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Biomedical subjects

Nicola Maffulli

Publications and source records attributed to Nicola Maffulli.

At least 19 recordsLinked to original sources
PubMed2006

Tissue engineering for tendon repair.

Tissue engineering aims to induce tissue self-regeneration in vivo or to produce a functional tissue replacement in vitro to be then implanted in the body. To produce a viable and functional tendon, a uniaxially orientated collagen type I matrix has to be generated. Biochemical and physical factors can potentially alter both the production and the organisation of this matrix, and their combination in a dose- and time-dependent manner is probably the key to in vitro engineered tendons. This review discusses the role of these different factors affecting tenocyte growth in a three-dimensional environment in vivo and in vitro, and underlines the future challenge of tendon tissue engineering.

Biocompatible Materials↗
PubMed2006

VOCCs and TREK-1 ion channel expression in human tenocytes.

Mechanosensitive and voltage-gated ion channels are known to perform important roles in mechanotransduction in a number of connective tissues, including bone and muscle. It is hypothesized that voltage-gated and mechanosensitive ion channels also may play a key role in some or all initial responses of human tenocytes to mechanical stimulation. However, to date there has been no direct investigation of ion channel expression by human tenocytes. Human tenocytes were cultured from patellar tendon samples harvested from five patients undergoing routine total knee replacement surgery (mean age: 66 yr; range: 63-73 yr). RT-PCR, Western blotting, and whole cell electrophysiological studies were performed to investigate the expression of different classes of ion channels within tenocytes. Human tenocytes expressed mRNA and protein encoding voltage-operated calcium channel (VOCC) subunits (Ca alpha(1A), Ca alpha(1C), Ca alpha(1D), Ca alpha(2)delta(1)) and the mechanosensitive tandem pore domain potassium channel (2PK(+)) TREK-1. They exhibit whole cell currents consistent with the functional expression of these channels. In addition, other ionic currents were detected within tenocytes consistent with the expression of a diverse array of other ion channels. VOCCs and TREK channels have been implicated in mechanotransduction signaling pathways in numerous connective tissue cell types. These mechanisms may be present in human tenocytes. In addition, human tenocytes may express other channel currents. Ion channels may represent potential targets for the pharmacological management of chronic tendinopathies.

Aged↗
PubMed2006

Carnosine, taurine and enzyme activities of human skeletal muscle fibres from elderly subjects with osteoarthritis and young moderately active subjects.

Ageing is associated with a reduction in muscle carnosine (beta-alanyl-L-histidine), but there are no data on the changes specifically in type I and type II muscle fibres. Given the higher carnosine content of type II fibers, changes observed in whole muscle may be secondary to a shift in fibre composition. Carnosine, beta-alanine, histidine, taurine, and citrate synthase (CS) and glycogen phosphorylase (Phos), were measured in pools of single muscle fibres from freeze-dried muscle biopsies of vastus lateralis of nine elderly sedentary subjects (65-80 years) with osteoarthritis of the knee and undergoing total knee replacement, and nine young moderately active healthy subjects (20-35 years). Fibres were characterised as type I or II by myosin ATPase activity. Carnosine was 53.2% lower in type II fibres of older subjects resulting in an estimated 7% (and most probably still higher) decline in intracellular physico-chemical buffering capacity. Younger subjects showed higher CS activities in type I and higher Phos activities in type II fibres. These differences were less apparent in elderly subjects. Possible causes for the change in the carnosine content are reduced physical activity, reduced meat intake, or the result of progressive denervation.

Adult↗
PubMed2006

The C677T polymorphism in the methylenetetrahydrofolate reductase gene (MTHFR), maternal use of folic acid supplements, and risk of isolated clubfoot: A case-parent-triad analysis.

Worldwide, 1-4 per 1,000 births are affected by clubfoot. Clubfoot etiology is unclear, but both genetic and environmental factors are thought to be involved. Low folate status in pregnant women has been implicated in several congenital malformations, and folate metabolism may be affected by polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR). Using a case-parent-triad design, the authors investigated whether the MTHFR C677T polymorphism, and maternal periconceptional folic acid supplement use, influenced risk of isolated clubfoot. Three hundred seventy-five United Kingdom case-parent triads were recruited in 1998-1999. Among the children, there was a significant trend of decreasing clubfoot risk with increasing number of T alleles: relative risk for CT vs. CC = 0.75, 95% confidence interval: 0.57, 0.97; relative risk for TT vs. CC = 0.57, 95% confidence interval: 0.35, 0.91; p trend = 0.006. This association was not modified by maternal folic acid use. Maternal MTHFR genotype did not influence clubfoot risk for the offspring overall, although a possible interaction with folic acid use was found. This is the first known report of a specific genetic polymorphism associated with clubfoot. The direction of the association is intriguing and suggests that DNA synthesis may be relevant in clubfoot development. However, clubfoot mechanisms are poorly understood, and the folate metabolism pathway is complex. Further research is needed to elucidate these relations.

Adolescent↗
PubMed2006

Systemic allergic reactions to aprotinin injection around the Achilles tendon.

