical difficulty and related reproducibility in an arthroscopic environment, and repair stability (in the suture-bone contact area). About cyclic performance, several authors have conceived test setups with the aim of simulating a real environment in dynamic load conditions. The aim of this study was to monitor gap formation in a cyclic test setup. Methods The performance (measured as gap formation) has been monitored as a function of bone density to verify the effect of the latter. The test blocks have been shaped using sawbones® test bricks (Malmo, Sweden) of different densities, and the following values have been tested: 10, 15, 20, 30 and 40 pcf. Findings The comparison has been made between the two groups: traditional transosseous and new approach with an interposed device. Regarding the traditional transosseous approach in a 10-pcf environment, not even the first loading cycle was completed, the whole bone bridge was destroyed in the first loading ramp and no further loading capability was present in the repair. By increasing the block density, the surface damage in the suture-block contact decreased. Interpretation With this work, it has been demonstrated how the traditional transosseous approach is strongly influenced by the bone quality up to the point where, in certain conditions, a safe and reliable repair is not guaranteed. © 2014 Elsevier Ltd.
2014
- Infraspinatus strength assessment and ultrasound evaluation of posterior capsulotenodesis after arthroscopic hill-sachs remplissage in traumatic anterior glenohumeral instability: a retrospective controlled study protocol
[Articolo su rivista]
Merolla, Giovanni; Porcellini, Giuseppe
abstract
Giovanni Merolla Co-investigator: Giuseppe Porcellini Investigation performed at the Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica - Italy PLAN OF CLINICAL INVESTIGATION (PCI): Version 1.0 of June 12, 2012 Approved by AV/IRST Ethical Committee (Comitato Etico Area Vasta Romagna) and authorized by AUSL RN ("Determina AUSL Rimini numero 326 del 29/03/2013: Remplissage U.O Chirurgia della Spalla - Valutazione clinica ed ultrasonografica dell'infraspinato dopo capsulo-tenodesi artroscopica (remplissage) nell'instabilità anteriore traumatica di spalla con lesione di Bankart e difetto omerale di Hill-Sachs").
2014
- Optimal positioning of the humeral component in the reverse shoulder prosthesis
[Articolo su rivista]
Nalbone, L.; Adelfio, R.; D'Arienzo, Matteo; Ingrassia, T.; Nigrelli, V.; Zabbara, F.; Paladini, P.; Campi, F.; Pellegrini, A.; Porcellini, G.
abstract
Total reverse shoulder arthroplasty is becoming more and more the standard therapeutic practice for glenohumeral arthropathy with massive lesions of the rotator cuff. The biomechanical principle of this prosthesis is represented by the reversion of the normal anatomy of the shoulder joint. This non-anatomical prosthesis leads to a medialization of the rotation centre of the glenohumeral joint and also to a distalization of the humeral head. All that causes a deltoid tension increasing so allowing a larger abduction of the arm. Main complications of the reverse shoulder prosthesis are due to the joint instability, the scapular notching and the wear of the polyethylene insert. Purpose: The main goal of the present work is to study the effect of the positioning of the humeral component on the intrinsic stability of the reverse shoulder prosthesis. In particular, through finite element method simulations, the variation of the stability ratio of the shoulder joint has been calculated for both vertical and horizontal dislocating loads depending on the humeral stem version angle. Moreover, in order to estimate the wear of the polyethylene cup, some analyses have been developed to calculate the pressures on the polyethylene insert. Results: The obtained results demonstrate the dislocation of a shoulder prosthesis and the wear of the polyethylene insert can be prevented or limited by conveniently varying the version angle of the humeral component. © 2013 Istituto Ortopedico Rizzoli.
2014
- Prediction bands and intervals for the scapulo-humeral coordination based on the Bootstrap and two Gaussian methods
[Articolo su rivista]
Cutti, A. G.; Parel, I.; Raggi, M.; Petracci, E.; Pellegrini, A.; Accardo, A. P.; Sacchetti, R.; Porcellini, G.
abstract
Quantitative motion analysis protocols have been developed to assess the coordination between scapula and humerus. However, the application of these protocols to test whether a subject's scapula resting position or pattern of coordination is "normal", is precluded by the unavailability of reference prediction intervals and bands, respectively. The aim of this study was to present such references for the "ISEO" protocol, by using the non-parametric Bootstrap approach and two parametric Gaussian methods (based on Student's T and Normal distributions).One hundred and eleven asymptomatic subjects were divided into three groups based on their age (18-30, 31-50, and 51-70). For each group, "monolateral" prediction bands and intervals were computed for the scapulo-humeral patterns and the scapula resting orientation, respectively. A fourth group included the 36 subjects (42±13 year-old) for whom the scapulo-humeral coordination was measured bilaterally, and "differential" prediction bands and intervals were computed, which describe right-to-left side differences.Bootstrap and Gaussian methods were compared using cross-validation analyses, by evaluating the coverage probability in comparison to a 90% target. Results showed a mean coverage for Bootstrap from 86% to 90%, compared to 67-70% for parametric bands and 87-88% for parametric intervals. Bootstrap prediction bands showed a distinctive change in amplitude and mean pattern related to age, with an increase toward scapula retraction, lateral rotation and posterior tilt.In conclusion, Bootstrap ensures an optimal coverage and should be preferred over parametric methods. Moreover, the stratification of "monolateral" prediction bands and intervals by age appears relevant for the correct classification of patients. © 2014 Elsevier Ltd.
2014
- Reverse Shoulder Arthroplasty in Patients Aged Sixty Years Old or Younger: Are we Really Doing the Best?
[Articolo su rivista]
Merolla, G; Porcellini, G
abstract
N/A
2014
- Robotics in shoulder rehabilitation
[Articolo su rivista]
Sicuri, Chiara; Porcellini, Giuseppe; Merolla, Giovanni
abstract
In the last few decades, several researches have been conducted in the field of robotic rehabilitation to meet the intensive, repetitive and task-oriented training, with the goal to recover the motor function. Up to now, robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors leaving less explored the field of orthopaedic shoulder rehabilitation. In this review we analyse the present status of robotic technologies, in order to understand which are the current indications and which may be the future perspective for their application in both neurological and orthopaedic shoulder rehabilitation.
2014
- Scapula fractures: Interobserver reliability of classification and treatment
[Articolo su rivista]
Neuhaus, Valentin; Bot, Arjan G. J.; Guitton, Thierry G.; Ring, David C.; Abdel-Ghany, Mahmoud I.; Abrams, Jeffrey; Abzug, Joshua M.; Adolfsson, Lars E.; Balfour, George W.; Bamberger, H. Brent; Barquet, Antonio; Baskies, Michael; Batson, W. Arnold; Baxamusa, Taizoon; Bayne, Grant J.; Begue, Thierry; Behrman, Michael; Beingessner, Daphne; Biert, Jan; Bishop, Julius; Alves, Mateus Borges Oliveira; Boyer, Martin; Brilej, Drago; Brink, Peter R. G.; Brunton, Lance M.; Buckley, Richard; Cagnone, Juan Carlos; Calfee, Ryan P.; Campinhos, Luiz Augusto B.; Cassidy, Charles; Catalano, Louis; Chivers, Karel; Choudhari, Pradeep; Cimerman, Matej; Conflitti, Joseph M.; Costanzo, Ralph M.; Crist, Brett D.; Cross, Brian J.; Dantuluri, Phani; Darowish, Michael; De Bedout, Ramon; DeCoster, Thomas; Dennison, David G.; DeNoble, Peter H.; DeSilva, Gregory; Dienstknecht, Thomas; Duncan, Scott F.; Duralde, Xavier A.; Durchholz, Holger; Egol, Kenneth; Ekholm, Carl; Elias, Nelson; Erickson, John M.; Esparza, J. Daniel Espinosa; Fernandes, C. H.; Fischer, Thomas J.; Fischmeister, Martin; Jaime, Forigua E.; Getz, Charles L.; Gilbert, Richard S.; Giordano, Vincenzo; Glaser, David L.; Gosens, Taco; Grafe, Michael W.; Filho, Jose Eduardo Grandi Ribeiro; Gray, Robert R. L.; Gulotta, Lawrence V.; Gummerson, Nigel William; Hammerberg, Eric Mark; Harvey, Edward; Haverlag, R.; Henry, Patrick D. G.; Hobby, Jonathan L.; Hofmeister, Eric P.; Hughes, Thomas; Itamura, John; Jebson, Peter; Jenkinson, Richard; Jeray, Kyle; Jones, Christopher M.; Jones, Jedediah; Jubel, Axel; Kaar, Scott G.; Kabir, K.; Kaplan, F. Thomas D.; Kennedy, Stephen A.; Kessler, Michael W.; Kimball, Hervey L.; Kloen, Peter; Klostermann, Cyrus; Kohut, Georges; Kraan, G. A.; Kristan, Anze; Loebenberg, Mark I.; Malone, Kevin J.; Marsh, L.; Martineau, Paul A.; McAuliffe, John; McGraw, Iain; Mehta, Samir; Merchant, Milind; Metzger, Charles; Meylaerts, S. A.; Miller, Anna N.; Wolf, Jennifer Moriatis; Murachovsky, Joel; Murthi, Anand; Nancollas, Michael; Nolan, Betsy M.; Omara, Timothy; Omid, Reza; Ortiz, Jose A.; Overbeck, Joachim P.; Page, Richard S.; Castillo, Alberto Pérez; Pesantez, Rodrigo; Polatsch, Daniel; Porcellini, G.; Prayson, Michael; Quell, M.; Ragsdell, Matthew M.; Reid, James G.; Reuver, J. M.; Richard, Marc J.; Richardson, Martin; Rizzo, Marco; Rowinski, Sergio; Rubio, Jorge; Guerrero, Carlos G. Sánchez; Satora, Wojciech; Schandelmaier, Peter; Scheer, Johan H.; Schmidt, Andrew; Schubkegel, Todd A.; Schulte, Leah M.; Schumer, Evan D.; Sears, Benjamin W.; Shafritz, Adam B.; Shortt, Nicholas L.; Siff, Todd; Silva, Dario Mejia; Smith, Raymond Malcolm; Spruijt, Sander; Stein, Jason A.; Pemovska, Emilija Stojkovska; Streubel, Philipp N.; Swigart, Carrie; Swiontkowski, Marc; Thomas, George; Tolo, Eric T.; Turina, Matthias; Tyllianakis, Minos; Van Den Bekerom, Michel P. J.; Van Der Heide, Huub; Van De Sande, M. A. J.; Van Eerten, P. V.; Verbeek, DIederik O. F.; Hoffmann, David Victoria; Vochteloo, A. J. H.; Wagenmakers, Robert; Wall, Christopher J.; Wallensten, Richard; Wascher, Daniel C.; Weiss, Lawrence; Wiater, J. Michael; Wills, Brian P. D.; Wint, Jeffrey; Wright, Thomas; Young, Jason P.; Zalavras, Charalampos; Zura, Robert D.; Zyto, Karol
abstract
Objectives: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. Design: Web-based reliability study. Setting: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. Participants: One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. Main Outcome Measurements: Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons. Results: The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), κ = 0.79) was substantial and the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. Conclusions: The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.
