Biomedical subjects

R Buzzi

Publications and source records attributed to R Buzzi.

At least 19 recordsLinked to original sources

PubMed1995

Results of surgical treatment of arthrofibrosis after ACL reconstruction.

We prospectively studied 31 knee arthrolyses performed for loss of motion after intra-articular anterior cruciate ligament (ACL) reconstruction. The arthrolysis was performed on average 10.6 months after the reconstruction (range 4-25). Seven knees were localized forms. They were treated with arthroscopic removal of a fibrous nodule and scar tissue anterior to the ACL, which was preserved. Twenty-four knees were global forms and treated arthroscopically (14) or in open procedure (10). Suprapatellar, medial, and lateral gutter adhesions were sectioned, and fibrous tissue was removed from the anterior compartment. A posteromedial and/or posterolateral capsulotomy was necessary in 7 knees. The ACL graft was nonfunctional and/or malpositioned in 19 knees. The results were evaluated with the IKDC form with an average follow-up of 3.5 years (range 1.5-7). Preoperatively the localized forms had an average extension loss of 11 degrees and an average flexion loss of 14 degrees compared to the opposite knee. At follow-up all the knees were satisfactory for symptoms. All except one achieved a satisfactory motion (within 5 degrees of extension loss and 15 degrees of flexion loss) and a satisfactory final result. Global forms had a greater preoperative flexion loss (average 34 degrees) and extension loss (average 17 degrees). At follow-up 58% were satisfactory for symptoms and 71% for arc of motion. However, the final result was satisfactory in only 37%. In conclusion, local forms have a good prognosis. In global forms motion may be improved by surgery, but the final result is downgraded by symptoms. Arthrolyses performed within 8 months from index operation had a better outcome.

Anterior Cruciate Ligament Injuries↗

PubMed1995

Insall-Burstein posterior-stabilized knee prosthesis in rheumatoid arthritis.

The authors reviewed 65 Insall-Burstein (Zimmer, Warsaw, IN) total condylar posterior-stabilized knee prostheses in 50 patients with rheumatoid arthritis with a follow-up period of at least 5 years (range, 5-13 years). Forty-two knees in 31 patients were evaluated using the Knee Society knee and functional rating scores. Radiographic assessment was performed using standing long radiographs (hip to ankle). Radiolucent lines were studied using fluoroscopic-centered views. Excellent or good clinical results were obtained in 95% of the cases, and the average knee score improved from 22.5 to 90 points. No cases of radiologic loosening were observed. Incomplete radiolucent lines around the tibial component were detected in only 17% and were nonprogressive. Two patients developed hematogenous late deep infection, which required removal of the prosthesis in both, followed, at a second stage, by arthrodesis in one and prosthesis reimplantation in the other. Three knees (7%) had a painful impingement of the patella. Two of these were successfully reoperated with arthroscopic debridement of the peripatellar synovial tissues. Survivorship analysis, based on endpoints such as prosthesis removal for any cause or radiologic loosening (complete radiolucent line thicker than 1 mm, tilt, or subsidence of the component), showed a cumulative success rate of 96.2% at 13 years.

Arthritis, Rheumatoid↗

PubMed1994

Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle.

Fourteen children affected by juvenile osteochondritis dissecans of the medial femoral condyle (16 knees) were treated by arthroscopic drilling of the lesion. The average age at operation was 12.8 years, and all the knees had open physes. Conservative treatment including restriction of activities had been unsuccessfully attempted in all cases for a period of > 1 year on average. At surgery each lesion was shown to have intact articular cartilage. All the lesions progressed to healing, and the patients were asymptomatic at an average of 56 months after the operation. Radiographic examination showed reconstitution of a normal or minimally flattened profile of the medial condyle. Arthroscopic drilling of the lesion in knees with juvenile osteochondritis dissecans and intact articular cartilage was effective to promote healing. The low morbidity and easy rehabilitation justify the procedure for these young patients when conservative measures fail.

Adolescent↗

PubMed1994

Surgical treatment of recurrent dislocation of the patella.

