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Professore Ordinario presso: Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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2020 - Mechanical alignment changes during flexion in total knee arthroplasty without affecting clinical outcomes [Articolo su rivista]
Giorgini, A.; Zambianchi, F.; Lombardi, M.; Francioni, E.; Marcovigi, A.; Catani, F.

Background: Primary aim of this study is to investigate if Hip-Knee-Ankle angle, measured in the coronal plane, changes with knee flexion after total knee arthroplasty. The secondary aim is to assess the relationship between Hip-Knee-Ankle during knee flexion and clinical outcome at mid-term follow up. Methods: 334 computer assisted total knee arthroplasties were retrospectively evaluated. A total of 233 patients were available for assessment of clinical outcomes at last follow up (mean 35 months). Hip-Knee-Ankle angle at different degrees of knee flexion and components' alignment were recorded intraoperatively. Findings: Patients were stratified based on the preoperative alignment: 202 varus knees, 99 neutral knees, and 33 valgus knees. In the varus knee group, 146 patients (89%) maintained a neutral overall limb alignment when flexed to 20°, 118 (72%) remained neutrally aligned at 45° and 92 (54%) at 90°. In valgus knee group, 26 (90%) remained neutrally aligned at 20°, 22 (75%) at 45° and 16 (55%) at 90°. In neutrally-aligned knee group, 88 (96%) remained neutrally aligned at 20°, 73 (79%) at 45° and 61 (66%) at 90°. Femoral component external rotation was correlated with varus alignment in flexion. Good outcomes were reported in 181 (78%) cases, fair results in 28 (12%) cases, poor results in 24 (10%) of cases. Poor results were not correlated to Hip-Knee-Ankle angle at different knee flexion angles. Interpretation: This study demonstrates that intraoperative Hip-Knee-Ankle angle changes as the knee moves into deeper flexion. However, neutral Hip-Knee-Ankle through the range of motion does not correlate with superior outcomes.

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.

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. (

2020 - 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.

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.

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.

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 - Can surgery relieve pain and act as first-line treatment for a large metastasis of the sternum? [Articolo su rivista]
Manfredini, Beatrice; Morandi, U.; De Santis, G.; Catani, F.; Stefani, A.; Pinelli, M.; Baccarani, A.; Starnoni, M.; BELLINI ARTIOLI, FRANCESCO; Aramini, B.

BACKGROUND: There are few papers published on sternal metastasis from renal cell carcinoma. The unifying element is the operability of the sternal metastasis if it is the only site of metastasis, on the operability of the primary site of the tumor and on the patient's health conditions. PRESENTATION OF THE CASE: We present a case of a 66-years-old man undergone sternal resection for a large painful metastasis. He was previously undergone left nephrectomy for clear cells carcinoma. En bloc resection of the sternal manubrium and right clavicle was performed, a Gore-Tex mesh was placed. Histology confirmed metastasis of kidney clear cells carcinoma. Patient was discharged with no complications and no pain. Chest CT at six months follow up was negative for recurrence. DISCUSSION AND CONCLUSION: We highlighted the importance of surgery as possible first-line treatment in symptomatic large sternum metastasis. Therefore, prospective studies should be considered to confirm our strategy.

2019 - Clinical results and short-term survivorship of robotic-arm-assisted medial and lateral unicompartmental knee arthroplasty [Articolo su rivista]
Zambianchi, F.; Franceschi, G.; Rivi, E.; Banchelli, F.; Marcovigi, A.; Khabbaze, C.; Catani, F.

Purpose: The aim of this multicentre, retrospective, observational study was to determine the incidence of revision and clinical results of a large cohort of robotic-arm-assisted medial and lateral UKAs at short-term follow-up. It was hypothesized that patients who receive robotic-arm-assisted UKA will have high survivorship rates and satisfactory clinical results. Methods: Between 2013 and 2016, 437 patients (470 knees) underwent robotic-arm-assisted medial and lateral UKAs at two centres. Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score 12 (FJS-12) and Short-Form Physical and Mental Health Summary Scales (SF-12) were administered to estimate patients’ overall health status pre- and post-operatively. Results were dichotomized as ‘excellent’ and ‘poor’ if KOOS/FJS-12 were more than or equal to 90 and SF-12 was more or equal to 45. Associations between patients’ demographic characteristics and clinical outcomes were investigated. Post-operative complications and pain persistence were recorded. Results: Following exclusions and losses to follow-up, 338 medial and 67 lateral robotic-arm-assisted UKAs were assessed at a mean follow-up of 33.5 and 36.3 months, respectively. Three medial UKAs were revised, resulting in a survivorship of 99.0%. No lateral implants underwent revision (survivorship 100%). On average, significant improvement in all clinical scores was reported in both medial and lateral UKA patients. In medial UKA patients, male gender was associated with higher probability of better scores in overall KOOS, FJS-12 and in specific KOOS subscales. No other associations were reported between biometric parameters and outcome for either medial or lateral UKA. Conclusions: Robotic-assisted medial and lateral UKAs demonstrated satisfactory clinical outcomes and excellent survivorship at 3-year follow-up. Continued patient follow-up is needed to determine the long-term device performance and clinical satisfaction. Level of evidence: Retrospective cohort study, Level IV.

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.

2019 - Does component placement affect short-term clinical outcome in robotic-arm assisted unicompartmental knee arthroplasty? [Articolo su rivista]
Zambianchi, F.; Franceschi, G.; Rivi, E.; Banchelli, F.; Marcovigi, A.; Nardacchione, R.; Ensini, A.; Catani, F.

Aims The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA). Patients and Methods Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded. Results Following exclusions and losses to follow-up, 334 medial robotic-arm assisted UKAs were assessed at a mean follow-up of 30.0 months (8.0 to 54.9). None of the measured parameters were associated with overall KOOS outcome. Correlations were described between specific KOOS subscales and intraoperative, post-implantation robotic data, and between FJS-12 and femoral component sagittal alignment. Three UKAs were revised, resulting in 99.0% survival at two years (95% confidence interval (CI) 97.9 to 100.0). Conclusion Although little correlation was found between intraoperative robotic data and overall clinical outcome, surgeons should consider information regarding 3D component placement and soft-tissue balancing to improve patient satisfaction. Reproducible and precise placement of components has been confirmed as essential for satisfactory clinical outcome.

2019 - Evaluation of Native Femoral Neck Version and Final Stem Version Variability in Patients With Osteoarthritis Undergoing Robotically Implanted Total Hip Arthroplasty [Articolo su rivista]
Marcovigi, Andrea; Ciampalini, Luigi; Perazzini, Piergiuseppe; Caldora, Patrizio; Grandi, Gianluca; Catani, Fabio

Background: Combined anteversion in total hip arthroplasty influences both dislocation risk and range of motion. One of its components, stem version (SV), could be dictated by many factors, from native femoral anatomy to stem geometry and surgeon's choice. In the present multicenter study, robotic technology was used to assess the influence of native femoral version on final SV and combined anteversion using a straight, uncemented stem. Methods: Three hundred sixty-two patients undergoing total hip arthroplasty were enrolled from 3 different orthopedic centers from 2012 and 2016. All patients underwent computed tomography planning with measurement of femoral neck version (FNV) and intraoperative measurement of stem version (SV), acetabular component version (AV), and combined version (CV) with robotic instrumentation. Results: Mean FNV was 5.0° ± 9.6° and SV was 6.4° ± 9.7°. The average difference between FNV and SV was 1.6° ± 9.8°. A moderate correlation was found between FNV and SV (R = 0.48, P <.001). SV was between 5° and 20° in 174 patients (48%). Mean CV was 28.2° ± 7.9°. A strong correlation was found between SV and CV (R = 0.89, P <.001). A significant difference in SV was found between the 3 centers (P <.001). CV was <25° in 109 patients (30.1%). Relative risk of CV < 25° was 8.6 times greater with SV < 5° (P <.001). Conclusion: With the use of an uncemented, single-wedge, straight stem, SV is highly variable. Despite being moderately correlated with native FNV, SV can be partially influenced by the surgeon. A low SV could be hardly corrected, bringing high risk of low CV.

2019 - General Assembly, Prevention, Operating Room - Surgical Attire: Proceedings of International Consensus on Orthopedic Infections [Articolo su rivista]
Autorino, Carlos M.; Battenberg, Andrew; Blom, Ashley; Catani, Fabio; Elganzoury, Ibrahim; Farrell, Anthony; Giorgini, Andrea; Goswami, Karan; Hernandez, Victor; Karas, Vasili; Kunutsor, Setor K.; Lewallen, David G.; Mahmoud, Ahmed Nageeb; Osman, Wael Samir; Sheehan, Eoin; Smith, Brian M.; Soliman, Ramy Ahmed; Spangehl, Mark; Young, Simon

Delphi consensus on PJI of the hip

2019 - 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.


2019 - Mechanical performance of cementless total knee replacements: It is not all about the maximum loads [Articolo su rivista]
Quevedo González, Fernando J.; Lipman, Joseph D.; Lo, Darrick; De Martino, Ivan; Sculco, Peter K.; Sculco, Thomas P.; Catani, Fabio; Wright, Timothy M.

Finite element (FE) models are frequently used to assess mechanical interactions between orthopedic implants and surrounding bone. However, FE studies are often limited by the small number of bones that are modeled; the use of normal bones that do not reflect the altered bone density distributions that result from osteoarthritis (OA); and the application of simplified load cases usually based on peak forces and without consideration of tibiofemoral kinematics. To overcome these limitations, we undertook an integrated approach to determine the most critical scenario for the interaction between an uncemented tibial component and surrounding proximal tibial bone. A cementless component, based on a modern design, was virtually implanted using computed-tomography scans from 13 patients with knee OA. FE simulations were performed across a demanding activity, stair ascent, by combining in vivo experimental forces from the literature with tibiofemoral kinematics measured from patients who had received the same design of knee component. The worst conditions for the bone–implant interaction, in terms of micromotion and percentage of interfacial bone mass at risk of failure, did not arise from the maximum applied loads. We also found large variability among bones and tibiofemoral kinematics sets. Our results suggest that future FE studies should not focus solely on peak loads as this approach does not consistently correlate to worst-case scenarios. Moreover, multiple load cases and multiple bones should be considered to best reflect variations in tibiofemoral kinematics, anatomy, and tissue properties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

2019 - Technology applications in shoulder replacement [Articolo su rivista]
Porcellini, G; Tarallo, L; Novi, M; Spiezia, F; Catani, F

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.

2019 - The Kinematics of the Three Compartments of the Native and Partially Implanted Knee [Capitolo/Saggio]
Zambianchi, Francesco; Nakamura, Shinichiro; Fiacchi, Francesco; Matsuda, Shuichi; Catani, Fabio

2019 - Volar PEEK plate for distal radial fracture: analysis of plate ruptures in a group of 120 patients [Articolo su rivista]
Tarallo, L.; Giorgini, A.; Catani, F.


2018 - A Rare Case of Triceps Brachii Injury after Electrocution [Articolo su rivista]
Lana, Debora; Tarallo, Luigi; Catani, Fabio

Injuries of the triceps brachii muscle are a rare entity and mostly concern its distal tendon. These represent the least common of all muscle and tendons injuries. The most common reported causes are repeated strong physical efforts, a fall on an outstretched forearm when a sudden deceleration is put on contract triceps, or a direct trauma. High-dosed and prolonged corticosteroid therapies, repeated local steroid injections, chronic renal failure, diabetes, rheumatoid arthritis, hyperparathyroidism, and osteogenesis imperfecta are reported as systemic causes. Even rarer are lesions of muscle fibers and avulsions or rupture at its musculotendinous junction, and these can be caused by direct trauma or by forced elbow flexion during triceps contraction. To the best of our knowledge, there is no article in the literature describing this type of injury that occurred after electrocution. In this article, we report an uncommon case of intramuscular tear associated with insertional distal tendon injury occurred in a man survived to high-voltage electric discharge.

2018 - A multicentric, open-label, randomized, comparative clinical trial of two different doses of expanded hbm-mscs plus biomaterial versus iliac crest autograft, for bone healing in nonunions after long bone fractures: Study protocol [Articolo su rivista]
Gmez-Barrena, E.; Padilla-Eguiluz, N. G.; Avendao-Sol, C.; Payares-Herrera, C.; Velasco-Iglesias, A.; Torres, F.; Rosset, P.; Gebhard, F.; Baldini, N.; Rubio-Suarez, J. C.; Garca-Rey, E.; Cordero-Ampuero, J.; Vaquero-Martin, J.; Chana, F.; Marco, F.; Garca-Coiradas, J.; Caba-Dessoux, P.; De La Cuadra, P.; Hernigou, P.; Flouzat-Lachaniette, C. -H.; Gouin, F.; Mainard, D.; Laffosse, J. M.; Kalbitz, M.; Marzi, I.; Sdkamp, N.; Stckle, U.; Ciapetti, G.; Donati, D. M.; Zagra, L.; Pazzaglia, U.; Zarattini, G.; Capanna, R.; Catani, F.

ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n = 108) will be randomly assigned to either the experimental low dose (n = 36), the experimental high dose (n = 36), or the comparator arm (n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

2018 - Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures [Articolo su rivista]
Mugnai, Raffaele; Tarallo, Luigi; Capra, Francesco; Catani, Fabio

Introduction: As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. Hypothesis: Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. Materials and Methods: Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. Results: The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (−16%) for the titanium plate. Statistical analysis between groups reported significant values (p < 001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (p =.197). Discussion: The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the post-operative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. Level of evidence: N/A.

2018 - Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study [Articolo su rivista]
Massari, Leo; Benazzo, Francesco; Falez, Francesco; Cadossi, Ruggero; Perugia, Dario; Pietrogrande, Luca; Aloj, Domenico Costantino; Capone, Antonio; D'Arienzo, Michele; Cadossi, Matteo; Lorusso, Vincenzo; Caruso, Gaetano; Ghiara, Matteo; Ciolli, Luigi; La Cava, Filippo; Guidi, Marco; Castoldi, Filippo; Marongiu, Giuseppe; La Gattuta, Alessandra; Dell'Omo, Dario; Scaglione, Michelangelo; Giannini, Sandro; Fortina, Mattia; Riva, Alberto; De Palma, Pier Luigi; Gigante, Antonio Pompilio; Moretti, Biagio; Solarino, Giuseppe; Lijoi, Francesco; Giordano, Giovanni; Londini, Pier Giorgio; Castellano, Danilo; Sessa, Giuseppe; Costarella, Luciano; Barile, Antonio; Borrelli, Mariano; Rota, Attilio; Fontana, Raffaele; Momoli, Alberto; Micaglio, Andrea; Bassi, Guido; Cornacchia, Rossano Stefano; Castelli, Claudio; Giudici, Michele; Monesi, Mauro; Branca Vergano, Luigi; Maniscalco, Pietro; Bulabula, M'Putu; Zottola, Vincenzo; Caraffa, Auro; Antinolfi, Pierluigi; Catani, Fabio; Severino, Claudio; Castaman, Enrico; Scialabba, Carmelo; Tovaglia, Venceslao; Corsi, Pietro; Friemel, Paolo; Ranellucci, Marco; Caiaffa, Vincenzo; Maraglino, Giovanni; Rossi, Roberto; Pastrone, Antonio; Caldora, Patrizio; Cusumano, Claudio; Squarzina, Pier Bruno; Baschieri, Ugo; Demattè, Ettore; Gherardi, Stefano; De Roberto, Carlo; Belluati, Alberto; Giannini, Antonio; Villani, Ciro; Persiani, Pietro; Demitri, Silvio; DI Maggio, Bruno; Abate, Guglielmo; De Terlizzi, Francesca; Setti, Stefania

Background. Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods. The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results. 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p &lt; 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions. This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

2018 - Changes in total knee arthroplasty design affect in-vivo kinematics in a redesigned total knee system: A fluoroscopy study [Articolo su rivista]
Zambianchi, Francesco; Fiacchi, Francesco; Lombari, Vincenzo; Venturelli, Luca; Marcovigi, Andrea; Giorgini, Andrea; Catani, Fabio

Background: Journey II Bi-Cruciate-Stabilized knee system was designed to overcome the complications of Journey Bi-Cruciate-Stabilized, including ilio-tibial band inflammation and episodes of dislocation. The purpose of this study was to assess differences in knee kinematics between the first and second-generation design by means of video-fluoroscopy. Re-designed prosthesis in-vivo kinematics was analyzed during activities of daily living and results were eventually compared with those of the previous system, as reported in a previously published study. It was hypothesized that changes in components’ design influences replaced knee's kinematic patterns. Methods: Sixteen patients (3 males, 13 females) implanted with the redesigned prosthesis were assessed by video-fluoroscopy during stair-climbing, chair-rising and leg-extension at 8 months of follow-up. Patterns of axial rotation and antero-posterior motion of the medial and lateral femoral condyles were obtained. Range of Motion and International Knee Society Score were recorded pre- and post-operatively. Student t-tests were applied to compare the mean of each interesting variables. Findings: The comparison of the kinematics of the two designs revealed similar patterns of axial rotation, with progressive femoral external rotation in flexion and reduced absolute values of displacement for the new system. Reduced posterior displacements of the medial and lateral condyles were observed in Journey II patients. In terms of absolute location, the lateral condyle in the redesigned prosthesis showed a more anterior position on the tibial-baseplate embedded coordinate system at maximal flexion. Interpretation: Design changes in the recently-introduced total knee system contributed to modify its in-vivo knee kinematics as demonstrated by video-fluoroscopy.

2018 - Comparison between absorbable pins and mini-screw fixations for the treatment of radial head fractures Mason type II-III [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Rocchi, Martina; Capra, Francesco; Catani, Fabio

Background: The treatment of comminuted radial head fractures can include prosthetic replacement or open reduction and internal fixation. The purpose of this study is to evaluate the results of two different internal fixation systems for Mason type II-III radial head fractures. Methods: Between 2005 and 2015, 82 patients were treated using pins and 65 patients by mini-screws. The follow-up protocol included: a clinical evaluation 15 days after surgery, and clinical and radiographic evaluations performed at 30 and 60 day intervals, unless any complications were reported by the patient. Over a period of at least 12-months of follow-up, patients were checked and interviewed. Clinical examinations included elbow range of motion (ROM), arm, shoulder and hand Disabilities, (DASH), and the Mayo Elbow Performance Score (MEPS). Results: Sixty-one subjects who had been treated with mini-screws were clinically reviewed at a mean 47.3 ± 35.8 month of follow-up; all patients who had been treated using absorbable pins were evaluated at a mean 82.5 ± 20.6 month of follow-up. No significant statistically differences were observed between the two groups in the mean ROM, DASH, and MEPS scores. Residual pain was reported in 15.8%of the patients treated by pins and 9.2% patients treated by mini-screws. Secondary displacement of fracture fragments was observed in 8.5% patients treated by pins and 1.6% using mini-screws. Conclusions: Both absorbable pins and mini-screws provided adequate strength and rigidity, allowing good clinical and functional scores at a mid-term follow-up. However, a higher rate of secondary displacement of the fracture fragments was reported among subjects who had been treated using absorbable pins.

2018 - Distal biceps tendon rupture: Advantages and drawbacks of the anatomical reinsertion with a modified double incision approach 11 Medical and Health Sciences 1103 Clinical Sciences [Articolo su rivista]
Tarallo, L.; Lombardi, M.; Zambianchi, F.; Giorgini, A.; Catani, F.

Background: Distal biceps tendon rupture occurs more often in middle-aged male population, involving the dominant arm. In this retrospective study, it's been described the occurrence of the most frequent adverse events and the clinical outcomes of patients undergoing surgical repair of distal biceps tendon rupture with the modified Morrey's double-incision approach, to determine better indications for patients with acute tendon injury. Methods: Sixty-three patients with acute distal biceps tendon rupture treated with a modified double-incision technique between 2003 and 2015 were retrospectively evaluated at a mean 24 months of follow-up. Clinical evaluation including range of motion (ROM) and isometric strength recovery compared to the healthy contralateral side assessment, together with documentation of nerve injury, was performed. Patients were asked to answer DASH, OES and MEPS scores. Results: The ROM recovery showed excellent results compared to the healthy contralateral side. The reported major complications included: one case of proximal radio-ulnar synostosis, 3 cases of posterior interosseous nerve (PIN) palsy and one case of a-traumatic tendon re-rupture. Concerning minor complications, intermittent pain, ROM deficiency &lt; 30° in flexion/extension and pronation/supination, isometric flexion strength deficiency &lt; 30% and isometric supination strength deficiency &lt; 60%, lateral antebrachial cutaneous nerve (LACBN) injury, were observed. The average DASH score was 8.5; the average OES was 41.5 and the MEPS was 96.3. Conclusion: The Morrey modified double-incision technique finds its indication in young and active patients if performed within 2 weeks from injury. If performed by experienced surgeons, the advantages can exceed the drawbacks of possible complications.

2018 - Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections [Articolo su rivista]
Argenson, Jean Noël; Arndt, Marius; Babis, George; Battenberg, Andrew; Budhiparama, Nicolaas; Catani, Fabio; Chen, Foster; de Beaubien, Brian; Ebied, Ayman; Esposito, Silvano; Ferry, Christopher; Flores, Henry; Giorgini, Andrea; Hansen, Erik; Hernugrahanto, K. D.; Hyonmin, Choe; Kim, Tae-Kyun; Koh, In Jun; Komnos, Georgios; Lausmann, Christian; Loloi, Jeremy; Lora-Tamayo, Jaime; Lumban-Gaol, I.; Mahyudin, F.; Mancheno-Losa, Mikel; Marculescu, Camelia; Marei, Sameh; Martin, Kimberly E.; Meshram, Prashant; Paprosky, Wayne G.; Poultsides, Lazaros; Saxena, Arjun; Schwechter, Evan; Shah, Jay; Shohat, Noam; Sierra, Rafael J.; Soriano, Alex; Stefánsdóttir, Anna; Suleiman, Linda I.; Taylor, Adrian; Triantafyllopoulos, Georgios K.; Utomo, Dwikora Novembri; Warren, David; Whiteside, Leo; Wouthuyzen-Bakker, Marjan; Yombi, Jean; Zmistowski, Benjamin

acute periprosthetic joint infection

2018 - Traumatic lesions of peripheral nerves at the elbow [Capitolo/Saggio]
Rovesta, C.; Marongiu, M. C.; Tarallo, L.; Catani, F.