Local aprotinin injections are used in the treatment of chronic tendinopathy. Severe allergic reactions, although uncommon, have been reported. We highlight two instances of systemic allergic reaction, and discuss the potential side effects of local aprotinin injections in the orthopaedic setting as well as the evidence base for its use.

Achilles Tendon↗
PubMed2006

Total knee arthroplasty: good agreement of clinical severity scores between patients and consultants.

BACKGROUND: Nearly 20,000 patients per year in the UK receive total knee arthroplasty (TKA). One of the problems faced by the health services of many developed countries is the length of time patients spend waiting for elective treatment. We therefore report the results of a study in which the Salisbury Priority Scoring System (SPSS) was used by both the surgeon and their patients to ascertain whether there were differences between the surgeon generated and patient generated Salisbury Priority Scores. METHODS: The Salisbury Priority Scoring System (SPSS) was used to assign relative priority to patients with knee osteoarthritis as part of a randomised controlled trial comparing the standard medial parapatellar approach versus the sub-vastus approach in TKA. The operating surgeons and each patient completed the SPSS at the same pre-assessment clinic. The SPSS assesses four criteria, namely progression of disease, pain or distress, disability or dependence on others, and loss of usual occupation. Crosstabs and agreement measures (Cohen's kappa) were performed. RESULTS: Overall, the four SPSS criteria showed a kappa value of 0.526, 0.796, 0.813, and 0.820, respectively, showing moderate to very good agreement between the patient and the operating consultant. Male patients showed better agreement than female patients. CONCLUSION: The Salisbury Priority Scoring System is a good means of assessing patients' needs in relation to elective surgery, with high agreement between the patient and the operating surgeon.

Arthroplasty, Replacement, Knee↗
PubMed2006

Sub-vastus approach versus the medial parapatellar approach in primary total knee: a randomised controlled trial [ISRCTN44544446].

BACKGROUND: Thirty thousand knee replacements are performed annually in the UK. There is uncertainty as to the best surgical approach to the knee joint for knee arthroplasty. We planned a randomised controlled trial to compare a standard medial parapatellar arthrotomy with sub-vastus arthrotomy for patients undergoing primary total knee arthroplasty in terms of short and long term knee function. METHODS: Patients undergoing primary total knee arthroplasty at the local NHS Trust are to be recruited into the study. Patients are to be randomised into either the sub-vastus or medial parapatellar approach to knee arthroplasty. The primary outcome measures will be the American Knee Society and WOMAC Scores. The secondary outcome measures will be patient based measures of EuroQol and SF-36. All outcomes will be measured pre-operatively, 1, 6, 12 and 52 weeks post-operatively. We will also review pain intensity using a pain and analgesia diary. Ease of surgical exposure and complications will also be analysed. DISCUSSION: Evidence is lacking concerning the best surgical approach to the knee joint for patients undergoing primary total knee replacement. This pragmatic randomised trial tests the hypothesis that the sub-vastus approach is significantly superior to the standard medial parapatellar approach in terms of short and long term knee function.

Journal Article↗
PubMed2006

Subcutaneous rupture of the Achilles tendon and ipsilateral fracture of the medial malleolus.

BACKGROUND: Although ankle fractures and an Achilles tendon rupture are relatively frequent in isolation, their association in the same injury is uncommon. CASE PRESENTATION: A 38 year old male tree surgeon fell six meters from a tree, sustaining a subcutaneous rupture of the Achilles tendon and an ipsilateral closed fracture of the medial malleolus. The injuries were diagnosed following clinical examination and imaging. CONCLUSION: This injury combination is infrequent, and management of the Achilles tendon rupture should take into account the necessity not to secondarily displace the fracture of the medial malleollus.

Accidental Falls↗
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

Extra-osseous osteochondroma-like soft tissue mass of the patello-femoral space.

BACKGROUND: Extraskeletal cartilaginous tumors are uncommon. Osteochondromas usually arise from the metaphyseal region of the growing skeleton. CASE PRESENTATION: A 53 year old man presented with a three years history of anterior knee pain and inability to flex his knee more than 90 degrees . Clinical examination and imaging studies revealed a nodular calcific mass in the anterior portion of the knee, displacing the medial portion of the patellar tendon. Following excision, histopathology confirmed the diagnosis of extra-osseous osteochondroma-like soft tissue mass, with no recurrence 24 months after surgery. CONCLUSION: An integrated clinical-pathologic diagnosis helps to clarify the nature of extraskeletal cartilaginous tumors that can arise at unusual anatomic site. Complete local surgical excision is the management of choice.

Humans↗
PubMed2006

Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy.

OBJECTIVE: Achilles tendinopathy is prevalent in athletes, but can also affect sedentary patients. We studied the effects of eccentric exercises in sedentary non-athletic patients with Achilles tendinopathy. METHODS: Thirty-four sedentary patients (18 males, average age 44 years, range 23-67; 16 females, average age 51 years, range 20-76; average BMI: 28.6+/-4.7, range 22.1-35.4) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance (39+/-S.D. 22.8) and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks. RESULTS: Fifteen patients (44%) did not improve with eccentric exercise regimen. Three patients improved after perintendinous injections aprotinin and local anaesthetic. Surgery was performed in seven patients as 6 months of conservative management failed to produce improvements. The overall average VISA-A scores at latest follow up was 50 (S.D. 26.5). CONCLUSIONS: Eccentric exercises, though effective in nearly 60% of our patients, may not benefit sedentary patients to the same extent reported in athletes.