Sixty-seven patients (69 knees) with recurrent patellar dislocation underwent either a lateral release (20 knees), a proximal realignment (14 knees), a distal realignment (16 knees), or a combined realignment (19 knees) procedure. Average respective followup was 8, 8, 6, and 4 years. Patients undergoing lateral release experienced a 40% recurrence of patellar dislocation. After a realignment procedure, redislocation was uncommon (4%), but pain and swelling were reported by 12% of the patients. Significant patellofemoral crepitation was present in 35% of the realignments. The congruence angle was corrected satisfactorily in the proximal realignments, but it remained abnormal in 25% of the distal realignments. The distance from the tuberosity to the sulcus was restored to normal by transposition of the tibial tuberosity, but remained abnormal in 36% of the proximal realignments. However, it did not preclude a good clinical result. Lateral release cannot be recommended for knees with severe dysplasia of the extensor mechanism. Proximal, distal, and combined realignments yielded similar clinical results. Retensioning of the medial structures and lateral release are effective in reducing the patella within the sulcus. Although transposition of the tuberosity is appealing, clinical advantages are less evident.

Adolescent↗

PubMed1993

Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction.

A series of 226 anterior cruciate ligament (ACL) reconstructions were reviewed to determine the incidence of patellofemoral (PF) problems and the associated prognostic factors. Patients were divided into four groups according to the type of injury (acute or chronic) and operation (through an arthrotomy or arthroscopic assisted). The average follow-up period was 39 months. Overall there was a 5% incidence of PF crepitus with pain and/or swelling, and a further 20% of clear PF crepitus without pain. The change from open surgery and cast to arthroscopic surgery and early motion allowed a decrease of PF problems from 40% to 21% in acute injuries, but the difference was less marked in chronic knees. A deficit greater than 10% at the one-leg hop test was present in 75% of the knees with PF crepitus and pain. The height of the patella was increased in 5% and decreased in 17% of the knees. Patients with rehabilitation difficulties had the largest decrease in patella height, whereas a patella alta was more frequent after patellar tendon reconstruction. A significant correlation was found between PF problems and female gender, positive congruence angle, preoperative PF crepitation, rehabilitation difficulties, flexion loss greater than 10 degrees, extension loss greater than 5 degrees, and variation in the height of the patella. The importance of avoiding immobilization, rehabilitation difficulties, and permanent flexion or extension loss is emphasized.

Acute Disease↗

PubMed1992

Arthroscopic anterior cruciate ligament reconstruction with patellar tendon.

Anterior cruciate ligament reconstruction using a bone-patella tendon-bone free autologous graft was performed with an arthroscopic technique in 73 patients with chronic insufficiency. Sixty-nine (94.5%) were available for personal follow-up 3-5 years after the operation. Six patients (8%) had had postoperative difficulties in regaining a complete range of motion. Symptoms of giving-way were cured in 97% of the cases, and 89% had returned to vigorous activities. Residual anterior laxity (defined as pivot shift 2+, and/or Lachman 2+, and/or KT-1000 > 5 mm at the manual maximum) was found in 13% and was more frequent in patients with an uncorrected varus laxity. Patellofemoral crepitus was present in 17% of the knees and was associated with pain and/or swelling in a further 4%; it correlated with radiographic evidence of patellofemoral incongruence (p = 0.009). Comparison of the results with those of a previous series performed by arthrotomy revealed a decreased incidence of limited range of motion, severe patellar symptoms, and changes in patellar height. Stability was the same.

Activities of Daily Living↗

PubMed1991

Autologous bone grafting for medial tibial defects in total knee arthroplasty.

Seventeen posterior stabilized Insall-Burstein knee arthroplasties were implanted in severely deformed varus knees with large medial tibial bony defects. The defect was filled with an autologous bone graft obtained from the same knee and fixed with one or two screws. The patients were reviewed during an average follow-up period of 4 years (range, 2-8 years). The graft was completely united in 14 cases (82%), with bony trabeculae crossing the interface. Fibrous union occurred in three cases (18%). There was no evidence of graft necrosis or collapse. The results were classified as excellent in 10 knees (59%), good in 6 (35%), and poor in 1 (6%), which was revised for femoral loosening. The importance of meticulous technique and correct component positioning is emphasized.

Aged↗

PubMed1991

Reconstruction of the chronically lax anterior cruciate ligament using the middle third of the patellar tendon. A 3-9 year follow-up.

After an average of 5 years, the authors reviewed 76 cases of anterior cruciate ligament reconstruction in which the middle third of the patellar tendon had been used as a free autogenous graft. A lateral Lemaire operation had been used in 85% of the cases and postoperative cast immobilization in 72%. Functional knee instability was eliminated in 96% of the patients. Pain was present at the follow-up in 14.5% of the patients and correlated with both meniscectomy (p = 0.03) and the presence of degenerative changes on the radiographs (p = 0.002). The pivot-shift was eliminated in 93% of the cases and the maximum manual test performed with the KT-1000 arthrometer was less than or equal to 5 mm in 83%. Lateral compartment laxity which was not corrected at operation was frequently associated with graft failure (p = 0.01). Seven patients had difficulty in rehabilitation, and in 6 of these the final result was unsatisfactory. Pain and swelling in the femoropatellar joint were present in 8% of the cases. Slight and moderate degenerative changes were shown on the radiographs in 48% and 10% of the patients, respectively, at follow-up; these findings correlated with meniscectomy (p less than 0.001) and rehabilitation problems (p = 0.03). This procedure achieved lasting, satisfactory results in 70% of the cases. Additional advances include greater care in positioning the graft, use of arthroscopy, and early mobilization. Further studies are needed to verify the advantages of these new techniques.

