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There is controversy about the role of minimally invasive surgery (MIS) for total hip arthroplasty (THA). The present study aimed to investigate whether a MIS approach has a positive impact on the outcome of THA via the Watson-Jones anterolateral approach. Clinical scores and radiological findings of minimally and standard invasive exposures were evaluated and compared. The present study was conducted according to the STROBE statement. Patients operated between 2017 and 2018 in two different orthopaedic institutions was performed. Patients with symptomatic coxarthrosis reducing considerably patient's quality of life were asked to participate in the present study. Patients were divided into two THA groups: MIS and standard invasive surgery (SIS). Surgical procedures were performed in by two experienced surgeons via the Watson-Jones approach. Data from 140 patients were collected (70 patients for each group) at two years follow-up. Leg length discrepancy was greater in the MIS cohort (P = 0.01). The Stiffness subscale of the WOMAC score resulted minimally increased in the SIS group (P = 0.03). The overall WOMAC score and the other subscales resulted similar between the two groups. Femoral offset, acetabular offset, cup orientation, cup inclination, VAS resulted similar between the two cohorts. Only a case of revision in the SIS group was reported. THA via the Watson-Jones approach achieves short terms excellent results. Surgery performed via a MIS approach does not provide any superior outcome compared to the SIS in terms of radiographic findings and clinical scores at two years follow-up.
Filippo Migliorini; Arnen Driessen; Jörg Eschweiler; Markus Tingart; Nicola Maffulli. No benefits of minimally invasive total hip arthroplasty via Watson-Jones approach: A retrospective cohort study. The Surgeon 2021, 1 .
AMA StyleFilippo Migliorini, Arnen Driessen, Jörg Eschweiler, Markus Tingart, Nicola Maffulli. No benefits of minimally invasive total hip arthroplasty via Watson-Jones approach: A retrospective cohort study. The Surgeon. 2021; ():1.
Chicago/Turabian StyleFilippo Migliorini; Arnen Driessen; Jörg Eschweiler; Markus Tingart; Nicola Maffulli. 2021. "No benefits of minimally invasive total hip arthroplasty via Watson-Jones approach: A retrospective cohort study." The Surgeon , no. : 1.
Introduction Hip fractures in the elderly impact negatively on functional dependence, and carry great social costs and morbidity. We assessed the decline in muscle mass and functional outcomes following hip fracture surgery . Material and methods Thirty patients with a hip fracture (mean age: 80.8 years) were assessed using dual-energy X-ray absorptiometry and reassessed for changes in body composition 1 year after hip surgery. Baseline demographic data, sarcopenia, and bone mineral density were recorded. Body mass index (BMI), handgrip strength, appendicular skeletal muscle mass (ASM), total body fat percentage, and responses to questionnaires measuring quality of life and activities of daily living (ADL) before injury and 1 year after hip surgery were analyzed to identify changes. Associations with changes in ADL or quality of life were analyzed with time-variant independent variables. Results Significant losses in ADL were identified at the 1-year follow-up, at which time only 43% of patients had regained their preinjury ADL status. Additionally, the participants had lost an average of 4.63% of ASM. ASM loss was significantly higher in patients with baseline sarcopenia than in those without (mean loss: 9.18% and 1.15%, respectively). When confounders were controlled for, a greater loss of ASM and handgrip strength and larger increase in BMI were associated with greater decrease in ADL 1 year after hip surgery. Conclusion Geriatric hip fracture patients may experience a significant loss of muscle mass, associated with impaired functional recovery 1 year after hip surgery, highlighting a potential treatment target of maintaining muscle mass to improve prognosis in these patients.
Yu-Pin Chen; Yi-Jie Kuo; Shen-Wu Hung; Tsai-Wei Wen; Pei-Chun Chien; Ming-Hsiu Chiang; Nicola Maffulli; Chung-Ying Lin. Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures. Injury 2021, 1 .
AMA StyleYu-Pin Chen, Yi-Jie Kuo, Shen-Wu Hung, Tsai-Wei Wen, Pei-Chun Chien, Ming-Hsiu Chiang, Nicola Maffulli, Chung-Ying Lin. Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures. Injury. 2021; ():1.
Chicago/Turabian StyleYu-Pin Chen; Yi-Jie Kuo; Shen-Wu Hung; Tsai-Wei Wen; Pei-Chun Chien; Ming-Hsiu Chiang; Nicola Maffulli; Chung-Ying Lin. 2021. "Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures." Injury , no. : 1.