2017 - An Unusual Case of Posterolateral Rotatory Instability of the Elbow [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Catani, Fabio

The authors present a case of posterolateral rotatory elbow instability (PLRI) caused by the concomitant presence of lateral ulnar collateral ligament (LUCL) insufficiency and an impression fracture of the volar margin of the radial head.

2017 - Assessment of patient-specific instrumentation precision through bone resection measurements [Articolo su rivista]
Zambianchi, Francesco; Colombelli, A.; Digennaro, V.; Marcovigi, Andrea; Mugnai, Raffaele; Fiacchi, Francesco; Sandoni, Dario; Belluati, A.; Catani, Fabio

Purpose: In the present study, the precision of two patient-specific instrumentation (PSI) systems for total knee arthroplasty (TKA) was evaluated by comparing bony resection thicknesses of the pre-operative PSI planning and intra-operative measurements by a vernier calliper. It was hypothesized that the data provided by pre-operative planning were accurate within ±2 mm of the bone resection thickness measured intra-operatively. Methods: Forty-one patient-specific TKAs were examined: 25 performed with Visionaire® technology and 16 with OtisMed® system. PSI accuracy was analysed comparing the resected bone thicknesses in the femoral and tibial cuts with pre-operatively planned resections. To determine pre-operative planning precision, the thickness values reported by the PSI planning were subtracted from the values reported intra-operatively by the calliper. Results: The mean absolute differences between pre-operatively planned resections and corresponding intra-operative thickness measurements ranged from a minimum of 2.6 mm (SD 0.8) to a maximum of 3.6 mm (SD 1.3) in all three anatomical planes in both groups. In every plane, the mean absolute discrepancies between planned resections and measured cuts differed significantly from zero (p < 0.0001). The proportion of differences within ±2 mm between intra-operative measured resections and planned PSI cuts occurred in more than 90 % of the cohort for femoral distal resections. Less precision was reported for the femoral posterior medial cuts (70.7 % within ±2 mm) and the tibial cuts (70.7 % on the medial, 75.6 % on the lateral side). Prosthetic component alignment on the coronal and transverse planes resulted in considerable deviations from the pre-operative planning. Conclusion: The two examined PSI technologies were accurate in femoral distal cuts, determining acceptable femoral component placement on the coronal plane. Posterior femoral and tibial cuts were less precise. Deviations from the pre-operative resection planning were reported in every plane. Inaccuracy was explained by ambiguous custom-made jigs placement on the bony surface. Level of evidence: III.

2017 - Humeral shaft non-union after intramedullary nailing [Articolo su rivista]
Campochiaro, Gabriele; Baudi, P; Gialdini, Mauro; Corradini, A; Duca, Vito; Rebuzzi, Manuela; Catani, Fabio

The humerus shaft is one of the sites with the largest probability of developing pseudoarthrosis after fracture. We present the results of nine patients with atrophic pseudoarthrosis of humeral shaft treated with angular stability plate associated with allograft and platelet-rich plasma (PRP), after a first treatment with intramedullary nail to correct the fracture.

2017 - Il trattamento del ginocchio rigido protesizzato [Articolo su rivista]
Marcovigi, Andrea; Zambianchi, Francesco; Francioni, Elena; Fiacchi, Francesco; Giorgini, Andrea; Sandoni, Dario; Catani, Fabio

2017 - Imaging of the Unstable Shoulder [Articolo su rivista]
Baudi, Paolo; Rebuzzi, Manuela; Matino, Giovanni; Catani, Fabio

Unstable shoulder can occur in different clinical scenarios with a broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic acute shoulder anterior dislocation or chronic anterior instability after repeated dislocations.Imaging in unstable shoulder is fundamental for choosing the right treatment preventing recurrence.The goal of imaging depends on clinical scenario and patient characteristics.

2017 - In vivo kinematics of knee replacement during daily living activities: Condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses [Articolo su rivista]
Belvedere, Claudio; Leardini, Alberto; Catani, Fabio; Pianigiani, Silvia; Innocenti, Bernardo

In total knee replacement, the investigation on the exact contact patterns at the post-cam in implanted patients from real in vivo data during daily living activities is fundamental for validating implant design concepts and assessing relevant performances. This study is aimed at verifying the restoration of natural tibio-femoral condylar kinematics by investigating the post-cam engagement at different motor tasks. An innovative validated technique, combining three-dimensional fluoroscopic and finite element analyses, was applied to measure joint kinematics during daily living activities in 15 patients implanted with guided motion posterior-stabilized total knee replacement. Motion results showed physiological antero-posterior translations of the tibio-femoral condyles for every motor task. However, high variability was observed in the position of the calculated pivot point among different patients and different motor tasks, as well as in the range of post-cam engagement. Physiological tibio-femoral joint rotations and contacts at the condyles were found restored in the present knee replacement. Articular contact patterns experienced at the post-cam were found compatible with this original prosthesis design. The present study reports replaced knee kinematics also in terms of articular surface contacts, both at the condyles and, for the first time, at the post-cam.

2017 - Mason type III radial head fractures treated by anatomic radial head arthroplasty: Is this a safe treatment option? [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Rocchi, M.; Capra, F.; Catani, Fabio

Background Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. Replacement through arthroplasty is the recommended treatment in the context of unstable elbow injury and comminuted radial head fracture. The midterm clinical, functional, and radiographic results in patients treated with anatomic radial head arthroplasty for a Mason type III radial head fracture are presented. Material and methods We performed a retrospective search of our facility's prospective trauma database to identify all skeletally mature patients who were treated by primary radial head replacement or open reduction and internal fixation following an acute radial head fracture. Inclusion criteria were Mason type III fractures and anatomic radial head arthroplasty (RHA). All the patients included were evaluated using a standard postoperative protocol including clinical and radiographic evaluation at 1, 3 and 12 months of follow-up. All the patients were reviewed clinically at an average of 30 months’ follow-up. Results Forty-one subjects (32 Mason type III and 9 Mason IV fractures) were treated with anatomic RHA (Acumed, Hillsboro, OR, USA). Of these, two patients (1 Mason type III and 1 Mason type IV) were excluded from the analysis because severe cognitive impairment. Moreover, we decided to exclude the subjects with a Mason type IV fracture to obtain a more homogeneous sample. Therefore, 31 patients with a Mason type III fracture were included in this study. Based on the Mayo Elbow Performance Score, excellent results were obtained in 24 (77%) patients, good in 3 (10%) and fair in 4 (13%) patients. Heterotopic ossification was reported in 8 patients (26% of cases). The final elbow flexion-extension range of motion was of 112°, with a mean flexion of 125°. The final forearm rotational range of motion was 134° with a mean pronation of 68° and a mean supination of 66°. Discussion Anatomic radial head replacement leads to a good functional recovery, even in the presence of severe instability, such as coronoid fractures and LUCL injury. However, patients should be informed of the high number of adverse events (mainly heterotopic ossification) following this treatment. Level of evidence Therapeutic IV.

2017 - Morphological Study: Ultrastructural Aspects of Articular Cartilage and Subchondral Bone in Patients Affected by Post-Traumatic Shoulder Instability [Articolo su rivista]
Baudi, Paolo; Catani, Fabio; Rebuzzi, Manuela; Ferretti, Marzia; Smargiassi, Alberto; Campochiaro, Gabriele; Serafini, Fabio; Palumbo, Carla

Post-traumatic shoulder instability is a frequent condition in active population, representing one of most disabling pathologies, due to altered balance involving joints. No data are so far available on early ultrastructural osteo-chondral damages, associated with the onset of invalidating pathologies, like osteoarthritis-OA. Biopsies of glenoid articular cartilage and sub-chondral bone were taken from 10 adult patients underwent arthroscopic stabilization. Observations were performed under Transmission Electron Microscopy-TEM in tangential, arcuate and radial layers of the articular cartilage and in the sub-chondral bone. In tangential and arcuate layers chondrocytes display normal and very well preserved ultrastructure, probably due to the synovial liquid supply; otherwise, throughout the radial layer (un-calcified and calcified) chondrocytes show various degrees of degeneration; occasionally, in the radial layer evidences of apoptosis/autophagy were also observed. Concerning sub-chondral bone, osteocytes next to the calcified cartilage also show signs of degeneration, while osteocytes farther from the osteo-chondral border display normal ultrastructure, probably due to the bone vascular supply. The ultrastructural features of the osteo-chondral complex are not age-dependent. This study represents the first complete ultrastructural investigation of the articular osteo-chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of articular cartilage and sub-chondral bone. Preliminary observations here collected represent the morphological basis for further deepening of pathogenesis related to shoulder instability, enhancing the relationship between cell shape and microenvironment; in particular, they could be useful in understanding if the early surgical treatment in shoulder instability could avoid the onset of OA.

2017 - Robotic-arm assisted partial knee arthroplasty: a single centre experience [Articolo su rivista]
Marcovigi, Andrea; Zambianchi, Francesco; Sandoni, Dario; Rivi, Elisa; Catani, Fabio

UKA has proven to be an effective surgical procedure, but its survivorship is still negatively affected by inaccuracy in component component positioning, implant and limb alignment. Robotic surgery has been introduced in order to minimize such technical errors. The aim of the present paper was to evaluate clinical and surgical outcomes after a 3 years' experience of robotic assisted UKA with the Mako Robotic Arm.

2016 - Clinical outcome is not affected by total knee arthroplasty alignment [Articolo su rivista]
Mugnai, Raffaele; Zambianchi, Francesco; Digennaro, Vitantonio; Marcovigi, Andrea; Tarallo, Luigi; DEL GIOVANE, Cinzia; Catani, Fabio

Purpose: This study aims to analyse the influence on total knee arthroplasty (TKA) clinical outcomes of biomechanical intra-operative computer-assisted surgery-measured parameters, together with radiographic and demographical data. Methods: Between 2007 and 2009, 227 computer-assisted surgery (CAS) primary TKAs were performed in 219 consecutive patients. Information about gender, age and body mass index (BMI) was collected for each patient. Before knee replacement, all patients underwent a complete radiographic examination and passive flexion–extension range of motion was recorded. All TKAs were implanted using an image-free knee navigation system. Patients included in the study were evaluated at 3, 6 and 12 months of follow-up and then yearly. At each follow-up, subjects were asked to answer the validated Italian version of the Knee Injury and Osteoarthritis Outcome Score. Results: One hundred and eighty patients (187 knees) had data available for analysis. Complications were reported in 13 patients (7.0 %). Intra-operative CAS-measured parameters, together with age, BMI, gender, pre- and post-operative radiographic alignment, did not influence TKA clinical results at a mean 2 years of follow-up. On the other hand, higher post-operative flexion arc of movement was suggestive of better clinical outcomes. Conclusion: TKA clinical outcome is influenced by post-operative knee flexion, other than neutral mechanical limb alignment. Therefore, it is recommended to prefer TKA designs that allow high flexion and to encourage early physical rehabilitation. Level of evidence: IV.

2016 - Corrective osteotomies of the radius: Grafting or not? [Articolo su rivista]
Mugnai, Raffaele; Tarallo, Luigi; Lancellotti, Enrico; Zambianchi, Francesco; Di Giovine, Ettore; Catani, Fabio; Adani, Roberto

AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting. METHODS: Our MEDLINE literature search included 280 studies using the following key words "Malunited distal radius fracture" and 150 studies using key words "Corrective osteotomy of the distal radius". Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria. RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn't use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft. CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft.

2016 - Deviations From Optimal Alignment in TKA: Is There a Biomechanical Difference Between Femoral or Tibial Component Alignment? [Articolo su rivista]
Innocenti, Bernardo; Bellemans, Johan; Catani, Fabio

Restoration of neutral mechanical alignment is one of the prerequisites for long-term TKA survival. This study aimed to investigate the effect of deviations from neutral alignment on bone and implant stress and on ligament strain. Using a previously validated finite element model, a neutrally aligned TKA model was compared to 3 different varus and valgus configurations induced by tibial or by femoral component only and by both component simultaneously. Each model underwent a 2500 N vertical load simulating the peak walking force. Varus and valgus alignment increased polyethylene and bone stress, and altered ligament strains, as compared to the neutral aligned model. Changes in alignment of the tibial component were always associated with more detrimental effects compared to the one of the femoral component.

2016 - Double-locking precontoured plating system for malunited fractures of the distal end of humerus [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Rocchi, M.; Rovesta, Claudio; Catani, Fabio

Background: Distal humeral malunions are uncommon injuries, often associated with limited elbow motion, pain, instability, weakness, and sometimes ulnar neuritis. The complex anatomy of the elbow joint makes this condition one of the most complex elbow injuries to treat. Materials and methods: Four patients were treated by the same surgeon between 2011 and 2013 using a double-locking precontoured plating system for malunited intra-articular or extra-articular fractures of the distal end of the humerus. Results: At a mean 3 years of follow-up, a significant improvement in the elbow motion and functional outcome, evaluated with the Mayo Elbow Performance Index and the Disability of the Arm, Shoulder, and Hand, were observed. Articular reduction obtained after the surgery was maintained in all patients without evidence of avascular necrosis. No other complications (i.e., infection, nervous iatrogenic lesions) were reported. Conclusions: Corrective osteotomy using double-locking precontoured plating system preceded by preoperative planning using a CT scan allowed an improvement in the functional outcome and elbow motion, without complications.

2016 - Potency biomarker signature genes from multiparametric osteogenesis assays: Will cGMP human bone marrow mesenchymal stromal cells make bone? [Articolo su rivista]
Murgia, Alba; Veronesi, Elena; Candini, Olivia; Caselli, Anna; D'Souza, Naomi; Rasini, Valeria; Giorgini, Andrea; Catani, Fabio; Iughetti, Lorenzo; Dominici, Massimo; Burns, Jorge S.

In skeletal regeneration approaches using human bone marrow derived mesenchymal stromal cells (hBM-MSC), functional evaluation before implantation has traditionally used biomarkers identified using fetal bovine serum-based osteogenic induction media and time courses of at least two weeks. However, emerging pre-clinical evidence indicates donordependent discrepancies between these ex vivo measurements and the ability to form bone, calling for improved tests. Therefore, we adopted a multiparametric approach aiming to generate an osteogenic potency assay with improved correlation. hBM-MSC populations from six donors, each expanded under clinical-grade (cGMP) conditions, showed heterogeneity for ex vivo growth response, mineralization and bone-forming ability in a murine xenograft assay. A subset of literature-based biomarker genes was reproducibly upregulated to a significant extent across all populations as cells responded to two different osteogenic induction media. These 12 biomarkers were also measurable in a one-week assay, befitting clinical cell expansion time frames and cGMP growth conditions. They were selected for further challenge using a combinatorial approach aimed at determining ex vivo and in vivo consistency. We identified five globally relevant osteogenic signature genes, notably TGF-β1 pathway interactors; ALPL, COL1A2, DCN, ELN and RUNX2. Used in agglomerative cluster analysis, they correctly grouped the bone-forming cell populations as distinct. Although donor #6 cells were correlation slope outliers, they contrastingly formed bone without showing ex vivo mineralization. Mathematical expression level normalization of the most discrepantly upregulated signature gene COL1A2, sufficed to cluster donor #6 with the bone-forming classification. Moreover, attenuating factors causing genuine COL1A2 gene down-regulation, restored ex vivo mineralization. This suggested that the signature gene had an osteogenically influential role; nonetheless no single biomarker was fully deterministic whereas all five signature genes together led to accurate cluster analysis. We show proof of principle for an osteogenic potency assay providing early characterization of primary cGMP-hBM-MSC cultures according to their donor-specific bone-forming potential.

2016 - The Impact of Bone Deformity on Osteoarthritic Varus Knee Correctability [Articolo su rivista]
Marcovigi, Andrea; Zambianchi, Francesco; Giorgini, Andrea; Digennaro, Vitantonio; Catani, Fabio

Background Bone deformities in the varus osteoarthritic knee may influence soft-tissue balancing and therefore knee correctability. The hypothesis of the present study was that the grade of coronal plane knee deformity may influence directly knee correctability along the entire range of motion from 0° to 90°. Tibial and femoral epiphyseal bone deformities were also analyzed to determine which kind had the greater impact on knee correctability. Methods A coronal plane deformity radiographic assessment and an intraoperative correctability assessment using computer-assisted surgery were performed on 118 varus osteoarthritic knees undergoing total knee arthroplasty. Knees were divided into groups taking into account the kind of bone deformity (tibial, femoral, and combined). Results A significant inverse correlation was found between coronal plane deformity and knee correctability at every 10 degrees of flexion. Correlation was strong at 0° and progressively got weaker at further flexion angles. According to literature, knees with a varus deformity >10° were rarely correctable in full extension, but often correctable in flexion, whereas knees with varus deformity >15° showed to be almost never correctable. Combined deformity group had a significantly lower rate of correctability along the entire range of motion. Conclusion The severity of varus knee malalignment always influenced knee correctability with the knee in full extension, in further flexion (20°-60°), correctability was mildly affected. Isolated tibial epiphyseal deformity and combined epiphyseal deformity have the greatest impact on knee correctability.

2016 - Traduzione in lingua italiana e validazione del questionario Work, Osteoarthritis and joint-Replacement Questionnaire (WORQ): dati preliminari. [Abstract in Atti di Convegno]
Lanfranchi, G.; Rovesta, C.; Chiesi, A.; Modenese, A.; Catani, F.; Gobba, F.

Traduzione in lingua italiana e validazione del questionario Work, Osteoarthritis and joint-Replacement Questionnaire (WORQ): dati preliminari.

Rebuzzi, Manuela; Paolo, Baudi; Ferretti, Marzia; Campochiaro, Gabriele; Gialdini, Mauro; Corradini, Alessandro; Palumbo, Carla; Catani, Fabio


2015 - Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis. A Delphi method consensus initiative among experts in Italy [Articolo su rivista]
Paoloni, Marco; Bernetti, Andrea; Belelli, Alberto; Brignoli, Ovidio; Buoso, Sandro; Caputi, Achille Patrizio; Catani, Fabio; Coclite, Daniela; Fini, Massimo; Mantovani, Lorenzo; Migliore, Alberto; Napoletano, Antonello; Viora, Ugo; Santilli, Valter

OBJECTIVE: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis.METHODS: A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants.RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting.CONCLUSIONS: The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies.

2015 - Complex fractures of the humeral shaft treated with antegrade locked intramedullary nail: clinical experience and long-term results [Articolo su rivista]
Campochiaro, Gabriele; Baudi, Paolo; Loschi, Roberta; Serafini, Fabio; Catani, Fabio

indications for surgical treatment of complex humeral shaft fractures are still controversial. The purpose of this study was to evaluate the outcomes of treating humeral shaft fractures using antegrade locked  intramedullary nail, compared to the treatment with traditional more aggressive techniques such as plate and screws.

2015 - Complex proximal humerus fractures: Hertel’s criteria reliability to predict head necrosis [Articolo su rivista]
Campochiaro, Gabriele; Rebuzzi, Manuela; Baudi, P.; Catani, Fabio

Background: The risk of post-traumatic humeral head avascular necrosis (AVN), regardless of the treatment, has a high reported incidence. In 2004, Hertel et al. stated that the most relevant predictors of ischemia after intracapsular fracture treated with osteosynthesis are the calcar length, medial hinge integrity and some specific fracture types. Based on Hertel’s model, the purpose of this study is to evaluate both its reliability and weaknesses in our series of 267 fractures, assessing how the anatomical configuration of fracture, the quality of reduction and its maintenance were predictive of osteonecrosis development, and so to suggest a treatment choice algorithm. Materials and methods: A retrospective study, level of evidence IV, was conducted to duly assess the radiographic features of 267 fractures treated from 2004 to 2010 following Hertel’s criteria treated with open reduction and internal fixation by angular stability plates and screws. The average age was 65.2 years. The average follow-up was 28.3 ± 17.0 months. The percentage of AVN, the quality and maintenance of reduction obtained during surgery were evaluated. Results: The AVN incidence was 3.7 %. No significant correlation with gender, age and fracture type was found. At the last follow-up X-ray, only 30 % presented all Hertel’s good predictors in the AVN group, 4.7 % in the non-AVN group (p < 0.05). About quality of reduction in the AVN group, it was poor in 50 %; while in the non-AVN group, it was poor in 3.4 % (p < 0.05). Four patients with AVN were symptomatic, and three needed a second surgery. Conclusions: Hertel’s criteria are important in the surgical planning, but they are not sufficient: an accurate evaluation of the calcar area fracture in three planes is required. All fractures involving calcar area should be studied with CT. Level of evidence: IV.