Adolescent↗

PubMed1991

Quadricepsplasty with the V-Y incision in total knee arthroplasty.

For over 8 years the authors have used the inverted V-Y incision of the quadriceps, a modification of the Coonse and Adams approach, in total knee arthroplasty (TKA) with serious reduction of flexion, ankylosis, or limited mobility of the patella because of previous operations. This procedure not only allows easy and complete exposure, but improves the range of flexion without incision-related complications. Detailed results of a consecutive series of 16 knee arthroplasties are presented.

Aged↗

PubMed1990

Knowledge-based battery design of short-term tests based on dose information.

A construction of batteries of short-term tests (STTs) is described which is based on a classification of 73 chemicals in regard to their carcinogenicity. The 73 chemicals were studied within the U.S. National Toxicology Program (Ashby and Tennant, 1988). The batteries are validated using the classification of 35 additional chemicals. They are defined by logically structured combinations of rules. The single rules are defined by the z-scores of the logarithmic values of the limiting doses obtained from the 4 in vitro STTs used in the study by Ashby and Tennant. The limiting dose is defined as the lowest effective dose or the highest ineffective dose (Waters et al., 1987). The batteries are constructed by minimizing the number of disagreements with the classification by Ashby and Tennant. Compared with the results obtained from single STTs, 2 batteries of 3 STTs have higher concordances with the carcinogenicity data, namely 70% for the NTP data and 74-77% for the independent test data. In addition, a theoretical result shows that the proposed battery design, for a large enough learning set of chemicals, leads to results which are replicated with high probability on a large enough validation set. Based on the first results obtained with a limited number of chemicals it is concluded that the knowledge-based battery design is worth further development.

Animals↗

PubMed1990

Fibrinolytic activity in the synovial membrane of osteoarthritis.

The fibrinolytic activity (FA) has been studied on the synovial membrane obtained from 16 patients with osteoarthritis (OA), 20 patients with rheumatoid arthritis (RA) and 11 control subjects. Todd's autohistographic method, modified by Lotti, was used to investigate the FA and the monoclonal antibodies against u-PA and t-PA were used to identify the main plasminogen activator. Our results show that the FA is increased in the synovial membrane of patients with OA in comparison with the synovial FA of control subjects. In the synovial membranes from patients with RA, the FA shows different results: in some specimens FA is increased, and in others it is diminished or similar, compared with FA of samples from healthy controls. Thus, our data on synovial FA in OA confirm the previous reports, performed in vitro, on the activation of the plasmin system in this degenerative disease. The activity of the fibrinolytic system seems to participate in the cartilage degeneration and, via the activation of collagenase, to perpetuate the cartilage damage.

Adult↗

PubMed1989

Classifications of subjects with the language PROLOG.

The logical language PROLOG is used for the definition and characterization of groups of subjects. The groups are firstly defined by sets of variables with comparable scales. Secondly, the single members of the groups are characterized by logically structured combinations of variables which do not necessarily have comparable scales. The performance of the characterizations is estimated by determining the rates sensitivity and specificity. The new classification method is applied in a follow-up study including the assessment of the activity of 76 healthy subjects during two controlled experiments. The classification with PROLOG is then compared with the methods of logistic regression and with discriminant analysis. The comparisons demonstrate that, under similar conditions, the results of a classification with PROLOG parallel the results of statistically based classification procedures. In addition, PROLOG permits characterizations of single subjects based on variables from different scientific disciplines.

Cardiovascular Physiological Phenomena↗

PubMed1989

Arthroscopic lateral release for patellar pain or instability.

Forty-five arthroscopic lateral releases were reviewed with a follow-up from 2 to 6 years (average 4 years). Satisfactory results were obtained in 60% of the patellar pain group (20 knees) and 68.5% of the instability group (19 knees). The results in osteoarthrosis (6 knees) were unsatisfactory. Postoperative hemarthrosis was infrequent (2.2%). Unfavorable prognostic factors are an incomplete release with an insufficient postoperative passive patellar tilt in the pain group and more than five preoperative dislocations in the instability group. After failure of conservative treatment, a lateral release can be reasonably used in pain syndromes with a tight lateral retinaculum and lateral patellar tracking and in milder cases of instability.

