Biomedical subjects

Biagio Moretti

Publications and source records attributed to Biagio Moretti.

11 recordsLinked to original sources

PubMed2006

Multilobulated popliteal cyst after a failed total knee arthroplasty.

Popliteal cyst is a rare finding after total knee arthroplasty (TKA), but when present, it might indicate a malfunction of the TKA related to generation of wear-particles, or loosening. We present a case of a multilobulated popliteal cyst developing in a patient 8 years after primary TKA. The cyst was associated with a mechanical prosthetic loosening. The primary complaint of the patient was pain in the posterior region of the knee. A two-stage procedure consisting of cyst excision at first, followed after 5 months by a revision TKA was performed. Intraoperatively, a darkish, multilobulated cyst with a well-defined thick wall filled with fluid containing polyethylene debris, communicating with the knee joint was found. After 3 years of follow-up, the patient was satisfied and walked without the support of a cane. The patient presented a satisfactory knee range of motion. Clinical, radiological and ultrasound investigations ruled out popliteal cyst recurrence. A dissecting popliteal cyst associated with a failed TKA should be excised because it contains polyethylene debris that constitutes an induced factor for prosthetic loosening. A two-stage procedure with quite a long time in-between, as presented in this paper, can be a useful alternative to manage such a problem, in particular in very old patients associated with other medical problems.

Aged↗

PubMed2006

Posttraumatic coccygeal instability.

PURPOSE: To report the middle term results of partial coccygectomy in a consecutive series of 15 patients with chronic coccygodynia. METHODS: Fifteen patients with chronic coccygodynia were referred to our outpatient clinics. The patients were investigated with dynamic lateral radiography and magnetic resonance imaging (MRI). We diagnosed a posttraumatic coccygodynia with instability of the coccygeal segment and performed a partial coccygectomy after failure of the conservative treatment. RESULTS: All patients underwent subjective and objective assessment after a mean time of 2.8 years from surgery. There were 11 excellent, 3 good, and 1 fair results. The mean time of improvement was 15 weeks, and no further improvement was observed after 6 months. CONCLUSION: Partial coccygectomy is a good therapeutic option for posttraumatic coccygodynia. Dynamic radiography is a useful tool to differentiate posttraumatic from idiopathic coccygodynia. MRI may be useful for further evaluation of the patients after inconclusive dynamic radiography.

Adult↗

PubMed2006

Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of 2 years' follow-up.

PURPOSE: The purpose of this study was to evaluate the clinical and subjective outcomes after arthroscopic-assisted double-bundle posterior cruciate ligament (PCL) reconstruction. METHODS: A series of 15 patients with grade III isolated chronic PCL tears underwent double-bundle PCL reconstruction. Of these patients, 8 (53%) had simultaneous fractures. The mean time from accident to surgery was 10.8 months (range, 8 to 15 months). The mean age at the time of surgery was 28.2 years (range, 17 to 43 years). All of the patients reported knee insecurity during activities of daily living or light sporting activities, with associated anterior knee pain in 5 patients. Preoperatively, posterolateral or posteromedial corner injuries were ruled out through accurate clinical examination. The knees were assessed before surgery and at a mean follow-up of 3.2 years (range, 2 to 5 years) with a physical examination, 4 different rating scales, and stress radiographs obtained with a Telos device (Telos, Marburg, Germany). RESULTS: Postoperative physical examination revealed a reduction of the posterior drawer and tibial step-off in all cases, although the posterior laxity was not completely normalized. Nevertheless, the patients were subjectively better after surgery. The subjective International Knee Documentation Committee score was significantly ameliorated. With regard to the objective International Knee Documentation Committee score, 6 knees (40%) were graded as abnormal because of posterior displacement of 6 mm or greater on follow-up stress radiographs with the Telos device. On the Lysholm knee scoring scale, the score was excellent in 13% of patients and good in 87%. The mean score on the Hospital for Special Surgery knee ligament rating scale was 85.8. The Tegner activity score showed an amelioration after surgery, but no patient resumed his or her preinjury level of activities. The postoperative stress radiographs revealed an improvement in posterior instability of 50% or more in all but 3 knees (20%). CONCLUSIONS: Our technique of double-bundle PCL reconstruction produced a significant reduction in knee symptoms and allowed the patients to return to moderate or strenuous activity, although the posterior tibial translation was not completely normalized and our results appear to be no better than the results of single-bundle PCL reconstruction. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Accidents, Traffic↗

PubMed2005

Extracorporeal shock wave therapy in runners with a symptomatic heel spur.

