Joints最新文献

{"title":"\"Great Expectations\": Reflections on Possible Analogies between our Patients and the Characters of Charles Dickens.","authors":"Giuseppe Milano","doi":"10.1055/s-0037-1607230","DOIUrl":"https://doi.org/10.1055/s-0037-1607230","url":null,"abstract":"In this issue of Joints, we publish an interesting article by Lawrence and colleagues entitled “Expectations of Shoulder SurgeryarenotAlteredbySurgeonCounselingof the Patient.”1 The authors of this article conducted a valid analysis of a population of patients who had consented to undergo shoulder surgery. Using a dedicated interview tool (Shoulder Surgery Expectations Survey by the Hospital for Special Surgery), they measured the expectations of these patients regarding the proposed treatment. Thiswas doneboth before and after appropriate and standardized preoperative counseling, which was provided at patients’ first visit, when they consented to the treatment. The data analysis showed that information provided to the patients by the physician produced no significant variation in the expectations of patients regarding the treatment, and these expectations were not significantly correlated with sociodemographic factors or variables related to the type of surgery. As the authors themselves suggest, this study prompts us to reflect upon two questions that assume considerable strategic value in modernmedicine, given that these are increasingly based on the needs of the patients and careful evaluation of the real “value” of the treatment they may receive:2 What influences a patient’s expectations regarding a treatment and to what extent, are these expectations shaped or modified by physician counseling? Although it has been shown that the subjective improvement produced by a treatment is often proportional to the patient’s expectations,3 it is also true that allowing the patient to develop expectations that are disproportionate to the estimated and expected effect of a treatment may increase the risk of an unsatisfactory, and even disappointing, subjective outcome. The expectations formed by orthopaedic patients depend on several variables (age, gender, type of activity, type of surgery, etc.), many of which have been analyzed with conflicting results, possibly because of confounding factors.4–8 Among these variables, patient information appears to play a key role and therefore impacts the potential patient satisfaction at follow-up. However, the literature is not unanimous on this point either,5,9 and this leads researchers, like Lawrence and colleagues,1 to question the adequacy and effectiveness of our current physician–patient communication strategies. Specialist counseling will furnish patients with a considerable amountof information that theymayendup forgettingor even fail to take in, but at the same time, doctors are not using potentially more effective means of communication to their best advantage. One of these, not to be underestimated, is communication through social media. Internet is, indeed, full of medical information allowing patients to find out about their condition and treatment and prepare for their medical consultation, but online medical information tends to be exchanged between lay users and on social media platforms. Moreover","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1607230","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35682368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglected Posterior Knee Dislocation: An Unusual Case Report.","authors":"Francesco Leonardi,&nbsp;Alessandra Zorzan,&nbsp;Augusto Palermo,&nbsp;Luigi Molfetta","doi":"10.1055/s-0037-1607219","DOIUrl":"https://doi.org/10.1055/s-0037-1607219","url":null,"abstract":"<p><p>Chronic dislocation of the knee is a rare condition due to a diagnostic mistake during emergency assessment. Usually, dislocation obliges the surgeon to carry out a broad assessment, with vascular and neurological examination, and a thorough assessment of joint injuries. The immediate and stable closed reduction can resolve neurovascular compression. The most serious late sequela is joint instability with impairment of ambulation and patient's autonomy. Treatment of neglected knee dislocation is surgical, that is, arthrodesis or arthroplasty, the latter representing the treatment of choice. The case described herein appears unique because of the clinical and radiographic features. Interestingly, over the years, the neurovascular bundle has inadvertently adapted to the posterior femur displacement without secondary damage.