2014
- Scapulothoracic arthroscopy for symptomatic snapping scapula: A prospective cohort study with two-year mean follow-up
[Articolo su rivista]
Merolla, G.; Cerciello, S.; Paladini, P.; Porcellini, G.
abstract
Background: Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnormal tissue at this site. Surgical treatment, when needed, may be either open or arthroscopic. The aim of this study was to evaluate prospectively the clinical outcomes of arthroscopic decompression in ten subjects with symptomatic snapping scapula. Patients and methods: Ten subjects, five men and five women, mean age 24 years, were treated by arthroscopy after unsuccessful conservative management for 6 months. Clinical outcomes were evaluated with the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score (CS), and simple shoulder test (SST). Follow-up was at 3 and 6 months; the final evaluation was conducted at a mean interval of 24 months. The final and preoperative X-rays were compared. Results: The WORC index increased significantly at 3 (p < 0.05), 6 (p < 0.01), and 24 months (p < 0.01). Similar outcomes were found for the CS at all 3 follow-up points (3 months, p < 0.05; 6 months, p < 0.01; 24 months, p < 0.01). Mean "yes" responses on the SST were 9.8 ± 1.4 at 3 months (p < 0.05), 10.2 ± 1.2 at 6 months (p < 0.01), and 10.6 ± 1.2 at 24 months (p < 0.01). X-ray examination depicted flattening of the anterior surface of the superior-medial angle of the scapula in the five patients who had had bone resection, whereas no significant difference with preoperative imaging was detected in the five patients who were managed by bursectomy and debridement alone. Conclusions: Arthroscopy is a feasible and minimally invasive treatment for painful snapping scapula syndrome. Comparative clinical trials are needed to collect conclusive data to state that it is the most suitable treatment for this condition. © 2014 Istituto Ortopedico Rizzoli.
2014
- Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale
[Articolo su rivista]
Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe
abstract
treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient's pain and disability, surgery should be considered.
2014
- Venous thromboembolism in patients undergoing shoulder surgery: Findings from the RECOS Registry
[Articolo su rivista]
Imberti, Davide; Ivaldo, Nicola; Murena, Luigi; Paladini, Paolo; Castagna, Alessandro; Barillari, Giovanni; Guerra, Enrico; Fama, Giuseppe; Castoldi, Filippo; Marelli, Bruno; Pierfranceschi, Matteo Giorgi; Camporese, Giuseppe; Dentali, Francesco; Porcellini, Giuseppe
abstract
Background Limited informations are available about venous thromboembolic (VTE) complications and thromboprophylaxis use after shoulder surgery. The primary end-point of the study was to determine the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90 days after shoulder surgery. Risk factors for VTE and thromboprophylaxis practices were also studied. Methods RECOS is a prospective multicenter registry of consecutive patients undergoing shoulder surgery recruited in nine hospitals in Italy. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratio (HR) and 95% confidence interval (CI) for some variables that were identified as risk factors for VTE. Results From June 2009 to June 2011 1366 patients (males 54.4%; mean age 55,65 ± 15.3 years) were enrolled. The surgical procedures were: arthroscopy (71.9%), hemiarthroplasty (17.2%) total replacement (8.9%), fixation for proximal humeral fracture (2%). After 90 days, the incidence of symptomatic VTE was 0.66% (95CI% 0.2-1.12). Mean age was significantly higher in patient with than in patients without VTE (67,1 +/3.49 years vs 55,6 +/- 0,42 years, respectively; p = 0.024). Duration of surgery > 60 minutes (HR:10.99; 95CI% 1.26-95.89; p = 0.030) was found as independent risk factor for VTE, while cancer, medical disease, venous insufficiency and previous VTE were not. Pharmacological thromboprophylaxis was prescribed in 33.5% (n = 457) of the patients, in 95.8% of whom for a duration > 10 days. Conclusions The risk of symptomatic VTE in patients undergoing shoulder surgery is low. The potential need for thromboprophylaxis should be based on a case by case evaluation. © 2014 Elsevier Ltd.
2013
- Arthroscopic treatment of early glenohumeral arthritis
[Articolo su rivista]
Porcellini, Giuseppe; Merolla, Giovanni; Campi, Fabrizio; Pellegrini, Andrea; Bodanki, Chandra Sekhar; Paladini, Paolo
abstract
Background: The articular cartilage of the shoulder is not endowed with intrinsic repair abilities, so the detection of chondral lesions during arthroscopy may indicate that additional articular procedures are needed. The aim of the current study was to evaluate the benefits of arthroscopy in patients with early shoulder arthritis, and to assess which clinical and radiological features are correlated with better arthroscopic outcomes. Materials and methods: Out of a total of 2,707 shoulders, 61 arthroscopies were performed on patients aged 30-55 years suffering from a painful early arthritic shoulder. We performed a retrospective study of 47 of those 61 patients with osteoarthritis at Samilson-Prieto stage I or II. SST and Constant score were used as outcome measures. Arthroscopic circumferential capsulotomy was performed to release the soft tissues and increase the joint space. Glenoid chondral lesions were caregorized according to location (anterior, posterior, centered) and size (small, large, total) and treated with microfractures; in the last 11 patients, we placed a engineered hyaluronic acid membrane, Hyalograft® C, on the surface of the glenoid. Postoperative care included mobilization the day after surgery, with the arm protected in a sling for two weeks. Follow-up examinations were performed at 3, 6, 12, and 24 months after surgery. The clinical and radiographic data collected were compared with those obtained at the last examination. Results: The mean Constant score increased from 43.8 points to 79.1, and the mean SST score increased from 4.9 points to 9.4 points. Clinical outcomes improved significantly in 44 patients (93.6 %). The three patients (6.4 %) with the lowest scores showed progression of arthritis. Age, gender, glenohumeral distance, and presence of engineered hyaluronic acid membrane were not related to clinical scores. Recovery of range of motion as well as small and centered cartilage lesions were statistically associated with improved outcome. Conclusion: The main finding was that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions. © 2012 The Author(s).
2013
- Clinical and radiographic mid-term outcomes after shoulder resurfacing in patients aged 50 years old or younger
[Articolo su rivista]
Merolla, G.; Bianchi, P.; Lollino, N.; Rossi, R.; Paladini, P.; Porcellini, G.
abstract
Purpose: Humeral resurfacing is a treatment option to conventional shoulder arthroplasty, conferring the advantages to preserve the bone stock and the normal joint geometry. Aim of the current study was to report clinical and radiographic mid-term outcomes in a population of 60 patients, aged 50 years or younger, who underwent shoulder resurfacing in osteoarthritis. Methods: The mean age was 48 ± 8.4, 36 were male and 24 female, dominant arm in 43 cases. Glenoid arthritis was treated in 36 cases (60 %) using a meniscus allograft in 22 cases, biologic patch in 4 cases and microfractures in 10 cases. Clinical and radiographic assessment was performed with Constant-Murley score and standard X-ray. Results: At an average follow-up of 44 months, the mean values of the constant score increased of 30 points (p < 0.05), the pain decreased of 4.56 points (p < 0.05) and the Simple Shoulder Test increased of 4.3 points (p < 0.05). We found lower scores (p > 0.05) in 9 patients (15 %) treated for glenoid arthritis using homologous meniscus (7 cases) and biologic patch (2 cases). A significant narrowing of joint space (5.92 mm postoperative versus 1.65 mm at 37 months) (p < 0.05) was found in the 22 cases treated with meniscus interposition. In 4 cases with type A2 preoperative glenoid morphology and in 9 cases type B1, we registered significantly lower scores compared with the overall study population (p < 0.01). Five unsatisfied patients (7 %), underwent to meniscus removal and glenoid reaming in 3 cases and conversion in total shoulder arthroplasty in 2 cases. Conclusions: Resurfacing arthroplasty is an effective device in young patients with advanced glenohumeral arthropathy; however, the high rate of postoperative glenoid erosion and the failure of biologic allograft lead us to consider glenoid replacement as the best option to improve clinical outcomes. © 2013 Istituto Ortopedico Rizzoli.
2013
- Implantation of cardioverter-defibrillator: Effects on shoulder function
[Articolo su rivista]
Diemberger, Igor; Pegreffi, Francesco; Mazzotti, Andrea; Foschi, Elia; Martignani, Cristian; Belli, Guido; Biffi, Mauro; Ziacchi, Matteo; Branzi, Angelo; Grigioni, Francesco; Maietta Latessa, Pasqualino; Porcellini, Giuseppe; Tentoni, Claudio; Boriani, Giuseppe
abstract
Abstract
BACKGROUND:
Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood.
METHODS:
Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life.
RESULTS:
Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5±9.1 to 41.8±11.4 (p=0.016), patients with NRS >1 increased from 14% to 44% (p<0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p<0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p<0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase ≥1 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r=0.570; p<0.001).
CONCLUSIONS:
ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life.
2013
- Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review
[Articolo su rivista]
Dellabiancia, Fabio; Porcellini, Giuseppe; Merolla, Giovanni
abstract
The correct functionality of the upper limbs is an essential condition for the autonomy of people with disabilities, especially for those in wheelchair. In this review we focused on the biomechanics of wheelchair propulsion and we described the instrumental analysis of techniques for the acquisition of wheelchair propulsion.
2013
- Motion analysis assessment of alterations in the scapulo-humeral rhythm after throwing in baseball pitchers
[Articolo su rivista]
Pellegrini, A.; Tonino, P.; Paladini, P.; Cutti, A.; Ceccarelli, F.; Porcellini, G.
abstract
Purpose: Throwing a baseball requires a coordinated sequence of scapula and humerus movements also called scapulo-humeral rhythm (SHR). Fatigue associated with repetitive throwing can lead to scapular dyskinesia, a recognized cause of shoulder disability in pitchers and overhead athletes. We introduce a novel device, the Xbus Kit, which can objectively assess scapular biomechanics and the effect of pitching on SHR. Methods: SHR was studied using the Xbus Kit (Xsens Technologies B.V., NL). Thirteen collegiate baseball pitchers (aged 20 ± 2.6) were studied, evaluating SHR in forward elevation and abduction in three sessions: before throwing (S1), after 60 pitches (S2) and 24 h after a pitching session (S3). Results: SHR changes were found in 85 % of pitchers (11 cases), and no changes were observed in 2 cases (15 %). We were able to subdivide pitchers into four groups, based on their response to pitching. Conclusion: Repetitive movement of pitching leads to SHR changes and sometimes, incomplete restoration of normal shoulder biomechanics. © 2013 Istituto Ortopedico Rizzoli.
2013
- Pectoralis minor tendon transfer for irreparable anterosuperior cuff tears
[Articolo su rivista]
Paladini, Paolo; Campi, Fabrizio; Merolla, Giovanni; Pellegrini, Andrea; Porcellini, Giuseppe
abstract
Background: Tears of the subscapularis tendon are a frequent cause of shoulder dysfunction. Tendon transfer techniques have been devised to treat irreparable tears. The objectives of this study were to explore the anatomic feasibility of using the pectoralis minor tendon as a graft for subscapularis tendon tears, the safety of the procedure, and the scope of this approach in improving shoulder function. Materials and methods: We performed open pectoralis minor transfer in 27 patients (22 men; mean age, 60 years) with irreparable tears of the upper two-thirds of the subscapularis tendon, grade III fatty degeneration, and irreparable supraspinatus tears. Constant and Simple Shoulder Test scores and functional outcomes were evaluated at 3, 12, and 24 months. All patients were available for follow-up. Results: The pectoralis minor tendon easily reached the subscapularis footprint. There were no cases of musculocutaneous nerve or brachial plexus injury or graft failure. Active forward flexion improved from 127° to 177°; external rotation with the arm at the side declined by 11°. The Simple Shoulder Test score improved by 5 points and the Constant score by 41 points, although the strength subscore did not rise significantly. Conclusions: This study showed that it is anatomically feasible to use the pectoralis minor tendon as a graft to treat upper subscapularis lesions; the procedure is safe in terms of brachial plexus and musculocutaneous nerve injury; and pectoralis minor transfer can improve shoulder function and provide pain relief in patients with Lafosse grade III subscapularis tears, likely through a tenodesis effect, even in the presence of irreparable supraspinatus tears. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.