The aim of this paper is to assess the benefit to treat plantar fasciitis with low-dose energy extracorporeal shock wave therapy (ESWT) and the efficacy of such treatment to abate the painful symptoms allowing a rapid return to the running activity. Our study included 54 running athletes treated for plantar fasciitis associated with a heel spur who received four sessions (once weekly) of low-dose ESWT, and followed prospectively on average 45 days, 6 and 24 months after their last session. The clinical results were excellent in 59% of cases, good in 12%, satisfactory in 21% and distinctly unsatisfactory in 8%. No patient was observed a significant modification of the heel spur at the follow-up X-ray. The ultrasound examination at 24 months showed a disappearance of the inflammation signs in 61% of cases. A strong correlation between ultrasound improvement and clinical results were found. Low-energy ESWT seems to be a good mean to treat plantar fasciitis in runners with a 71% of good or excellent results and a persistent improvement lasting 24 months. A randomized multicentric study seems to be necessary to define the type of energy that should be used in the future to treat plantar fasciitis, in particular in the athletic patients, to allow a faster return to sports activities.

Adult↗

PubMed2005

Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis.

To evaluate the results of the treatment with medium-energy extracorporeal shock wave therapy (ESWT) in rotator cuff calcifying tendinitis. Fifty-four non-consecutive patients, who were referred to our institute for rotator cuff calcifying tendinitis, were managed with a standardized protocol in four sessions of medium-energy (0.11 mJ/mm2) ESWT administered with an electromagnetic lithotriptor. Pain was evaluated at the end of each session, functional state of shoulder was assessed at 1 and 6 months after the end of procedure. All patients underwent radiographs and sonography imaging. No systemic or local complications. Thirty-eight patients (70%) reported satisfactory functional results. Radiographs and sonographs showed a disappearance of calcium deposit in 29 patients (54%) and in 19 patients (35%) it appeared to be reduced more than a half. A correlation was found between residual calcium deposit and the clinical outcome, but some patients showed a reduced pain without modification of calcium deposit. These results were unmodified at 6 months follow-up. Our protocol of medium-energy ESWT provides good results overall about pain modulation.

Adult↗

PubMed2005

Arthroscopic treatment of anterior shoulder instability using knotless suture anchors.

PURPOSE: In this study, we evaluated the results of arthroscopic stabilization of the shoulder using knotless anchors and the lesions associated with anterior-inferior labrum avulsion. TYPE OF STUDY: Retrospective clinical study. METHODS: Twenty consecutive patients affected with anterior unidirectional post-traumatic shoulder instability were treated with arthroscopic reconstruction using knotless anchors. During the surgical procedure, associated lesions such as superior labrum anterior posterior (SLAP) (15%) and rotator interval (15%) were repaired. The patients were evaluated at a mean follow-up of 43 months. RESULTS: Eighty percent of patients resumed sports activity without any limitation and 90% of patients were satisfied with the results of surgery. One patient (5%) had a recurrent dislocation; this patient resumed a contact sport activity despite medical advice. One patient (5%) related signs of shoulder insecurity at the extreme degree of abduction and external rotation; this patient had resumed sports activity with a moderate limitation and was the only patient who was not completely satisfied with the results of surgery. No significant difference was observed between the operated and the contralateral shoulder according to the Rowe and Constant scores. The mean loss of external rotation was 3 degrees . We did not have any cases of anchor loosening, nor did we find signs of shoulder degenerative osteoarthritis on the radiographs. CONCLUSIONS: The knotless anchor seems to be a viable alternative for arthroscopic labrum repair, allowing a good capsular shift. Arthroscopic management of shoulder instability allows us to diagnose and treat associated lesions, thus improving the success rate of this type of surgery. LEVEL OF EVIDENCE: Level IV, case series.