2015 - Distal triceps tendon repair using Krakow whipstitches, K wires, tension band and double drilling technique: A case report [Articolo su rivista]
Tarallo, Luigi; Zambianchi, Francesco; Mugnai, Raffaele; Costanzini, Carlo Alberto; Catani, Fabio

Introduction: The management of distal triceps tears must address each patient's medical and functional status: in general, the literature has described satisfactory nonsurgical treatment in tears less than 50%. Tears greater than 50% are treated nonsurgically in a sedentary person and surgically in active patients. Complete tears are generally managed surgically: most reported repair techniques describe the use of Bunnell or Krakow whipstitch techniques, passing the sutures through transosseous drill holes in the ulna. Other described techniques include the use of suture anchors and direct tendon repair to a periosteal flap raised from the olecranon. Case presentation: In the presented report we describe the surgical technique used to treat a complete traumatic distal triceps tendon rupture associated with olecranon fracture in a 40-year-old Caucasian man with underlying poor tendon quality and postoperative assessment. To the best of our knowledge no studies describing the performed surgical technique, utilizing Krakow whipstitches, olecranon fixation with K wires and Zuggurtung tension band through transosseous drill holes have been previously described in the literature. At 30 days postoperatively the patient had regained full elbow flexion/extension and pronation/supination. Conclusions: The described methodology, using a double ulnar tunnel to obtain fixation of the fragment, associated with a whipstitch locking-type suture for the triceps tendon, allowed proper fixation of the fracture and optima reinsertion of the detached tendon on its footprint with sufficient strength.

2015 - Mesenchymal stem/stromal cells as a delivery platform in cell and gene therapies [Articolo su rivista]
D’Souza, Naomi; Rossignoli, Filippo; Golinelli, Giulia; Grisendi, Giulia; Spano, Maria Carlotta; Candini, Olivia; Osturu, Satoru; Catani, Fabio; Paolucci, Paolo; Horwitz, Edwin M.; Dominici, Massimo

Regenerative medicine relying on cell and gene therapies is one of the most promising approaches to repair tissues. Multipotent mesenchymal stem/stromal cells (MSC), a population of progenitors committing into mesoderm lineages, are progressively demonstrating therapeutic capabilities far beyond their differentiation capacities. The mechanisms by which MSC exert these actions include the release of biomolecules with anti-inflammatory, immunomodulating, anti-fibrogenic, and trophic functions. While we expect the spectra of these molecules with a therapeutic profile to progressively expand, several human pathological conditions have begun to benefit from these biomolecule-delivering properties. In addition, MSC have also been proposed to vehicle genes capable of further empowering these functions. This review deals with the therapeutic properties of MSC, focusing on their ability to secrete naturally produced or gene-induced factors that can be used in the treatment of kidney, lung, heart, liver, pancreas, nervous system, and skeletal diseases. We specifically focus on the different modalities by which MSC can exert these functions. We aim to provide an updated understanding of these paracrine mechanisms as a prerequisite to broadening the therapeutic potential and clinical impact of MSC.

2015 - Pediatric medial epicondyle fractures with intra-articular elbow incarceration [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Fiacchi, Francesco; Adani, Roberto; Zambianchi, Francesco; Catani, Fabio

Background: Intra-articular incarceration of the epicondylar fragment occurs in 5–18 % of all cases of medial epicondyle fracture. It requires stable fixation to allow early motion, since elbow stiffness is the most common complication following medial epicondyle fracture. In this retrospective study, we report the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration. Methods: Thirteen children who had a fracture of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) were surgically treated in our university hospital between 1998 and 2012. There were eight male and five female patients. The mean age at the time of injury was 13 years (range 9–16). Operative treatment consisted of open reduction and internal fixation with one or two 4.0-mm cannulated screws under fluoroscopic control. Results: All of the patients were clinically reviewed at an average follow-up of 29 months. The overall range of motion limitation was about 5° for flexion–extension and 2° for pronation–supination. The score was excellent in all patients (mean 96.3). Complications occurred in four (31 %) children: two cases of symptomatic screw head prominence, irritation with partial lesion of the distal triceps myotendinous junction in one patient, and median nerve entrapment syndrome in one patient. Conclusions: In conclusion, open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. However, particular attention is should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications. Level of evidence: Therapeutic IV.

2015 - Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate [Articolo su rivista]
Rotini, R; Cavaciocchi, M.; Fabbri, D.; Bettelli, G.; Catani, Fabio; Campochiaro, Gabriele; Fontana, M.; Colozza, A.; De Biase, C. F.; Ziveri, G.; Zapparoli, C.; Stacca, Francesco; Lupo, R.; Rapisarda, S.; Guerra, Emmanuele

Background: Locking plate fixation is a reliable treatment for many displaced proximal humeral fractures. Carbon fiber-reinforced–poly-ether-ether-ketone (CFR-PEEK) plates have recently been introduced as an alternative to traditional metallic plates. Methods: In a multicenter study involving the Orthopedic Services of 6 Italian hospitals, 182 patients with a proximal humeral fracture were treated with a Diphos H (Lima Corporate, San Daniele del Friuli, Italy) CFR-PEEK plate, 160 of whom were followed clinically and radiographically for 2 years or more. Fractures were classified by Neer’s system. The functional results were assessed by Constant and DASH scores. Results: The average time to radiographic healing was 5.6 months in 158 of 160 cases. Mean Constant score was 76, and mean DASH score was 28 at 2 years. There were two nonunions (one septic and one aseptic) and 13 cases of partial (9) or massive (4) humeral head necrosis. In three of the 78 patients treated with the first-generation plates, hardware breakage happened during the operation and the plate was replaced. There was no failure among the cases treated with the thicker second-generation plate. In eight cases, there was a perforation of the humeral head by the cephalic screws. Conclusions: CFR-PEEK plates proved as reliable as metallic plates in the treatment of proximal humeral fractures. The advantages of these new devices include a better visualization of fracture reduction during intraoperative fluoroscopic assessment and easy hardware removal due to the absence of screw-plate cold fusion.

2015 - Shear fractures of the distal humerus: Is the use of intra-articular screws a safe treatment? [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Zambianchi, Francesco; Costanzini, Carlo Alberto; Catani, Fabio

Background: Coronal shear fractures of the distal humerus are uncommon injuries and are not exempt from complications. The aim of this research is to evaluate the possible advantages and drawbacks using cannulated compression headless screws. Materials and methods: We performed a prospective study including all the consecutive patients who were treated with cannulated screws for coronal shear fractures of the distal humerus between 2010 and 2013. Following the Dubberley’s classification, three patients were type 1A, one patient was 1B, three patients were 2B, and one patient was 3B. The mean follow-up was 30 months. The clinical and radiological evaluation included analysis of passive range of motion, functional outcome, radiological evaluation of fracture healing and reduction maintenance, and the occurrence of possible adverse events. Results: All fractures healed, and radiographic union was observed at an average of 3 months. The average elbow range of motion was 125°, with 125° of flexion and 20 of extension. According to the Broberg and Morrey score, there were four excellent and four good results. Using the Mayo Elbow Performance Index, five cases achieved excellent scores and three reported good results. Adverse events reported in three cases were as follows: heterotopic ossification, complex regional pain syndrome and delayed lateral collateral ligament disruption. Conclusions: The use of cannulated compression headless screws has given satisfactory results, allowing a strong inter-fragmentary compression, early mobilization, with high union rates and good elbow function. However, patients should be counseled about the high proportion of adverse events following these injuries.

2015 - Surgeon’s experience influences UKA survivorship: a comparative study between all-poly and metal back designs [Articolo su rivista]
Zambianchi, Francesco; Digennaro, V.; Giorgini, Andrea; Grandi, G.; Fiacchi, Francesco; Mugnai, Raffaele; Catani, Fabio

Purpose: Concerns exist regarding prosthetic positioning and post-operative limb alignment in unicompartmental knee arthroplasty (UKA). In this study, we hypothesized deviations of the post-op anatomical femoro-tibial angle (aFTA) and the tibial component alignment to be factors influencing UKA survivorship. Moreover, by a comparison between all-poly and metal back UKAs, we hypothesized that prosthetic design plays a role in implant survivorship. Methods: One hundred ninety-five medial UKAs were performed on 176 patients by two experienced surgeons and one low-UKA user. One hundred and forty-seven UKAs were included in the study: 72 all-poly and 75 metal back. Measurements were performed on radiographs: mechanical femoro-tibial angle, Cartier angle, aFTA and tibial posterior slope (PS) on pre-op radiographs; femoral and tibial component varus/valgus, aFTA and tibial component PS on post-op radiographs. Results: At an average follow-up of 61 months (min. 30, max. 107), 147 UKAs were evaluated: The reported survivorship rate was 93.1 %. Eleven implants underwent revision: ten all-poly and one metal back. No differences were reported between the two groups in the radiographic measurements. Significant radiographic differences were reported between revised and not revised UKAs: Revised UKAs were associated with overcorrection of the pre-op Cartier angle and under correction of pre-op aFTA. Most of revised UKAs were performed by the low-volume UKA surgeon. Conclusions: Surgeon’s experience is essential to achieve good results in UKA: Preserving the tibial epiphyseal axis and avoiding excessive or insufficient corrections of the pre-operative limb alignment are predictor of successful replacement, while prosthetic designs, models and fixation geometry do not affect UKA outcome. Level of evidence: IV.

2015 - Ultrastructural aspects of articular cartilage and subchondral bone in patients affected by post-traumatic shoulder instability: preliminary observations [Abstract in Rivista]
Baudi, Paolo; Campochiaro, Gabriele; Rebuzzi, Manuela; Ferretti, Marzia; Serafini, Fabio; Catani, Fabio; Palumbo, Carla

Post traumatic shoulder instability is a frequent condition in young active population. Notwithstanding a lot of data have been collected on capsular-legament lesions and gleno-humeral defects, no data are available on early ultrastructural ostheo-condral damages that are known to be highly associated with the onset of invalidating pathologies, like osteoarthritis (OA). Thus, the mechanisms of joint instability and the identification of which components in the articular complex are primarily affected in instability are of clinical significance, particularly in the light of deepening knowledge on the onset/development of OA. In the present study, biopsies of the articular cartilage and sub-chondral bone were taken from 10 patients (aged 26-40) underwent surgery in Policlinico of Modena. The withdrawals were immediately fixed and embedded for Transmission Electron Microscopy (TEM). The observations were performed in tangential, arcuate, and radial layers of the articular cartilage as well as in sub-chondral bone. TEM observations showed that chondrocytes in the superficial layers (i.e. tangential and arcuate) display normal and very well preserved ultrastructure, probably due to synovial liquid supply; otherwise, chondrocytes in the radial layer (not only in calcified but also in the un-calcified one) show various degrees of degeneration, with cytoplasm partially coerced and variously-sized vacuoles, both signs of suffering; occasionally, in the radial layer, chondrocytes with morphological signs of apoptosis or autophagy were also observed. As far as sub-chondral bone is concerned, osteocytes next the deeper calcified cartilage (within 80-100 micra from the cement line) also show evidences of degeneration, while osteocytes more distant from the osteo-chondral border display normal ultrastructure probably due to the vascular bone supply. In all patients of the study, the ultrastructural features of osteo-chondral complex are not depending on age. The present study represents the first ultrastructural investigation of the articular osteo-chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of the articular cartilage and sub-chondral bone. These preliminary observations are the basis to understand if the early surgical treatment in shoulder instability could avoid the onset of OA.

2015 - cGMP-compliant transportation conditions for a prompt therapeutic use of marrow mesenchymal stromal/stem cells [Capitolo/Saggio]
Veronesi, Elena; Burns, Jorge Phillip Joaquin Sans; Murgia, Alba; Candini, Olivia; Rasini, Valeria; Mastrolia, Ilenia; Catani, Fabio; Paolucci, Paolo; Dominici, Massimo

We recently described conditions for safe 18-h manufacturer-to-patient transportation of freshly harvested hBM-MSC expanded under cGMP protocols using human platelet lysate (hPL), that allowed prompt use as an advanced therapeutic medicinal product. Here we outline important considerations when comparing different transportation conditions, highlighting that although cell transportation may involve a reduction in viability, this did not undermine the ultimate bone-forming regenerative potential of the cGMP-hBM-MSC population.

2014 - A new volar plate made of carbon-fiber-reinforced polyetheretherketon for distal radius fracture: analysis of 40 cases [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Zambianchi, Francesco; Catani, Fabio

BACKGROUND: Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures. MATERIALS AND METHODS: We included 40 consecutive fractures of AO types B and C that remained displaced after an initial attempt at reduction. The fractures were classified according to the AO classification: 21 fractures were type C1, 9 were type C2, 2 were type C3, 2 were type B1 and 6 were type B2. RESULTS: At a 12-month follow-up no cases of hardware breakage or loss of the surgically achieved fracture reduction were documented. All fractures healed, and radiographic union was observed at an average of 6 weeks. The final Disabilities of Arm, Shoulder and Hand score was 6.0 points. The average grip strength, expressed as a percentage of the contralateral limb, was 92 %. Hardware removal was performed only in one case, for the occurrence of extensor tenosynovitis. CONCLUSION: At early follow-up this device showed good clinical results and allowed maintenance of reduction in complex, AO fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

2014 - Causes and treatments of lag screw's cut out after intramedullary nailing osteosinthesis for trochanteric fractures [Articolo su rivista]
Gazzotti, Gabriele; Matino, Giovanni; Tsatsis, Christos; Sacchetti, Gianluigi; Baudi, Paolo; Catani, Fabio

Background. Superior cut-out of a lag screw remains a serious complication in the treatment of trochanteric or subtrochanteric fractures and it is related to many factors: the type of fracture, osteoporosis and the stability of fracture reduction. Little is known about the outcome after revision surgery for complications of the gamma nail. We assessed the outcome in patients who had revision surgery because of lag screw's cut out after gamma nailing for a trochanteric fracture.Material and Method. We present a study of 20 consecutive patients who underwent treatment after 20 cut-out of the lag screw fixation of a trochanteric fracture with Gamma Locking Nail from September 2004 to November 2010. In 16 patients hip prothesis was performed, in 1 the removal of the implant and in 3 the reosteosynthesis. We reviewed 13 patients: 10 total hip arthroplasty, 2 endoprothesis and 1 reosteosynthesis of nail and lag screw (mean follow up: 26 months, mean age: 73 years old), 7 patients died. Patients were reviewed retrospectively by an independent observer. Clinical evaluation was performed, Oxford score and Harris Hip score were measured. X-Ray examination was performed after a minimum of 12 months of follow up.Results. Mean Harris Hip Score mean was 67 and mean Oxford score was 32 in hip prothesis group (12 patients). We had several complications, Implant-related complications were: 2 ipometria > 2cm, 2 recurrent hip arthroplasty dislocations (1 reoperated), 4 persistent thigh pain. In only 4 patients none complications were observed. Another patient,  who had been subjected to reosteosinthesis, obtained better results (HHS:95, Oxford score:45) but with a 2 cm ipometria and occasional pain in the thigh.Conclusion. Cut out after gamma nail is consequent to biological or mechanical causes. Treatment of this complication is hip prosthesis (parzial or total hip arthroplasty), reosteosynthesis of the lag screw and/or the nail and the removal of the implant. Conversion to total/parzial hip arthroplasty may be a demanding operation with a higher complication rate respect to the standard, while reosteosynthesis is possible in selected patients and early cutting out.

2014 - Design and kinematics in total knee arthroplasty [Articolo su rivista]
Digennaro, Vitantonio; Zambianchi, Francesco; Marcovigi, Andrea; Mugnai, Raffaele; Fiacchi, Francesco; Catani, Fabio

Purpose: Posterior stabilised (PS) total knee arthroplasty (TKA) design development that focused on restoring normal knee kinematics was followed by the introduction of reason-guided motion designs. Although all PS fixed-bearing knee designs were thought to have similar kinematics, reports show they have differing incidences and magnitudes of posterior femoral rollback and axial rotation. In this retrospective comparative study between two guided-motion total knee systems, we hypothesised that kinematic pattern has an influence on clinical and functional outcomes. Methods: This study represents the continuation of a previously reported clinical and kinematics analysis. We retrospectively reviewed 347 patients treated with two different TKA designs: Scorpio NRG (Stryker Orthopedics) and Journey Bi-Cruciate Stabilised (BCS) knee system (Smith & Nephew). Two hundred and eighty-one patients were assessed clinically. Patients were divided into groups according to implanted TKA. Clinical evaluation with the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire was performed. Fifteen Scorpio NRG and 16 Journey BCS patients underwent video fluoroscopy during stair climbing, chair rising/sitting and step up/down at six months of follow-up. Results: At an average 29 months of clinical follow-up, patients with Journey BCS TKAs reported better clinical results. Stiffness was more frequently reported in the Journey group (5.2 % vs 1.2 %), whereas anterior knee pain was observed in the Scorpio NRG group (1.9 %) only. Both prosthetic models reported different posterior translation of the medial and lateral contact points (CP) in all analysed motor tasks during knee flexion (BCS 10-18 mm; NRG Scorpio 2-3 mm). Both designs produced progressive external rotation of the femoral component relative to the tibia during flexion. Conclusions: Journey BCS showed statistically significant better KOOS results. The higher posterior femoral rollback observed in the kinematic assessment of this design, associated with a better patellofemoral design, may be the reason for better clinical outcome. The reported cases of stiffness and anterolateral joint pain could be attributed to excessive medial and lateral tibiofemoral posterior translation. The NRG group demonstrated good axial rotation, but this was not coupled with physiological kinematic patterns. Patellofemoral pain can be explained by a less friendly femoral-groove design. TKA clinical-functional outcome and complications were highly influenced by the bearing geometry and kinematic pattern of prosthetic designs. © 2014 Springer-Verlag Berlin Heidelberg.

2014 - Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach.

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

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 - Hemiarthroplasty versus reverse shoulder arthroplasty: Comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture [Articolo su rivista]
Baudi, P; Campochiaro, Gabriele; Serafini, F.; Gazzotti, G.; Matino, Giovanni; Rovesta, Claudio; Catani, Fabio

Purpose: To compare functional and radiographic results of reverse prosthesis versus hemiarthroplasty after complex displaced proximal humeral fractures in elderly patients when adequate ORIF cannot be achieved and prosthetic shoulder replacement is required. Methods: From 2008 to 2012, 67 patients were treated with hemiarthroplasty or reverse arthroplasty. We evaluated 53 cases with an average follow-up of 27.5 months (range 12-64). Twenty-eight patients with an average age of 71.4 years were treated with a hemiarthroplasty and 25 patients with an average age of 77.3 years with a reverse prosthesis. All patients were assessed before and after surgery by Constant-ASES-DASH score, strength in abduction, ER1, ER2, and X-rays. Results: In hemiarthroplasty group, we observed a mean Constant score of 42.3 pt, ASES score 51.3 pt, and DASH score 46.1, with an average strength of 1.3 lb in abduction and of 3.7 lb in ER1 and 1.8 lb in ER2. In reverse arthroplasty group, we measured a mean Constant of 56.2 pt, ASES 69.3 pt, and DASH score 40.4, with an average strength of 4.3 lb in abduction and of 3.3 lb in ER1 and 3.2 lb in ER2. Radiographically, it is interesting to observe that greater tuberosity healing rate was 37 % in hemiarthroplasty group compared to 84 % in reverse arthroplasty group. About complications, the highest rate was recorded in the hemiarthroplasty group. Conclusion: Reverse shoulder arthroplasty indication is steadily increasing in acute displaced proximal humeral fracture. Pain and articular movement results appear better than those with hemiarthroplasty. Our data are similar to the international literature. © 2014 Istituto Ortopedico Rizzoli.

2014 - How to improve femoral component rotational alignment in computer-assisted TKA [Articolo su rivista]
Zambianchi, Francesco; Luyckx, T.; Victor, J.; Digennaro, V.; Giorgini, Andrea; Catani, Fabio

Purpose: Although several anatomical landmarks have been proposed to obtain adequate femoral component alignment in total knee arthroplasty (TKA), there is still no consensus regarding the best way to correctly position the prosthetic component on the horizontal plane. A previous computed tomography (CT)-based study has demonstrated anatomical transepicondylar axis (aTEA) to be externally rotated relative to surgical transepicondylar axis (sTEA) of approximately 4.5°. In this study, it is described a new methodological approach to femoral component rotational positioning through the use of previously reported CT scan information and navigation. Methods: Eight consecutive patients scheduled for navigated TKA were selected. Rotational placement of the femoral component was performed using navigation system. The femoral component was implanted setting 4.5° of internal rotation relative to the aTEA. Within 1 week from surgery, all patients underwent a CT scan, and the posterior condylar angle (PCA) was measured. A PCA of 0.0°, meaning component placement parallel to sTEA, was set as femoral rotational alignment target. Clinical evaluation was performed at a mean 14.3 months of follow-up with KOOS questionnaire. Results: The mean PCA measured on post-operative CT images was 0.4° (SD 1.3°), meaning that the femoral component was averagely implanted with 0.4° of internal rotation relative to the sTEA. Seven out of eight cases (87.5 %) resulted to have within 1° deviation from the rotational alignment target. All patients but one reported good clinical results. Conclusions: Relevant finding of the present study was that the use of navigation and aTEA as a reference demonstrated to be accurate to set up femoral component rotational positioning on the horizontal plane in TKA. Further study should be performed to confirm this conclusion. Level of evidence: III. © 2014 Springer-Verlag Berlin Heidelberg.