Introduction: The diagnosis of diabetic foot osteomyelitis (DFO) is usually clinical. Its severity is related to the location and depth of the lesion, and the presence of necrosis or gangrene. The aetiology of diabetic foot osteomyelitis (DFO) is usually polymicrobial, and DFO is often associated with chronic or recurring ulceration. Areas covered: We built on the International Working Group on the Diabetic Foot (IWGDF) guidelines on the management of diabetic foot infection, providing an outline of the current and new concepts in pharmacotherapy in DFO. We assess future strategies in both medical, surgical and combination management of DFO. Expert opinion: Surgical removal of infected bone is considered as the standard treatment, but a medical approach of certain selected situations has now proven efficacy in selected patients. The combination of new modalities in local antibiotic delivery may provide better long-term solutions and more lasting remission and avoid the disadvantages of prolonged systemic antibiotics.
Raju Ahluwalia; Jose Luiz Lázaro-Martínez; Ines Reichert; Nicola Maffulli. Advances in pharmacotherapy for diabetic foot osteomyelitis. Expert Opinion on Pharmacotherapy 2021, 1 -11.
AMA StyleRaju Ahluwalia, Jose Luiz Lázaro-Martínez, Ines Reichert, Nicola Maffulli. Advances in pharmacotherapy for diabetic foot osteomyelitis. Expert Opinion on Pharmacotherapy. 2021; ():1-11.
Chicago/Turabian StyleRaju Ahluwalia; Jose Luiz Lázaro-Martínez; Ines Reichert; Nicola Maffulli. 2021. "Advances in pharmacotherapy for diabetic foot osteomyelitis." Expert Opinion on Pharmacotherapy , no. : 1-11.
Cristian Aletto; Rocco Aicale; Nicola Maffulli. Letter to Editor: Role of an orthogeriatrician in the management of patients with hip fracture. International Orthopaedics 2021, 1 -1.
AMA StyleCristian Aletto, Rocco Aicale, Nicola Maffulli. Letter to Editor: Role of an orthogeriatrician in the management of patients with hip fracture. International Orthopaedics. 2021; ():1-1.
Chicago/Turabian StyleCristian Aletto; Rocco Aicale; Nicola Maffulli. 2021. "Letter to Editor: Role of an orthogeriatrician in the management of patients with hip fracture." International Orthopaedics , no. : 1-1.
Introduction: Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus databases were accessed in June 2021. All clinical studies investigating outpatient THA were considered. The outcomes of interest were pain, infection, mortality, revision, dislocation, readmission rates, and deep vein thrombosis (DVT). Results: Data from 102,839 patients were included. A total of 52% (153,168 of 102,839 patients) were women. The mean age of patients was 62.6 ± 4.6 years, the mean BMI was 29.1 ± 1.8 kg/m2. Good comparability was found in age, BMI, and gender (p > 0.1). No difference was found in pain (p = 0.4), infections (p = 0.9), mortality (p = 0.9), rate of revision (p = 0.1), dislocation (p = 0.9), and readmission (p = 0.8). The outpatient group demonstrated a greater rate of DVT (OR 3.57; 95% CI 2.47 to 5.18; p< 0.0001). Conclusions: In selected patients, outpatient THA can be performed safely with optimal outcomes comparable with inpatient THA. Clear and comprehensive pre-operative planning should involve a multi-disciplinary group composed of orthopaedic surgeons, anaesthesia and rehabilitation specialists, and physiotherapists. Each centre performing outpatient THA should implement continuous homecoming welfare activity, to supervise physiotherapy and monitor anticoagulant therapy.
Filippo Migliorini; Lucio Cipollaro; Francesco Cuozzo; Francesco Oliva; Andrea Marino; Nicola Maffulli. Outpatient Total Hip Arthroplasty: A Meta-Analysis. Applied Sciences 2021, 11, 6853 .
AMA StyleFilippo Migliorini, Lucio Cipollaro, Francesco Cuozzo, Francesco Oliva, Andrea Marino, Nicola Maffulli. Outpatient Total Hip Arthroplasty: A Meta-Analysis. Applied Sciences. 2021; 11 (15):6853.
Chicago/Turabian StyleFilippo Migliorini; Lucio Cipollaro; Francesco Cuozzo; Francesco Oliva; Andrea Marino; Nicola Maffulli. 2021. "Outpatient Total Hip Arthroplasty: A Meta-Analysis." Applied Sciences 11, no. 15: 6853.