Accidents↗

PubMed2004

Role of cytokines in gonarthrosis and knee prosthesis aseptic loosening.

Cytokines, which have been demonstrated in synovial fluids during various joint diseases, play an important role in mediating synovial inflammation and in regulating the immune response of many inflammatory processes. We studied synovial fluid, serum, and synovial fragments obtained from 33 patients--10 affected by serious gonarthrosis re-quiring a prosthetic implant, 8 with knee prosthesis aseptic loosening, and (as controls) 15 affected by degenerative meniscopathies--to evaluate the degree of inflammation and level of interleukins (IL-2, IL-4, IL-6, IL-10) and interferon gamma secretion. Histological analysis revealed slightly more infiltration by inflammatory cells in the synovial tissue of patients with gonarthrosis and knee prosthesis aseptic loosening than in that of the control group, with a high prevalence of macrophages. Moreover, we observed enhanced production of the studied cytokines, especially in synovial fluid as compared to serum, indicating that in the pathological conditions examined the inflammatory events are mainly localized. Because the role of these cytokines is to modulate inflammation, better knowledge of the involvement of cells and their soluble mediators in articular damage could guide immunomodulating treatment.

Aged↗

PubMed2003

MR in the study of knee cartilage pathologies: influence of location and grade on the effectiveness of the method.

PURPOSE: To evaluate the diagnostic effectiveness of magnetic resonance (MR) in knee cartilage pathologies of different regions and grades with the aim of establishing the role of MR in treatment choice. MATERIALS AND METHODS: We enrolled 90 patients who underwent MR and arthroscopy of the knee. To classify cartilage lesions we used a simplified grading system that correlates MR to arthroscopic reports and divides lesions into low and high grades. The MR examinations were performed with a 1.5 T superconducting magnet with a standard protocol to obtain quality images in a short time, using T1-weighted spin-echo sequences, T2* weighted gradient-echo sequences and inversion recovery sequences. The MR diagnostic specificity, sensitivity and accuracy and MR positive predictive value and negative predictive value in identifying and grading the chondral lesions of the femorotibial and patellofemoral compartments were calculated and compared to arthroscopy parameters. RESULTS: The analysis of each grade of chondral lesions reveals an MR accuracy of 94% in high-grade lesions of the femorotibial and patellofemoral compartments and an MR accuracy of 78% in low-grade lesions of patellofemoral compartment and of 70% in low-grade lesions of femorotibial compartment. This result suggests MR is useful for the grading of chondral lesions in clinical practice. CONCLUSIONS: MR diagnostic effectiveness substantially changes according to the different location and grade of chondral lesions. While MR seems to be nearly equivalent to arthroscopy for high-grade lesions subject to surgery, it appears to be less accurate in diagnosing low-grade lesions, in particular femorotibial lesions.

Adult↗

PubMedDate not supplied

Peritalar dislocations: a retrospective study of 18 cases.

The purpose of this study is to retrospectively evaluate 18 consecutive cases of peritalar dislocations referred to our department during a period of 25 years and to delineate the factors influencing long-term prognosis. There were 13 (73%) medial and 5 (27%) lateral dislocations. Six patients (33%) suffered an open injury, including 2 of 13 (15%) medial and 4 of 5 (80%) lateral dislocations. Associated fractures involving the hindfoot or forefoot were noted in 7 feet, including 3 of 5 lateral dislocation cases. Reduction was accomplished under general anesthesia; in no case was open reduction necessary. In 4 of 6 open injuries with associated fractures, temporary fixation with Kirschner wires was performed. Patients were immobilized in a plaster cast for 4 weeks, or for 6 weeks in the presence of fracture, followed by weightbearing as tolerated. At a mean follow-up of 10.2 years (range, 4 to 26 years), 10 patients (56%) showed excellent results; all had sustained a closed medial low-energy dislocation. There were 3 cases (17%) with fair results and 5 cases (28%) with poor results. Forty-five percent of patients showed a restriction of activity, a reduction of subtalar range of motion, and moderate or severe radiographic signs of hindfoot degenerative arthritis. There were no cases of talar avascular necrosis, and in no case was secondary surgery necessary. Lateral dislocation and open medial dislocations with concomitant fractures showed a greater potential for poor prognosis. The results were independent from period of cast immobilization, suggesting that 4 to 6 weeks of immobilization provides acceptable long-term results.