2014 - In vivo kinematics of medial unicompartmental osteoarthritic knees during activities of daily living [Articolo su rivista]
Fiacchi, Francesco; Zambianchi, Francesco; Digennaro, V; Ricchiuto, I; Mugnai, Raffaele; Catani, Fabio

Few studies exist describing unicompartmental osteoarthritic knee kinematics. Moreover, the role of the anterior cruciate ligament (ACL) in the determination of knee kinematics has not been fully described. The objective of the current study was to analyze the in vivo kinematics of knees with medial osteoarthritis (OA) and intact ACL during closed and open chained motion. Eight patients scheduled for UKA diagnosed with primary medial OA underwent knee CT-scans and video-fluoroscopy. Fluoroscopic analysis included stair climbing, chair rising and leg extension. Three-dimensional bone positions were obtained from each image by iterative procedures using a CAD-model-based shape-matching technique. Patterns of axial rotation and anterior-posterior (AP) motion of the medial and lateral femoral condyle were obtained with specific software. The femur reported an overall external rotation relative to the tibia from extension to flexion in all tasks. Average AP translation of the medial femoral condyle were smaller in open-chained tasks than in weight-bearing conditions. Average AP motion of the lateral femoral condyle reported an overall posterior translation with knee flexion. The absent natural "screw-home" mechanism and the lack of medial condyle posterior translation was explained by bone-cartilage defects and meniscal degeneration. Relevant findings were the kinematic pattern differences between weight-bearing and open chained activities, suggesting that in biphasic muscle contraction and unloaded conditions, the function of the cruciate ligaments was not physiological. The kinematics of knees with medial OA and intact ACL differed from healthy knees.

2014 - Load sharing and ligament strains in balanced, overstuffed and understuffed UKA. A validated finite element analysis [Articolo su rivista]
Innocenti, Bernardo; Bilgen, Ömer Faruk; Labey, Luc; Van Lenthe, G. Harry; Sloten, Jos Vander; Catani, Fabio

The aim of this study was to quantify the effects of understuffing and overstuffing UKA on bone stresses, load distribution and ligament strains. For that purpose, a numerical knee model of a cadaveric knee was developed and was validated against experimental measurements on that same knee. Good agreement was found among the numerical and experimental results. This study showed that, even if a medial UKA is wellaligned with normal soft tissue tension and with correct thickness of the tibia component, it induces a stiffness modification in the joint that alters the load distribution between the medial and lateral compartments, the bone stress and the ligament strain potentially leading to an osteoarthritic progression.

2014 - Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio

Background: Multiple techniques for corrective osteotomy have been developed in recent years with the same aims: to improve the radiographic parameters and improve motion, pain and grip strength. Volar fixed-angle plates have added a new concept to the treatment of distal radius fractures thanks to the low morbidity of the surgical approach and the strength of the final construct, allowing early mobilization and return to function.Materials and methods: Between 2005 and 2012, 20 patients with symptomatic dorsally malunited extra-articular fractures of the distal radius underwent corrective osteotomy using a volar locking plate without additional bone graft. At a mean follow-up of 50&nbsp;months, all the patients were clinically and functionally evaluated.Results: All measurements of pain, final range of motion and grip strength significantly improved compared with preoperative measurements. The mean preoperative DASH score reduced from 54 points preoperatively to 25 postoperatively. Based on the modified Mayo wrist score, we obtained 14 excellent and six good results. Palmar tilt improved from an average of 23° to 11°. Radial inclination improved from an average of 29° to 22°, and ulnar variance decreased from an average of 3.6&nbsp;mm to 0.9&nbsp;mm. There were two cases of transient median neuroapraxia that resolved before the 6-week follow-up appointment. No other major complications, including non-union and infection, were observed.Conclusion: The volar approach and locking plate, without necessarily the use of bone grafting, proved to be an effective approach for addressing symptomatic and even severe deformities of the distal radius.Type of study/level of evidence: Therapeutic IV.

2014 - Perioperative antibiotics [Articolo su rivista]
Hansen, Erik; Belden, Katherine; Silibovsky, Randi; Vogt, Markus; Arnold, William; Bicanic, Goran; Bini, Stefano; Catani, Fabio; Chen, Jiying; Ghazavi, Mohammad; Godefroy, Karine M.; Holham, Paul; Hosseinzadeh, Hamid; Kim II, Kang; Kirketerp Moøller, Klaus; Lidgren, Lars; Lin, Jian Hao; Lonner, Jess H.; Moore, Christopher C.; Papagelopoulos, Panayiotis; Poultsides, Lazaros; Randall, R. Lor; Roslund, Brian; Saleh, Khalid; Salmon, Julia V.; Schwarz, Edward; Stuyck, Jose; Dahl, Annette W; Yamada, Koji

The preoperative dose of antibiotics should be administered within 1 h of surgical incision; this can be extended to 2 h for vancomycin and fluoroquinolones. Furthermore, surveillance measures are critical in ensuring clinician compliance with this objective.

2014 - Simple and comminuted displaced olecranon fractures: A clinical comparison between tension band wiring and plate fixation techniques [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Capra, Francesco; Zambianchi, Francesco; Catani, Fabio

Introduction: The purpose of this retrospective study is to compare the clinical, functional outcome and complications occurrence between tension band wiring (TBW) and plate fixation both for simple and comminuted displaced olecranon factures.Materials and methods: Between January 2005 and June 2012 (minimum 1-year follow-up), 78 consecutive patients with Mayo type IIA and IIB fractures were treated with the following methods: tension band wire or plate and screws fixation. The primary outcome of this study was the functional outcome, assessed by the following self-administered evaluation scales: the disabilities of the arm, shoulder and hand, and the Mayo Elbow Performance Score. Secondary outcome measures included the assessment of pain level, analysis of passive range of motion, and the occurrence of any early or late complications.Results: Comparing the clinical results between the two groups, at mean 33 months follow-up, no significant differences in the functional and clinical outcome were observed. Complications were reported in 48 and 17 % of cases, following TBW and plate fixation in patients treated for type IIA fractures, and similarly in 40 and 23 % of cases in type IIB fractures, respectively. Hardware removal was more frequently performed in TBW group: 38 versus 17 % for type IIA fractures and 20 versus 6 % for type IIB fractures.Conclusions: The findings of this study indicate that both with the use of TBW and plate fixation excellent/good clinical outcomes with minimal loss of physical capacity, little pain and disability can be obtained in the majority of patients with simple and comminuted displaced olecranon fractures. Hardware removal was most frequently observed after TBW.Level of evidence: Therapeutic IV.

2014 - Transportation conditions for prompt use of Ex Vivo expanded and freshly harvested clinical-grade bone marrow mesenchymal stromal/stem cells for bone regeneration [Articolo su rivista]
Veronesi, Elena; Murgia, Alba; Caselli, Anna; Grisendi, Giulia; Piccinno, MARIA SERENA; Rasini, Valeria; Giordano, Rosaria; Montemurro, Tiziana; Bourin, Philippe; Sensebé, Luc; Rojewski, Markus T.; Schrezenmeier, Hubert; Layrolle, Pierre; Ginebra, Maria Pau; Panaitescu, Carmen Bunu; Gómez Barrena, Enrique; Catani, Fabio; Paolucci, Paolo; Burns, Jorge Phillip Joaquin Sans; Dominici, Massimo

Successful preliminary studies have encouraged a more translational phase for stem cell research. Nevertheless, advances in the culture of human bone marrow-derived mesenchymal stromal/stem cells (hBM-MSC) and osteoconductive qualities of combined biomaterials can be undermined if necessary cell transportation procedures prove unviable. We aimed at evaluating the effect of transportation conditions on cell function, including the ability to form bone in vivo, using procedures suited to clinical application. hBM-MSC expanded in current Good Manufacturing Practice (cGMP) facilities (cGMP-hBM-MSC) to numbers suitable for therapy were transported overnight within syringes and subsequently tested for viability. Scaled-down experiments mimicking shipment for 18 h at 4°C tested the influence of three different clinical-grade transportation buffers (0.9\% saline alone or with 4\% human serum albumin [HSA] from two independent sources) compared with cell maintenance medium. Cell viability after shipment was >80\% in all cases, enabling evaluation of (1) adhesion to plastic flasks and hydroxyapatite tricalcium phosphate osteoconductive biomaterial (HA/β-TCP 3D scaffold); (2) proliferation rate; (3) ex vivo osteogenic differentiation in contexts of 2D monolayers on plastic and 3D HA/β-TCP scaffolds; and (4) in vivo ectopic bone formation after subcutaneous implantation of cells with HA/β-TCP scaffold into NOD/SCID mice. Von Kossa staining was used to assess ex vivo osteogenic differentiation in 3D cultures, providing a quantifiable test of 3D biomineralization ex vivo as a rapid, cost-effective potency assay. Near-equivalent capacities for cell survival, proliferation, and osteogenic differentiation were found for all transportation buffers. Moreover, cGMP-hBM-MSC transported from a production facility under clinical-grade conditions of 4\% HSA in 0.9\% saline to a destination 18 h away showed prompt adhesion to HA/β-TCP 3D scaffold and subsequent in vivo bone formation. A successfully validated transportation protocol extends the applicability of fresh stem cells involving multicentric trials for regenerative medicine.

2014 - Up-regulation of the chemo-attractive receptor ChemR23 and occurrence of apoptosis in human chondrocytes isolated from fractured calcaneal osteochondral fragments [Articolo su rivista]
Sena, Paola; Manfredini, Giuseppe; Benincasa, Marta; Mariani, Francesco; Smargiassi, Alberto; Catani, Fabio; Palumbo, Carla

To study the expression level of a panel of pro/anti-apoptotic factors and inflammation-related receptors in chondral fragments from patients undergoing surgical treatment for intra-articular calcaneal fractures, cartilage fragments were retrieved from calcaneal fractures of 20 patients subjected to surgical treatment. Primary cultures were performed using chondral fragments from fractured and control patients. Chondrocyte cultures from each patient of the fractured and control groups were subjected to immunofluorescence staining and quantitatively analyzed under confocal microscopy. Proteins extracted from the cultured chondrocytes taken from the fractured and control groups were processed for Western blot experiments and densitometric analysis. The percentage of apoptotic cells was determined using the cleaved PARP-1 antibody. The proportion of labelled cells was 35% for fractured specimens, compared with 7% for control samples. Quantification of caspase-3 active and Bcl-2 proteins in chondrocyte cultures showed a significant increase of the apoptotic process in fractured specimens compared with control ones. Fractured chondrocytes were positively stained for ChemR23 with statistically significant differences with respect to control samples. Densitometric evaluation of the immunoreactive bands confirmed these observations. Human articular chondrocytes obtained from patients with intra-articular calcaneal fractures express higher levels of pivotal pro-apoptotic factors, and of the chemoattractive receptor ChemR23, compared with control cultures. On the basis of these observations, the authors hypothesize that consistent prolonged chondrocyte death, associated with the persistence of high levels of proinflammatory factors, could enhance the deterioration of cartilage tissue with consequent development of post-traumatic arthritis following intra-articular bone fracture.

2013 - A new volar plate DiPhos-RM for fixation of distal radius fracture: Preliminary report [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio

We analyzed the efficiency of a new plate DiPhos-RM in CFR-PEEK [carbon-fiber-reinforced poly (etheretherketone)] for the volar fixation of distal radius fractures. The new plate's composition has the advantage of x-ray absolute transparency, therefore allowing to monitor the healing of the fracture. The desired combination of high strength and low rigidity is obtained through the use of the polymer composites CFR-PEEK. In this preliminary study (from March 2012 to June 2012), 10 cases of intra-articular distal radius fractures were treated with DiPhos-RM produced by Lima Corporate (Italy). The fractures were classified according to the AO classification, 4 fractures were type C1, 3 type C2, and 3 were A2. A preoperative computed tomography scan was carried out in all patients. One patient also underwent a postoperative computed tomography scan. Grip strength, range of motion, and DASH score were evaluated at follow-up. There were no cases of hardware failure. Specifically, no loss of position or alignment of fixed-angle locking screws or breakage of the plate were observed. Radiographic union was present at an average of 6 weeks (range, 5 to 8 wk). The overall preliminary experience with this new plate is favorable. The new plate is easy to apply and provides the surgeon dual options of fixed-angle or variable-angle screws. It was rigid enough to maintain the reduction also in AO type C articular fractures. Copyright © 2013 by Lippincott Williams & Wilkins.

2013 - Can TKA design affect the clinical outcome? Comparison between two guided-motion systems. [Articolo su rivista]
Mugnai, Raffaele; Digennaro, V; Ensini, A; Leardini, A; Catani, Fabio

In a retrospective comparative analysis in patients undergoing primary guided-motion total knee arthroplasty (TKA), the authors have evaluated whether different TKA implant design would influence the clinical and functional outcomes. METHODS: Between 2007 and 2009, 227 computer-assisted primary TKAs were performed in 219 consecutive patients. Patients received one of the two different fixed-bearing guided-motion TKA designs assisted by navigation surgery: the Scorpio Non-Restrictive Geometry (NRG) knee system and the Journey Bi-Cruciate Stabilized (BCS) knee systems. RESULTS: Data were available for 180 patients (187 knees). No significant differences were observed between the two groups with respect to preoperative demographic characteristics, range of motion (ROM) and radiographic knee alignment. At a mean follow-up of 29 months, the Journey BCS group had higher mean Knee Injury and Osteoarthritis Outcome Score (KOOS) in all subscales and a greater ROM than the Scorpio NRG group. This difference was statistically significant for the KOOS subscales of pain (p = 0.007) and knee-related quality of life (p = 0.045), as well as for postoperative ROM (p = 0.018). Considering the overall complications, 1 patient of Scorpio NRG group (0.5%) and 5 in Journey BCS (2.7%) had stiffness. Anterior knee pain was reported in 4 cases of Scorpio NRG group (2.1%). In the Journey BCS group were observed 2 cases (1.1%) of frontal plane instability and 1 case (0.5%) of synovitis pain. CONCLUSIONS: The bearing geometry and kinematic pattern of different guided-motion prosthetic designs can affect the clinical-functional outcome and complications type in primary TKA. LEVEL OF EVIDENCE: Clinical study, Level III.

2013 - Closed reduction of acute volar dislocation of the distal radioulnar joint [Articolo su rivista]
Tarallo, L.; Adani, R.; Catani, F.

Isolated acute distal radioulnar joint (DRUJ) dislocation is a rare injury. In this report we describe a case of acute traumatic volar dislocation of the ulnar head in a 70-year-old man after an accidental fall

2013 - Coronal alignment is a predictor of the rotational geometry of the distal femur in the osteo-arthritic knee. [Articolo su rivista]
Luyckx, T; Zambianchi, F; Catani, Fabio; Bellemans, J; Victor, J.

PURPOSE: There is a lot of inter-individual variation in the rotational anatomy of the distal femur. This study was set up to define the rotational anatomy of the distal femur in the osteo-arthritic knee and to investigate its relationship with the overall coronal alignment and gender. METHODS: CT-scans of 231 patients with end-stage knee osteo-arthritis prior to TKA surgery were obtained. This represents the biggest series published on rational geometry of the distal femur in literature so far. RESULTS: The posterior condylar line (PCL) was on average 1.6° (SD 1.9) internally rotated relative to the surgical transepicondylar axis (sTEA). The perpendicular to trochlear anteroposterior axis (⊥TRAx) was on average 4.8° (SD 3.3°) externally rotated relative to the sTEA. The relationship between the PCL and the sTEA was statistically different in the different coronal alignment groups (p < 0.001): 1.0° (SD 1.8°) in varus knees, 2.1° (SD 1.8°) in neutral knees and 2.6° (SD 1.8°) in valgus knees. The same was true for the ⊥TRAx in these 3 groups (p < 0.02).There was a clear linear relationship between the overall coronal alignment and the rotational geometry of the distal femur. For every 1° in coronal alignment increment from varus to valgus, there is a 0.1° increment in posterior condylar angle (PCL vs sTEA). CONCLUSION: The PCL was on average 1.6° internally rotated relative to the sTEA in the osteo-arthritic knee. The relationship between the PCL and the sTEA was statistically different in the different coronal alignment groups.

2013 - Distal radius articular fractures: a comparison between ORIF with angular stability plate and percutaneous Kirschner wires. [Articolo su rivista]
Tronci, Vincenzo; Campochiaro, Gabriele; Gazzotti, Gabriele; Rebuzzi, Manuela; Tsatsis, Christos; Catani, Fabio

Distal radius articular fractures: a comparison between ORIF with angular stability plate and percutaneous Kirschner wires. Tronci V1, Campochiaro G, Gazzotti G, Rebuzzi M, Tsatsis C, Catani F. Author information Abstract PURPOSE OF THE STUDY: To analize and compare vantages and disadvantages in long-term of two different techniques to treat distal radius articular fractures: ORIF with plate versus percutaneous pinning with K-wires. MATERIALS AND METHODS: We reviewed 77 distal radial articular fractures treated surgically from 2005 to 2009. Fractures were divided in two homogeneous groups according to patient age, gender, fracture-type and follow-up. The first group was treated with ORIF using angular stability volar plate, while the second one with closed reduction, K-wires percutaneous pinning and ante-brachial plaster casting. Functional outcomes were assessed with MAYO and DASH score, wrist range-of-movement and handgrip. Radiographic parameters were calculated in the post-operative and long-term x-rays. RESULTS: ORIF group showed better mean DASH and MAYO score, range of movement and handgrip strength compare to K-wires group. Expecially in type C fractures and in younger patients (<65 years). Minor differences were observed in type B fractures. About complications: two cases of surgically-treated medial nerve compression in ORIF group and one in K-wire group, one case of algodystrophy in K-wire group. Referring to radiographic parameters, long term values show data positive for ORIF. CONCLUSIONS: Though several studies about these techniques has been performed, but no scientific evidence proves the superiority of one surgical treatment. C-type need to be treated with plate in young patients or in elderly patients with high functional demand. Elderly patients with low functional demand can achieve satisfactory results also with percutaneous pinning, especially in Btype fractures.

2013 - Fresh osteochondral allograft is a suitable alternative for wide cartilage defect in the knee. [Articolo su rivista]
Giorgini, Andrea; Donati, D; Cevolani, L; Frisoni, T; Zambianchi, Francesco; Catani, Fabio

INTRODUCTION: There are several surgical options to restore a wide osteochondral defect in the knee. Fresh osteochondral allografts are usually considered a poor alternative due to their difficulties in surgical application. The aim of this work is first to present our experience including the surgical technique and the functional results of patients receiving fresh osteochondral allograft to restore major knee lesions, then, to compare our results with other results presented in literature. METHODS: Between 2006 and 2011, we treated 11 patients with osteochondral lesion of the knee (Outerbridge IV°). The average lesion size was 10.3 cm(2) (range 3-20 cm(2)). The average age was 34 years (range 18-66). Patients were followed from 12 to 55 months (average of 26.5) through clinical examination, X-ray film and MRI every 3 months for the first year, then every 6 months. RESULTS: The treatment was successful in 10 patients showing pain regression and mean IKDC subjective score improvements from 27.3 to 58.7. The IKDC objective score also improved of at least one class for each patient except the who failed. The radiographs show good osteointegration in all cases but one. CONCLUSIONS: Fresh allograft is an effective therapy for osteochondral defects repair because it allows functional recovery in a considerable number of patients. This technique obtains better results in lesion smaller than 8 cm(2). However larger lesion show good results. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

2013 - KNEE SURGERY USING COMPUTER ASSISTED SURGERY AND ROBOTICS F. Catani, S. Zaffagnini, Ed. Springer, 2013, ISBN 9783642314292 [Monografia/Trattato scientifico]
Catani, Fabio; Zaffagnini, S.

Knee Surgery using Computer Assisted Surgery and Robotics Knee Surgery using Computer Assisted Surgery and Robotics This book discusses the full range of current applications of computer-assisted surgery and robotics in the field of knee surgery, and also considers potential future applications. The impact of computer-assisted surgery on a wide range of surgical procedures is clearly explained. Procedures considered include total knee arthroplasty, unicompartmental knee arthroplasty, cruciate ligament reconstruction, patellofemoral arthroplasty, and revision surgery. In each case, technical aspects are thoroughly addressed in a readily understandable manner. Knee Surgery Using Computer-Assisted Surgery and Robotics will be an ideal guide to this exciting field for both novice and more experienced surgeons who treat knee injuries and disorders.

2013 - Management of displaced radial neck fractures in children: Percutaneous pinning vs. elastic stable intramedullary nailing [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Fiacchi, Francesco; Capra, Francesco; Catani, Fabio

Background: The treatment of radial neck fractures in children varies according to the displacement, angulation, and skeletal maturity. There is a general agreement that displaced radial neck fractures with more than 30 angulations (Judet type III and IV fractures) should be surgically treated. There are several treatment possibilities for Judet type III and IV fractures including percutaneous pin reduction, elastic stable intramedullary nailing (ESIN), and open reduction with or without internal fixation. In this retrospective study we compared the clinical and radiographical outcomes, and complications following intramedullary versus percutaneous pinning in displaced radial neck fractures in children. Materials and methods: Between 2000 and 2011, 20 patients were treated using closed reduction: in 12 cases we used percutaneous pinning, and in 8 cases we used ESIN. According to Judet classification the two groups were composed as follows: 10 (77 %) type III and 3 (23 %) type IV fractures in the percutaneous pinning group; 4 (57 %) type III, and 3 (43 %) type IV fractures in the ESIN group. Results: After an average of 42 months, excellent results in Mayo elbow performance scores (MEPS) were obtained in 71 and 69 % of ESIN and percutaneous pinning groups respectively, with good results in the remaining cases apart from one fair case (8 %) in the percutaneous pinning group. After a radiological evaluation, all fractures healed in excellent or good alignment. When comparing the two groups, the subjects treated with the ESIN technique had higher range of motion (ROM) in flexion, extension and pronation. No patients developed complications, except three cases of asymptomatic enlargements of the radial head, reported only in the percutaneous pinning group. Conclusion: In this research the clinical outcome, assessed with the MEPS, and the radiological alignment, were comparable between the subjects that were treated with percutaneous pinning and those with ESIN techniques; whereas the ESIN technique demonstrated higher ROM in flexion, extension and pronation. The ESIN technique seems to be the ideal approach both for the higher ROM values and for the absence of complications. © 2012 The Author(s).