To cross-culturally adapt and validate the Victorian Institute of Sports Assessment – Hamstrings (VISA-H) scale into Spanish. Clinical measurement study (psychometric analysis). Sports clubs and physiotherapy clinics. The Spanish version of the VISA-H (VISA-H-Sp) scale was administered to 101 subjects: 50 healthy runners and 51 patients with a clinical diagnosis of PHT. The Victorian Institute of Sports Assessment – Hamstrings. Cronbach's alpha for the VISA-H-Sp was >0.8. The ICC 2,1 was 0.993 (95%CI 0.991–0.995). In the exploratory factor analysis, a one-factor solution explained 72.1% of the total variance. Athletes with PHT scored significantly lower in the VISA-H-Sp than healthy subjects (P < 0.001). The VISA-H-Sp score results in the PHT group showed significant correlations with SF-36 physical components (Spearman r’>0.6; P < 0.001), and low or non-significant association with psychological dimensions. The standard error of measurement was 1.45 whereas the minimal detectable change was 4.02 points. The responsiveness indicators included an effect size of 2.75, and a standardised response mean of 3.1 at discharge. The VISA-H-Sp shows adequate psychometric properties for assessing the severity of symptoms in Spanish-speaking athletes who suffer from PHT.
Blanca De-La-Cruz-Torres; Nicola Maffulli; Sergio Hernández-Sánchez. Cross-cultural adaptation of the Victorian institute of sports assessment - Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy. Physical Therapy in Sport 2021, 51, 50 -57.
AMA StyleBlanca De-La-Cruz-Torres, Nicola Maffulli, Sergio Hernández-Sánchez. Cross-cultural adaptation of the Victorian institute of sports assessment - Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy. Physical Therapy in Sport. 2021; 51 ():50-57.
Chicago/Turabian StyleBlanca De-La-Cruz-Torres; Nicola Maffulli; Sergio Hernández-Sánchez. 2021. "Cross-cultural adaptation of the Victorian institute of sports assessment - Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy." Physical Therapy in Sport 51, no. : 50-57.
Lumbar stenosis and instability frequently coexist. Spinal canal decompression is often combined with fixation of the relevant vertebral segment and can be performed using different techniques and devices, including pedicle screws and interspinous devices and facet screws. The present study evaluates the clinical outcome of laminectomy and single-level fusion using a minimally invasive technique for rigid posterior spinal column fixation with two cross-linked lag screws. The records of patients operated from 2012 to 2016 were retrieved from the computerised medical record database system. Data on age, sex, surgical level, type of deficit and disease were collected. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires were administered pre-operatively and at 1, 6, 12 and 24 months after surgery. A total of 46 consecutive patients were operated between January 2012 to October 2016. One intraoperative complication was reported, and 4 patients experienced radiographic pseudarthrosis postoperatively. Five patients underwent additional surgery. The lumbar and lower limb VAS score, ODI and SF-36 scores showed statistically significant improvement for each score at the first and last follow-up (p < 0.01). Percutaneous lumbar transfacet screw placement with the Facet-Link ® system is feasible and safe but with a relatively high rate of poor articular fusion. This technique can reduce the morbidity of single-level lumbar spinal stenosis and mild instability and improve patient outcome scores. Comparative studies, including randomised controlled trials, are needed to confirm these findings.
Michele Bochicchio; Rocco Aicale; Rocco Romeo; Pier Vittorio Nardi; Nicola Maffulli. Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series. The Surgeon 2021, 1 .
AMA StyleMichele Bochicchio, Rocco Aicale, Rocco Romeo, Pier Vittorio Nardi, Nicola Maffulli. Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series. The Surgeon. 2021; ():1.
Chicago/Turabian StyleMichele Bochicchio; Rocco Aicale; Rocco Romeo; Pier Vittorio Nardi; Nicola Maffulli. 2021. "Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series." The Surgeon , no. : 1.
Background Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. Methods A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. Results Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). Conclusion The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.
Marco Quaranta; Luca Miranda; Francesco Oliva; Filippo Migliorini; Gabriela Pezzuti; Nicola Maffulli. Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician. Journal of Orthopaedic Surgery and Research 2021, 16, 1 -8.
AMA StyleMarco Quaranta, Luca Miranda, Francesco Oliva, Filippo Migliorini, Gabriela Pezzuti, Nicola Maffulli. Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician. Journal of Orthopaedic Surgery and Research. 2021; 16 (1):1-8.