2013
- Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique
[Articolo su rivista]
Merolla, G; Nastrucci, G; Porcellini, G
abstract
Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement.
2013
- Snapping scapula syndrome: Current concepts review in conservative and surgical treatment
[Articolo su rivista]
Merolla, Giovanni; Cerciello, Simone; Paladini, Paolo; Porcellini, Giuseppe
abstract
The snapping scapula, also called "washboard syndrome" is a controversial condition attributed to bony and soft tissue abnormalities. The syndrome was understimated for long time and often associated only with specific osseous abnormalities. The nodal point in the overview of the syndrome is that crepitus associated with symptomatic bursitis may be physiologic and is not uncommon a clinical presentation without any form of crepitus or craquement. In the current rewiew we analyzed the current concepts in the conservative and surgical management of snapping scapula syndrome, preceded by a description of scapular anatomy, pathophysiology of scapulothoracic articulation and clinical features of snapping scapula.
2013
- Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: A prospective randomized comparative study
[Articolo su rivista]
Fauci, Francesco; Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Background: Acromioclavicular (AC) dislocation involves complete loss of articular contact; it is defined as chronic when it follows conservative management or unsuccessful surgical treatment. Materials and methods: The study compared the clinical and radiographic outcomes of AC joint stabilization performed in 40 patients with chronic dislocation using a biological allograft (group A) or a synthetic ligament (group B). Demographic data included: M/F: 25/15; mean age: 35 ± 3.2 years; previous surgery in 11 patients, including Weaver-Dunn (3), coracoacromial ligament repair (4), stabilization with K-wires (4). Dislocation was type III in 14 (35 %) and type IV in 26 (65 %) patients. Clinical assessment was with the Constant-Murley score (pre- and postoperative) and with the modified UCLA score. Enrollment started in January 2004 and was completed in March 2008. Patients were evaluated at 1 and 4 years. Postoperative X-rays were examined to assess joint stability in the coronal and axial planes, coracoclavicular ossification, and signs of AC joint osteoarthritis and distal clavicular osteolysis. Results: The "biological" group achieved significantly better clinical scores than the "synthetic" group at both 1 and 4 years. Poor subjective satisfaction and lower clinical scores were found in the 3 patients (1 from group A and 2 from group B) who experienced complete postoperative dislocation. No significant correlations were found with other radiographic parameters. Conclusions: The biological graft afforded better clinical and radiographic outcomes than the synthetic ligament in patients with chronic AC joint instability. Fixation to the clavicle constitutes the main weakness of both approaches and needs improving. © 2012 The Author(s).
2013
- Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: A prospective comparative study with rehabilitation therapy
[Articolo su rivista]
Merolla, G.; Bianchi, P.; Porcellini, G.
abstract
Background: Rotator cuff (RC) tendinopathy is a common cause of pain and shoulder dysfunction. The literature evidence suggests that a combination of overuse and extrinsic compression may induce chronic RC tendinopathy. Aim of the current study was to compare the results of subacromial sodium hyaluronate injections with rehabilitation therapy. Materials and methods: We enrolled 48 patients (M/F: 26/22; mean age: 50 years; shoulder right/left: 29/19) with persistent shoulder pain for at least 4 months. Exclusion criteria were as follows: RC tear, calcifying tendinitis, glenohumeral instability, osteoarthritis, rheumatic diseases, physical therapy and/or injection in the previous 4 months, shoulder surgery, anesthetic nerve block, trauma, and severe medical diseases. The included subjects received either two ultrasound-guided subacromial hyaluronic acid (HA) injections (25 patients, HA group) at baseline and 14 days, or underwent rehabilitation therapy (23 patients, Physio group) including active shoulder mobilization, soft tissue stretching and humeral head positioner and propeller muscles strengthening for 30 days (3 sessions every week). Clinical assessment of shoulder function was performed with visual analog scale score for pain (0-100), Oxford Shoulder Score (OSS), and Constant-Murley Score (CS). Overall, patients were examined at baseline, week 2, week 4, week 12, and week 24. Statistical significance was set at 5 % (p < 0.05). Results: Reduction in overall pain in the HA group was statistically significant at week 2 (p < 0.05) week 4 (p < 0.05), week 12 comparing to baseline. Similarly, pain subscores (at night and with activity) were significantly lower at week 2 (p < 0.05), week 4 (p < 0.05), and week 12 (p < 0.05), respectively. In the Physio group, pain decreased significantly at week 2 (p < 0.05) but not maintained at week 4 (p > 0.05), week 12 (p > 0.05), and week 24 (p > 0.05). CS and OSS in the HA group increased significantly at week 2 (p < 0.05), week 4 (p < 0.05), and week 12 (p < 0.05). A non-statistically significant increase in clinical scores was found at week 24 (p > 0.05). A significant improvement of CS and OSS we found in the Physio group at week 2 (p < 0.05), but not at weeks 4, 12, and 24 (p > 0.05). Conclusions: Subacromial HA injections could be an effective and safe alternative treatment for patients suffering from RC tendinopathy. We believe that the results of this study are encouraging but not lasting and we might suppose that a series of three to four subacromial sodium hyaluronate injections could provide good mid- and long-term clinical benefits. © 2013 Istituto Ortopedico Rizzoli.
2012
- Ambulatory measurement of the scapulohumeral rhythm: Intra- and inter-operator agreement of a protocol based on inertial and magnetic sensors
[Articolo su rivista]
Parel, I.; Cutti, A. G.; Fiumana, G.; Porcellini, G.; Verni, G.; Accardo, A. P.
abstract
To measure the scapulohumeral rhythm (SHR) in outpatient settings, the motion analysis protocol named ISEO (INAIL Shoulder and Elbow Outpatient protocol) was developed, based on inertial and magnetic sensors. To complete the sensor-to-segment calibration, ISEO requires the involvement of an operator for sensor placement and for positioning the patient's arm in a predefined posture. Since this can affect the measure, this study aimed at quantifying ISEO intra- and inter-operator agreement. Forty subjects were considered, together with two operators, A and B. Three measurement sessions were completed for each subject: two by A and one by B. In each session, the humerus and scapula rotations were measured during sagittal and scapular plane elevation movements. ISEO intra- and inter-operator agreement were assessed by computing, between sessions, the: (1) similarity of the scapulohumeral patterns through the Coefficient of Multiple Correlation (CMC 2), both considering and excluding the difference of the initial value of the scapula rotations between two sessions (inter-session offset); (2) 95% Smallest Detectable Difference (SDD 95) in scapula range of motion.Results for CMC 2 showed that the intra- and inter-operator agreement is acceptable (median≥0.85, lower-whisker ≥0.75) for most of the scapula rotations, independently from the movement and the inter-session offset. The only exception is the agreement for scapula protraction-retraction and for scapula medio-lateral rotation during abduction (inter-operator), which is acceptable only if the inter-session offset is removed. SDD 95 values ranged from 4.4° to 8.6° for the inter-operator and between 4.9° and 8.5° for the intra-operator agreement.In conclusion, ISEO presents a high intra- and inter-operator agreement, particularly with the scapula inter-session offset removed. © 2011 Elsevier B.V..
2012
- Growth factors and tendon healing
[Capitolo/Saggio]
Oliva, Francesco; Gatti, Stefano; Porcellini, Giuseppe; Forsyth, Nicholas R.; Maffulli, Nicola
abstract
Recent attention has focused on the biological pathways by which tendons heal leading to the identification of some growth factors (GFs) with involvement in this process. No studies have been published on the time course of the various GFs during the tendon healing process in vivo in humans. We review what is known about these GFs and their role in tendon healing. Copyright © 2012 S. Karger AG, Basel.
2012
- Instability and rotator cuff Tear
[Capitolo/Saggio]
Porcellini, G.; Caranzano, F.; Campi, F.; Paladini, P.
abstract
Prevalence of rotator cuff tears after traumatic dislocation increases with advancing age, as a consequence of the age-associated deterioration of structures and mechanical properties of the tendons of the rotator cuff. These act as effective stabilizers of the joint, compressing the humeral head in the three-dimensional concavity of the glenoid. It is impossible to establish whether a lesion of the capsulo-labrum complex or of the rotator cuff causes or follows a dislocation, regardless of whether it is anterior or posterior. A peripheral nerve or a brachial plexus injury can be associated with tendon lesion and instability, developing the 'terrible triad' of the shoulder. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age of the patients, functional demands, and type of lesion. Copyright © 2012 S. Karger AG, Basel.
2012
- Long-term subscapularis strength assessment after Bristow-Latarjet procedure: Isometric study
[Articolo su rivista]
Paladini, Paolo; Merolla, Giovanni; De Santis, Elisa; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Background: The subscapularis is the strongest rotator cuff muscle. Bristow-Latarjet procedure may impair subscapularis function. The aim of the study is to describe the difference in isometric subscapularis (SSC) strength after L-shape tenotomy versus muscle split in patients who underwent to Bristow-Latarjet procedure. Materials and methods: From 2000 to 2006, we enrolled 376 patients for Bristow-Latarjet procedures. We identified 2 groups according to the subscapularis approach. Group A included 264 subjects with subscapularis L shape tenotomy; group B included 112 subjects with subscapularis muscle split. The subscapularis function was assessed with lift-off and belly-press tests. Isometric strength of rotator cuff muscle was assessed at an average follow-up of 45 months in group A and 42 months in group B, recording the maximum isometric peak torque (PT) (N), maximum isometric couple (Nm), relative strength index (N/Kg), strength, couple and external/internal rotator ratio. Constant and Rowe were used as scores. Results: Subscapularis assessment in the overall population showed 33 cases (8.8%) with a positive Lift-off test and 30 cases (8%) with a positive belly-press test. Rowe and Constant scores increased in both groups (P < .01). The mean PT in group A was lower of 24,8 Nw than group B (P < .01); similarly, the max PT values of group A were lower of 26.1 Nw than group B (P < .01). Conclusion: L-shaped tenotomy in Bristow-Latarjet procedure has a weakening effect on the subscapularis and for these reasons we strongly recommend the muscle split approach for an optimal subscapularis function recovery. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
2012
- Pectoralis major tendon rupture. Surgical procedures review
[Articolo su rivista]
Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Pectoralis major (PM) muscle is the powerful dynamic stabiliser of the shoulder that acts as a flexor, adductor and internal rotator. The rupture of the PM tendon is a relatively rare injury that was firstly described in a French boy by Patissier in 1822 and later, in 1861, by Letenneur who reported another similiar case. To date, over 200 cases have been published. In this article we describe the clinical anatomy and the mechanism of injuries of PM and we review the surgical procedures for acute and chronic ruptures.