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1607219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35681671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic Double-Bundle Medial Patellofemoral Ligament Reconstruction with Autologous Semitendinosus: Aperture Fixation Both at the Femur and the Patella.","authors":"Michele Vasso,&nbsp;Katia Corona,&nbsp;Giuseppe Toro,&nbsp;Marco Rossini,&nbsp;Alfredo Schiavone Panni","doi":"10.1055/s-0037-1607192","DOIUrl":"https://doi.org/10.1055/s-0037-1607192","url":null,"abstract":"<p><p>Medial patellofemoral ligament (MPFL) represents the main restraint against lateral patellar displacement. The MPFL insertion at the patella is up to 30 mm wide and is located along the upper half of the medial patellar rim. The femoral insertion of the MPFL is approximately 10 mm distal to the apex of the adductor tubercle and 16 mm proximal to the medial epicondyle. Since most of the patients suffer from MPFL rupture just after the first patellar dislocation, MPFL reconstruction results necessarily in all cases of chronic objective patellar instability to reestablish the primary passive patellofemoral stabilizer. Over time, different techniques of MPFL reconstruction have been proposed with promising results in terms of patient satisfaction and redislocation rate. However, each of these techniques may present peculiar problems and/or complications. An anatomic double-bundle MPFL reconstruction through an aperture fixation both at the femur and at the patella is here presented. The anatomic double-bundle MPFL reconstruction could allow recreating the fan-shape and biomechanics of original MPFL, whereas aperture fixation could provide a strong and safe fixation without risk of loosening or slackening of the graft.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1607192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35681672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellofemoral Arthroplasty: Current Concepts and Review of the Literature.","authors":"Gabriele Pisanu,&nbsp;Federica Rosso,&nbsp;Corrado Bertolo,&nbsp;Federico Dettoni,&nbsp;Davide Blonna,&nbsp;Davide Edoardo Bonasia,&nbsp;Roberto Rossi","doi":"10.1055/s-0037-1606618","DOIUrl":"https://doi.org/10.1055/s-0037-1606618","url":null,"abstract":"<p><p>Patellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35681668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction?","authors":"Riccardo Di Miceli,&nbsp;Carlotta Bustos Marambio,&nbsp;Alessandro Zati,&nbsp;Roberta Monesi,&nbsp;Maria Grazia Benedetti","doi":"10.1055/s-0037-1606617","DOIUrl":"https://doi.org/10.1055/s-0037-1606617","url":null,"abstract":"<p><p><b>Purpose</b>  The aim of this study was to assess the effect of knee bracing and timing of full weight bearing after anterior cruciate ligament reconstruction (ACLR) on functional outcomes at mid-term follow-up. <b>Methods</b>  We performed a retrospective study on 41 patients with ACLR. Patients were divided in two groups: ACLR group, who received isolated ACL reconstruction and ACLR-OI group who received ACL reconstruction and adjunctive surgery. Information about age at surgery, bracing, full or progressive weight bearing permission after surgery were collected for the two groups. Subjective IKDC score was obtained at follow-up. Statistical analysis was performed to compare the two groups for IKDC score. Subgroup analysis was performed to assess the effect of postoperative regimen (knee bracing and weight bearing) on functional outcomes. <b>Results</b>  The mean age of patients was 30.8 ± 10.6 years. Mean IKDC score was 87.4 ± 13.9. The mean follow-up was 3.5 ± 1.8 years. Twenty-two (53.7%) patients underwent ACLR only, while 19 (46.3%) also received other interventions, such as meniscal repair and/or collateral ligament suture. Analysis of overall data showed no differences between the groups for IKDC score. Patients in the ACLR group exhibited a significantly better IKDC score when no brace and full weight bearing after 4 weeks from surgery was prescribed in comparison with patients who worn a brace and had delayed full weight bearing. No differences were found with respect to the use of brace and postoperative weight bearing regimen in the ACLR-OI group. <b>Conclusion</b>  Brace and delayed weight bearing after ACLR have a negative influence on long-term functional outcomes. Further research is required to explore possible differences in the patients operated on ACLR and other intervention with respect to the use of a brace and the timing of full weight bearing to identify optimal recovery strategies. <b>Level of Evidence</b>  Level III, retrospective observational study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606617","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35682219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Talonavicular Coalition as a Cause of Foot Pain.","authors":"Armando Macera,&nbsp;Francesca Teodonno,&nbsp;Christian Carulli,&nbsp;Alberto Frances Borrego,&nbsp;Massimo Innocenti","doi":"10.1055/s-0037-1606616","DOIUrl":"https://doi.org/10.1055/s-0037-1606616","url":null,"abstract":"<p><p>Tarsal coalitions have an incidence of 2% and are often underdiagnosed. These are considered to be one of the causes of chronic ankle and foot pain. Among all tarsal coalitions, the talonavicular type represents a rare and uncommon condition. The purpose of this article was to present the case of a 35-year-old male patient with a bilateral talonavicular coalition treated conservatively. A review of the literature was also performed to understand the management of this rare condition.