Chicago/Turabian StyleMarco Quaranta; Luca Miranda; Francesco Oliva; Filippo Migliorini; Gabriela Pezzuti; Nicola Maffulli. 2021. "Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician." Journal of Orthopaedic Surgery and Research 16, no. 1: 1-8.
Background: Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. Methods: Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. Results: A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 ( P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% ( P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. Conclusion: For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems Level of Evidence: Level III, retrospective study.
Stefano Ferranti; Filippo Migliorini; Federico Maria Liuni; Marco Corzani; Alfio Azzarà; Flavio Polliano; Abusaa Saher Sami Tawfiq; Nicola Maffulli. Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems. Foot & Ankle International 2021, 1 .
AMA StyleStefano Ferranti, Filippo Migliorini, Federico Maria Liuni, Marco Corzani, Alfio Azzarà, Flavio Polliano, Abusaa Saher Sami Tawfiq, Nicola Maffulli. Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems. Foot & Ankle International. 2021; ():1.
Chicago/Turabian StyleStefano Ferranti; Filippo Migliorini; Federico Maria Liuni; Marco Corzani; Alfio Azzarà; Flavio Polliano; Abusaa Saher Sami Tawfiq; Nicola Maffulli. 2021. "Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems." Foot & Ankle International , no. : 1.
Tendon injuries are a common cause of pain and of restriction of sports or daily life. The pathogenesis of chronic tendon injuries is considered multifactorial; however, the precise role of each predisposing factor remains incompletely understood and remain largely unknown. Therefore, many conservative and surgical treatment have been described in literature with variable results. Minimally invasive surgical techniques have been developed to reduce post-surgical complications and morbidity. Furthermore, they produced faster recovery times and shorter hospital stays compared to traditional open techniques. In this chapter, the recent advances in minimally invasive surgery for the most common Achilles tendon pathologies are reported, including high-volume injections, multiple percutaneous longitudinal tenotomies and minimally invasive stripping, and minimally invasive Achilles tendon repair.
Nicola Maffulli; Alessio Giai Via; Francesco Oliva. Emerging Operative Procedures for Tendons. Tendinopathy 2021, 355 -363.
AMA StyleNicola Maffulli, Alessio Giai Via, Francesco Oliva. Emerging Operative Procedures for Tendons. Tendinopathy. 2021; ():355-363.
Chicago/Turabian StyleNicola Maffulli; Alessio Giai Via; Francesco Oliva. 2021. "Emerging Operative Procedures for Tendons." Tendinopathy , no. : 355-363.
Background: Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. Purpose: To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. Study Design: Systematic review; Level of evidence, 4. Methods: The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. Results: Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement ( P < .0001), preoperative acetabular index ( P = .01), and BMI ( P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. Conclusion: Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.
Filippo Migliorini; Nicola Maffulli; Alice Baroncini; Jörg Eschweiler; Markus Tingart; Marcel Betsch. Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review. The American Journal of Sports Medicine 2021, 1 .
AMA StyleFilippo Migliorini, Nicola Maffulli, Alice Baroncini, Jörg Eschweiler, Markus Tingart, Marcel Betsch. Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review. The American Journal of Sports Medicine. 2021; ():1.
Chicago/Turabian StyleFilippo Migliorini; Nicola Maffulli; Alice Baroncini; Jörg Eschweiler; Markus Tingart; Marcel Betsch. 2021. "Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review." The American Journal of Sports Medicine , no. : 1.
The management of transchondral and osteochondral talar lesions has evolved, with microfracturing originally considered the best initial treatment. Despite talar lesions being a tri-dimensional defect, most studies use two-dimensional parameters to grade them. We propose in this study that tri-dimensional sizing may be more appropriate in evaluation for treatment. The present study evaluated the outcomes of treatment of talar lesions performed by a single surgeon, creating and using an algorithm based on volume, location, and integrity of the subchondral plate. The lesions were classified as "small" (up to 125 mm3), "medium" (125 mm3-1500 mm3), and "large" (>1500 mm3) based upon evaluation of the pre-operative MRI. Location of the lesion was also noted on a nine-region grid pattern of the talar dome. These three parameters dictated whether a lesion required microfracturing or retrograde drilling, autogenous or allogenous bone graft, and whether an open versus an arthroscopic approach was required. Over a ten-year period, surgery was performed on 204 lesions. Overall, the average time to return to activity was 7.93 ± 5.00 (range 2-36) months. The average pre-operative American Orthopaedic Foot and Ankle score was 76.44 ± 10.98 (range 52-86), and the average post-operative American Orthopaedic Foot and Ankle score was 96.12 ± 3.46 (range 81-100), P=.0001. By using the proposed algorithm, the outcome and return to activity for most patients can be better predicted, regardless of the size or location of the osteochondral lesion". The treatment algorithm implemented in the present investigation yielded overall acceptable results, with only 7 of the 204 lesions needing additional surgery.