2013 - The rotator cuff tear repair with a new arthroscopic transosseous system: the Sharc-FT(®). [Articolo su rivista]
Baudi, P; Rasia Dani, E; Campochiaro, Gabriele; Rebuzzi, Manuela; Serafini, Fabio; Catani, Fabio

Abstract PURPOSE: Today, in rotator cuff tear repair, the transosseous sutures are considered superior from a biological and biomechanical point of view. Our purpose is to present the early clinical and biomechanical data of a new arthroscopic rotator cuff tear transosseous repair system: the Sharc-FT®. MATERIALS AND METHODS: A total of 34 patients with rotator cuff tear affecting supraspinatus and infraspinatus, 1 to 3 cm wide, were treated and evaluated from 2010 to 2013. The average age was 63.2 years. Mean follow-up was 18.6 months. All patients were assessed through Constant score in the preoperative step and at 3-, 6-, and 12-month follow-up, performing an MRI 6 months after surgery. RESULTS: The patients have shown a mean preoperative Constant score of 24.5 pt that constantly increases after surgery, until a mean value of 86.9 at 12 months. Regarding complications two cases of adhesive capsulitis were recorded. CONCLUSIONS: This device permits to obtain transosseous sutures with cortical fixation; to greatly reduce the problems of lack of bone resistance; to decrease motion at tendon-footprint interface improving fatigue resistance; to make the stress-load distribution homogeneous at the footprint, thus optimizing biological healing. A later evaluation will be necessary, especially for the incidence of retears.

2013 - Volar plate fixation for the treatment of distal radius fractures: Analysis of adverse events [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

OBJECTIVES:: Determining the rate of specific adverse events after volar plating performed for distal radius fractures. DESIGN:: Retrospective. SETTING:: University level I trauma center. PATIENTS:: We searched the electronic database of all surgical procedures performed in our department using the following keywords: distal radius fracture, wrist fracture, and plate fixation. We identified 315 patients, 12 of whom were lost at follow-up. INTERVENTION:: Volar plate fixation for the treatment of distal radius fractures. MAIN OUTCOME MEASUREMENTS:: At an average follow-up of 5 years, 303 patients were evaluated through medical records and clinical and radiographic assessment for specific adverse events after volar plate fixation. RESULTS:: Adverse events were observed in 18 patients (5.9%). Implant-related adverse events, including tendon impairments, intra-articular screws, and screw loosening, were observed in 15 patients (5.0%). Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally. Flexor impairments were represented by 2 cases of tenosynovitis and 2 cases of flexor pollicis longus rupture. Screw penetration into the radioulnar joint was observed in 1 case. Loss of reduction was identified in 3 cases. One patient had a deep postoperative infection treated with operative debridement. One patient experienced injury to the median nerve during routine implant removal unrelated to tendon issues. CONCLUSIONS:: The majority of adverse events after volar plate fixation were due to technical errors in implant placement. In our cohort, tendon impairments were the most frequently observed; among these, extensor tendon impairments were the most represented (50% of all adverse events). All 12 tendon-related adverse events were due to technical shortcomings with implant placement. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

2012 - Displaced mid-shaft clavicular fractures: surgical treatment with a pre-contoured angular stability plate. [Articolo su rivista]
Campochiaro, G; Tsatsis, C; Gazzotti, G; Rebuzzi, M; Catani, Fabio

The treatment for displaced mid-shaft clavicle fracture is highly controversial. In the last years, several biomechanical studies showed better functional results after surgical treatment. The purpose of this study is to evaluate the use of pre-contoured angular stability plate in this type of fracture. From June 2005 to July 2009, we have surgically treated 89 patients with displaced clavicle fracture. We have reevaluated 68 patients for a total of 70 interventions. Outcomes were assessed with Constant score, Dash questionnaire and X-rays. The mean follow-up period was 2 years. Excellent and good results were achieved for all the patients revaluated. The mean Constant score was 94.1 pt, and DASH score was 4.1. We had two cases of nonunion (2.9 %), while there was no case of infection and vascular or nervous lesions. A review of the international literature indicates that there is not a largely accepted gold standard for the treatment for displaced mid-shaft clavicle fractures. In the last 10 years, biomechanical and clinical studies have shown that nonoperative treatment for this type of fractures, with marked shortening or diastasis of the clavicle superior to 2 cm, may result in lower functional outcomes or higher percentage of nonunion. Nowadays, a lot of surgical options are available for the treatment for displaced mid-shaft clavicle fractures. Our experience with pre-contoured angular stability plates has shown excellent clinical outcome. On the basis of our study, we support the use of pre-contoured angular stability plate.

2012 - Early migration of the cemented tibial component of unicompartmental knee arthroplasty: a radiostereometry study. [Articolo su rivista]
A., Ensini; P., Barbadoro; A., Leardini; Catani, Fabio; S., Giannini

PURPOSE: Unicompartmental knee arthroplasty has good clinical results but high revision rates. A unicompartmental knee arthroplasty design features an all-polyethylene and conforming tibial component, and we hypothesized that this may put at risk its fixation. Implant-to-bone micromotion was measured together with relevant clinical outcomes. METHODS: The migration of the tibial component in twenty patients was measured at 3, 6, 12 and 24 months, using standard radiostereometry, along with the relevant clinical outcomes using the IKS scoring system. RESULTS: The eighteen arthroplasties at 24 months were found successful, with very good functional (mean 87.7; SD 15.4) and knee scores (mean 94.8; SD 10.1). The means and the standard deviations of the maximum total point motion (MTPM) for the four follow-ups were, respectively, as small as 0.4 ± 0.1 mm, 0.6 ± 0.2 mm, 0.6 ± 0.3 mm and 0.7 ± 0.3 mm, an average over all patients but one. In this knee, these were 1.6, 2.1, 2.4 and 2.2 mm, therefore not at high risk of aseptic loosening according to the literature. Only one knee was found at this risk, having the MTPM from 12 to 24 months of 0.5 mm, and the component moving and sinking medially, and rising laterally. CONCLUSION: At 2-year follow-up, a successful implant-to-bone fixation can be achieved in conforming all-polyethylene cemented tibial component together with excellent clinical outcomes. LEVEL OF EVIDENCE: Prognostic studies, Level I.

2012 - Treatment of the ulna non-unions using dynamic compression plate fixation, iliac bone grafting and autologous platelet concentrate [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio

Clinical study of a series of ten patients treated between 2004 and 2009 for non-unions of the ulna. The patients have been treated with osteosynthesis using a dynamic compression plate and biological enhancement of the consolidation using bone graft and autologous platelet injection. The follow-up consisted of clinical and radiographic assessment. Functional scores used were the Visual Analogue Scale (VAS) for pain and the Disability Assessment for the Shoulder and Hand (DASH) questionnaire. The mean time of follow-up was 21 months. Considering both clinical and radiological criteria, bony union was achieved in 9/10 cases on average time of 4 months. According to the system of Anderson, 5 patients provided an excellent result, 2 a satisfactory result, 2 an unsatisfactory result and 1 treatment resulted in failure. At follow-up, the mean VAS score for pain in the upper limb was 1 (range, 0-4) at rest and 2 (range, 0-7) during activities. The physical function and symptoms of the upper limb, evaluated with the DASH questionnaire, scored 17 points. In conclusion, at a mean 21 months follow-up, there was high success regarding both forearm alignment, clinical and functional results. The use of three combined methods provides high success regarding both radiological and clinical results, even if we have no information on the prevalent efficacy of one particular method. © Springer-Verlag 2011.

2011 - Diagnosis of flexible flatfoot in children: a systematic clinical approach. [Articolo su rivista]
M. G., Benedetti; F., Ceccarelli; L., Berti; D., Luciani; Catani, Fabio; M., Boschi; S., Giannini

The goal of this study was to provide measures of symptoms and signs in a consecutive case series of children with flexible flatfoot based on a systematic clinical approach. Fifty-three children (age range, 10-14 years) previously diagnosed with flexible flatfoot were evaluated by a structured interview and clinical assessment. Most patients had foot symptoms (65.3\% of feet) and functional limitation (68.3\%). Symptoms included a sensation of discomfort (11.3\%), such as early tiredness or difficulties during prolonged standing or walking, and pain (54\%), mostly located in the plantar aspect of the foot (28.7\%) and the medial hindfoot (18.8\%). Body mass index was positively correlated to the presence of symptoms and their severity. Even if an enlarged footprint was present in 93.1\% of feet, objective assessment evidenced the presence of heel valgus only in 83\% of feet. Forefoot adduction was present in 22\% of feet. Jack's test provided varus correction in only 54\% of feet. Internal knee rotation was the most common associated disalignment, present in 43.6\% of limbs. Symptoms were significantly correlated to knee alignment, and functional limitation was correlated to heel valgus. Standing balance on 1 leg was significantly correlated to footprint grading severity. A systematic clinical approach to assess children with flexible flatfoot should always be recommended for the correct diagnosis and the associated treatment management based on symptoms, functional limitation, and foot dysfunction. Functional assessment by specific tests should be included in the examination, as evidence exists that morphology and function are not necessarily related.

2011 - Does medio-lateral motion occur in the normal knee? An in-vitro study in passive motion. [Articolo su rivista]
C., Belvedere; A., Leardini; S., Giannini; A., Ensini; L., Bianchi; Catani, Fabio

Medio-lateral translation during knee flexion continues to raise controversy. Small population sizes, small joint flexion ranges, less-reliable measurement techniques and disparate experimental conditions led to inconsistent reports in the past. To study this subject with more accurate and reliable measurements, we carried out femur and tibia tracking in 22 intact cadaver knees during passive joint motion using a state-of-the-art surgical navigation system. Trackers with active light-emitting diodes were fixed onto the femur and tibia, and an instrumented pointer was used to digitize a number of anatomical landmarks. International recommendations were adopted for anatomical-based reference frame definitions and joint kinematic analysis. For the first time, knee joint translations were reported in both the femoral and tibial reference frames, and over a flexion/extension arc as large as 140°. During flexion, in the femoral reference frame, the center of the tibial plateau moved 4.8 ± 2.8mm medially when averaged over the specimens. In the tibial frame, the knee center moved 13.3 ± 5.7 mm laterally. The relative femoral-to-tibial medio-lateral translation was, on average over the specimens, nearly 20\% of the width of the tibial plateau, and can be as large as 35\%. Medio-lateral translation occurs in the natural normal knee joint.

2011 - Early clinical results of the BOX ankle replacement are satisfactory: a multicenter feasibility study of 158 ankles. [Articolo su rivista]
Giannini, S; Romagnoli, M; O'Connor, Jj; Catani, Fabio; Nogarin, L; Magnan, B; Malerba, F; Massari, L; Guelfi, M; Milano, L; Volpe, A; Rebeccato, A; Leardini, A.

A new design for a 3-part ankle replacement was developed in an effort to achieve compatibility with the naturally occurring ligaments of the ankle by allowing certain fibers to remain isometric during passive motion. In order to test the design concept clinically, 158 prostheses were implanted in 156 patients within a 9-center trial and were followed up for a mean of 17 (range 6 to 48) months. The mean age at the time of surgery was 60.5 (range 29.7 to 82.5) years. Outcome measures included the American Orthopaedic Foot & Ankle Surgery hindfoot-ankle score and range of motion measured on lateral radiographs of the ankle. The preoperative American Orthopaedic Foot & Ankle Surgery score of 36.3 rose to 74.6, 78.6, 76.4, and 79.0, respectively, at 12, 24, 36, and 48 months. A significant correlation between meniscal bearing movement on the tibial component (mean 3.3 mm; range 2 to 11 mm) and range of flexion at the replaced ankle (mean 26.5°; range 14° to 53°) was observed in radiograms at extreme flexions. Two (1.3\%) revisions in the second and third postoperative years necessitated component removal (neither were for implant failure), and 7 (4.4\%) further secondary operations were required. The results of this investigation demonstrated that non-anatomic-shaped talar and tibial components, with a fully conforming interposed meniscal bearing, can provide safety and efficacy in the short term, although a longer follow-up period is required to more thoroughly evaluate this ankle implant.

2011 - In-vivo knee kinematics in rotationally unconstrained total knee arthroplasty. [Articolo su rivista]
Catani, Fabio; C., Belvedere; A., Ensini; A., Feliciangeli; S., Giannini; A., Leardini

Total knee replacement designs claim characteristic kinematic performance that is rarely assessed in patients. In the present study, in vivo kinematics of a new prosthesis design was measured during activities of daily living. This design is posterior stabilized for which spine-cam interaction coordinates free axial rotation throughout the flexion-extension arc by means of a single radius of curvature for the femoral condyles in the sagittal and frontal planes. Fifteen knees were implanted with this prosthesis, and 3D video-fluoroscopic analysis was performed at 6-month follow-up for three motor tasks. The average range of flexion was 70.1° (range: 60.1-80.2°) during stair-climbing, 74.7° (64.6-84.8°) during chair-rising, and 64.1° (52.9-74.3°) during step-up. The corresponding average rotation on the tibial base-plate of the lines between the medial and lateral contact points was 9.4° (4.0-22.4°), 11.4° (4.6-22.7°), and 11.3° (5.1-18.0°), respectively. The pivot point for these lines was found mostly in the central area of the base-plate. Nearly physiological range of axial rotation can be achieved at the replaced knee during activities of daily living.

2011 - Joint line is well restored when navigation surgery is performed for total knee arthroplasty. [Articolo su rivista]
A., Ensini; Catani, Fabio; N., Biasca; C., Belvedere; S., Giannini; A., Leardini

PURPOSE: The incorrect restoration of the joint line during TKA can result in joint instability, anterior knee pain, limited range of motion, and joint stiffness. The joint line level is usually measured only on pre- and post-operative radiographs. Current knee navigation systems can now potentially support intra-operatively joint line restoration by controlling the exact amount of the bone-cartilage removed and the corresponding overall thickness of the components implanted. The aim of this study was to assess how well the joint line level is restored and the tibiofemoral overstuffing prevented when standard knee surgical navigation is used carefully also with these purposes. Intra-operative measurements during navigated TKA were taken. METHODS: Sixty-seven primary TKAs were followed prospectively. The variation before and after prosthesis component implantation of the joint line level, both in the femoral and tibial reference, was measured intra-operatively by an instrumented probe. Overstuffing was measured as the difference between the overall craniocaudal thickness of the femoral and tibial prosthesis components inserted and the thickness of the bone-cartilage removed. RESULTS: A significant elevation in the joint line level after prosthesis implantation was found with respect to the tibial reference (1.9 ± 2.4 mm, mean ± SD), very little to the femoral reference (0.3 ± 2.1 mm), perhaps accounted for the femur-first operative technique utilized. Overstuffing was on the average of 2.2 ± 3.0 mm. CONCLUSIONS: These results suggest that a knee navigation system can also support well a proper restoration of the joint line level and limit the risk of overstuffing when relevant measurements are taken carefully during operation. LEVEL OF EVIDENCE: III.

2011 - Muscle activity around the knee and gait performance in unicompartmental knee arthroplasty patients: a comparative study on fixed- and mobile-bearing designs. [Articolo su rivista]
Catani, Fabio; M. G., Benedetti; L., Bianchi; V., Marchionni; S., Giannini; A., Leardini

PURPOSE: Unicompartmental knee arthroplasty (UKA) offers clinical and functional advantages over total knee arthroplasty. The aim of this study was to compare the functional recovery of patients with mobile UKA versus fixed-bearing designs by state-of-the-art gait analysis and, in particular, by assessing muscular activity. METHODS: Ten patients with the Oxford (mobile bearing) and ten patients with Optetrak (fixed bearing) UKA were evaluated at a minimum follow-up of 1 year post-operatively by gait analysis, which includes the main time-distance parameters, kinematics and kinetics of the replaced knee, and muscular activity of the main relevant muscles. Twenty healthy young subjects were used as controls. RESULTS: The mean International Knee Society score was 92.7 ± 11.2 for all 20 UKA knees; for the Oxford UKA, it was 94.1 ± 9.5; and for the Optetrak UKA, it was 91.5 ± 12.9, although follow-up was significantly lower for the latter. Time-distance parameters showed a slower gait in both groups compared with that of controls, and the Oxford group had values closer to the controls. Knee joint flexion was similar to that of controls at initial contact and loading response with no differences between groups. In all patients, the joint moments were smaller to that of controls. Residual abnormalities such as the prolonged rectus femoris activity were present in both designs, and the only difference distinguishing the Optetrak group from the others was the combined co-contraction of the hamstrings. CONCLUSIONS: A good restoration of gait was achieved by most unicompartmental knee patients independently of the UKA design, although some abnormalities persisted in muscle activity around the knee. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

2011 - Navigation-assisted total knee arthroplasty in knees with osteoarthritis due to extra-articular deformity. [Articolo su rivista]
Catani, Fabio; V., Digennaro; A., Ensini; A., Leardini; S., Giannini

PURPOSE: Extra-articular post-traumatic deformity may make difficult the implantation of total knee arthroplasty (TKA). Staged surgical procedures, including femoral or tibial osteotomy, can be required to restore proper alignment. These procedures may be inappropriate because of high rate of complications. Intra-articular resection is an alternative procedure, but it is limited by the potential compromise of collateral knee ligaments. Conventional instrumentation cannot be used in patients with previous trauma and residual bone deformity. We want to assess whether computer-assisted surgery may be a good alternative to traditional techniques. METHODS: Twenty consecutive TKAs were performed in 20 patients (12 men and 8 women) with knee arthritis due to extra-articular deformity. The mean age was 52 years. According to Moreland method, the mean (± standard deviation) of the pre-operative hip-knee-ankle angle was 10.4° ± 8.3° in varus. In all cases, an image-free knee navigation system was used because of the severe deformity or the presence of retained hardware that prevented the use of the intramedullary rod. The average follow-up was 3.1 years. RESULTS: One month after surgery, the mean hip-knee-ankle angle was 0.8° ± 1.2° in varus. At follow-up, the Knee Society Score increased from an average of 48 pre-operatively to 91 (P < 0.05) post-operatively, with over 90\% of excellent and good results. Mean range of motion improved from a 7°-74° mean range pre-operatively to 0°-94° post-operatively. CONCLUSIONS: The general value of navigation systems in achieving accurate bone cuts and restoring the mechanical axis has been established in the literature for standard TKA but not yet for extra-articular deformity. Our findings at mid-term follow-up on a large cohort of these patients showed that these systems used for intra-articular resection are a very effective alternative to previous techniques. LEVEL OF EVIDENCE: Prospective study, Level IV.

2011 - Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint. [Articolo su rivista]
F., Cenni; A., Leardini; A., Cheli; Catani, Fabio; C., Belvedere; M., Romagnoli; S., Giannini

PURPOSE: In some cases of total ankle replacement, perfect alignment of the prosthetic components is not achieved. This study analyses the extent to which component positioning is critical for the final range of motion. METHODS: Fourteen patients undergoing total ankle replacement were assessed preoperatively and postoperatively at seven and 13 months follow-up. X-ray pictures of the ankle were taken in static double leg stance, i.e. at neutral joint position, and in maximum plantarflexion and dorsiflexion. Measurements were obtained by a specially devised computer program based on anatomical reference points digitised on the radiograms. These allowed calculation of the position and orientation of the components in the sagittal and coronal planes, together with the joint range of motion. RESULTS: The mean range of motion was about 34 degrees at the first follow-up and maintained at the second. Tibial and talar components were more anterior than the mid-tibial shaft in 11 and nine patients, respectively. Mean inclination was about four degrees posterior for the tibial component and nearly one degree anterior for the talar component. A significantly larger range of motion was found in ankles both with the talar component located and inclined more anteriorly than the tibial. CONCLUSIONS: Correlation, though weak, was found between motion at the replaced ankle and possible residual subluxation and inclination of the components. However, a satisfactory range of motion was also achieved in those patients where recommended locations for the components could not be reached because of the size of the original joint deformity.

2011 - The treatment of distal radius articular fractures of C1-C2 type with DVR plate: analysis of 40 cases. [Articolo su rivista]
Tarallo, Luigi; Adani, Roberto; Mugnai, Raffaele; Catani, F.

The aim of this investigation was to evaluate the efficiency of fixed angle plates DVR in the treatment of C1 and C2 type articular wrist fractures according to the AO classification. From July 2005 to March 2009, 40 wrist fractures were treated: 18 were of C1 type while 22 of C2 type according to AO classification. The age of patients varied from 25 to 79 years old. The average length of follow-up was 17 months (range, 4-37 months). The average articular motility was flexion 59.4° and extension 62.7°. Final radiographic parameters were of 18.7° of average ulnar inclination, 10.3° of average dorsal inclination, and 1.45 mm of negative ulnar variance. All patients were reassessed according to Mayo Modified Wrist Score getting a very good/good result in 82% of cases and a medium/poor one in 18%. The DASH score pulled off 46.3 points in the first group, 5.1 in the second group, and 6 in the third one. The statistical analysis based on Student's t test showed how C1 and C2 classification did not influence the results using the same treatment. DVR plate showed a very good reliability and a sufficient stability with both C1 and C2 fractures. © 2011 Springer-Verlag.