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35681669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis.","authors":"Augusto Dagnino,&nbsp;Nicola Ursino,&nbsp;Carlo A M Ripamonti,&nbsp;Carlo E Fiorentini,&nbsp;Michele Scelsi,&nbsp;Riccardo D'Ambrosi,&nbsp;Nicola M Portinaro","doi":"10.1055/s-0037-1606619","DOIUrl":"https://doi.org/10.1055/s-0037-1606619","url":null,"abstract":"<p><p>Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606619","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35681670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture Anchors Fixation in MPFL Reconstruction using a Bioactive Synthetic Ligament.","authors":"Massimo Berruto,&nbsp;Paolo Ferrua,&nbsp;Daniele Tradati,&nbsp;Francesco Uboldi,&nbsp;Eva Usellini,&nbsp;Bruno Michele Marelli","doi":"10.1055/s-0037-1606336","DOIUrl":"https://doi.org/10.1055/s-0037-1606336","url":null,"abstract":"<p><p>Medial patellofemoral ligament (MPFL) reconstruction has a key role in patellofemoral instability surgery. Many surgical techniques have been described so far using different types of grafts (autologous, heterologous, or synthetic) and fixation techniques. The hereby described technique for MPFL reconstruction relies on the use of a biosynthetic graft (LARS Arc Sur Tille, France). Fixation is obtained by means of suture anchors on the patellar side and a resorbable interference screw on the femoral side locating the insertion point according to Schottle et al. An early passive range of motion (ROM) recovery is fundamental to reduce the risk of postoperative stiffness; a partial weight bearing with crutches is allowed until 6 weeks after the surgery. In our experience, the use of a biosynthetic graft and suture anchors provides stable fixation, minimizing donor site morbidity and reducing the risk of patellar fracture associated with transosseous tunnels. This technique represents a reliable and reproducible alternative for MPFL reconstruction, thereby minimizing the risk of possible complications.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35682215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People.","authors":"Carlo Doria,&nbsp;Giulia R Mosele,&nbsp;Francesca Badessi,&nbsp;Leonardo Puddu,&nbsp;Gianfilippo Caggiari","doi":"10.1055/s-0037-1605555","DOIUrl":"https://doi.org/10.1055/s-0037-1605555","url":null,"abstract":"<p><p><b>Purpose</b>  To evaluate the prevalence of adhesive capsulitis (AC) of the shoulder in patients with type 1 diabetes mellitus (T1DM) in Sardinia. <b>Methods</b>  In this cross-sectional study, we evaluated 943 patients with T1DM attending the division of Endocrinology and Metabolism at the University Hospital in Sassari, Italy. The criteria for diagnosing AC were: pain for at least 1 month, inability to lie on the affected shoulder, and restricted active and passive shoulder joint movements in at least three planes. Age, gender, duration of DM, blood pressure, and presence of neuropathy and retinopathy were noted. Metabolic control of DM was evaluated with glycosylated hemoglobin A1c (GHbA1c) blood concentrations. <b>Results</b>  AC was diagnosed in 331 patients (prevalence: 35.1%). Age, duration of DM, high blood pressure levels, and the presence of neuropathy and retinopathy were significantly associated with AC. No significant association was observed between gender and AC. There was no significant difference in mean levels of GHbA1c in T1DM patients with or without AC. <b>Conclusion</b>  This study shows that AC of the shoulder is a common disorder in patients with T1DM in Sardinia. It is significantly associated with age, duration of DM, and related complications. <b>Level of Evidence</b>  Level IV, observational cross-sectional study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1605555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35682371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Clinical, MRI, and Arthroscopic Findings: A Guide to Correct Diagnosis of Meniscal Tears.","authors":"P Antinolfi,&nbsp;R Crisitiani,&nbsp;F Manfreda,&nbsp;S Bruè,&nbsp;V Sarakatsianos,&nbsp;G Placella,&nbsp;M Bartoli,&nbsp;A Caraffa","doi":"10.1055/s-0037-1605583","DOIUrl":"https://doi.org/10.1055/s-0037-1605583","url":null,"abstract":"<p><p><b>Purpose</b>  The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases. <b>Methods</b>  A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared. <b>Results</b>  Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears. <b>Conclusion</b>  Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool. <b>Level of Evidence</b>  Level II, prospective study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1605583","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35682311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}