Amol Saxena; Nicola Maffulli; Anqi Jin; Eghosa Isa; Jessica Jaswal; Ryan Allen. Outcomes of talar osteochondral and transchondral lesions using an algorithmic approach based on size, location and subchondral plate integrity: a 10-year study on 204 lesions. The Journal of Foot and Ankle Surgery 2021, 1 .
AMA StyleAmol Saxena, Nicola Maffulli, Anqi Jin, Eghosa Isa, Jessica Jaswal, Ryan Allen. Outcomes of talar osteochondral and transchondral lesions using an algorithmic approach based on size, location and subchondral plate integrity: a 10-year study on 204 lesions. The Journal of Foot and Ankle Surgery. 2021; ():1.
Chicago/Turabian StyleAmol Saxena; Nicola Maffulli; Anqi Jin; Eghosa Isa; Jessica Jaswal; Ryan Allen. 2021. "Outcomes of talar osteochondral and transchondral lesions using an algorithmic approach based on size, location and subchondral plate integrity: a 10-year study on 204 lesions." The Journal of Foot and Ankle Surgery , no. : 1.
Introduction: The use of cell-based therapies in the management of sports injuries of the upper limb is increasingly popular despite the limited scientific evidence available for their use. We aim to evaluate the evidence for the use of cell-based therapies in these injuries and recommend areas for further research. Areas covered: In accordance with a published protocol (PROSPERO; Registration No. CRD42020193258), a comprehensive search of the literature was performed using the MEDLINE and EMBASE databases from inception to June 2020. All human studies reporting on the clinical, histological, or radiological outcomes following the use of cell-based therapies in the management of epicondylitis or rotator cuff pathology were included in this study. This resulted in 22 studies being included in this review, all of which underwent risk of bias assessments. Expert opinion: The evidence for the use of cell-based therapies in upper limb sports injuries is limited and generally of low quality. Given the heterogeneity in the cell types used, their harvesting methods and cell amounts, future research should be targeted at developing standardization of the reporting of these studies and more direct comparative studies looking at the efficacy of the different cell types. Graphical Abstract
Kwaku Baryeh; Vipin Asopa; Nardeen Kader; Nick Caplan; Nicola Maffulli; Deiary Kader. Cell-based therapies for the treatment of sports injuries of the upper limb. Expert Opinion on Biological Therapy 2021, 1 -14.
AMA StyleKwaku Baryeh, Vipin Asopa, Nardeen Kader, Nick Caplan, Nicola Maffulli, Deiary Kader. Cell-based therapies for the treatment of sports injuries of the upper limb. Expert Opinion on Biological Therapy. 2021; ():1-14.
Chicago/Turabian StyleKwaku Baryeh; Vipin Asopa; Nardeen Kader; Nick Caplan; Nicola Maffulli; Deiary Kader. 2021. "Cell-based therapies for the treatment of sports injuries of the upper limb." Expert Opinion on Biological Therapy , no. : 1-14.
Introduction: The impact of sex, age, body mass index (BMI) in fibromyalgia is still unclear. A systematic review was conducted to investigate whether sex, age and BMI influence the clinical outcomes and rate of adverse events. Methods: The present study was performed according to the PRISMA guidelines. The literature search was performed in February 2021. All the RCTs investigating pharmacological strategies for fibromyalgia were accessed. Results: Data from 51 RCTs (17,311 patients) were collected. Short Form 36 emotional, Social function and physical role subscales showed evidence of a negative association with BMI (P = 0.02, P = 0.002 and P = 0.0001, respectively). Depression and anxiety subscales of the Hospital Anxiety and Depression score demonstrated evidence of a positive association with age (P = 0.04 and P = 0.001, respectively) and sex (P = 0.00005 and P = 0.0001, respectively). Visual analog scale evidenced a positive association with BMI (P = 0.04). Clinical Global Impression Severity scale demonstrated evidence of a negative association with BMI (P = 0.02). Conclusion: Irrespective from the pharmacological approach, a higher BMI is negatively associated with a favorable outcome in patients with fibromyalgia. The association with sex and age remains controversial. Level of evidence: I, systematic review of RCTs.