2012
- Prevalence of shoulder discomfort in paraplegic subjects
[Articolo su rivista]
Pellegrini, Andrea; Pegreffi, Francesco; Paladini, Paolo; Verdano, Michele Arcangelo; Ceccarelli, Francesco; Porcellini, Giuseppe
abstract
The annual incidence of acute spinal cord injury, as reported in the National Spinal Cord Injury Statistical Center, was estimated to be approximately 40 cases per million, or approximately 11.000 new cases in the United States each year (1). In subjects with spinal cord injury, overstress of the upper extremities occurs not only during daily life activities, but also utilizing wheelchair. The aim of this study is to determine the prevalence of shoulder discomfort in subjects affected by paraplegia living in our country area and evaluate the associated risk factors negatively affecting the shoulder function.
2012
- Salter-harris type II proximal humerus injuries: State-of-the-art treatment
[Articolo su rivista]
Verdano, Michele Arcangelo; Pellegrini, Andrea; Lunini, Enricomaria; Porcellini, Giuseppe; Ceccarelli, Francesco
abstract
Proximal epiphyseal injuries of the humerus represent a very low percentage of traumatic growth pathologies, 5 % of all fractures during childhood. In the literature, there have been only a limited number of clinical studies investigating these injuries, basically from an epidemiological point of view, focusing on the incidence of the different types of fractures. We report our experience of 6 young patients with Salter-Harris type II proximal humerus epiphyseal injuries adopting a minimally invasive surgical technique consisting of closed reduction and percutaneous fixation with Kirschner wires. At 2 years of follow-up, the results consisting in constant; disabilities of the arm, shoulder, and hand; simple shoulder test; and Visual Analogue Scale scores obtained have been excellent and all the patients come back to a normal life with sports practice and normal daily activities. The range of motion was completely restored without any deficit in abduction-adduction, flection-extension, or intra-extra rotation. No differences in anthropometric parameters were found with no case of malangulation, vascular, or neurological complications. Our data support with evidence how the close reduction internal fixation with K-wires treatment can give to the surgeons and the patients a better security about the correct fracture healing. Furthermore, with this article, we will provide a detailed review of the literature in order to define the state-of-the-art treatment to better face such a challenging skeletal injury. © Istituti Ortopedici Rizzoli 2012.
2012
- Shoulder arthroplasty in alkaptonuric arthropathy: A clinical case report and literature review
[Articolo su rivista]
Merolla, Giovanni; Dave, Arpit C.; Pegreffi, Francesco; Belletti, Lorenza; Porcellini, Giuseppe
abstract
Alkaptonuria is a rare hereditary metabolic disease of autosomal recessive inheritance, resulting from deficiency of the enzyme homogentisic acid oxidase. The term ''alkaptonuria'' was first used in 1859 by Boedeker to describe a patient's urinary reducing compound, and in 1866, Virchow coined the term ''ochronosis'' due to typical yellow pigmentation. Deposition of this pigment in articular cartilage leads to ochronotic arthropathy, the most incapacitating complication of alkaptonuria. We report a rare case of shoulder ochronotic arthritis, treated with total shoulder arthroplasty, achieving a successful long-term clinical and radiological outcomes. © 2012 Springer-Verlag.
2012
- Shoulder replacement in osteoarthritis: Design, biomechanics and surgical technique
[Capitolo/Saggio]
Merolla, G.; Campi, F.; Porcellini, G.
abstract
2012
- Treatment of clavicle fractures
[Articolo su rivista]
Paladini, P; Pellegrini, A; Merolla, G; Campi, F; Porcellini, G
abstract
Clavicle fractures are very common injuries in adults (2-5%) and children (10-15%) (1) and represent the 44-66% of all shoulder fractures (2). Despite the high frequency the choice of proper treatment is still a challenge for the orthopedic surgeon. With this review we wants to focus the attention on the basic epidemiology, anatomy, classification, evaluation and management of surgical treatments in relationship with the gravity of injuries. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion. We performed a review of the English literature thought PubMed to produce an evidence-based review of current concept and management of clavicle fracture. We finished taking a comparison with our survey in order to underline our direct experience.
2011
- Conservative management of rotator cuff tear
[Articolo su rivista]
Pegreffi, Francesco; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Ranking among the most prevalent of shoulder disorders, lesions involving shoulder rotator cuff strike million of patients in the United States at different points in their lives. Despite the fact that rotator cuff disease is a very common cause of pain and disability of the upper arm, a high proportion of patients is asymptomatic and unaware of performing daily living activities despite of a shoulder lesion. Given these drawbacks, surgeons are trying exploring whether conservative treatment is a viable option for the management of these injuries. This study presents a rationale to consider nonoperative treatment an effective option when dealing with patients with rotator cuff tears. © 2011 by Lippincott Williams & Wilkins.
2011
- Conservative management of rotator cuff tears: literature review and proposal for a prognostic. Prediction Score
[Articolo su rivista]
Merolla, Giovanni; Paladini, Paolo; Saporito, Marco; Porcellini, Giuseppe
abstract
Rotator cuff tears are a common cause of pain and shoulder dysfunction. The prevalence of the rotator cuff tears increases with the age reaching the 80% in patients aged more than 80 year. Symptomatic shoulders usually are initially treated conservatively and then, in case of poor outcomes, with surgery. Different parameters are still used to decide between the conservative or surgical treatment in patients with rotator cuff tears. Aim of the current study is to characterize the various features used in decision making and to validate a "Prediction Score" that let us know which patients could have a good and stable outcome with non operative treatment. We enrolled 60 patients (mean age 52 years) with symptomatic rotator cuff tears who were assigned to conservative treatment and were evaluated at 6,9 and 12 months follow-up. We developed a score based on 18 clinical and radiographic parameters. 27 patients ("non conservative") (45%) with a mean prediction score of 16.1 ± 1.7 interrupted the conservative treatment, while 33 patients ("conservative") (55%) with an average prediction score of 11.3 ± 1.8 remained conservatively treated at last follow-up. The conservative patients were 14 years older than non conservative patients. According to the results of this study we identified a value of 13 points as a "cut-off" score to predict good results by conservative management of rotator cuff tear. These outcomes support the assumption that a predictive prognostic score may guarantee a rational approach in the management of subjects with RC tears, especially in elderly who continue to have the higher rate of recurrence and therefore could be well treated with standard conservative therapies.
2011
- Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: A retrospective controlled trial
[Articolo su rivista]
Merolla, Giovanni; Sperling, John W.; Paladini, Paolo; Porcellini, Giuseppe
abstract
Shoulder osteoarthritis affect about 32% of patients over 60 years. Conservative treatment are recommended to restore shoulder function while shoulder arthroplasty remains the standard treatment for severe osteoarthritis. When conservative therapies fail and surgical approach is precluded, viscosupplementation with HA may be the treatment of choice. Currently, there is minimal information available comparing the results of Hylan G-F 20 and corticosteroid injections for the treatment of shoulder osteoarthritis. Therefore, the purpose of this study was to examine the results of these two treatments at specific time points with validated outcome measurements. Retrospective comparative cohort study. The study population included 84 patients, 51 of whomtreated with Hylan G-F 20 and 33 with a corticosteroid. Gleno-humeral osteoarthritis was graded according to Samilson-Prieto classification and rotator cuff was assessed with MRI. Both groups received three injections 1 week apart and were evaluated using a Visual Analog Scale (VAS) for pain and satisfaction, the Shoulder Pain and Disability Index (SPADI) and the Constant-Murley scale. Outcomes were registered at 1, 3, and 6 months. The Hylan G-F 20 group showed a significant pain reduction (P<0.05), improvement in the Constant-Murley, SPADI scores (P<0.05), and satisfaction (P<0.01) at all three follow-up times. Pain, clinical scores, and subjective satisfaction in the corticosteroid group improved in the first post treatment month only (P<0.05) compared with the baseline. Overall, lower clinical advantages were found in patients with greater degree of osteoarthritis and rotator cuff tears. Intra-articular injections with Hylan G-F 20 are effective in reducing pain for up to 6 months in gleno-humeral osteoarthritis whereas corticosteroids injections resulte in improvement at 1 month only. In patients with severe osteoarthritis and/or full-thickness, RC tears results tended to be worse. © 2011 Springer-Verlag.
2011
- Gleno-Humeral arthritis in young patients: Clinical and radiographic analysis of humerus resurfacing prosthesis and meniscus interposition
[Articolo su rivista]
Lollino, Nicola; Pellegrini, Andrea; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Recently, interest about glenoid resurfacing with lateral meniscus in osteoarthritis of the shoulder has been increasing. Aim of this study is to evaluate the results of this procedure, from a clinical and a radiographic point of view. Constant score, DASH (Disability of the Arm, Shoulder, and Elbow) questionnaire, some specific questions about satisfaction after surgery, and radiographic exams were performed pre-operatively and post-operatively, at a minimum follow-up of 2 years. Constant score improved from 49.8 to 66.2. 84.4% of the patients were satisfied. Mean Dash was about 24.2 points. Gleno-Humeral measurement on X-Ray shows a good widening of the articular space after surgery (5.92 mm), but a narrowing (2.07 mm), at 2 years of follow-up. We have suspended glenoid resurfacing because narrowing of the articular space at follow-up can be related to meniscal resorption and clinical results are good but comparable with humeral resurfacing alone, as seen in the literature. Long-term follow-up studies are needed. © 2011 Springer-Verlag.
2011
- Glenohumeral instability and rotator cuff tear
[Articolo su rivista]
Porcellini, Giuseppe; Caranzano, Francesco; Campi, Fabrizio; Pellegrini, Andrea; Paladini, Paolo
abstract
The prevalence of rotator cuff tears after traumatic dislocation increases with advancing age, a likely consequence of the age-associated deterioration of the structure and mechanical properties of the tendons of the rotator cuff. These are the effective stabilizers of the glenohumeral joint, compressing the humeral head in the 3-dimensional concavity of the glenohumeral joint. It is impossible to establish whether a lesion of the capsular-labrum complex or of the rotator cuff causes or follows a dislocation, regardless of whether it is anterior or posterior. A peripheral nerve or a brachial plexus injury can be associated with tendon lesion and instability, developing the "terrible triad" of the shoulder. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion. © 2011 by Lippincott Williams & Wilkins.
2011
- Humeral bone defect after multiple surgeries in a post-traumatic case
[Articolo su rivista]
Paladini, Paolo; Campi, Fabrizio; Pellegrini, Andrea; Caranzano, Francesco; Porcellini, Giuseppe
abstract
N/A
2011
- Partial repair of irreparable supraspinatus tendon tears: Clinical and radiographic evaluations at long-term follow-up
[Articolo su rivista]
Porcellini, Giuseppe; Castagna, Alessandro; Cesari, Eugenio; Merolla, Giovanni; Pellegrini, Andrea; Paladini, Paolo
abstract
Background: Irreparable rotator cuff tears are a common source of pain and disability even in middle-aged patients. Although most rotator cuff tears can be completely repaired to bone, a significant proportion of these cannot be sutured by traditional methods. In these cases it is possible to perform a functional repair of the cuff to help restore the force couple of the cuff on the humeral head and to increase the acromion-humeral distance (AHD). This technique provides peripheral repair of the cuff tear without complete closure of the cuff defect. Our hypothesis was that arthroscopic partial suture of the cuff leads to pain relief and functional improvement for the patients while restoring the AHD. Materials and methods: All patients (67 cases) were arthroscopically treated with functional repair of the posterior cuff. The follow-up was at least 5 years. All the patients had clinical and radiographic evaluations and assessment with the Simple Shoulder Test and Constant score. Results: The mean Constant score increased from 44 points to a mean of 73 points, the mean Simple Shoulder Test score increased from 4.6 to 9.0, and the mean AHD increased from 6.1 mm to 9.1 mm. Discussion and conclusion: Functional repair of the infraspinatus, leaving the greater tuberosity uncovered, in patients with irreparable cuff tears gives good results in terms of patient satisfaction and in restoring the AHD even at long-term follow-up. Complications were rare and in line with the usual sequelae of a rotator cuff repair. © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.