2010 - Can Patellar Tendon Angle reveal sagittal kinematics in total knee arthroplasty? [Articolo su rivista]
R., Stagni; S., Fantozzi; Catani, Fabio; A., Leardini

The Patellar Tendon Angle is strongly correlated with both patello-femoral and tibio-femoral joint kinematics. Thus, the Patellar Tendon Angle might be regarded as a concise indicator of the antero-posterior translation of the femur with respect to the tibia. Twelve subjects, who had undergone total knee arthroplasty, were investigated by video-fluoroscopy during step-up/down. The kinematics at the replaced knee was reconstructed by means of 3D fluoroscopy. The Patellar Tendon Angle and the knee-flexion angle were measured on sagittal fluoroscopic images with software designed for the purpose. The slope of the linear trend of the Patellar Tendon Angle versus knee-flexion angle relationship correlated significantly with the mean (p = 0.001), most anterior (p = 0.001), and most posterior (p = 0.016) position reached by the femur over the tibia. The Patellar Tendon Angle versus knee-flexion angle relationship provides relevant information about the anterior or posterior positioning of the femur over the tibia, but it cannot be interpreted as quantification of the actual antero-posterior translation of the femur over the tibia.

2010 - The Mark Coventry Award: Articular contact estimation in TKA using in vivo kinematics and finite element analysis. [Articolo su rivista]
CATANI, Fabio; B., Innocenti; C., Belvedere; L., Labey; A., Ensini; A., Leardini

In vivo fluoroscopy is a well-known technique to analyze joint kinematics of the replaced knee. With this method, however, the contact areas between femoral and tibial components, fundamental for monitoring wear and validating design concepts, are hard to identify. We developed and tested a novel technique to assess condylar and post-cam contacts in TKA. The technique uses in vivo motion data of the replaced knee from standard fluoroscopy as input for finite element models of the prosthesis components. In these models, tibiofemoral contact patterns at the condyles and post-cam articulations were calculated during various activities. To test for feasibility, the technique was applied to a bicruciate posterior-stabilized prosthesis. Sensitivity of the finite element analysis, validation of the technique, and in vivo tests were performed. To test for potential in the clinical setting, five patients were preliminarily analyzed during chair rising-sitting, stair climbing, and step up-down. For each task and patient, the condylar contact points and contact line rotation were calculated. The results were repeatable and consistent with corresponding calculations from traditional fluoroscopic analysis. Specifically, natural knee kinematics, which shows rolling back and screw home, seemed replicated in all motor tasks. Post-cam contact was observed on both the anterior and posterior faces. Anterior contact is limited to flexion angle close to extension; posterior contact occurs in deeper flexion but is dependent on the motor task. The data suggest the proposed technique provides reliable information to analyze post-cam contacts.

2010 - To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty? [Articolo su rivista]
M. G., Benedetti; Catani, Fabio; E., Benedetti; L., Berti; A. D., Gioia; S., Giannini

The aim of this study was to evaluate the effects of limb lengthening up to 20 mm after THA on symmetry of hip kinematics and kinetics during common activities of daily living. Twenty patients (age range 49-80 years) operated on with Link Lubinus II THA, with lateral access and a mean follow-up of 16 months, were assessed by gait analysis during level walking, stair ascending and descending. The time-distance, hip kinetics and kinematics values were statistically compared between the operated side and the non-operated side in order to assess symmetry. The 12-item Questionnaire was used to assess satisfaction and personal perception of limb lengthening. Mean value of limb lengthening after THA was 11 mm (SD 6). Minor abnormalities were found in the kinematics and kinetics of the operated and non-operated hips during level walking and stair climbing. The score of the questionnaire corresponded to a high level of satisfaction after THA and only two patients complained of limping independent from the amount of discrepancy. From this study we can conclude that a leg length inequality in the range of 1-20 mm does not impair the symmetry of time-distance parameters and of hip kinematics and kinetics during gait and stairs walking. Although objective, gait analysis data did not correspond to patient's perception of discrepancy, which is subjective and irrespective of the amount of lengthening. There is biomechanical evidence that a limb lengthening of up to two centimetres after THA in general does not need to be corrected by means of a contralateral shoe lift. Individual decisions to the contrary need to be justified.

2009 - In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty: a combined fluoroscopic and gait analysis study. [Articolo su rivista]
Catani, Fabio; A., Ensini; C., Belvedere; A., Feliciangeli; M. G., Benedetti; A., Leardini; S., Giannini

After total knee arthroplasty, changes in articular surface geometry, soft tissue treatment, and component alignment can alter normal lower limb function. The guided motion bi-cruciate substituting prosthesis was designed specifically to restore physiological knee joint motion. We determined whether this design could in vivo normal kinematics and kinetics, not only at the replaced knee, but also throughout both lower limbs. Sixteen patients (4 male, 12 female, mean age of 68.2 years with a range from 58 to 79 years) with primary knee osteoarthritis were implanted with the bi-cruciate substituting prosthesis. At 6-month follow-up, knee joint kinematics was assessed by video-fluoroscopy during stair-climbing, chair-rising/sitting, and step-up/down. Lower limb overall function was also assessed on the same day by standard gait analysis with simultaneous electromyography during level walking. By video-fluoroscopy, mean anteroposterior translations between femoral and tibial components during the three motor tasks were 9.7 +/- 3.0, 10 +/- 2.6, and 6.9 +/- 3.5 mm on the medial compartment, and 14.3 +/- 3.5, 18.5 +/- 3.0, and 13.9 +/- 3.8 mm on the lateral compartment, respectively. Axial rotation ranged from 5.6 degrees to 26.2 degrees. Gait analysis revealed restoration of nearly normal walking patterns in most patients. This rare combination of measurements, i.e., accurate rotation-translation at the replaced knee and complete locomotion patterns at both lower limb joints, suggested that bi-cruciate substituting arthroplasty can restore physiological knee motion and normal overall function.

2009 - Three-dimensional patellar motion at the natural knee during passive flexion/extension. An in vitro study. [Articolo su rivista]
C., Belvedere; A., Leardini; A., Ensini; L., Bianchi; Catani, Fabio; S., Giannini

Patellar maltracking may result in many patellofemoral joint (PFJ) disorders in the natural and replaced knee. The literature providing quantitative reference for normal PFJ kinematics according to which patellar maltracking could be identified is still limited. The aim of this study was to measure in vitro accurately all six-degrees-of-freedom of patellar motion with respect to the femur and tibia on 20 normal specimens. A state-of-the-art knee navigation system, suitably adapted for this study aim, was used. Anatomical reference frames were defined for the femur, tibia, and patella according to international recommendations. PFJ flexion, tilt, rotation, and translations were calculated in addition to standard tibiofemoral joint (TFJ) kinematics. All motion patterns were found to be generally repeatable intra-/interspecimens. PFJ flexion was 62\% of the corresponding TFJ flexion range; tilt and translations along femoral mediolateral and tibial proximodistal axes during TFJ flexion were found with medial, lateral, and distal trends and within 12 degrees , 6 and 9 mm, respectively. No clear pattern for PFJ rotation was observed. These results concur with comparable reports from the literature and contribute to the controversial knowledge on normal PFJ kinematics. Their consistence provides fundamental information to understand orthopedic treatment of the knee and for possible relevant measurements intraoperatively.

2008 - Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty. [Articolo su rivista]
Catani, Fabio; N., Biasca; A., Ensini; A., Leardini; L., Bianchi; V., Digennaro; S., Giannini

Computer-navigated total knee arthroplasty is aimed at improving accuracy in the positioning of prosthetic components and realigning the lower limb. The optimal position and orientation of the bone resection planes are targeted by the navigation system, but, after these are obtained, additional manual surgical actions, which may considerably affect final component alignment, are necessary for implantation. The aim of this study was to measure the alignment deviation caused by standard impaction of the tibial and femoral components following bone resections with use of navigation control.Ninety-one primary total knee arthroplasties were performed with an image-free knee navigation system. The alignment of the tibial and femoral bone resections was measured in three planes during surgery by the instrumented probe of the system. The alignment measure was repeated after final tibial and femoral component implantation with cement. The alignment deviations between the two measures were considered the positioning error associated with the final manual implantation of the components.The alignment deviations between the bone resections and the subsequent implant placement were >1 degrees in the frontal plane of the femur and in the frontal and sagittal planes of the tibia in 20\%, 11\%, and 33\% of the patients, respectively. The deviations were >2 degrees in 4\%, 3\%, and 9\% of the patients, respectively. Deviations as large as 3 degrees were found at the tibia in the sagittal plane (the posterior slope).Positioning of the femoral and tibial components in total knee arthroplasty, which mainly involves cementation and impaction of the final components, can introduce a considerable error in alignment, regardless of how accurately the resection planes are made. After computer-navigated total knee arthroplasty, it would be useful therefore to check the alignment of the prosthetic component carefully before the cement hardens.

2008 - Functional outcome of meniscal-bearing total ankle replacement: a gait analysis study. [Articolo su rivista]
M. G., Benedetti; A., Leardini; M., Romagnoli; L., Berti; Catani, Fabio; S., Giannini

Most clinical studies on total ankle replacement (TAR) report assessments based on traditional clinical scores or radiographic analysis. Only a few studies have used modern instrumentation for quantitative functional analysis during the execution of activities of daily living. The aim of this study was to use gait analysis to compare the functional performance of patients who underwent TAR versus a control population.A retrospective analysis was performed of ten consecutive patients who had undergone meniscal-bearing TAR. Clinical and functional assessments were performed at a mean follow-up of 34 months with a modified Mazur scoring system and state-of-the-art gait analysis.Gait analysis assessment of TAR at medium-term follow-up showed satisfactory results for all patients, with adequate recovery of range of motion. Because the literature reports unsatisfying long-term results, it is important to evaluate these patients over a longer follow-up period.This study showed that TAR yields satisfactory, but not outstanding, general functional results at nearly 3 years' follow-up. These gait analysis results highlight the importance of integrating in vivo measurements with the standard clinical assessments of patients who underwent TAR while they perform activities of daily living. These results also emphasize the importance of evaluating the functional outcome of TAR over time.

2007 - Alignment of resection planes in total knee replacement obtained with the conventional technique, as assessed by a modern computer-based navigation system. [Articolo su rivista]
C., Belvedere; A., Ensini; A., Leardini; L., Bianchi; Catani, Fabio; S., Giannini

To improve the anatomy-based alignment of prosthetic components in total knee replacement, surgical navigation systems have recently been developed, based on anatomical reference frame definitions through landmark digitations and functional calibration. In this study, femoral and tibial resection plane alignments, obtained by conventional tecnique, were measured intraoperatively during total knee replacements by a navigation system to quantify potential errors in conventional bone preparation techniques.Femoral and tibial resection plane alignments, obtained by conventional femoral intramedullary and tibial extramedullary cutting guides, were measured intraoperatively in 25 primary total knee replacements by a navigation system. This system enabled the surgeon to calculate, before definitive bone sawing, the final position and orientation of all resection planes.The measurements revealed unsatisfactory alignments in nearly all anatomical planes. Except for tibial varus/valgus, final plane orientations were considerably different from those targeted by the surgeon via the navigation system, respectively 7 degrees, 8 degrees and 10 degrees apart in varus-valgus and flexion-extension at the femur, and in flexion-extension at the tibia.Modern computer-aided surgery in total knee replacement, once relevant precision has been established in all femur and tibia anatomical planes, can in the future limit the current critical component misalignments.

2007 - Alignments and clinical results in conventional and navigated total knee arthroplasty. [Articolo su rivista]
A., Ensini; Catani, Fabio; A., Leardini; M., Romagnoli; S., Giannini

In this prospective, randomized, controlled study, we compared the performance of conventional and navigated total knee arthroplasties. Component alignment was measured in 60 patients operated on using navigation and in 60 patients operated on using the conventional technique. The groups then were divided into a subpopulation to measure alignments of the distal femoral cuts in the three anatomic planes, the proximal tibial cut in the frontal and sagittal planes, and the resulting lower limb mechanical axis in the frontal plane. Postoperative weightbearing long-view radiographs were evaluated as were clinical results using three standard questionnaires at 28 months followup. The intraoperative measurements (mean +/- standard deviation) at the resection planes showed navigated surgeries result in more accurate alignments than conventional surgeries for the femur: in the frontal plane, 0.1 degrees +/- 0.9 degrees and 0.7 degrees +/- 1.6 degrees valgus, respectively; in the sagittal plane, 1.1 degrees +/- 1.8 degrees and 2.8 degrees +/- 2.0 degrees flexion; and in the transversal plane, 0.1 degrees +/- 1.2 degrees and 0.9 degrees +/- 1.7 degrees internal rotation. The navigated technique also reduced the number of cases with final mechanical axes greater than 3 degrees from 20.0\% to 1.7\%. Postoperative radiographs showed better component alignment using navigation, particularly at the femur. However, clinical scoring systems showed this radiographic improvement did not necessarily result in a better clinical outcome at short-term followup.

2007 - Patellar tracking during total knee arthroplasty: an in vitro feasibility study. [Articolo su rivista]
C., Belvedere; Catani, Fabio; A., Ensini; J. L., Moctezuma; A., Leardini

Abnormal patellar tracking results in patello-femoral (PF) joint disorders and frequently in failure of total knee arthroplasty (TKA). It is fundamental to assess this tracking intra-operatively, i.e. since the implantation of the femoral and tibial components. The aim of this study was to assess the feasibility of three-dimensional anatomical-based patellar tracking intra-operatively in standard TKA. A surgical navigation system was utilized to test the new technique in-vitro. An original tracking device and a reference frame were designed and an articular convention for the description of PF joint kinematics was adopted. Six fresh-frozen amputated legs were analyzed with the new technique. Landmark digitations were used to define anatomical reference frames for the femur, tibia, and patella. Five trials of passive flexion were performed with 100 N force on the quadriceps, before and after standard knee arthroplasty. Patellar flexion, tilt, rotation and shift were calculated in addition to standard tibio-femoral (TF) joint kinematics. An intra-specimen repeatable path of motion over repetitions and a coupled path of motion throughout the flexion-extension cycle were observed in all intact knees, both at the TF and PF joints. Replication of the original PF motion in the intact knee was not fully accomplished in the replaced knee. These results revealed the feasibility and the necessity of patellar tracking during TKA. By monitoring intra-operatively also the PF kinematics, the surgeon has a more complete prediction of the performance of the final implant and therefore a valuable support for the most critical surgical decisions.

2007 - Total knee replacement versus osteochondral allograft in proximal tibia bone tumours. [Articolo su rivista]
M., Colangeli; D., Donati; M. G., Benedetti; Catani, Fabio; E., Gozzi; E., Montanari; S., Giannini

Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results.

2006 - A new software tool for 3D motion analyses of the musculo-skeletal system. [Articolo su rivista]
A., Leardini; C., Belvedere; L., Astolfi; S., Fantozzi; M., Viceconti; F., Taddei; A., Ensini; M. G., Benedetti; Catani, Fabio

Many clinical and biomechanical research studies, particularly in orthopaedics, nowadays involve forms of movement analysis. Gait analysis, video-fluoroscopy of joint replacement, pre-operative planning, surgical navigation, and standard radiostereometry would require tools for easy access to three-dimensional graphical representations of rigid segment motion. Relevant data from this variety of sources need to be organised in structured forms. Registration, integration, and synchronisation of segment position data are additional necessities. With this aim, the present work exploits the features of a software tool recently developed within a EU-funded project ('Multimod') in a series of different research studies.Standard and advanced gait analysis on a normal subject, in vivo fluoroscopy-based three-dimensional motion of a replaced knee joint, patellar and ligament tracking on a knee specimen by a surgical navigation system, stem-to-femur migration pattern on a patient operated on total hip replacement, were analysed with standard techniques and all represented by this innovative software tool. Segment pose data were eventually obtained from these different techniques, and were successfully imported and organised in a hierarchical tree within the tool.Skeletal bony segments, prosthesis component models and ligament links were registered successfully to corresponding marker position data for effective three-dimensional animations. These were shown in various combinations, in different views, from different perspectives, according to possible specific research interests.Bioengineering and medical professionals would be much facilitated in the interpretation of the motion analysis measurements necessary in their research fields, and would benefit therefore from this software tool.

2006 - Clinical and biomechanical assessment of patella resurfacing in total knee arthroplasty. [Articolo su rivista]
L., Berti; M. G., Benedetti; A., Ensini; Catani, Fabio; S., Giannini

Currently there is a limited understanding of the factors influencing range of motion by comparing patellar resurfacing vs non-resurfacing in total knee arthroplasty during activities of daily living. A recent meta-analysis of patellar replacement confirms better outcome with patella resurfacing; however, the result can be influenced by many other factors, such as: component design, surgeon experience, and technical aspects of the surgery. This study compares the biomechanics of the knee in patients after total knee arthroplasty with and without patellar resurfacing during stair climbing.Forty-seven patients with total knee arthroplasty were assessed at the mean follow-up of 24 months. In all of them a posterior stabilised fixed bearing prosthesis (Optetrak PS, Exactech) was implanted. Twenty-six patients were treated without patellar resurfacing and 21 with patellar resurfacing. Clinical evaluations were performed using the International Knee Society and the Hospital for Special Surgery scores. Ten patients with patellar resurfacing and 10 patients without patellar resurfacing were also studied with motion analysis during stair climbing; 10 healthy subjects were studied for statistical comparison.Clinical passive knee flexion, International Knee Society Function and Hospital for Special Surgery scores were significantly higher in the patellar resurfacing group. During stair climbing, active knee joint range of motion during the stance phase was greater in patients with patellar resurfacing. The maximum adduction moment was significantly higher in the group without patellar resurfacing.Patients with patellar resurfacing demonstrated better clinical scores, and kinematic and kinetic data while ascending stairs.

2006 - Dislocation of central venous catheters in paediatric patients. [Articolo su rivista]
R., Giretti; M., Caruselli; R., Zannini; E. d., Vivo; G., Piattellini; P., Bechi; Catani, Fabio; M., Amici; F., Santelli; R., Pagni

Children have limited venous access possibilities; therefore, when long-term therapy is necessary, it is better to place a catheter in a central vein. The Port catheter, totally implanted, is less exposed to the risk of infection and permits a normal life. However, there is the possibility of the displacement or fragmentation of the catheter that can be diagnosed initially only by clinical symptoms and later by a chest X-ray. We report a case of disconnection between the Port catheter and the reservoir resulting in catheter migration to the left pulmonary artery.

2006 - Femoral rollback of cruciate-retaining and posterior-stabilized total knee replacements: in vivo fluoroscopic analysis during activities of daily living. [Articolo su rivista]
S., Fantozzi; Catani, Fabio; A., Ensini; A., Leardini; S., Giannini

Restoration of the physiological flexor/extensor mechanism at the knee in terms of appropriate muscular lever arms, proper required quadriceps force, and suitable patellofemoral compressive force, is fundamental for the success of total knee replacement. Therefore, measurements of anteroposterior translation of the femoral component over the tibial base-plate against joint flexion during daily living activities are essential for the assessment of the in vivo performance of current prosthesis designs. Patients treated with posterior stabilized and cruciate retaining prostheses with excellent clinical scores were evaluated during stair climbing, sitting and rising from a chair, and step up and down, using a three-dimensional pose reconstruction technique based on videofluoroscopy. The posterior stabilized patients experienced a fairly consistent and physiological rollback specific of each motor task, demonstrating proper function of the spine-cam mechanism. Rollback was somehow inconsistent among subjects in the cruciate retaining group, accompanied with a smaller range of knee flexion. In this group, more posterior locations of the condyles correlated significantly with higher clinical and functional scores. Articular surface conformity restores physiological rollback in the presence of a spine-cam mechanism, but not coherently in the presence of the posterior cruciate ligament.

2006 - Influence of tibial component posterior slope on in vivo knee kinematics in fixed-bearing total knee arthroplasty. [Articolo su rivista]
Catani, Fabio; S., Fantozzi; A., Ensini; A., Leardini; D., Moschella; S., Giannini

The relation between prosthesis component kinematics and posterior slope of the tibial component in total knee arthroplasty is much debated. Three-dimensional kinematics of the replaced knee was obtained by video fluoroscopy in 23 knees treated by cruciate-retaining or cruciate-substituting arthroplasty. Relative position and orientation of the metal components were calculated in stair ascending, getting up from and sitting down on a chair, and single step up-and-down. Significant correlations were found between tibial component posterior slope and anteroposterior position of tibiofemoral lateral contact and between this slope and maximum knee flexion. These correlations were task and design specific. However, the average of the tibiofemoral contact positions over all three motor tasks was slightly posterior to the midline of the tibial base plate, reaching at most 84\% of its anteroposterior dimension. Performing a posterior slope of the tibial cut does not put total knee arthroplasty with high conforming designs at higher risk of failure, even when large posterior inclinations need to be achieved.

2006 - Wear patterns on tibial plateau from varus osteoarthritic knees. [Articolo su rivista]
D., Moschella; A., Blasi; A., Leardini; A., Ensini; Catani, Fabio

The knowledge of cartilage wear patterns at the medial tibial plateau is important to understand the main causes of arthritis in varus knees. The most important factors influencing knee arthritis in fact seem to be the severity of the degenerative changes determined by the lower limb mechanical axis and the abnormal knee joint kinematics which frequently results from dysfunction of the anterior cruciate ligament.We studied the wear patterns of cartilage damage in 70 medial tibial plateaus resected at operation during total knee arthroplasty indicated for varus osteoarthritic knee. Anterior cruciate ligament and medial meniscus integrity was assessed intra-operatively. Calibrated digital images were used to measure the wear patterns with a standard software tool. The medial compartment of the tibial plateau was divided into six zones, and the amount of cartilage and bone destruction in each zone was classified into two grades.The wear pattern was found to be highly dependent upon knee varus deformity (Mann Whitney P<0.001) and anterior cruciate ligament integrity (Friedman P<0.0005). Anterior cruciate ligament was found intact in 35.7\% of the cases. Wear patterns on intact anterior cruciate ligament knees occurred in the central to medial aspect of the tibial plateau. Anterior cruciate ligament deficient knees had significantly larger wear patterns anteriorly and posteriorly in the most medial region of the medial plateau.These observations suggest altered joint mechanics exist in anterior cruciate ligament deficient varus knees, which would worsen cartilage degeneration and osteoarthritis progression.