Adult↗

PubMed1989

Arthroplasty for the stiff or ankylosed knee.

Twenty stiff (range of motion, less than 50 degrees) and six ankylosed knees were replaced with the posterior stabilized condylar prosthesis and evaluated after an average of 4.5 years (range, 2.5-7.5 years). There were 81% good to excellent, 11.5% fair, and 7.5% poor results. The maximum overall degree of flexion improved from an average of 60 degrees before surgery to 85 degrees after surgery. Flexion contracture was reduced from 28 degrees to 7 degrees, and the total arc of motion significantly increased from 32 degrees to 78 degrees. Less motion was achieved in the ankylosed knees. A modified inverted V-Y quadricepsplasty was a useful approach to the knee in 11 cases.

Adult↗

PubMed1989

[Aseptic loosening of the Charnley prosthesis].

Out of 100 Charnley prostheses implanted for idiopathic arthrosis and followed up a minimum of 5 years after surgery, 59 were fixed, 24 were characterised by probable radiologic loosening of the femoral component, 13 by probable loosening, and 4 by possible radiologic loosening of the acetabular component. None of the patients was submitted to further surgery. Some of the features of the patients were found to be associated with a higher incidence of femoral loosening. In most of the cases loosening was minimal, only radiologic, and not clinically apparent, and numerous technical improvements in the use of cement and in the design of the prosthesis were introduced subsequent to the period when these patients were operated on.

Adult↗

PubMed1989

[Total hip prosthesis according to Charnley. Review of our cases].

This is a follow-up study of 363 Charnley hip replacements out of 548 implanted from 1970 to June 1984. Clinical results, with a 2-year minimum follow-up (average 5 years, maximum 15 years) are excellent or good in 89.5% of the cases. In the group with minimum 5-year follow-up (average 7, maximum 15 years) the clinical results remain good to excellent in 89.2% of the cases. Radiographic results have been studied in the group with minimum 5-year follow-up. Component stability or radiographic loosening have been studied, taking into account the presence of radiolucent lines between bone and cement, between metal and cement, or based on component migration or positional shift. We have detected radiographic loosening in 11.5% of the acetabular and 13.5% of the femoral components. A correlation was sought between radiographic loosening and some clinical (diagnosis, weight, follow-up period) and radiographic (postoperative component position, polyethylene wear, cement technique, periosteal reaction, myositis ossificans) parameters. There is no strong relationship between radiographic loosening and clinical results, as 28 of 35 radiographically loose prostheses maintained excellent or good results. Finally, the results of a selected group of 29 hips, with a minimum follow-up of 10 years, is reported.

Adult↗

PubMed1989

[Accuracy in high tibial osteotomy in varus gonarthrosis].

We have verified our technical accuracy in a series of 72 high tibial osteotomies for medical gonarthrosis, which were operated following Install's technique. An acceptable alignment (6 degrees-15 degrees valgus) was achieved in 83% of the cases; a loss of correction during the healing phase was detected in 10% of the knees. We have modified some details of the previously employed technique in order to improve accuracy. The leg alignment is determined on 30 x 90 cm standing radiographs, defining the mechanical axes; we aim at 4 degrees of valgus. A guide is employed to determine the width of the wedge of bone to be removed. The osteotomy is fixed by means of two screws and wire; the fixation obtained is stable enough to allow early weigh bearing and range of motion. With these modifications we have been able to improve technical accuracy and we have rendered the postoperative course more acceptable to the patients.

Adult↗

PubMed1989

[Transversal fracture of the patella: experimental evaluation of the Lotke and Ecker method of internal fixation].

Four different methods of internal fixation of transverse fractures of the patella were experimentally evaluated in eight cadaver knees: circumferential wiring, tension band cerclage, cerclage over Kirschner wires and the Lotke's method. Linear and angular displacements were accurately measured by means of a micrometer while actively extending the knee from 90 degrees of flexion to full extension. Circumferential wiring gave the highest displacements, up to 25 mm at 30 degrees of flexion on average. Tension band cerclage showed much better results but the greatest stability was obtained with the cerclage over Kirschner wires and with the Lotke's technique which yielded displacements of less than 1 mm. These last two methods combine the tension band principle and transosseous fixation, which are both essential to obtain a stable fixation.

Evaluation Studies as Topic↗