2011
- Radiographic studies and findings: A cadaveric study
[Capitolo/Saggio]
Porcellini, G.; Fauci, F.; Campi, F.; Paladini, P.
abstract
Shoulder Instability: A Comprehensive Approach
2011
- The baseball
[Articolo su rivista]
Beltrami, G.; Mantovani, C.; Pellegrini, A.; Pierucci, A.; Porcellini, G.
abstract
2010
- Ambulatory measurement of the scapulohumeral rhythm: Intra- and inter-rater reliability of a protocol based on inertial and magnetic sensors
[Capitolo/Saggio]
Garofalo, P.; Cutti, A. G.; Parel, I.; Fiumana, G.; Porcellini, G.; Cappello, A.
abstract
A new protocol has been recently proposed to measure the coordinated movement of humerus and scapula, through an inertial & magnetic measurement system, in ambulatory settings. Since the protocol requires the intervention of a rater, the aim of this study was to assess its intra- and inter-rater reliability. Results for the coefficient of multiple correlation showed a reliability of the protocol ranging from 0.84 to 1, thus supporting its use for clinical assessment. © 2010 The authors and IOS Press. All rights reserved.
2010
- Editorial: Minimally invasive surgery options in managing shoulder osteoarthritis
[Articolo su rivista]
Porcellini, Giuseppe
abstract
N/A
2010
- Infraspinatus scapular retraction test: A reliable and practical method to assess infraspinatus strength in overhead athletes with scapular dyskinesis
[Articolo su rivista]
Merolla, Giovanni; De Santis, Elisa; Campi, Fabrizio; Paladini, Paolo; Porcellini, Giuseppe
abstract
Background Alteration of normal scapulohumeral rhythm due to the fatigue of scapular-stabilizing muscles induces decrease of rotator cuff strength. In this study we analyzed the interobserver and intraobserver realibility of the infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT) in 29 overhead athletes with scapular dykinesis, before and after 6 months of scapular musculature rehabilitation. Materials and methods Subjects with magnetic resonance imaging (MRI) findings of labral injuries (2 cases, 5%) and cuff tears (4 cases, 11%) were excluded. Scapular dyskinesis patterns were evaluated according to Kibler et al. (J Shoulder Elbow Surg 11:550-556, 2002). We found a type I dyskinesis in 24 cases (83%) and a type II in 5 cases (17%). Patients were tested by using IST and ISRT and the maximum infraspinatus strength (kg) was registered by a handheld dynamometer. Changes in shoulder IR were measured by using a standard goniometry. Rehabilitation continued for 6 months and was focused on the restoration of scapular muscular control and balance. We used a paired Student t test for the significance of the force values (alpha = 0.01). Intraclass correlation coefficient (ICC) and standard error (SE) were applied to determine the realibility of repeated values collected within testers and between testers. Results Values of ICC close to 1 at baseline and at 6 months indicated a higher interexaminer and intraexaminer realibility. IST force values registered a significant increase at 6 months for both examiners (P<0.01). The mean difference between IST and ISRT values were not significant at 6 months (P>0.01). The increase of glenohumeral internal rotation was significant at 6 months (P<0.01). Conclusion The good realibility and the easy reproducibility make the ISRT an excellent test to assess patients with infraspinatus weakness due to scapular dyskinesis and address them toward an appropriate program of rehabilitation aimed to restore scapular musculature balance and control. © The Author(s) 2010.
2010
- Infraspinatus strength assessment before and after scapular muscles rehabilitation in professional volleyball players with scapular dyskinesis
[Articolo su rivista]
Merolla, Giovanni; De Santis, Elisa; Sperling, John W.; Campi, Fabrizio; Paladini, Paolo; Porcellini, Giuseppe
abstract
Hypothesis: This study tested the hypothesis that infraspinatus strength in professional volleyball players can be assessed with the scapula free (infraspinatus strength test, IST) and with the scapula retracted (infraspinatus scapula retraction test, ISRT) before and after scapular musculature training. Materials and methods: A prospective study was performed in 31 professional volleyball players. Isometric strength (kg) of the infraspinatus with IST and with ISRT was recorded by a handheld dynamometer and compared with the values found after 3 and 6 months of rehabilitation. Magnetic resonance imaging was performed to exclude articular and cuff pathology. Pain scores were assessed using a visual analog scale. Results: The mean increase in the force values of IST was statistically significant after 3 months (P < .01) and 6 months (P < .001) of rehabilitation. The mean difference between IST and ISRT decreased from 4.72 ± 0.007 before rehabilitation to 1.2 ± 0.26 at 3 months and to 0.4 ± 0.006 at 6 months. The mean score for pain was 2.4 ± 1.8 at 3 months and 2.6 ± 1.4 at 6 months. Discussion: Acquired scapular dyskinesis in overhead athletes can lead to the rotator cuff weakness. Inhibition due to pain and the negative biomechanic effect of scapular dyskinesis results in specific infraspinatus dysfunction that arise with the ISRT. Conclusions: ISRT is practical and consistent to assess the infraspinatus strength in overhead athletes with scapular dyskinesis. A functional rehabilitation protocol, designed to restore scapular muscles balance and shoulder mobility, is essential in the training program to prevent shoulder dysfunction and improve sports performance. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.
2010
- Multichannel computed tomography (MCCT) analysis of glenoid erosion in shoulder hemiarthroplasty: Preliminary clinical applications
[Articolo su rivista]
Merolla, G.; Campi, F.; Paladini, P.; Cavagna, E.; Porcellini, G.
abstract
Glenoid wear following shoulder hemiarthroplasty (HA) has been reported around 80% in long-term follow-up studies. Radiographic analysis is useful to depict glenoid erosion but does not evaluate accurately glenoid bone loss. Multichannel computed tomography (MCCT) allows scanning with submillimeter section thickness through dense areas of glenoid bone, despite the presence of metallic prostheses. In this preliminary study, we performed a MCCT analysis of glenoid erosion, in 15 patients with painful shoulder HA, at an average follow-up of 5.5 years. Clinical scores were retrospectively assessed at an early (1 year), medium (2.5 years), and late (5.5 years) follow-up. We analyzed the following glenoid features: articular line space (ALS), glenoid length (bone stock), glenoid version, morphology of erosion (concentric, superior ed inferior tilt), and gross bone defects. Glenoid was retroversed in 13 patients (minimum 0° maximum 8°), antiversed in 2 patients (2° and 6°). Erosion was described as concentric in 13 patients, eccentric ("superior tilt") in 1 patient, biconcave in another patient. The mean glenoid length was 19.7 mm (min 16.4 max 22.7). Gross bone defects were described in six patients. The scores registered at latest follow-up showed a significant decrease compared with the values at 1 year (P<0.001) and at 2.5 years (P<0.001). The patients with glenoid erosion associated with gross defects and ALS ≤1.2 mm had lower scores for pain and lower scores for ROM (P<0.01). Multidetector CT analysis establishes a new frontier in the postoperative management of shoulder arthroplasty, and its application in the glenoid analysis offers a significant contribution for the following reasons: qualitative and quantitative glenoid features are better seen because volume-rendering eliminates most streak artifacts and produces high-quality images; spatial information relative to the prosthetic devices and the relationship among hardware and bone can be better demonstrated; allows an accurate preoperative planning prior to starting with revision surgery. © 2010 Springer-Verlag.
2010
- Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: Strength assessment before and after restoration of scapular musculature balance
[Articolo su rivista]
Merolla, Giovanni; De Santis, Elisa; Campi, Fabrizio; Paladini, Paolo; Porcellini, Giuseppe
abstract
A disturbance in scapulohumeral rhythm may cause negative biomechanic effects on rotator cuff (RC). Alteration in scapular motion and shoulder pain can influence RC strength. Purpose of this study was to assess supraspinatus and infraspinatus strength in 29 overhead athletes with scapular dyskinesis, before and after 3 and 6 months of rehabilitation aimed to restore scapular musculature balance. A passive posterior soft tissues stretching was prescribed to balance shoulder mobility. Scapular dyskinesis patterns were evaluated according to Kibler et al. Clinical assessment was performed with the empty can (EC) test and infraspinatus strength test (IST). Strength values were recorded by a dynamometer; scores for pain were assessed with VAS scale. Changes of shoulder IR were measured. The force values increased at 3 months (P<0.01) and at 6 months (P<0.01). Changes of glenohumeral IR and decrease in pain scores were found at both follow-up. Outcomes registered on pain and strength confirm the role of a proper scapular position for an optimal length-tension relationship of the RC muscles. These data should encourage those caring for athletes to consider restoring of scapular musculature balance as essential part of the athletic training. © 2010 Springer-Verlag.
2009
- Complex shoulder disorders: evaluation and treatment
[Articolo su rivista]
Tonino, Pietro M; Gerber, Christian; Itoi, Eiji; Porcellini, Giuseppe; Sonnabend, David; Walch, Gilles
abstract
Evaluation of patients with shoulder disorders often presents challenges. Among the most troublesome are revision surgery in patients with massive rotator cuff tear, atraumatic shoulder instability, revision arthroscopic stabilization surgery, adhesive capsulitis, and bicipital and subscapularis injuries. Determining functional status is critical before considering surgical options in the patient with massive rotator cuff tear. When nonsurgical treatment of atraumatic shoulder stability is not effective, inferior capsular shift is the treatment of choice. Arthroscopic revision of failed arthroscopic shoulder stabilization procedures may be undertaken when bone and tissue quality are good. Arthroscopic release is indicated when idiopathic adhesive capsulitis does not respond to nonsurgical treatment; however, results of both nonsurgical and surgical treatment of posttraumatic and postoperative adhesive capsulitis are often disappointing. Patients not motivated to perform the necessary postoperative therapy following subscapularis repair are best treated with arthroscopic débridement and biceps tenotomy.
2009
- Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty
[Articolo su rivista]
Merolla, Giovanni; Campi, Fabrizio; Paladini, Paolo; Lollino, Nicola; Fauci, Francesco; Porcellini, Giuseppe
abstract
Glenoid component loosening is the weak point in the failure of total shoulder arthroplasty (TSA). In this study we analyse the radiographic risk factors observed on 86 cemented polyethylene glenoid components and their relationship with clinical signs at a mean follow-up of 5.8 years. Clinical assessment included Simple Shoulder Test (SST) and Constant-Murley score. Radiograms were taken to detect periprosthetic radiolucency, tilt, medial displacement and polyethylene thinning. Pearson's correlation coefficient and Spearman's rank correlation coefficient were calculated for statistical analysis. In 61 patients (71%) lucent lines were less than 2 mm wide (grade 2) and in 6 cases (7%) they were >or=2 mm wide (grade 3 and 4). Thinning of the polyethylene was found in 11 cases (13%), glenoid tilt in 6 cases (7%) and medial migration of the component in 5 cases (6%). Complete glenoid prosthetic loosening was found in 3 cases (3.5%) associated with polyethylene wear and glenoid bone loss. The Constant-Murley score associated with radiolucency grade 3 and 4 was less than 45% (38.39 +/- 8.9) (p < 0.05), while a score less than 56% (30.72 +/- 8.7) was found in patients with glenoid tilt and medial migration (p < 0.01). The mean SST score was 4.8 +/- 2.8 in case of glenoid tilt and migration of the component (p < 0.01). Removal of the glenoid component and conversion to hemiarthroplasty or reverse prostheses is suggested in painful glenoid loosening. An exhaustive analysis of radiograms is essential to detect early and late complications or risk factors of glenoid loosening.