Filippo Migliorini; Nicola Maffulli; Jörg Eschweiler; Markus Tingart; Arne Driessen; Giorgia Colarossi. BMI but not age and sex negatively impact on the outcome of pharmacotherapy in fibromyalgia: a systematic review. Expert Review of Clinical Pharmacology 2021, 1 -10.
AMA StyleFilippo Migliorini, Nicola Maffulli, Jörg Eschweiler, Markus Tingart, Arne Driessen, Giorgia Colarossi. BMI but not age and sex negatively impact on the outcome of pharmacotherapy in fibromyalgia: a systematic review. Expert Review of Clinical Pharmacology. 2021; ():1-10.
Chicago/Turabian StyleFilippo Migliorini; Nicola Maffulli; Jörg Eschweiler; Markus Tingart; Arne Driessen; Giorgia Colarossi. 2021. "BMI but not age and sex negatively impact on the outcome of pharmacotherapy in fibromyalgia: a systematic review." Expert Review of Clinical Pharmacology , no. : 1-10.
SARS-CoV-2 induces a cytokine storm and can cause inflammation, fibrosis and apoptosis in the lungs, leading to acute respiratory distress syndrome (ARDS). ARDS is the leading reason for the mortality and morbidity the associated to COVID-19, and the cytokine storm is a prominent etiological factor. Mesenchymal stem cell-derived extracellular vesicles are an alternative therapy for management of inflammatory and autoimmune conditions because of their immunosuppressive properties. The immunomodulatory and tissue regeneration capabilities of extracellular vesicles may support their application as a prospective therapy for COVID-19. We explored the clinical evidence on extracellular vesicles as antiviral agents and in mitigating ARDS, and their therapeutic potential in COVID-19. Clinical trials using extracellular vesicles are registered against COVID-19 associated complications, with some evidence of safety and efficacy. Extracellular vesicles present an alternative potential to cell therapy for COVID-19 management, but further pre-clinical and clinical investigations are needed.
Ashim Gupta; Kashte Shivaji; Sachin Kadam; Manu Gupta; Hugo C. Rodriguez; Anish G. Potty; Saadiq F. El-Amin; Nicola Maffulli. Immunomodulatory extracellular vesicles: an alternative to cell therapy for COVID-19. Expert Opinion on Biological Therapy 2021, 1 -10.
AMA StyleAshim Gupta, Kashte Shivaji, Sachin Kadam, Manu Gupta, Hugo C. Rodriguez, Anish G. Potty, Saadiq F. El-Amin, Nicola Maffulli. Immunomodulatory extracellular vesicles: an alternative to cell therapy for COVID-19. Expert Opinion on Biological Therapy. 2021; ():1-10.
Chicago/Turabian StyleAshim Gupta; Kashte Shivaji; Sachin Kadam; Manu Gupta; Hugo C. Rodriguez; Anish G. Potty; Saadiq F. El-Amin; Nicola Maffulli. 2021. "Immunomodulatory extracellular vesicles: an alternative to cell therapy for COVID-19." Expert Opinion on Biological Therapy , no. : 1-10.
The origin of wrestling as a sport can be traced back to the Sumerians 5000 years ago. In ancient Egypt drawings in the tomb of Beni-Hassan show 400 pairs of wrestlers [1]. For the Greeks, wrestling trained men for war, and drawings of Greek wrestling style resemble contemporary Freestyle wrestling [1]. In 708 BC, wrestling was incorporated as a major discipline in the Olympic Games [1, 2]. Greek wrestling was called pankration (“all power”), combined boxing and wrestling techniques, and the pankratists were skilled at throws, takedowns, joint locks, and choke holds using the maneuvers in present day wrestling, and also now forbidden in Olympic Freestyle and Greco-Roman wrestling, but allowed in, for example, judo, Brazilian JuJitsu, and mixed martial arts. Trainers focused on developing strength, endurance, and skills best suited to each fighter. The only rules were that fighters were not allowed to bite or gouge out the opponent’s eyes, but these were permitted in Sparta. The Olympic Pankration competition 332–331 BC is depicted on an amphora. Pankration was used on the battlefield by the Spartan hoplites and the Macedonian phalanx in the army led by Alexander the Great. Roman pancratium competitions took place in the Colosseum [3]. Wrestling and pancratium continued in many countries, and wrestling was reintroduced into the Olympic Games in 1896 [4]. Freestyle wrestling was included in the 1904 Olympic Games [2], Greco-Roman wrestling in the 1908 Olympic Games [5], and females were included in the World Championship organized by the International Federation of Associated Wrestling Styles (FILA) in 1987, to became an Olympic sport in the 2004 Olympic Games [4]. Wrestling is at present a very popular sport. It allows the participation of individuals matched according to their weight. Two different styles are Olympic sports: Freestyle wrestling, where the legs can be used to throw and grab an opponent, and the attacks can be brought below the waist; and Greco-Roman wrestling, which allows holds and attacks only above the waist, and only the upper limbs can be used to attack the opponent [4, 6]. Wrestling causes injuries found in other contact sports. Physicians must know how to manage such injuries, and must be able to assist athletes in different problems such as diet and weight loss, skin infections, and ear injuries.