2005 - Advanced multimodal visualisation of clinical gait and fluoroscopy analyses in the assessment of total knee replacement. [Articolo su rivista]
A., Leardini; L., Astolfi; S., Fantozzi; M., Viceconti; M. G., Benedetti; Catani, Fabio

Traditional gait and fluoroscopy analysis of human movement are largely utilised but are still limited in registration, integration, synchronisation and visualisation capabilities. The present work exploits the features of a recently developed software tool based on multimodal display (Data Manager developed within the EU-funded project 'Multimod') in an exemplary clinical case. Standard lower limb gait analysis, comprising segment position, ground reaction force and EMG data collection, and three-dimensional fluoroscopy analysis at the replaced joint were performed in a total knee replacement patient while ascending stairs. Clinical information such as X-rays and standard scores were also available. Data Manager was able to import all this variety of data and to structure these in an original hierarchical tree. Bone and prosthesis component models were registered to corresponding marker position data for effective three-dimensional animations. These were also synchronised with corresponding standard video sequences. Animations, video, time-histories of collected and also processed data were shown in various combinations, according to specific interests of the bioengineering and medical professionals expected to observe and to interpret this large amount of data. This software tool demonstrated to be a valuable means to enhance representation and interpretation of measurements coming from human motion analysis. In a single software, a thorough and effective clinical and biomechanical analysis of human motion was performed.

2005 - Migration of cemented stem and restrictor after total hip arthroplasty: a radiostereometry study of 25 patients with Lubinus SP II stem. [Articolo su rivista]
Catani, Fabio; A., Ensini; A., Leardini; L., Bragonzoni; S., Toksvig Larsen; S., Giannini

The aim of this study was to investigate the migration pattern of the Lubinus SP II prosthesis stem. Migration at the stem-cement and at the bone-cement interface was assessed. Twenty-five patients were studied by radiostereometry during a period of 2 years. The migration of the head, of 2 points on the collar, of the stem tip, and also of the cement restrictor, was measured. The collar and the head were found stable at 2 years' follow-up, whereas an anterior migration occurred at the stem tip (median, 0.3 mm; 25th percentile, 0.04 mm; 75th percentile, 1.27 mm). Virtually no subsidence or axial rotation of the stems was observed. An anterior migration of the restrictor marker was also observed, compatible with a rigid sagittal plane rotation of the stem and of the cement mantle about the collar. Therefore, stem tip migration occurred at the bone-cement interface. Key words: total hip arthroplasty, anatomic stem, radiostereometry, subsidence, bone-cement interface.

2004 - A new semi-automated measurement technique based on X-ray pictures for ankle morphometry. [Articolo su rivista]
R., Stagni; A., Leardini; Catani, Fabio; A., Cappello

Knowledge of human joint morphology is important in orthopaedic surgery and in prosthesis design. The literature on quantitative morphological analysis of the ankle joint is particularly scarce. A semi-automated radiographic measurement method was developed to collect morphological measures of the ankle joint. The method was based on standard lateral and antero-posterior X-ray pictures of the ankle joint. These were then scanned and analysed by means of specialized software designed for the purpose, which requires minimal operator contribution. Accuracy of the method was experimentally assessed by in vitro direct measurements. Intra- and inter-operator variability was also tested. Accuracy was assessed to be within 1mm for most measurements. Repeatability was not affected by operator skill and was within 2mm. The newly proposed method was applied successfully on 15 male adult subjects and relevant results are reported. The method allows ankle morphology to be analysed in a large number of subjects providing reliable data for anthropometric statistics.

2004 - Clinical evaluation of resurfacing of the patella in posterior-stabilizing total knee replacement. [Articolo su rivista]
A., Rizzo; Catani, Fabio; A., Ensini; M. V., Turriago; S., Giannini

The authors report their experience in the implantation of 108 posterior-stabilized cemented total knee replacements, where in 43 cases the patella was not resurfaced (group 1) and in 65 in was resurfaced (group 2). The ability to perform daily activities, the subjective function of the patello-femoral joint and the index of patient satisfaction were evaluated by means of a telephone interview; furthermore, a clinical-radiographic evaluation was carried out in 50 cases. The results of the present study indicate the need of resurfacing the patella using a posterior-stabilized prosthetic design, based on the fact that more joint excursion, a low incidence of complications on the patello-femoral joint, and improved ability to perform daily activities were demonstrated.

2004 - Dynamic in-vivo tibio-femoral and bearing motions in mobile bearing knee arthroplasty. [Articolo su rivista]
S., Fantozzi; A., Leardini; S. A., Banks; M., Marcacci; S., Giannini; Catani, Fabio

To determine the tibio-femoral and bearing motions in well functioning mobile bearing total knee arthroplasties, a quantitative analysis by means of fluoroscopy was carried out during stair ascending, chair rising-sitting and step up-down motor tasks. Femoral and tibial component positions were obtained using a CAD-model-based shape matching technique. Direct measurement of mobile bearing motion was carried out by tracking previously inserted tantalum beads. A relatively small motion of the bearing was observed. The advantage of self-alignment claimed for the mobile bearing arthroplasty seems to be confirmed by subject-specific ranges of motion exhibited by these patients. It has also been demonstrated that these total knee arthroplasties, which are not fully conforming in flexion, provide little constraint to antero-posterior motion, leading to a kinematic pattern very similar to an ACL deficient knee.

2004 - Mobility of the human ankle and the design of total ankle replacement. [Articolo su rivista]
A., Leardini; J. J., O'Connor; Catani, Fabio; S., Giannini

Our prior research has shown that currently available total ankle implants fail to restore physiologic ankle mobility. Most of the modern mobile-bearing designs that feature a flat tibial component and a talar component with anatomic curvature in the sagittal plane function nonphysiologically with the natural ligament apparatus. To establish a more natural relationship between the implanted components and the retained ankle ligaments, we have developed a new design. According to our prior research, we suggest that physiologic ankle mobility is reproduced best with a design featuring a spherical convex tibial component, a talar component with radius of curvature in the sagittal plane longer than that of the natural talus, and a fully conforming meniscal component. Our preliminary observations in trial implantation and in a few patients suggest that while reproducing physiologic ankle mobility, the new design is capable of maintaining complete congruence at the two articulating surfaces of the meniscal bearing over the entire motion arc, with the prospect of minimizing wear of this component.

2004 - The stability of the cemented tibial component of total knee arthroplasty: posterior cruciate-retaining versus posterior-stabilized design. [Articolo su rivista]
Catani, Fabio; A., Leardini; A., Ensini; G., Cucca; L., Bragonzoni; S., Toksvig Larsen; S., Giannini

Micromotion of the tibial component in 40 knee arthroplasties for gonarthrosis was studied using Roentgen stereophotogrammetric analysis. The stability of this component was assessed for 2 years' postoperatively. In all arthroplasties, an attempt was made to reconstruct the preoperative posterior slope. Posterior cruciate-retaining (CR) and posterior-stabilized (PS) components showed at 2 years a maximum total point motion of 0.6 +/- 0.4 mm and 0.7 +/- 0.5 mm, respectively. Whereas 92.5\% of the implants were determined to be stable, 1 of the CR group and 2 of the PS group displayed migration between the first and the second year of at least 0.2 mm. A negative correlation between subsidence of the tibial component at 2 years of follow-up and the difference between preoperative and postoperative tibial slope was found. Consequently, we suggest that restoring the original posterior slope of the tibial plateau must be a goal of tibial component implantation.

2004 - [Gait analysis after rotationplasty hip surgery for malignant tumor of the proximal femur]. [Articolo su rivista]
D., Donati; M. G., Benedetti; Catani, Fabio; L., Berti; R., Capanna

Rotationplasty of the hip joint is a special surgical technique used for the treatment of malignant tumors of the proximal part of the femur. We report a clinical case and gait analysis results before and after rehabilitation training. Evaluation of joint motion, kinetic moments, and the electromyographic findings enabled us to document progressive adaptation of muscle and joint function to their new role in the motor pattern, demonstrating the exceptional strength of rotationplasty. Active control of two fulcrums in the lower limb, the pseudo hip proximally and the pseudo knee intermedially, makes this type of operation extremely advantageous compared to the alternative of hip disarticulation or hemipelvectomy. Total absence of pain together with the preservation of articular and cutaneous proprioception are important advantages. Rotationplasty is an attractive alternative for treatment of malignant tumors of the proximal part of the femur.

2003 - Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs. [Articolo su rivista]
S., Fantozzi; M. G., Benedetti; A., Leardini; S. A., Banks; A., Cappello; D., Assirelli; Catani, Fabio

Understanding total knee replacement mechanics and their influence on patient mobility requires accurate analysis of knee joint kinematics and traditional full body kinematics and kinetics. Three-dimensional fluoroscopic and gait analysis techniques were carried out on patients with either mobile bearing or posterior stabilized knee prostheses during stair ascent. Statistically significant correlation was found between knee flexion at foot strike and the position of the mid-condylar contact points, and between maximum knee adduction moment and corresponding lateral trunk tilt. A more complete and powerful assessment of the functional performances of different TKR designs can be performed in-vivo by combining gait and fluoroscopic analyses.

2003 - Mobile and fixed bearing total knee prosthesis functional comparison during stair climbing. [Articolo su rivista]
Catani, Fabio; M. G., Benedetti; R. D., Felice; R., Buzzi; S., Giannini; P., Aglietti

The purpose of this investigation is to determine the functional performance of the mobile bearing total knee replacement prosthesis as compared to the fixed bearing type total knee replacement prosthesis.Kinematics, kinetics, and electromyography data were gained from 10 patients with mobile bearing and 10 patients with a fixed bearing posterior stabilized Insall Burstein II total knee replacement during ascending and descending stairs. A control group of 10 normal subjects, matched by sex and age, was also analysed.No significant biomechanical differences in patients with different total knee replacement designs have been reported from level-walking studies. Slightly better performance of posterior retaining with respect to cruciate sacrificing total knee replacement designs have been claimed from stair climbing studies. Only one study has been conducted regarding mobile versus fixed bearing total knee replacement assessed by gait analysis. This study did not show any biomechanical differences between the two groups.Motion analysis was used to quantify the knee kinematics, kinetics, and electromyography (right and left longissimus dorsi, gluteus medius, rectus femoris, biceps femoris, semitendinosus, gastrocnemius and tibialis anterior muscles) during stair ascent and descent.The mobile bearing group demonstrated a reduced knee extensor moment during stair climbing and descending, and a reduced knee adductor moment during stair climbing. When ascending stairs, most of the mobile bearing patients show a peak knee flexion and a peak knee flexion moment at the late stance phase during the double support period. This kinematic and kinetic pattern is absent in normal subject. Both mobile bearing and fixed bearing groups showed abnormal electromyography patterns in both descending and ascending.During stair climbing, the mobile bearing design demonstrates a different kinematic pattern to the fixed bearing total knee replacement. Lower limb compensatory mechanisms seemed to be adopted particularly by the mobile bearing patients during ascending stairs.Total knee replacement patient with mobile bearing design can feel excessive femoro-tibial motion during daily living activities such as stair climbing and descending. Proprioceptive control of this tibio-femoral translation is needed as demonstrated by the lower limb compensatory mechanism. This data suggest that antero-posterior constraint structures (ligamentous or mechanical) are important to obtain reproducible knee kinematics.

2003 - Muscle activation pattern and gait biomechanics after total knee replacement. [Articolo su rivista]
M. G., Benedetti; Catani, Fabio; T. W., Bilotta; M., Marcacci; E., Mariani; S., Giannini

The aim of this study is to evaluate residual muscle function abnormalities after total knee replacement, with respect to gait kinematics and kinetics.Longitudinal study on a follow-up of up to two years.Gait usually presents an excellent improvement after total knee replacement. Nevertheless, some kinematics and kinetics abnormalities persist even after a long period of time and they might have implications in long-term prosthesis failure. Additionally, lower limb muscle activity has not been sufficiently studied in the past directly by means of dynamic EMG.Nine patients who had a posterior cruciate sparing total knee replacement design were evaluated by means of clinical assessment and gait analysis at the end of rehabilitation trials at six, twelve and twenty four months. EMG from trunk and lower limb muscles was registered and elaborated through a statistical detector for the on-off timing.Gait analysis showed a slow gait, with a "stiff knee gait pattern" and prolonged muscular co-contractions during stance.Knee kinematics and kinetics abnormalities during loading acceptance after total knee replacement are associated with co-contractions in muscular activation pattern.Gait pattern at two years after total knee replacement is deemed unphysiological, potentially dangerous for the implant duration in time and responsible for residual disability in patients. Muscular behavior during daily activities provides insight into the integration of the prosthetic biomechanics within the muscular-skeletal system. This information is of relevance to improve prosthetic design, rehabilitation programs and knee motor performance.

2003 - Pre-operative planning and gait analysis of total hip replacement following hip fusion. [Articolo su rivista]
M. G., Benedetti; E., Montanari; Catani, Fabio; G., Vicenzi; A., Leardini

A computer-based pre- and post-operative analysis of total hip replacement (THR) is presented. The analysis was performed by using and innovative combination of X-ray measurements and gait analysis. The several important biomechanical factors that affect effective THR are analysed in a test clinical case of conversion of hip fusion into THR. Geometrical positioning of the artificial joint should restore correct motion and adequate leverage of the surrounding muscles in order to exert the appropriate functional joint moments. Hip joint centre positioning pre- and post-operation was evaluated using a computer-based X-ray measurement tool. This enabled the calculation of the medio-lateral and proximal-distal off-set of the joint centre, the lever arms of the abductor muscles and the limb length discrepancy. Pre- and post-operative function was also evaluated using gait analysis, including joint kinematics, kinetics and electromyography. The whole analysis suggests that a good restoration of joint motion, a regression of pelvic compensation and a phasic activity of gluteus medius occur only when a good positioning of the prosthetic hip joint is obtained. This study proved a fundamental role played by these two computer-based tools in the support of the clinical decision making process.

2002 - Computer-assisted preoperative planning of a novel design of total ankle replacement. [Articolo su rivista]
A., Leardini; L., Rapagnà; A., Ensini; Catani, Fabio; A., Cappello

Computer-assisted preoperative planning are particularly sought for enhancing surgical implantation and improving clinical outcome of ankle joint replacement arthroplasty. A planning tool was designed to enhance the surgical implantation of a novel ligament-compatible three-component prosthesis. The tool includes a geometric and mechanical model of the ankle complex. The geometry of the articular surfaces and of main ligaments is defined from digitisation on a scanned lateral radiographs of the joint. From the expected movement arc and from component dimensions, a mechanical model of the ligaments is used to select the optimal size and the position the three prosthesis components. The planning is based on the minimisation of ligament change in length and of bone stock to be removed. The main output report is a detailed picture of the replaced ankle with indications of component locations and quantitative measure of bone cuts. An advanced report also superimposes the resulting prediction of prosthesis component kinematics at the replaced joint to the original radiographs.

2001 - Computer-assisted design of the sagittal shapes of a ligament-compatible total ankle replacement. [Articolo su rivista]
A., Leardini; Catani, Fabio; S., Giannini; J. J., O'Connor

The poor results of total ankle replacement have been attributed to the inability of designers to restore adequately the critical mutual function of the ligaments and the articular surfaces. The purpose of this study was to design sagittal shapes of the articular surfaces for a new ankle prosthesis to be compatible with the geometry of the retained ligamentous structures. Several ligament-compatible pairs of articular surfaces were tested using a computerised version of a four-bar linkage model. The kinematics of the ankle when replaced by non-conforming two-component and by fully conforming three-component designs with either flat, concave or convex tibial surfaces were assessed by the model. A ligament-compatible convex-tibia fully-congruent three-component prosthesis showed the best features. The three-component prosthesis allows complete congruence over the entire range of flexion. A convex shape for the tibial arc was preferred because of the better degree of entrapment of the meniscal bearing. A 5 cm convex-tibia arc radius gave 2 mm entrapment together with 9.8 mm of tibial bone cut. Ligament elongation imposed by full congruence of the articular surfaces was less than 0.03\% of the original length. The original patterns of joint kinematics and ligament tensioning are closely restored in the joint replaced by the proposed prosthesis.

2001 - Surgical treatment of flexible flatfoot in children a four-year follow-up study. [Articolo su rivista]
B. S., Giannini; F., Ceccarelli; M. G., Benedetti; Catani, Fabio; C., Faldini

Surgical treatment of flexible flatfoot in children a four-year follow-up study

2000 - Analysis of ground reaction forces by means of wavelet transform. [Articolo su rivista]
F., Verdini; T., Leo; S., Fioretti; M. G., Benedetti; Catani, Fabio; S., Giannini

To identify details of clinical relevance in ground reaction forces by means of wavelet transform.A retrospective analysis of gait tests performed by total knee replacement patients and a control population has been performed.The ground reaction forces have been processed by means of wavelet transform. Results of the wavelet analysis are represented, in a time-frequency plane, by tiles. These are coloured in different grey levels associated to the values of a suitable energy function of the expansion coefficients, resulting from the wavelet transform.The high frequency tiles revealed the presence of irregularities with clinical significance in the first part of the stance phase. These transients in ground reaction forces are described in a quantitative manner allowing to monitor their evolution during the patient observation time. The heel strike transient has been identified by the tile representation of the vertical component of ground reaction forces and confirmed by its correlation with corresponding irregularities in the other components.The tile representation allows to detect and to quantify details not easily perceivable by the examiner through traditional techniques. The wavelet transform seems particularly appealing for clinical applications such as outcome assessment or treatment evaluation and can assist in the definition of normative models of ground reaction forces. The effectiveness of the procedure suggest to try to automate it.The tile representation allows to identify and to keep the records of ground reaction forces clinically significant details, such as heel strike transient.

2000 - Cruciate ligament forces in the human knee during rehabilitation exercises. [Articolo su rivista]
D. E., Toutoungi; T. W., Lu; A., Leardini; Catani, Fabio; J. J., O'Connor

To determine the cruciate ligament forces occurring during typical rehabilitation exercises.Design. A combination of non-invasive measurements with mathematical modelling of the lower limb.Background. Direct measurement of ligament forces has not yet been successful in vivo in humans. A promising alternative is to calculate the forces mathematically.Sixteen subjects performed isometric and isokinetic or squat exercises while the external forces and limb kinematics were measured. Internal forces were calculated using a geometrical model of the lower limb and the "dynamically determinate one-sided constraint" analysis procedure.During isokinetic/isometric extension, peak anterior cruciate ligament forces, occurring at knee angles of 35-40 degrees, may reach 0.55x body-weight. Peak posterior cruciate ligament forces are lower and occur around 90 degrees. During isokinetic/isometric flexion, peak posterior cruciate forces, which occur around 90 degrees, may exceed 4x body-weight; the anterior cruciate is not loaded. During squats, the anterior cruciate is lightly loaded at knee angles up to 50 degrees, after which the posterior cruciate is loaded. Peak posterior cruciate forces occur near the lowest point of the squat and may reach 3.5x body-weight.For anterior cruciate injuries, squats should be safer than isokinetic or isometric extension for quadriceps strengthening, though isokinetic or isometric flexion may safely be used for hamstrings strengthening. For posterior cruciate injuries, isokinetic extension at knee angles less than 70 degrees should be safe but isokinetic flexion and deep squats should be avoided until healing is well-advanced.Good rehabilitation is vital for a successful outcome to cruciate ligament injuries. Knowledge of ligament forces can aid the physician in the design of improved rehabilitation protocols.

2000 - Muscle performance about the knee joint in patients who had distal femoral replacement after resection of a bone tumor. An objective study with use of gait analysis. [Articolo su rivista]
M. G., Benedetti; Catani, Fabio; D., Donati; L., Simoncini; S., Giannini

The treatment of a malignant bone tumor in the distal aspect of the femur often requires great sacrifice of bone and muscle. The extent of quadriceps removal has been reported to influence the long-term functional efficiency of a patient's gait. The objective of the present study was to determine gait function as it relates to the residual quadriceps strength and to the specific component or components of the quadriceps removed in patients treated with total knee replacement because of a malignant bone tumor in the distal aspect of the femur.Sixteen patients were evaluated after implantation of a modular hinged cementless knee prosthesis. The patients were assigned to two groups on the basis of the different components of the quadriceps muscle that were resected. Group 1 consisted of five patients who had removal of the vastus medialis and the vastus intermedius and two who had removal of the vastus medialis only. Group 2 consisted of nine patients who had removal of the vastus lateralis and the vastus intermedius. Residual muscular strength about the treated knee was measured by voluntary maximum contraction isometric testing. Foot-ground reaction forces, kinematic and kinetic findings, and electromyographic activity during free-speed walking were recorded.The kinematic study showed that the patients in Group 1 tended to have a stiff-knee gait during stance, whereas those in Group 2 (in which the vastus medialis was spared) had a more regular flexion-extension knee pattern. Electromyographic findings showed that a higher percentage of patients in Group 1 had reduced or absent rectus femoris activity during the loading response. Compared with the contralateral side, knee-extension strength in the treated limb was decreased in both groups. However, there were no significant differences between the groups with respect to the pattern of strength loss.Good gait function can be achieved in patients with a distal femoral tumor that is treated with distal femoral resection, partial excision of the quadriceps, and total knee arthroplasty with insertion of a hinged prosthesis. Patients in whom the vastus lateralis and vastus intermedius were removed had better gait performance and a more physiological knee-loading pattern than did patients in whom the vastus medialis was removed.