2009
- Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder
[Articolo su rivista]
Porcellini, Giuseppe; Paladini, Paolo; Campi, Fabrizio; Pegreffi, Francesco
abstract
Hypothesis: This study investigated tuberosity osteolysis, an uncommon and frequently misdiagnosed form of calcific tendinitis of the shoulder, and evaluated its effects on clinical and surgical outcomes. Materials and methods: A total of 126 patients with calcific tendinitis studied with radiographs, ultrasound, and magnetic resonance images (MRIs) were divided into groups positive and negative for tuberosity osteolysis and treated by arthroscopy. Follow-up evaluation was at 2 years, using the Constant score. Results: Tuberosity osteolysis was associated with significantly lower Constant scores, both before and after surgical treatment. Clinical and imaging findings exhibited a significant correlation. A 100% correlation was found between arthroscopy and MRI findings of tuberosity osteolysis compared with 90% with radiographs. Conclusion: Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis that should be considered in clinical and surgical practice. Level of evidence: Level 2; Prospective non-randomized comparison prognosis study. © 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.
2009
- Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment
[Articolo su rivista]
Porcellini, Giuseppe; Campi, Fabrizio; Pegreffi, Francesco; Castagna, Alessandro; Paladini, Paolo
abstract
Background: Arthroscopic repair of anterior dislocation of the shoulder can fail. We hypothesized that patients who are at higher risk for redislocation following repair could be recognized preoperatively on the basis of their clinical history. The purpose of the present study was to identify the risk factors for recurrence in a community-based population of patients with traumatic unidirectional instability that was treated with a single arthroscopic technique. Methods: From January 2000 to December 2003, 625 patients with anterior unidirectional instability were managed with an arthroscopic Bankart technique, and 385 met the criteria for inclusion in the study. Demographic data were collected, and clinical follow-up was performed at three, six, twelve, twenty-four, and thirty-six months. Results: At thirty-six months, thirty-one patients (8.1%) had experienced a redislocation; the rate was 13.3% among patients who were twenty-two years of age and younger and 6.3% among older patients. Age at the time of the first dislocation, male sex, and the time from the first dislocation until surgery were significant risk factors for recurrence (p < 0.05 for all). Conclusions: Patients who are more likely to have a redislocation following arthroscopic repair of an anterior shoulder dislocation can be identified preoperatively on the basis of sex, age, and the time from the first dislocation to surgery. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2009 by the Journal of Bone and Joint Surgery, Incorporated.
2009
- Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus, treated initially by internal fixation or hemiarthroplasty
[Articolo su rivista]
Lollino, Nicola; Paladini, Paolo; Campi, Fabrizio; Merolla, Giovanni; Rossi, Paolo; Porcellini, Giuseppe
abstract
Complex (3-4 fragments) fractures of the proximal humerus often have a bad outcome, whatever treatment is performed. When revision surgery is required, reverse shoulder prosthesis can improve function and reduce pain in these patients. We analysed whether the choice of the first treatment (hemiarthroplasty vs. reduction and fixation) can influence the outcome of revision surgery. Our data demonstrate that results are not significantly dependent on the choice of the first implant, even though there is a tendency for patients with previous hemiarthroplasty to have a worse outcome.
2009
- Subacromial widening osteotomy of the scapular spine: Surgical technique and literature review
[Articolo su rivista]
Lollino, Nicola; Caranzano, Francesco; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
N/A
2009
- Surgical approach to acute pectoralis major tendon rupture
[Articolo su rivista]
Merolla, G; Campi, F; Paladini, P; Porcellini, G
abstract
Pectoralis major rupture is a very uncommon injury first time described by Patissier in 1822. Tears are classified on the type (partial and complete) or on the site (tendinous, myotendinous junction, intramuscular). Ruptures are reported in young high-performance athletes as results of eccentric contractions of the musculotendinous unit. The most probable mechanism in elderly patients is a brisk tearing movement applied to stiff atrophic muscle. Injuries generally involve the sternal portion; the localization to the clavicular portion is rare and can be misdiagnosed as muscle sprain. Preoperative planning include MRI as gold standard regarding operative versus non operative treatment decisions. Surgical repair is recommended in cases of complete tears because of loss of strenght in adduction, flexion and internal rotation. Aim of the current study is to describe the surgical repair of acute pectoralis major tendon rupture in 5 patients. Surgery was performed through a modified delto-pectoral approach; pectoralis major tendon was attached at its anatomic insertion using two metallic anchors. The patient as been immobilized in a sling for 30 days and then assisted physiotherapy begun; strenght exercises were allowed at 90 days. At a mean follow-up of 24 months results were excellent in all cases with restoration of strenght and coming back to previously sports activity.
2008
- Efficacy of anatomical prostheses in primary glenohumeral osteoarthritis
[Articolo su rivista]
Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
More than 32.8% of the over-60s suffer from shoulder osteoarthritis. For advanced osteoarthritis, arthroplasty is the treatment of choice. Current systems have moved on from the first shoulder prosthesis implanted by Neer in 1974, thanks to the use of adaptable modular systems. The aim of this study was to investigate the effectiveness of anatomical shoulder replacements in 30 cases of primary glenohumeral osteoarthritis through clinical and radiographic follow-up for a mean of 5 years. All implants were total cemented prostheses. Preoperative investigations included a clinical examination, conventional X-rays and CT. The Constant-Murley scale was used to evaluate the results; the mean score increased from 21.4 preoperative to 69.8 postoperative (p<0.05). In patients aged under 50, the increase in the mean postoperative Constant Score and ROM was greater than for the sample as a whole. The following complications were encountered: 2 postoperative radial nerve paralyses, resolving in 3 months, 2 cases of glenoid loosening, 1 periprosthetic fracture and 3 cases of pain and stiffness. The results led us to conclude that anatomical prostheses are effective in the treatment of severe primary glenohumeral arthropathy.
2008
- Endoscopic approach to cubital tunnel syndrome
[Articolo su rivista]
Merolla, G; Staffa, G; Paladini, P; Campi, F; Porcellini, G
abstract
The cubital tunnel syndrome is one of the most common entrapment neuropathy of the upper limb. The ulnar nerve can be compressed in the oteofibrous tunnel by the bone structures, the Osborne's ligament, the fascia of the ulnar flexor muscle of the carpus or of the aponeurosis of the deep flexor of the fingers. Pressure values in the cubital tunnel >50 mm Hg induce blocking of intraneural circulation with electrodiagnostic modifications, clinical signs and histological changes including demyelinazion of the nerve proximal to the cubital tunnel. Surgery becomes essential in case of failure of conservative and physical therapy. Various surgical techniques have been described in the literature for the treatment of the ulnar neuropathy at the elbow. In this paper the authors report a new endoscopic technique for the treatment of ulnar nerve entrapment at the elbow which requires respect of specific electrodiagnostic and clinical criteria of inclusion. The restored joint active motion following elbow arthroscopy in osteoarthritis can induce or get worse a ulnar nerve neuropathy; endoscopy neurolysis is essential to remove perineural adherences and reduces the nerve stress. Immediate well-being of the patient, lesser invasiveness and minimum vascular complications are clear advantages of the endoscopic approach, while the treatment of the pathologies proximal and distal to the Struther's arcade is a limit of the technique.
2008
- Informed consent in shoulder surgery
[Articolo su rivista]
Porcellini, Giuseppe; Campi, Fabrizio; Paladini, Paolo; Rossi, Paolo; Lollino, Nicola
abstract
Informed consent is an essential tool for diagnosis and therapy in medicine, and is of fundamental importance in surgery, where it underpins the operation itself. Its origins can be traced back to US forensic medicine but is now incorporated into the Italian legal system, with different consequences depending on the context in which it is applied. This article describes our experiences in shoulder surgery, with suitable references to legislation and analysis of the literature studies in this area.
2008
- Radiographic analysis of shoulder anatomical arthroplasty
[Articolo su rivista]
Merolla, Giovanni; Di Pietto, Francesco; Romano, Stefania; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
abstract
Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40° in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and "bone stock", prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40° of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening. © 2008 Elsevier Ireland Ltd. All rights reserved.
2007
- Long-term outcome of acute versus chronic bony Bankart lesions managed arthroscopically
[Articolo su rivista]
Porcellini, Giuseppe; Paladini, Paolo; Campi, Fabrizio; Paganelli, Massimo
abstract
Background: Acute bony Bankart lesions can be successfully treated with an arthroscopic approach to fix the avulsed bone fragment to the glenoid without grafting. Hypothesis: Chronic bony Bankart lesions with glenoid defects can be repaired arthroscopically in the same manner as acute lesions. Study Design: Cohort study; Level of evidence, 2. Methods: Over 6 years, 215 of 406 unstable shoulders were managed with an arthroscopic approach. A bony Bankart lesion was detected in 68 (31.6%); of these, 41 were operated on <3 months after the first dislocation (acute group) and 27 at a longer interval (chronic group). Preoperative evaluation was by radiography and computed tomography. A modified Bankart technique was used to repair the capsulolabral complex and fix the avulsed bone fragment to the healthy glenoid with suture anchors. Long-term follow-up data (at least 4 years) were available for 65 patients (41 acute and 24 chronic). Preoperative and postoperative Rowe scores were compared. Results: One patient from the acute group (2.4%) and 1 patient in the chronic group (4.2%) experienced traumatic redislocation. The mean postoperative Rowe scores increased, from 59 to 92 and from 43.5 to 61, respectively (both P <.001). Conclusion: An arthroscopic procedure using suture anchors appears to enable successful treatment of acute bony Bankart lesions. Chronic lesions had less favorable outcomes. © 2007 American Orthopaedic Society for Sports Medicine.
2006
- Shoulder instability and related rotator cuff tears: Arthroscopic findings and treatment in patients aged 40 to 60 years
[Articolo su rivista]
Porcellini, Giuseppe; Paladini, Paolo; Campi, Fabrizio; Paganelli, Massimo
abstract
Purpose: To report our experience with the arthroscopic treatment of patients aged 40 to 60 years with rotator cuff lesions, shoulder instability, or both, and to seek a relationship among capsular-labral complex lesions, cuff tears, number of dislocations, and patient age. Type of Study: Case series. Methods: From January 2000, all patients aged between 40 and 60 years undergoing an arthroscopic procedure for rotator cuff lesions, shoulder instability, or both were divided into 3 cohorts: shoulder instability (group I), complete cuff tear (group C), and instability and complete cuff tear (group IC). In May 2002 there were 50 patients per group. Arthroscopic findings were analyzed using the Pearson correlation coefficient and the χ2test to seek correlations between the lesions. The Student t test was used to highlight significant differences between preoperative and postoperative scores. Results: There was a strong correlation between the rising number of dislocations and associated lesions of the supraspinatus and infraspinatus (P < .001); this correlation became stronger after 7 episodes of dislocation (P < .0001). There was no correlation between capsular or Bankart lesion and presence or absence of rotator cuff tears (P > .5). Two cases of recurrence of instability were recorded in group IC. Postoperatively, the Constant and Rowe scores rose significantly and consistently in all patients (P < .001). Conclusions: Rotator cuff tears and glenohumeral instability appear to be closely related. Patient age and number of dislocations do not appear to correlate with Bankart or capsular lesions, whereas posterosuperior cuff tears seem to be influenced by number of dislocations. Although data do not permit us to conclude whether repair of the sole cuff tear can achieve shoulder stability nor whether shoulder stabilization alone can resolve the instability, treatment of both lesions should be performed arthroscopically. Level of Evidence: Level IV, case series. © 2006 by the Arthroscopy Association of North America.