Adolescent↗

PubMedDate not supplied

Aspects of Magnetic Resonance in the surgical treatment of osteochondral lesions of the knee.

AIM: To assess the magnetic resonance (MR) appearance of knee cartilage chondroplasty procedures and their evolution in order to evaluate the usefulness of the method in monitoring postoperative rehabilitation. MATERIALS AND METHODS: Sixty-two patients treated with knee chondroplasty for high-grade cartilage injuries (Noyes' stages II and III) were examined with MR. Forty patients were treated with abrasion chondroplasty, fifteen with osteochondral graft in the injury site and seven with the matrix-induced autologous chondrocyte transplant technique. All patients were operated on by the same orthopaedic team and examined with the same MR protocol. The MR follow-up was performed six months and one year after surgery in the patients treated with abrasion chondroplasty and osteochondral graft, and one week, three months and one year after surgery in the patients treated with cartilage transplant. In the patients treated with abrasion chondroplasty we assessed the fibrocartilage repair and the subchondral bone features, in the patients treated with osteochondral graft we examined the cartilage, the subchondral bone and the graft borders, while in the patients treated with cartilage transplant we evaluated the features and the evolution of the transplant and the subchondral bone. Arthrosynovitis was assessed in all patients. In seven patients a cartilage repair biopsy was performed in arthroscopy. RESULTS: In all the patients MR imaging proved useful in monitoring the chondroplasty. In the patients treated with abrasion chondroplasty the cartilage repair appeared as a hypointense non-homogeneous irregular strip of tissue that replaced the articular surface. The subchondral bone was sclerotic with some geodes. In the later examination the repair was unchanged. In the patients treated with osteochondral graft the articular cartilage was similar to the adjacent hyaline cartilage, although more non-homogeneous. The subchondral bone was sclerotic and in three cases oedematous. In four cases the graft extended beyond the articular border. In the cartilage transplant the matrix appeared as a hypointense stripe after a week due to hydration and it had thinned with signal reduction in the later follow-ups. In the cases with unfavourable clinical evolution the subchondral bone was oedematous and sclerotic in the later examinations. In the cases with unfavourable clinical evolution there was moderate arthrosynovitis, regardless of the chondroplasty technique performed. CONCLUSIONS: MR imaging is useful for monitoring the maturation and the integration of knee chondroplasty and can be proposed as a replacement of arthroscopy for the assessment of postoperative rehabilitation.

Adult↗

PubMedDate not supplied

Tibial plateau fractures: evaluation with multidetector-CT.

PURPOSE: To evaluate the role of Multislice CT (MSCT) in classifying tibial plateau fractures and deciding on the appropriate therapeutic treatment compared to conventional radiology. MATERIALS AND METHODS: Twenty-five patients with a clinical diagnosis of tibial plateau fracture were studied with plain film and MSCT. The CT images were reconstructed with MPR and 3D technique and the fractures classified according to the Swiss AO-ASIF classification. The following radiographic and CT parameters were used: fracture location and size, number of fragments or degree of depression of fracture; plateau area involved; surgical access; degree of osteoporosis and bone tissue loss. RESULTS: The plain film and MSCT classification showed agreement in 48% of cases and disagreement in 52%. MSCT better demonstrated disruption of the tibial plateau surface and showed a larger number of fragments. In 60% of patients the CT features led the orthopaedist to modify the treatment. In three patients CT demonstrated bone tissue loss, suggesting for bone graft. In four patients CT showed alteration of the bone architecture and suggested the use of different material for osteosynthesis. Compared to axial CT, the MSCT MPR and 3D reconstructions enabled a more accurate assessment of plateau depression, and of rotation and separation of the fragments. The 3D technique proved better than MPR in evaluating rotation of fractured fragments as it provides an overall view as well as the possibility of rotating the bone segments. CONCLUSIONS: MSCT and 3D reconstructions are very useful for classifying tibial plateau fractures and for preoperative assessment. Patients with clinical evidence of fracture might benefit from an examination with CT instead of conventional radiology.

Accidents, Occupational↗