2000 - The role of the passive structures in the mobility and stability of the human ankle joint: a literature review. [Articolo su rivista]
A., Leardini; J. J., O'Connor; Catani, Fabio; S., Giannini

The mobility and stability of the ankle joint have been extensively investigated, but many critical important issues still need to be elucidated. However, there seems to be a general agreement on several important observations. A more isometric pattern of rotation for the calcaneofibular and the tibiocalcaneal ligaments with respect to all the others has been reported. Many recent studies have found changing positions of the instantaneous axis of rotation, suggesting that the hinge joint concept is an oversimplification for the ankle joint. A few recent works have also claimed anterior shift of the contact area at the tibial mortise during dorsiflexion, which would imply combined rolling and sliding motion at this joint. Many findings from the literature support the view of a close interaction between the geometry of the ligaments and the shapes of the articular surfaces in guiding and stabilizing motion at the ankle joint.

1999 - A geometric model of the human ankle joint. [Articolo su rivista]
A., Leardini; J. J., O'Connor; Catani, Fabio; S., Giannini

A two-dimensional four-bar linkage model of the ankle joint is formulated to describe dorsi/plantarflexion in unloaded conditions as observed in passive tests on ankle complex specimens. The experiments demonstrated that the human ankle joint complex behaves as a single-degree-of-freedom system during passive motion, with a moving axis of rotation. The bulk of the movement occurred at the level of the ankle. Fibres within the calcaneofibular and tibiocalcaneal ligaments remained approximately isometric. The experiments showed that passive kinematics of the ankle complex is governed only by the articular surfaces and the ligaments. It was deduced that the ankle is a single-degree-of-freedom mechanism where mobility is allowed by the sliding of the articular surfaces upon each other and the isometric rotation of two ligaments about their origins and insertions, without tissue deformation. The linkage model is formed by the tibia/fibula and talus/calcaneus bone segments and by the calcaneofibular and tibiocalcaneal ligament segments. The model predicts the path of calcaneus motion, ligament orientations, instantaneous axis of rotation, and conjugate talus surface profile as observed in the experiments. Many features of ankle kinematics such as rolling and multiaxial rotation are elucidated. The geometrical model is a necessary preliminary step to the study of ankle joint stability in response to applied loads and can be used to predict the effects of changes to the original geometry of the intact joint. Careful reconstruction of the original geometry of the ligaments is necessary after injury or during total ankle replacement.

1999 - Analysis of function after intra-articular fracture of the os calcis. [Articolo su rivista]
Catani, Fabio; M. G., Benedetti; L., Simoncini; A., Leardini; S., Giannini

Fractures of the os calcis with intra-articular involvement can cause difficulty in treatment and can result in abnormal function throughout the ankle-foot complex. We evaluated the function of the ankle-foot complex and the overall gait pattern after fracture of the os calcis, and we compared the results of surgical and nonsurgical treatment. Those in whom the geometry of the os calcis and joint was restored by reconstructive surgery had better compensation of gait and a better clinical-functional score. Complex disturbances in gait were found in the group of patients that did not undergo open reduction or internal fixation.

1999 - Flat foot functional evaluation using pattern recognition of ground reaction data. [Articolo su rivista]
A., Bertani; A., Cappello; M. G., Benedetti; L., Simoncini; Catani, Fabio

Main purpose of this study was to apply quantitative gait analysis and statistical pattern recognition as clinical decision-making aids in flat foot diagnosis and post-surgery monitoring.Statistical pattern recognition techniques were applied to discriminate between normal and flat foot populations through ground reaction force measurements; ground reaction forces time course was assumed as a sensible index of the foot function.Gait analysis is becoming recognized as an important clinical tool in orthopaedics, in pre-surgery planning, post-surgery monitoring and in a posteriori evaluation of different treatment techniques. Statistical pattern recognition techniques have been utilized with success in this field to identify the most significant variables of selected motor functions in different pathologies, and to design classification rules and quantitative evaluation scores.Ground reaction forces were recorded during free speed barefoot walks on 28 healthy subjects, and 28 symptomatic flexible flat foot children selected for surgical intervention. A new feature selection algorithm, based on heuristic optimization, was applied to select the most discriminant ground reaction forces time samples. A two-stage pattern recognition system, composed by three linear feature extractors, one for each ground reaction force component, and a linear classifier, was designed to classify the feet of each subject using the selected features. The output of the classifier was used to define a functional score.The classifier assigned the ground reaction force patterns performed by each subject into the right class with an estimated error of 15\%, corresponding to an assignment error for each subject's foot of 9\%. The most discriminant ground reaction forces time samples selected are in full agreement with the pathophysiology of the symptomatic flexible flat foot. The obtained score was utilized to monitor the 1 and 2 years post-operative functional recovery of two differently treated subgroups of 32 flexible flat foot subjects.Statistical pattern recognition techniques are promising tools for clinical gait analysis; the obtained score provides important functional information that could be used as a further aid in the clinical evaluation of flat foot and different surgical treatment techniques.Symptomatic flexible flat foot surgical decision making is frequently difficult because of the lack of objective criteria to assess functional abnormalities of the foot/ankle complex. Gait analysis and statistical pattern recognition can give us parameters with which to characterize "functional" flat foot. Moreover, we can objectively follow up the recovery of the foot/ankle complex function after surgical treatment.

1999 - Kinematics of the human ankle complex in passive flexion; a single degree of freedom system. [Articolo su rivista]
A., Leardini; J. J., O'Connor; Catani, Fabio; S., Giannini

The restoration of original range and pattern of motion is the primary goal of joint replacement and ligament reconstruction. The objective of the present work is to investigate whether or not a preferred path of joint motion at the intact human ankle complex is exhibited during passive flexion. A rig was built to move the ankle complex through its range of flexion while applying only the minimum necessary load to drive ankle flexion. Joint motion was constrained only by the articular surfaces and the ligaments. The movements of the calcaneus, talus and fibula relative to the stationary tibia in seven cadaveric specimens were tracked with a stereophotogrammetric system. It was shown that the calcaneus follows a unique path of unresisted coupled motion relative to the tibia and that most of the motion occurred at the ankle, with little motion at the subtalar level. The calcaneofibular and the tibiocalcaneal ligaments showed near-isometric pattern of rotations. All specimens showed motion of the axis of rotation relative to the bones. Deviations from the unique path due to the application of load involved mostly subtalar motion and were resisted. The ankle complex exhibits one degree of unresisted freedom, the ankle behaving as a single degree of freedom mechanism and the subtalar as a flexible structure. We deduced that the calcaneofibular and tibiocalcaneal ligaments together with the articular surfaces guide ankle passive motion, other ligaments limit but do not guide motion.

1999 - Validation of a functional method for the estimation of hip joint centre location. [Articolo su rivista]
A., Leardini; A., Cappozzo; Catani, Fabio; S., Toksvig Larsen; A., Petitto; V., Sforza; G., Cassanelli; S., Giannini

The present study assesses the accuracy with which the subject specific coordinates of the hip joint centre (HJC) in a pelvic anatomical frame can be estimated using different methods. The functional method was applied by calculating the centre of the best sphere described by the trajectory of markers placed on the thigh during several trials of hip rotations. Different prediction methods, proposed in the literature and in the present investigation, which estimate the HJC of adult subjects using regression equations and anthropometric measurements, were also assessed. The accuracy of each of the above-mentioned methods was investigated by comparing their predictions with measurements obtained on a sample of 11 male adult able-bodied volunteers using roentgen stereophotogrammetric analysis (RSA), assumed to provide the true HJC locations. Prediction methods estimated the HJC location at an average rms distance of 25-30 mm. The functional method performed significantly better and estimated HJCs within a rms distance of 13 mm on average. This result may be confidently generalised if the photogrammetric experiment is carefully conducted and an optimal analytical approach used. The method is therefore suggested for use in motion analysis when the subject's hip range of motion is not limited. In addition, the facts that it is not an invasive technique and that it has relatively small and un-biased errors, make it suitable for regression equations identification with no limit to sample size and population typology.

1998 - Data management in gait analysis for clinical applications. [Articolo su rivista]
M. G., Benedetti; CATANI, Fabio; A., Leardini; E., Pignotti; S., Giannini

OBJECTIVE: To study the reliability of gait analysis data obtained using the Calibrated Anatomical System Technique (CAST) protocol and to verify the suitability and repeatability of the extraction of a number of parameters from the waveforms obtained. DESIGN: The experimental protocol and the parametric analysis technique were applied on a population of able-bodied subjects. BACKGROUND: The clinical interpretation process of gait data still needs a more accurate analysis of the reliability and repeatability of the measurements and a suitable procedure for data reduction useful for data comparison. METHODS: Gait analysis was performed in 20 able-bodied subjects using a stereophotogrammetric system and a forceplate. 124 parameters relative to time-distance, kinematic and kinetic variables were calculated by means of an automatic procedure and statistically analysed. RESULTS: Most of the parameters were found to be normally distributed with relatively small range of variation. Few of them showed poor repeatability, mostly due to the experimental inaccuracies introduced. Correlation of several gait parameters with age, sex, and speed of progression was also identified.

1998 - Functional evaluation in total hip replacement patients. [Articolo su rivista]
Catani, Fabio; M. G., Benedetti; R., Binazzi; M. D., Zerbi; A., Leardini; S., Giannini

An evaluation of total hip replacement patients requires objective criteria that allow for the measurement of any changes in the biomechanics of the prosthesis and the effects of these changes on clinical findings. An evaluation of loading and joint movement during walking in these patients has been dealt with by many authors. In this study 15 patients who had undergone total hip replacement for coxarthrosis primary or secondary to congenital dysplasia were examined by kinematic and kinetic gait analysis, clinical evaluation, and radiographic evaluation of the position of the neocenter of prosthetic joint rotation. The patients with prostheses in congenital dysplasia presented with a pattern of walking that was significantly modified. In agreement with what is reported in the literature proximal positioning had less influence on gait parameters as compared to lateral dislocation. Furthermore, changes in positioning observed did not seem to have negative effects on joint loading, measured indirectly by the calculation of joint moments.

1998 - The influence of clinical and biomechanical factors on the results of valgus high tibial osteotomy. [Articolo su rivista]
Catani, Fabio; M., Marcacci; M. G., Benedetti; A., Leardini; A., Battistini; F., Iacono; S., Giannini

The results of the surgical treatment of valgus high tibial osteotomy were studied based on clinical and radiographic assessment and gait-analysis in 21 patients affected with arthrotic varus knee. Although tibial osteotomy has been in use for some time now, the reasons for its frequent failure are still not fully understood. A statistical analysis of the clinical and biomechanical parameters taken into account in this study have shown that hypercorrection in valgus is required to unload the medial compartment and to prevent the recurrence of deformity in varus and pain. Walking with the limb extrarotated may also be a compensatory mechanism, in order to reduce the adductor moment in the knee and overloading of the medial compartment.

1996 - Position and orientation in space of bones during movement: experimental artefacts. [Articolo su rivista]
A., Cappozzo; CATANI, Fabio; A., Leardini; M. G., Benedetti; U. D., Croce

This paper deals with the experimental problems related to the reconstruction of the position and orientation of the lower limb bones in space during the execution of locomotion and physical exercises. The inaccuracies associated with the relative movement between markers and underlying bone are analysed. Quantitative information regarding this movement was collected by making experiments on subjects who had suffered fractures and were wearing either femoral or tibial external fixators. These latter devices provided frames that were reliably rigid with the bone involved, and hence the possibility of assessing the relative movement between markers mounted on the skin and this bone. Anatomical frames associated with thigh and shank were reconstructed using technical frames based on different clusters of skin markers and their rotation with respect to the relevant bone evaluated. Marker movement was also assessed in subjects with intact musculoskeletal structures using digital videofluoroscopy.

1995 - Position and orientation in space of bones during movement: anatomical frame definition and determination. [Articolo su rivista]
A., Cappozzo; CATANI, Fabio; U. D., Croce; A., Leardini

This paper deals with methodological problems related to the reconstruction of the position and orientation of the human pelvis and the lower limb bones in space during the execution of locomotion and physical exercises using a stereophotogrammetric system. The intention is to produce a means of quantitative description of joint kinematics and dynamics for both research and application. Anatomical landmarks and bone-embedded anatomical reference systems are defined. A contribution is given to definition of variables and relevant terminology. The concept of anatomical landmark calibration is introduced and relevant experimental approaches presented. The problem of data sharing is also addressed. This material is submitted to the scientific community for consideration as a basis for standardization. RELEVANCE: In order to make movement analysis effective in the solution of clinical problems, a structured conceptual background is needed in addition to standardized definitions and methods. Technical solutions which make data sharing and relevant data banks possible are also of primary importance. This paper makes suggestions in this context.

1995 - The role of muscular co-contraction of the hip during movement. [Articolo su rivista]
Catani, Fabio; A., Hodge; R. W., Mann; A., Ensini; S., Giannini

The joint biomechanics of the hip was studied analyzing the kinematic, kinetic, electromyographic and in vivo pressure parameters during walking, going up stairs, and getting up from a chair. The most significant clinical and biomechanical data emerged when the temporal correlation between intra-articular pressure variations and electric activity of the bi-articular muscles was studied. The presence of co-contraction of the bi-articular muscles during the support and oscillation phases was evident. The maximum joint pressure values were measured while getting up from a chair when the hip was flexed more than 100 degrees. The posterior region of the acetabulum was that most submitted to loading. This data is useful in gaining an understanding of joint physiology, in correctly setting up physio-kinesitherapeutic protocols, and in setting up pre-clinical prosthetic mechanical tests.

1994 - Osteoid osteoma of the lateral cuneiform bone. [Articolo su rivista]
Catani, Fabio; L., Sangiorgi; P., Picci; S., Giannini

An unusual case of osteoid osteoma is reported emphasizing the necessity of a careful history and physical examination combined with an adequate imaging supply. Treatment was surgical with an en bloc excision of the lesion.

1994 - Patellar resurfacing in tumor endoprosthesis: a study in regard to power transmission. [Articolo su rivista]
T., Tsuboyama; R., Windhager; D., Campanacci; S., Galletti; Catani, Fabio; R., Capanna; M., Campanacci; T., Yamamuro; R., Kotz

Relation between quadriceps muscle mass and knee extension strength was investigated after resection of malignant bone tumor and endoprosthetic replacement of the distal femur in 19 patients with patellar resurfacing (Group A) and 16 patients without resurfacing (Group B). In all cases, a modular cementless, hinged prosthesis had been used. Age and follow-up period were comparable in the 2 groups. Muscle mass was measured ultrasonographically and strength was evaluated isokinetically. All the data on the operated side are given as percentage of the non-operated side. There was a positive correlation between muscle mass and strength in both groups. By linear regression analysis, a slightly lower value of strength was predicted in the unresurfaced group than in the resurfaced group. Analysis of covariance revealed that the influence of patellar resurfacing on strength was significant. This factor should also be considered in making a decision about patellar resurfacing with a tumor endoprosthesis.

1994 - Surgical repair of achilles tendon ruptures using polypropylene braid augmentation. [Articolo su rivista]
S., Giannini; M., Girolami; F., Ceccarelli; Catani, Fabio; S., Stea

Surgical repair in fresh rupture of the Achilles tendon should be considered in active patients and athletes to restore their preinjury level of activity. Fifteen cases of Achilles tendon rupture underwent surgical repair using interpositional augmentation. This technique provides an immediate mechanical strength of the repair, avoiding the need for a postoperative plaster cast and allowing immediate motion of the ankle. No wound infection, scar adherence of the skin to the tendon, or rerupture of the tendon is present in this series. All patients were subjectively satisfied with the results and returned to their preinjury level of activity. Objectively, isokinetic assessment revealed no significant difference, as per t-test evaluation (P < .05), between the operated leg and the controlateral one.

1993 - Gait analysis in patients after Van Nes rotationplasty. [Articolo su rivista]
Catani, Fabio; R., Capanna; M. G., Benedetti; A., Battistini; A., Leardini; G., Cinque; S., Giannini

Gait was analyzed through kinetic, kinematic, and temporal-distance parameters assessment to evaluate the functional performance of ten children treated by the classical Van Nes rotationplasty (VNR). Van Nes rotationplasty is a surgical procedure, which permits the conversion of the ankle joint into a "pseudo-knee" joint. The data were compared with measurements of a normal population of ten healthy subjects. Significant differences with respect to the normal were found in stride duration, stride length, cadence, velocity, and stance-swing ratio, and in ground-reaction forces parameters, which define the propulsive phase in the prosthetic side and the acceptance phase in the sound side. There were differences in some kinematic parameters as well. Van Nes rotationplasty is acceptable from a biomechanical-functional point of view, particularly with respect to the active control of the pseudo-knee, which allows a smooth and coordinate gait pattern.

1992 - Avulsion of the long head of the triceps in kidney transplant. [Articolo su rivista]
L., D'Elia; A., Ahdieh; R. A., Pamplò; Catani, Fabio

The authors describe a case of avulsion of the long head of the triceps in a patient with kidney transplant. An analysis of the case and a review of the literature suggest weakening of the osteotendinous junction due to the associated action of renal osteodystrophy and cortisone therapy.

1992 - Functional evaluation of patients fitted with total knee prostheses. [Articolo su rivista]
S., Giannini; M., Gandolfi; M., Marcacci; Catani, Fabio; F., Ceccarelli; A. P., Molgora

Degenerative or inflammatory diseases of the knee joint account for a large proportion of diseases affecting the elderly. Treatment aims to eliminate pain, correct the deformity and maintain complete joint mobility. In cases of total joint degeneration, fitting of a joint prosthesis is the technique currently favoured since elimination of pain and correction of the deformity, accompanied by recovery of joint mobility (the fundamental requirements for normal everyday life) can only be obtained if the knee joint is completely replaced. With the discovery of new materials and increasingly sophisticated knowledge about articular mechanics, the knee prosthesis, although more recent than the hip prosthesis, has become ever more widespread to the point that it now represents an irreplaceable aid in the treatment of this common disease. The clinical results obtained are already stable and particularly encouraging and prosthesis design is sophisticated and accurate. There is, however, still the suspicion that current prostheses can be considered "rudimentary" in comparison with the physiological and biomechanical behaviour of the human joint. We therefore wanted to begin an evaluation using a gait analysis system to assess patients fitted with knee prostheses. The first impressions gained in this study are the subject of this article.

1992 - Kinematic and isokinetic evaluation of patients with flat foot. [Articolo su rivista]
S., Giannini; Catani, Fabio; F., Ceccarelli; M., Girolami; M. G., Benedetti

In recent years research into joint physiology and biomechanics of movement has employed high-technology instruments to quantify the parameters which determine whether the behavior of a joint or kinematic chain is normal or pathologic. Motion analysis, featuring evaluation of both kinematics and the foot-ground reaction, enables us to measure the temporal and quantitative events of normal and pathologic gaits. The use of motion analysis in the study of flat foot has confirmed the ability to discriminate between "normal" and pathologic. Analysis of these themes has enabled us to follow the temporal evolution of the quantitative parameters both before and after treatment, which can be either surgical or conservative. Evaluation of the kinematic changes and the foot-ground reaction also provides information about the quality and effectiveness of the corrective treatment. For instance, the change in the subtalar alignment following application of an endo-orthotic implant can be targeted for validation by motion analysis. All of the joints comprised in the kinematic chain of the lower limb work together to achieve a symmetrical, rhythmic, and most of all harmonic gait.

1992 - Rotationplasty in segmental resections of the femur. [Articolo su rivista]
R., Capanna; M. D., Ben; D. A., Campanacci; Catani, Fabio; S., Giannini

The authors report 26 cases of high-grade malignant tumors of the distal femur (23 osteosarcomas, 3 Ewing's tumors) submitted to rotation-plasty. The five-years actuarial survival rate (in the 23 cases of osteosarcoma) was 69\% and there was no incidence of local recurrence. The following complications were observed: wound dehiscence (6 cases), arterial thrombosis (in 2 patients submitted to resection and vascular termino-terminal suturing), paralysis of the sciatic nerve (2 cases), delay in consolidation (2 cases), traumatic fracture of the neo-femur (3 cases). All of the complications were resolved favorably, 5 of these requiring surgical treatment (33\%). Satisfactory functional results were obtained in all of the cases, except in one patient who had limitation of the ankle joint subsequent to vascular compartmental syndrome. On the basis of the oncological, functional and biomechanical results reported in this study and in the literature, the authors discuss current indications for rotation-plasty.

1986 - [Hand-Schüller-Christian syndrome arising in the mandible. A case report]. [Articolo su rivista]
C., Marchetti; G., Ercolani; R., Gibelli; D., Donati; Catani, Fabio

The history of Letterer-Siwe, Hand-Schüller-Christian disease, and eosinophilic granuloma of the bone, and the evolution of the concept of grouping them together under the common term of histiocytosis X are presented. The characteristics of the disease, with particular emphasis on oral manifestations, are reviewed. The therapy for the disease is briefly outlined. One case of Hand-Schüller-Christian syndrome is presented. The discussion is focused on the problem of chemotherapy in disseminated forms.

1986 - [Systemic and nonsystemic causes of pathological mandibular fractures]. [Articolo su rivista]
C., Marchetti; G., Ercolani; R., Gibelli; D., Donati; Catani, Fabio

The problem of pathological fractures of the lower jaw with particular reference to their aetiology is examined in the light of personal experience. Odontogenic and hematogenic osteomyelitis, primary and metastatic tumours, degenerative lesions, traumas, inclusions of the teeth and the whole apparatus are discussed individually.