2005
- Arthroscopic neurolysis of the ulnar nerve at the elbow
[Articolo su rivista]
Porcellini, G; Paladini, P; Campi, F; Merolla, G
abstract
Cubital tunnel syndrome is a frequent form of neuropathy caused by entrapment of the upper limb. Conservative treatment and physical therapy are the treatment of choice for at least 6 months prior to any type of surgery. The surgical techniques proposed for treatment of this syndrome include simple decompression, transposition and neurolysis. It is the purpose of this study to demonstrate the advantages of arthroscopy for neurolysis of the ulnar nerve at the elbow in a specific cohort of patients. The patients were evaluated preoperatively and postoperatively based on subjective (VAS) and objective (Bishop and Dellon) scales. The degree of patient satisfaction on the average was more than 60%. The mean increase in Bishop score was 5 points (minimum 3, maximum 7). Results appeared to be good and stable at 6 and 12-month follow-up evaluation.
2005
- Comparison between arthroscopy and arthrotomy in the treatment of shoulder instability
[Articolo su rivista]
Paladini, P; Campi, F; Paganelli, M; Porcellini, G
abstract
Anterior post-traumatic shoulder instability represents a common finding in orthopaedic surgery. The surgical treatment of this lesion is often indispensable for the normal social life of the patient and for the sports activity of the young. The Bankart procedure with capsular retensioning by arthrotomic access has for years been the gold standard. In the last 10 years arthroscopic accesses have gained more and more consent for the surgical treatment of such lesions, with results that have considerably improved in time. It is the purpose of this study to compare the results obtained in patients affected with anterior-inferior post-traumatic shoulder instability treated by Bankart surgery, arthrotomic and arthroscopic, with a minimum follow-up of 4 years.
2005
- The Bristow-Latarjet method in the treatment of shoulder instability that cannot be resolved by arthroscopy. A review of the literature and technical-surgical aspects
[Articolo su rivista]
Salvi, A E; Paladini, P; Campi, F; Porcellini, G
abstract
Arthroscopy has surpassed traditional types of open surgery in the treatment of shoulder instability because of its mini-invasiveness and shorter rehabilitation time. Despite this, in some cases, such as those involving significant glenoid erosions and extensive capsular lesions, arthroscopic methods fail the objectives, and methods that were believed to have been surpassed are again used, such as the Bristow-Laterjet procedure. It is the purpose of this article to describe use of the method in light of the possibilities offered by arthroscopy.
2005
- The inverse prosthesis as a revision prosthesis in failures of shoulder hemiarthroplasty
[Articolo su rivista]
Paladini, P; Collu, A; Campi, E; Porcellini, G
abstract
The authors describe their series of seven cases of complications and failures of shoulder hemiarthroplasty that were submitted to revision surgery involving an inverse prosthesis. This prosthesis has for some time now been indicated in elderly patients with arthropathy caused by rupture of the cuff. In our cases this prosthesis was implanted in patients who had undergone shoulder hemiarthroplasty for fracture and for arthrosis. The Constant score was used for pre- and postoperative evaluation. Results at mid-term, from 2 to 4 years, indicate evident improvement in Constant score that rose from a mean of 23.14 preoperatively to a mean of 49.14 postoperatively. Despite the limited follow-up the authors suggest the use of the inverse prosthesis as an effective alternative solution in shoulder arthroplasty revision surgery.
2004
- Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years
[Articolo su rivista]
Porcellini, Giuseppe; Paladini, Paolo; Campi, Fabrizio; Paganelli, Massimo
abstract
From 1996 to 1999, 95 shoulders with calcifying tendinitis of the rotator cuff were treated arthroscopically by the same surgeon and assigned to the same rehabilitation program. The 63 patients matching the inclusion criteria were reviewed after a mean follow-up of 36 months. Preoperative and postoperative clinical functional assessment was performed separately by the same three surgeons using the Constant method. The Pearson correlation coefficient was used to verify interobserver variability and to correlate the presence of residual calcifications with follow-up Constant scores and preoperative ultrasound findings. At 24 months, improved Constant scores were inversely related to the number and size of residual calcifications in all patients. Ultrasound examination showed no cuff tears. As outcome seemed to relate strongly only to the presence of residual calcium deposits in the tendon, their complete removal is recommended.
2003
- Arthroscopic approach to the glenoid fractures
[Articolo su rivista]
Porcellini, G.; Campi, F.; Paladini, P.; Paganelli, M.
abstract
The fractures of the scapula and of the glenoid are infrequent lesions. These lesions occur for high energy impacts like road accident and they generally present associated lesions like dislocation of the gleno-humeral Joint, acromio-clavicular joint, sterno-clavicular joint and clavicular fratures (floating shoulder). At the most glenoid fractures are minimally displaced and well treated in not surgical way. When the fractures of the glenoid have a significant displacement that is able to cause dislocation of the shoulder it is necessary to perform a surgical treatment, easier in acute than n chronic cases. Bigliani anatomically classified these lesion suggesting his own treatment. The surgical treatment is obligatory for the glenoid rim fragments displaced more then 10 mm, with an history of recurrent dislocation of the shoulder or when the glenoid fracture involves more than 25% of the glenoid surface. We report our own indications for treatment and our surgical arthroscopic experience for these kind of lesion.
2002
- Arthroscopic approach to acute bony Bankart lesion
[Articolo su rivista]
Porcellini, Giuseppe; Campi, Fabrizio; Paladini, Paolo
abstract
To report on an arthroscopic approach to a bony Bankart lesion that uses a modified Bankart technique to fix the avulsed bone fragment to the healthy glenoid.
2002
- Articular impingement in malunited fracture of the humeral head
[Articolo su rivista]
Porcellini, Giuseppe; Campi, Fabrizio; Paladini, Paolo
abstract
We report on the case of a fracture of the humeral metaepiphysis, surgical neck, and greater tuberosity treated conservatively. Malunion of a fracture of the greater tuberosity developed an impingement on the glenoid surface, causing an articular locking in internal rotation that resolved with slight pressure and a painful "click." The impinging bone was removed arthroscopically. Its extreme posterior position required opening a second, novel portal close to the posterior edge of the acromion for instrument access. Complete removal of the impinging bone restored free internal rotation without signs of impingement on the glenoid surface. Passive motion was initiated immediately postoperatively, and active motion in a water pool was initiated after 2 weeks. After 1 year, the patient has no pain, has maintained complete range of motion, and experiences no limitations in daily or sports activities. The peculiar features of this case are the absence of soft tissue scar stiffness and deficiency of the rotator cuff, because malunion of the bone fragment to the posterior edge of the humeral head produced a mechanical block of internal rotation, and the arthroscopic treatment of the impingement through an atypical superoposterior portal, which has not been described in the literature before.
2001
- Complex traumatic-degenerative injury of the proximal metaepiphysis of the humerus
[Articolo su rivista]
Porcellini, G; Campi, F; Piu, M; Paladini, P
abstract
The authors describe one case of displaced fracture of the proximal third of the humerus with high-grade degenerative arthropathy in the humeral head and in the glenoid surface on a humerus that had previously been treated thirty years earlier with a Delitala intramedullary nail for diaphyseal fracture.
2001
- [Neonatal chronic kidney failure associated with cyclo-oxygenase-2 inhibitors administered during pregnancy]
[Articolo su rivista]
Peruzzi, Leonardo; Gianoglio, B; Porcellini, G; Conti, Giulia; Amore, A; Coppo, R
abstract
Non-steroidal anti-inflammatory drugs (NSAID) are used since years as tocolytic due to their capacity to inhibit cyclo-oxygenase (COX) expressed in uterus and fetal membranes, fundamental for labour initiation and maintenance. The use of nimesulide, a COX-2 selective NSAID, has been recently proposed due to its capacity to selectively inhibit the enzyme expressed in the myometrium and endometrium. A case of neonatal irreversible end stage renal failure after maternal assumption of nimesulide as tocolytic for 6 week is reported. Cesarean section at the 32nd week due to oligohydramnios gave birth to a baby girl of 2090 g, in good general conditions, without signs of respiratory distress and of visible abnormalities. From birth she displayed oligo-anuria which required dialytic substitutive therapy from the second day of life. At US scan both kidneys had normal diameters for gestational age slightly increased echogenicity and a reduced cortico-medullary differentiation. On the 20th day of life she had a surgical renal biopsy for the persistence of oligo-anuria, showing fetal glomeruli, without lymphocytic interstitial infiltrate, and normal tubuli without evidence of necrosis. She is now 16 months old and under automated peritoneal dialysis on a home dialysis program. The occurrence of chronic renal failure in strict relationship with maternal nimesulide assumption in this case is strongly suggestive for a pharmacological damage, either direct or mediated by renin angiotensin inhibition, and possibly modulated by genetic factors, likely to account for the different outcome of similarly treated patients. A cautious use of this drug as long term tocolytic should be recommended while waiting for ad hoc experimental and clinical evidences of safeness.
1999
- Acute complex SLAP lesion
[Articolo su rivista]
Porcellini, Giuseppe
abstract
The SLAP lesion is a frequently observed lesion of the shoulder involving the superior glenoid labrum and long head biceps tendon. It is caused by falls onto an outstretched arm, inferior traction pull, abduction-external rotation injuries, anterior traction, and upward traction. The authors describe a complex SLAP lesion: type IV associated with an anterior Bankart lesion, that underwent arthroscopic treatment a few days after trauma. At 1-year follow-up of the patient, clinical evaluation and magnetic resonance imaging showed good healing of the long head biceps tendon and of the glenoid labrum, superior and anterior. In similar cases where evaluation is difficult because of shooting pain, drug resistance, and functional limitations of movements, we recommend arthroscopic evaluation a few days after trauma for better accuracy of imaging in the evaluation of acute lesions. © 1999 by the Arthroscopy Association of North America.
1999
- Hemiarthroplasty of the shoulder. Clinical experience in 18 cases treated by the Neer monoblock prosthesis
[Articolo su rivista]
Porcellini, G; Campi, F; Baccarani, G; Galassi, R
abstract
The authors report the results of 18 hemiarthroplasties of the shoulder performed between 1990 and 1994 using the Neer II monoblock prosthesis, emphasizing the technical and surgical problems encountered. The patients treated numbered 13 for traumatic pathology (acute fractures: 7; sequelae of fracture of the proximal epiphysis of the humerus: 6), and 5 for degenerative lesions (arthrosis: 3; rheumatoid arthritis: 2). An evaluation of the results was based on the Constant method and isokinetic testing. Results based on follow-up obtained after 2 to 6 years were satisfactory in 83% of the cases.