I. Riccio; F. Rosati Tarulli; N. Maffulli. Wrestling. Specific Sports-Related Injuries 2021, 471 -485.
AMA StyleI. Riccio, F. Rosati Tarulli, N. Maffulli. Wrestling. Specific Sports-Related Injuries. 2021; ():471-485.
Chicago/Turabian StyleI. Riccio; F. Rosati Tarulli; N. Maffulli. 2021. "Wrestling." Specific Sports-Related Injuries , no. : 471-485.
The role of a tourniquet for knee arthroplasty remains controversial. The present Bayesian network meta-analysis investigated the role of various protocols for tourniquet inflation for knee arthroplasty, assessing data on pain control, clinical and functional outcomes, and the rate of deep vein thrombosis (DVT). The present Bayesian network meta-analysis was conducted according to the PRISMA guidelines. In March 2021, all clinical trials investigating the role of tourniquet use for knee arthroplasty were considered for inclusion. Groups were divided into those which used a tourniquet in knee arthroplasty procedures versus those which completed the procedure without tourniquet, or with varying protocols of tourniquet use. The hierarchical random-effects model analysis was adopted in all comparisons. Data from 54 articles (5497 procedures) were retrieved. The absence of tourniquet group evidenced the lowest rate of DVT, and scored the lowest in the visual analogic scale (VAS) at 24–48 h, 1, 3, and 12 months follow-up. The same group evidenced the greatest gain of motion at 3-days, 1 week, 1 month, 3 months, 6 months, and 12 months follow-up, and the highest Knee Society Rating System scores at 1, 3, and 12 months follow-up. Of the outcome data assessed, the straight-leg-raise test was markedly inconsistent: therefore, no recommendations from this test can be made. With regards to the endpoints considered in the present study, knee arthroplasties undertaken without the use of a tourniquet perform better overall.
Filippo Migliorini; Nicola Maffulli; Jörg Eschweiler; Matthias Knobe; Markus Tingart; Marcel Betsch. Tourniquet use during knee arthroplasty: A Bayesian network meta-analysis on pain, function, and thromboembolism. The Surgeon 2021, 1 .
AMA StyleFilippo Migliorini, Nicola Maffulli, Jörg Eschweiler, Matthias Knobe, Markus Tingart, Marcel Betsch. Tourniquet use during knee arthroplasty: A Bayesian network meta-analysis on pain, function, and thromboembolism. The Surgeon. 2021; ():1.
Chicago/Turabian StyleFilippo Migliorini; Nicola Maffulli; Jörg Eschweiler; Matthias Knobe; Markus Tingart; Marcel Betsch. 2021. "Tourniquet use during knee arthroplasty: A Bayesian network meta-analysis on pain, function, and thromboembolism." The Surgeon , no. : 1.
Evidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL) reconstruction are lacking. This systematic review was conducted to investigate whether patient characteristics have an influence in the clinical outcomes of MPFL reconstruction for patients with patellofemoral instability. This study followed the PRISMA guidelines. The main databases were accessed in February 2021. All the studies reporting outcomes of primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. A multivariate analysis diagnostic tool was used to analyse the association between age, gender and time from injury to surgery and the surgical outcomes at last follow-up. A total of 50 articles (2037 procedures) were included. The mean follow-up was 40.90 ± 24.8 months. The mean age was 23.6 ± 3.9 years. 64.3% (1309 of 2037 patients) were female. The mean time from injury to surgery was 64.5 ± 48.9 months. Women showed no statistically significant association with the Kujala score or complications. Older patients had a reduced risk to incur re-dislocations (P = 0.01) and revisions (P = 0.01). Longer time from injury to surgery was associated with greater risk to incur re-dislocations (P = 0.01), and with lower Kujala score (P < 0.0001). No other statistically significant association was evidenced. The time span from the first patellar dislocation to the surgical reconstruction was a negative prognostic factor, while sex had no influence on surgical outcomes. The role of patients age on surgical outcomes remains unclear.