Achilles Tendon↗
PubMed2006

Short-term effectiveness of hyperthermia for supraspinatus tendinopathy in athletes: a short-term randomized controlled study.

BACKGROUND: Hyperthermia has been introduced as a physical therapy modality for soft tissue injuries. HYPOTHESIS: The authors tested the null hypothesis that there are no short-term differences after the use of hyperthermia, ultrasound, and exercises for tendinopathy of the supraspinatus tendon. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: The authors studied 37 athletes (29 men, 8 women; mean age, 26.7 +/- 5.8 years; range, 19-43 years) with supraspinatus tendinopathy who had had symptoms between 3 and 6 months. Subjects were randomly assigned to 3 groups. Group A (n = 14) received hyperthermia at 434 MHz. Group B (n = 12) received continuous ultrasound at 1 MHz at an intensity of 2.0 w/cm(2) 3 times a week. Group C (n = 11) undertook exercises, consisting of pendular swinging and stretching exercises 5 minutes twice a day every day. All interventions were undertaken for 4 weeks. Subjects were evaluated at baseline, immediately on completion of treatment, and at 6 weeks after the end of the intervention using mean pain score for pain at night, during movement, and at rest on a visual analog scale; pain on resisted movement and painful arc on active abduction between 40 degrees and 120 degrees on a 4-point scale; and Constant score. RESULTS: Patients who received hyperthermia experienced significantly better pain relief than did patients receiving ultrasound or exercises: group A, 5.96 to 1.2 (P = .03); group B, 6.3 to 5.15 (P = .10); group C, 6.1 to 4.9 (P = .09). CONCLUSION: Hyperthermia at 434 MHz appears safe and effective in the short term for the management of supraspinatus tendinopathy.

Adult↗
PubMed2006

Reconstruction of a chronic quadriceps tendon tear in a body builder.

Chronic quadriceps tendon tears are uncommon. We report about a body builder taking a cocktail of anabolic drugs for several years in whom reconstruction of a chronic quadriceps tendon tear was performed using ipsilateral hamstring tendons with good results despite the 7 month delay between injury and surgery. The use of hamstring tendons is a good option for the management of these lesions.

Accidents, Traffic↗
PubMed2006

Recurrent subluxation of the peroneal tendons.

BACKGROUND: Recurrent peroneal tendon subluxation is uncommon. HYPOTHESIS: The authors tested the null hypothesis that there are no differences between preoperative and postoperative status after anatomical repair of the superior peroneal retinaculum. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In the period 1996 to 2001, the authors operated on 14 patients (all men; mean age, 25.3 +/- 6.3 years; range, 18-37 years) with traumatic recurrent unilateral peroneal tendon subluxation, with a follow-up of 38 +/- 3 months (range, 22-47 months). RESULTS: No patient experienced a further episode of peroneal tendon subluxation, and all had returned to their normal activities. Maximum calf circumference, functional ability, peak torque, total work, and mean power of plantar flexion were always lower in the operated leg, but the differences did not reach statistical significance. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score increased significantly from 54.3 +/- 11.4 to 94.5 +/- 6.4 (P = .03), with 5 patients reporting a fully normal ankle. CONCLUSION: If an anatomical approach is used, reattachment of the superior retinaculum is a most appropriate technique. It returns patients to a high level of physical activity and gives a high rate of satisfactory results both objectively and subjectively. Randomized control trials may be the way forward in determining the best surgical management method. However, the relative rarity of the condition and the large number of techniques make such a study difficult.

Adolescent↗
PubMed2006

Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability.

The management of chronic lateral instability of the ankle remains controversial. In general, the anterior talofibular ligament (ATFL) must be reconstructed in all patients. Some will also need reconstruction of the calcaneofibular ligament (CFL) (or its function) to regain stability of both the ankle and the subtalar joints, and to avoid recurrence of instability. After reconstruction, most authors report good to excellent results in 80% to 85% of patients. We describe the augmented reconstruction technique of ATFL and CFL with a semitendinosus tendon allograft through a peroneal bone tunnel fixed with biodegradable anchors, and advocate this procedure as a safe, effective method to manage lateral ankle instability.

Chronic Disease↗
PubMed2006

Acute lateral ankle sprains in track and field athletes: an expanded classification.

We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track and field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally, but there is a lack in international literature on predicting the time needed for full recovery. Taking into consideration (1) active range of motion, (2) edema, (3) stress radiographs findings, and (4) full rehabilitation time, we divided grade III sprains in IIIA and IIIB, proposing that these injuries can be classified in four categories (I, II, IIA, IIIB). The range of motion-edema-stress radiographs classification that we propose evaluates the severity of lateral ankle injuries, is an easy and practical method, and predicts full return in athletic activities without residual complaints, if the proper rehabilitation program is executed.

Acute Disease↗