1996
- Calcific tendinitis of the rotator cuff with trochiteal osteolysis. A rare clinical radiologic complication
[Articolo su rivista]
Porcellini, G; Campi, F; Battaglino, M
abstract
Among cases of calcific tendinitis that are unresponsive to any type of non-surgical treatment, the authors report 3 cases, out of a total of 32 submitted to surgery, that presented with an osteolytic cavity filled with calcium salts in the insertional region of the supraspinous tendon. These patients presented with pain that they had been experiencing for an average of 4 years, with acute recurrent episodes. When this pathology can be determined radiographically, early surgery is recommended, considering that any type of non-surgical treatment is destined to fail.
1996
- Increased plasma level of vascular endothelial glycoprotein thrombomodulin as an early indicator of endothelial damage in bone marrow transplantation
[Articolo su rivista]
Testa, S.; Manna, A.; Porcellini, A.; Maffi, F.; Morstabilini, G.; Denti, N.; Macchi, S.; Rosti, G.; Porcellini, G.; Cassi, D.; Ferrari, L.
abstract
We investigated the nature of hemostatic alterations occurring after bone marrow transplantation. In 45 patients, we evaluated the coagulation parameters, naturally occurring anticoagulants and thrombomodulin at days +15 and +22 after conditioning therapy. It was observed that endothelial cell damage is a central pathogenetic mechanism in some BMT complications. The increased plasma level of thrombomodulin after conditioning therapy is therefore discussed as a marker of endothelial cell injury. At day +15 a significant increase of fibrinogen from 276.1 mg/dl to 389.1 mg/dl was observed, while the natural anticoagulants all decreased significantly. Eleven patients with clinical complications related to endothelial damage had a significant thrombomodulin increase which, in uncomplicated patients, remained unchanged or resulted in lower than baseline values. Analysis of the data shows a strong correlation between clinical findings, reflecting endothelial cell injury and thrombomodulin increase when the increment is ≤ 30%. We found a significant elevation in thrombomodulin in 70% of clinical complications related to endothelial cell damage namely: septicemia, GVHD, VOD. There were four cases (or 9%) of false positive data, and only two (or 4.5%) of false negative results. We therefore propose thrombomodulin assessment as a valid parameter to monitor chemotherapy toxicity-related complications.
1996
- Isokinetic testing to evaluate patients submitted to surgery for the treatment of surgical lesion of the rotator cuff
[Articolo su rivista]
Porcellini, G; Baccarani, G; Campi, F; Galassi, R
abstract
A total of 100 cases surgically treated for rupture of the extra-rotator cuff were evaluated by isokinetic testing. Results were evaluated after a period of time ranging from 1 to 4 years, based on the Constant system, defining the type of lesion of the cuff based on the Snyder classification system, and measuring strength postsurgery using isokinetic testing after 3 and 6 months, and 1 year. Isokinetic testing made it possible to accurately evaluate which patients are capable of obtaining better recovery, and how much time is required for physiotherapy for postoperative rehabilitation, also allowing for correction on an individual basis of any muscular imbalance.
1994
- Osteoarthritis caused by synovial chondromatosis of the shoulder
[Articolo su rivista]
Porcellini, G.; Campi, F.; Brunetti, E.
abstract
N/A
1994
- [Rotator cuff rupture in the shoulder impingement syndrome. Echography and arthrography: 2 diagnostic methods compared]
[Articolo su rivista]
Porcellini, G; Campi, F; de Nicolò, F; Vottari, S; Valbonesi, C; Arcangeli, E
abstract
After briefly reviewing the shoulder impingement syndrome, the authors investigate the role of two diagnostic imaging methods, i.e., ultrasonography (US) and arthrography, in demonstrating the typical features of this condition. Over a 15 months' period, 190 patients suffering from shoulder pain were examined with arthrography; 50 of them subsequently underwent acromion plastic surgery and rotator cuff stitching. This study was aimed at comparing US and arthrographic results, applying classifiable criteria to make the most accurate diagnosis of rotator cuff tears. The lack of visibility of the rotator cuff at US was the major and clearest sign of tear (100% of cases). The association between cuff thinning and hypo/hyperechoic damaged focal areas was another major sign (in 76.19% of complete tears and in 14.28% of incomplete tears). Hyperechoic focal areas alone proved to be a false-positive finding in 5 cases, while in 11 of 19 cases normal US patterns were a false-negative finding; in 3 cases other conditions were diagnosed. To conclude, the value of US is emphasized in the screening of the painful shoulder and the use of arthrography is suggested when both clinical tests and US fail to yield enough information for a diagnosis to be made.
1994
- Tears of the rotator cuff associated with neurologic disorders: a description of two cases
[Articolo su rivista]
Porcellini, G; Campi, F; Brunetti, E
abstract
Based on their clinical experience with the two cases described, the authors analyze the association between surgically treatable tear of the rotator cuff and neurologic pathology. A semeiologic sign is emphasized, which may be of help in differential diagnosis involving isolated lesion of the rotator cuff. Furthermore, after a review of the literature, the authors express doubts as to the type of surgical treatment to be carried out.
1993
- Fracture of the coracoid process associated with fracture of the clavicle: description of a rare case
[Articolo su rivista]
Baccarani, G; Porcellini, G; Brunetti, E
abstract
The authors report on a case of fracture of the coracoid process associated with fracture of the clavicle. Open reduction and internal fixation of the coracoid process lead to a good clinical and radiographic outcome.
1993
- Osteolysis of the distal clavicle
[Articolo su rivista]
Porcellini, Giuseppe
abstract
A brief account of the possible causes of osteolysis of the distal clavicle is followed by the description of a clinical case of post-traumatic origin. Stress is laid on the utility of continued radiographic monitoring to disclose injuries that are not apparent at the time of the acute trauma, and the appropriate surgical management is discussed.
1993
- Quiz. McLaughlin fracture of the right humeral head with posterior dislocation of the shoulder
[Articolo su rivista]
Porcellini, Giuseppe
abstract
N/A
1990
- CT examination in the heel's fractures
[Articolo su rivista]
Porcellini, Giuseppe
abstract
1990
- The Steindler method in the treatment of paralytic elbow flexion
[Articolo su rivista]
Andrisano, A; Porcellini, G; Stilli, S; Libri, R
abstract
Based on an average follow-up of 8.6 years, the authors analyse the functional results obtained in 16 patients submitted to Steindler flexoroplasty of the elbow between 1975 and 1986. The absence of active flexion of the elbow produces a severe deficit in the upper limb even when there is good function of the shoulder and hand. Since 1921, the year in which Steindler published a report on his surgical method, numerous surgical methods have been described for the treatment of paralytic elbow. Clark (1946), Merle d'Aubigné et al. (1956), Brook and Sendon (1959) propose transposing pectoralis major by suturing it to the tendon of the biceps muscle. Le Coeur (1953) instead isolates pectoralis minor and then transposes it on the biceps tendon. Bunnel (1951) describes two methods: the first consists in isolating the sternocleidomastoid by lengthening it with the fascia lata and inserting it into the tendon of the biceps, the second proposes anteriorly transposing the distal triceps tendon. Hovnanian (1956) and Zancolli and Mitré (1973) transpose the latissimus dorsi by inserting it distally on the distal biceps tendon, while Axer et al. (1973) transpose part of the same muscle. It is the purpose of this study to report the experience obtained using the Steindler method in 22 patients affected with paralysis of the flexor muscles of the elbow.
1989
- Post-injective quadriceps contracture
[Articolo su rivista]
Valdiserri, L; Andrisano, A; Manfrini, M; Mazzetti, Maura; Porcellini, G
abstract
After reviewing the literature, the authors report 19 patients affected with post-injective contracture of the quadriceps muscle observed by them between 1971 and 1983. Clinical evaluation, indications for surgery and the results of surgery are discussed.
1988
- [Atypical case of solitary neurofibroma localized in the hand]
[Articolo su rivista]
Zanotti, G; Porcellini, G; De Tullio, V
abstract
1987
- A new syndrome with ocular, skeletal and renal involvement
[Articolo su rivista]
Cirillo Silengo, M; Lopez Bell, G; Biagioli, Mario; Guala, A; Porcellini, G; Franceschini, Paolo
abstract
A patient with retinitis pigmentosa, hypertension with interstitial nephropathy, short limb dwarfism with Madelung deformity of the forearms and an unclassified type of brachydactyly is described. Such bone dysplasia has never been reported to date either as a single entity or associated with renal and retinal diseases.
1987
- [Spinal metastasis: experience in diagnosis and treatment at the Rizzoli Institute]
[Articolo su rivista]
Boriani, S; Ruggieri, P; Donati, D; Porcellini, G; Savini, R
abstract
1986
- [Computerized axial tomography in the preoperative study of osteoid osteoma]
[Articolo su rivista]
Torricelli, P; Ruggieri, P; Biagini, R; Martinelli, C; Porcellini, G; Boriani, S
abstract
N/A
1986
- [Platelet-activating factor: a new biochemical and pharmacologic frontier]
[Articolo su rivista]
Porcellini, G
abstract
1985
- [Bolus doses of netilmicin in the treatment of infections of the urinary tract]
[Articolo su rivista]
Porcellini, Giuseppe
abstract
1981
- [Renal tubular damage after rapid intravenous contrast study with iopamidol]
[Articolo su rivista]
Stratta, P; Porcellini, G; Bianchi, S D; Granone, A; Gatti, G; Salomone, M; Ragni, R
abstract
Reference is made to results obtained in 53 nephropathics in the study of urinary elimination of alphaglycosidase and lysozyme before and after rapid contrastography with sodium and meglumine diatrizoate and with iopamidol. A statistically significant difference in alphaglycosidase was evident with both media, whereas no change was noted for lysozyme. As far as the evaluation of alphaglycosidase was concerned, the tubular alteration induced by each medium was the same in terms of statistical comparison of the mean differences before and after urography.
1981
- [Use of amikacin in renal pathology]
[Articolo su rivista]
Triolo, G; Mangiarotti, G; Pacitti, A; Jeantet, A; Paola, M; Messina, M; Cardelli, R; Randone, D F; Porcellini, G; Martini, P F; Segoloni, G P
abstract
1981
- UTILITA DEL TEST DI DEGRANULAZIONE DEI BASOFILI NELLO STUDIO DELLE REAZIONI DI IPERSENSIBILITA AI MEZZI DI CONTRASTO IODATI [Usefulness of the basophil degranulation test in the study of hypersensitivity reactions to iodate contrast media]
[Articolo su rivista]
Stratta, P; Camussi, G; Porcellini, G; Dogliani, M; Bianchi, S D; Vercellone, A
abstract
The ability of basophils and tissue mastocytes activated by sensitised IgE antibodies to release mediators in the presence of the specific antigen underlies immediate hypersensitivity reactions. This phenomenon can be explored by the in vitro basophil degranulation test adopted not only in experimental pathology, but in human allergological pathology and in the study of post-streptococcal and lupus glomerulonephritis. The test has been carried out to analyse sensitisation to iodate contrast media in 71 patients already submitted to contrastography, 37 of whom had given evidence of allergic reactions. All patients with a previous history of sensitisation presented, in vitro, a positive reaction (56 + 15.3% degranulation) in the presence of the contrast medium. Against this, none of the patients with negative test presented an allergic reaction during contrastography. Stress is laid on the practical importance of the test prior to performance of contrastography so as to predict possible sensitisation and select the most suitable medium.
1980
- Platelet-activating factor (PAF) release from rat peritoneal cells, evidence for mastocyte-macrophage cooperation
[Articolo su rivista]
Camussi, G; Tetta, C; Bussolino, F; Masera, C; Emanuelli, G; Ragni, Rosa Angela; Porcellini, G
abstract
N/A