Showing papers by "Nicola Maffulli published in 1994"
TL;DR: The average distance between the anterior tibial tuberosity and the trochlear groove is normally 13 mm, and a distance > 20 mm associated with knee pain should probably warrant surgery as discussed by the authors.
Abstract: This paper analyzes some of the radiologic measurements used in the diagnosis and management of patellofemoral disorders. Measurements such as condylar width and height and patellar height from the true lateral view are helpful to determine the type and severity of intercondylar dysplasia. Skyline views provide information on the type and degree of patellar subluxation and dysplasia, especially of the medial aspect of the trochlear groove. In asymptomatic subjects, the trochlear angle does not exceed 140 degrees, and the lateral medial intercondylar ratio in dysplasia is > 1.7. Scanograms specifically assess the longitudinal axis of the lower limb. Computed tomography (CT) measurements for patellar subluxation do not provide significant additional information over that provided by skyline views. The average distance between the anterior tibial tuberosity and the trochlear groove is normally 13 mm, and a distance > 20 mm associated with knee pain should probably warrant surgery. Because of multiplanar facilities and exposure to nonionizing radiations, magnetic resonance imaging is progressively replacing CT scanning for quantitative and qualitative measurements, at least in a research environment. Its use in routine clinical practice is not yet warranted, given its high costs.
131 citations
TL;DR: This paper reviews some of the methods used experimentally and clinically to monitor limb lengthening using callotasis, outlining their possible advantages and disadvantages for application in routine clinical practice.
Abstract: Limb lengthening using callotasis needs careful preoperative planning and great care during the lengthening period. The most common method used to monitor limb lengthening is plain radiography, but the time of frame removal is still left to the judgment of the surgeon. This paper reviews some of the methods used experimentally and clinically to monitor the process, outlining their possible advantages and disadvantages for application in routine clinical practice. Considering availability, cost, and safety, an imaging protocol could involve preoperative assessment with computed tomography scan; immediate postoperative anteroposterior (AP) and lateral radiographs; weekly ultrasound scanning for the 1st 8 weeks; and monthly AP and lateral radiographs during the lengthening phase and if there is any clinical suspicion of complication during the consolidation phase. If available, dual energy bone densitometry can be performed every 2 to 4 weeks from 8 weeks, until removal of the fixator.
28 citations
TL;DR: The protease antiprotease mechanism opens new perspectives in the diagnosis and pharmacologic management of osteoarthritis, and a more rational therapy against cartilage disruption becomes feasible.
Abstract: Among other factors, articular cartilage degeneration is caused by proteolytic enzymes. Different cell types of the synovial fluid and/or the synovial membrane and cartilage release specific proteases. Normally, these are finely tuned with their inhibitors. When this balance is altered, the proteolytic action may prevail, producing tissue damage, cartilage disruption, and ultimately a full osteoarthritic picture. The protease antiprotease mechanism opens new perspectives in the diagnosis and pharmacologic management of osteoarthritis. Early diagnosis and improved monitoring of the evolution of the disease are made possible, and a more rational therapy against cartilage disruption becomes feasible.
18 citations
TL;DR: Biomechanical comparison of the traditional Ilizarov steel rings with rings made of oriented carbon fibers shows that the mechanical characteristics of the carbon fiber rings are comparable with those exhibited by traditional steel rings, being elastically rigid over the whole range of loads applied.
Abstract: The mechanical and biomechanical characteristics of an external fixation system determine the biologic environment of the treated site. Traditionally, the Ilizarov system uses steel rings, which are heavy and can interfere with radiographic imaging. Biomechanical comparison of the traditional Ilizarov steel rings with rings made of oriented carbon fibers shows that the mechanical characteristics of the carbon fiber rings are comparable with those exhibited by traditional steel rings, being elastically rigid over the whole range of loads applied (147 N, 441 N, 735 N, 1029 N, 1110.34 N, 1192.7 N, 1274 N, 1355.3 N, 1437.7 N, 1519 N, and 1600.4 N). The plastic deformation exhibited by steel rings at high loads thus is avoided. In a clinical situation, such a deformation in response to loading would alter the biomechanics of the fracture site, possibly affecting the healing process.
16 citations
TL;DR: The Keller-Lelievre technique for hallux valgus correction was modified by detaching the extensor hallucis brevis tendon from the proximal phalanx, and reattaching it on the medial sesamoid, retaining significant correction and showing better functional results.
Abstract: The Keller-Lelievre technique for hallux valgus correction was modified by detaching the extensor hallucis brevis tendon from the proximal phalanx, and reattaching it on the medial sesamoid. Thirty-five consecutive patients were assigned randomly to 1 of 2 groups. Patients in Group 1 received the modified operation, and the original Keller-Lelievre technique was used for the control group. The only significant radiographic difference at 6 months was the distance between the first and the fifth metatarsal heads. There were only slightly significant differences in function and in pain relief between the 2 groups at the 6th postoperative month. At 3 years, these differences were greater, with the group treated by the modification described herein, retaining significant correction and showing better functional results.
15 citations