Filippo Migliorini; Jörg Eschweiler; Marcel Betsch; Matthias Knobe; Markus Tingart; Nicola Maffulli. Prognostic factors for isolated medial patellofemoral ligament reconstruction: A systematic review. The Surgeon 2021, 1 .
AMA StyleFilippo Migliorini, Jörg Eschweiler, Marcel Betsch, Matthias Knobe, Markus Tingart, Nicola Maffulli. Prognostic factors for isolated medial patellofemoral ligament reconstruction: A systematic review. The Surgeon. 2021; ():1.
Chicago/Turabian StyleFilippo Migliorini; Jörg Eschweiler; Marcel Betsch; Matthias Knobe; Markus Tingart; Nicola Maffulli. 2021. "Prognostic factors for isolated medial patellofemoral ligament reconstruction: A systematic review." The Surgeon , no. : 1.
Introduction: Secondary spinal cord injury (SCI) sets on immediately after trauma and, despite prompt treatment, may become chronic. SCI is a complex condition and presents numerous challenges to patients and physicians alike, also considering the lack of an approved pharmacological therapy. Areas covered: This review describes the pathophysiological mechanisms leading to secondary SCI to highlight possible targets for pharmacological therapy. Furthermore, an extensive search of the literature on different databases (PubMed, Google scholar, Embase, and Scopus) and of the current clinical trials (clinicaltrials.gov) was performed to investigate the current outlook for the pharmacological management of SCI. Only drugs with performed or ongoing clinical trials were considered. Expert opinion: Pharmacological therapy aims to improve motor and sensory function in patients. Overall, drugs are divided into neuroprotective compounds, which aim to limit the damage induced by the pro-inflammatory and pro-apoptotic milieu of SCI, and neuroregenerative drugs, which induce neuronal and axonal regrowth. While many compounds have been trialed with promising results, none has yet completed a stage III trial and has been approved for the pharmacological management of SCI.
Alice Baroncini; Nicola Maffulli; Jörg Eschweiler; Markus Tingart; Filippo Migliorini. Pharmacological management of secondary spinal cord injury. Expert Opinion on Pharmacotherapy 2021, 1 -8.
AMA StyleAlice Baroncini, Nicola Maffulli, Jörg Eschweiler, Markus Tingart, Filippo Migliorini. Pharmacological management of secondary spinal cord injury. Expert Opinion on Pharmacotherapy. 2021; ():1-8.
Chicago/Turabian StyleAlice Baroncini; Nicola Maffulli; Jörg Eschweiler; Markus Tingart; Filippo Migliorini. 2021. "Pharmacological management of secondary spinal cord injury." Expert Opinion on Pharmacotherapy , no. : 1-8.
Background: Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. Hypothesis: We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. Study Design: Prospective case series. Level of Evidence: Level 4. Methods: A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. Results: Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale ( P = 0.03) and WOMAC ( P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months ( P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. Conclusion: PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. Clinical Relevance: This research supports the use of autologous PRP injections for symptomatic DMLs.
Mattia Alessio-Mazzola; Lamberto Felli; Roberto Trentini; Matteo Formica; Andrea Giorgio Capello; Stefano Lovisolo; Nicola Maffulli. Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study. Sports Health: A Multidisciplinary Approach 2021, 1 .
AMA StyleMattia Alessio-Mazzola, Lamberto Felli, Roberto Trentini, Matteo Formica, Andrea Giorgio Capello, Stefano Lovisolo, Nicola Maffulli. Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study. Sports Health: A Multidisciplinary Approach. 2021; ():1.
Chicago/Turabian StyleMattia Alessio-Mazzola; Lamberto Felli; Roberto Trentini; Matteo Formica; Andrea Giorgio Capello; Stefano Lovisolo; Nicola Maffulli. 2021. "Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study." Sports Health: A Multidisciplinary Approach , no. : 1.