Archives of Medicine & Surgery University of Milan https://riviste.unimi.it/index.php/AMSUM <p>Archives of Medicine &amp; Surgery, published by the University of Milan, collects manuscript on all the fields of medical knowledge.&nbsp;</p> Università degli studi di Milano en-US Archives of Medicine & Surgery University of Milan <p>The author retains the right to create derivative works and to reproduce, distribute, execute or publicly display her/his Work at conferences and presentations, lectures, and in case of any other professional activity.</p> <p><a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" rel="license"><img style="border-width: 0;" src="https://i.creativecommons.org/l/by-nc-nd/4.0/88x31.png" alt="Licenza Creative Commons"></a><br>Content on this site is licensed under a <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" rel="license">Creative Commons Attribution - Non commercial - No Derivs 4.0 International</a>.</p> Archives of medicine and surgery of the university of Milan https://riviste.unimi.it/index.php/AMSUM/article/view/13399 Pietro Randelli Riccardo Compagnoni Copyright (c) 2020 Riccardo Compagnoni, Pietro Randelli https://creativecommons.org/licenses/by-nc-nd/4.0 2020-05-03 2020-05-03 1 1 1 1 10.13130/AMSUM/13399 Bone marrow lesions in the knee: early results of patients treated with subcondroplasty https://riviste.unimi.it/index.php/AMSUM/article/view/13400 <div title="Page 1" class="page"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>Introduction: Subchondroplasty is a percutaneous procedure in which calcium phosphate is injected inside BMLs (Bone Marrow Lesions) area under fluoroscopic guidance. The main aim of the present cohort study is to evaluate the effects of subchondroplasty associated to knee arthroscopy in reducing pain and improving in knee function in patients suffering from BMLs located on femoral condyles or tibial plateau.</p> <p>Methods: 30 patients (mean age 65.4 years) were evaluated pre-operatively and at 6 and 12 months after surgery. Numeric pain Rating Scale (NRS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC) were evaluated. Secondarily, edema healing and bone structure were controlled at follow-up by x-ray and MRI.</p> <p>Results: An improvement in all evaluated scores was found at 6 months after surgery compared to the baseline. NRS changed from a mean value of 7 to 1 at 6 months and to 0.86 at 1 year of follow-up, revealing a marked improvement of pain after the procedure (p&lt;0.0001). Furthermore, IKDC and WOMAC scores showed a statistically significant improvement in knee function at 6 months after subchondroplasty (from 26.96 to 70.10 and from 46.87 to 9.00, respectively), which remained stable after 12 months; KSS in every section (objective, satisfaction and function) raised as well during the follow-up. In three cases the treatment failed and a total knee replacement was performed due to persistence of symptoms.</p> <p>Conclusions: Subchondroplasty seems to be safe, reliable and effective in pain reduction and knee function improvements, even though effects at long term still have to be verified.<br>Level of evidence: II, Prospective cohort study</p> </div> </div> <img width="467.22" height="0.5" alt="page1image3685616" src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAdQAAAABCAYAAABno19EAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAPrAAAD6wBex0DAAAAAC5JREFUOBFjlJCQiGdgYFAA4lEwGgKjITAaAqMhMBoCoyFAYggwMjL+ff78eQsAyYEFAmAXJoAAAAAASUVORK5CYII="> <div class="layoutArea"> <div class="column"> <p>Keywords: BML; MRI; STIR; CRPS; SONK.</p> </div> </div> </div> </div> Pietro Randelli Martina Ricci Riccardo Compagnoni Copyright (c) 2020 Pietro Randelli, Martina Ricci, Riccardo Compagnoni https://creativecommons.org/licenses/by-nc-nd/4.0 2020-05-03 2020-05-03 1 1 2 8 10.13130/AMSUM/13400 Kinematic Alignment technique for Total Knee Arthroplasty: a scoping review https://riviste.unimi.it/index.php/AMSUM/article/view/13403 <p><strong>Purpose</strong></p> <p>This scoping review aims to analyze history, philosophy, surgical technique, and results of Kinematic Alignment (KA) in total knee arthroplasty (TKA). KA co-aligns the axes and joint lines of the components with the three «kinematic» axes and joint lines of the pre-arthritic or native knee without placing restrictions on the pre-operative deformity and post-operative correction.</p> <p><strong>Methods</strong></p> <p>A scoping review of the existing literature utilizing PubMed was performed in march 2020. 44 studies published in peer-reviewed journals over the last ten years in English were reviewed.&nbsp;</p> <p><strong>Results</strong></p> <p>The growing interest in KA is confirmed by the presence of several studies comparing MA and KA techniques reported in the literature. Many reviews and meta-analysis showed that the functional outcomes and flexion range of motion of the KA technique were similar or even better than ones of the mechanically aligned MA implants.</p> <p><strong>Conclusion</strong></p> <p>The KA TKA is an effective alternative method to MA TKA, striving to increase patients satisfaction after TKA. Multicenter RCTs with longer follow up and larger sample studies are needed to clarify its longevity and results.</p> <p><strong>Keywords: </strong>Kinematic alignment; Knee; Mechanical alignment; Outcome; Total knee arthroplasty.</p> <p>Level of evidence: V</p> Filippo Calanna Riccardo Compagnoni Paolo Ferrua Matteo Lo Duca Pietro Randelli Copyright (c) 2020 Filippo Calanna, Riccardo Compagnoni, Paolo Ferrua, Matteo Lo Duca, Pietro Randelli https://creativecommons.org/licenses/by-nc-nd/4.0 2020-05-03 2020-05-03 1 1 9 16 10.13130/AMSUM/13403 Management of shoulder pain in the emergency room: a narrative review https://riviste.unimi.it/index.php/AMSUM/article/view/14953 <p><strong>ABSTRACT</strong></p> <p><em>Background (Introduction)</em></p> <p>The frequency of Emergency Room (ER) accesses for shoulder pain is constantly increasing. The presenting symptoms are similar across the various pathological conditions, therefore an appropriate focus on the pathogenetic mechanism (traumatic or not-traumatic) and the correct imaging choice is of extreme importance. The correct treatment strategy is fundamental. The aim of this study is to provide a simple and straightforward guide toward the correct treatment when facing a painful shoulder in ER.<span class="Apple-converted-space">&nbsp;</span></p> <p><em>Materials and methods</em></p> <p>We performed a narrative review analyzing 34 published articles from the most updated literature focused on the management of shoulder emergencies. The most significant data were collected to propose a document suggesting the most effective treatments in this group of patients.<span class="Apple-converted-space">&nbsp;</span></p> <p><em>Results</em></p> <p>Authors developed a guide that could help clinicians to propose the correct treatment when dealing with patients with acute shoulder pain in ER.<span class="Apple-converted-space">&nbsp;</span></p> <p><em>Conclusions</em></p> <p>Shoulder emergencies are frequent and different possible treatments can be proposed to the patients, as a consequence of local guidelines and hospital habits. This narrative review could help clinicians in the emergency room to propose an effective treatment in some of the most common situations.<span class="Apple-converted-space">&nbsp;</span></p> <p>&nbsp;</p> <p>Keywords</p> <p>Acute shoulder pain, shoulder traumatology, shoulder emergencies, painful shoulder</p> <p>&nbsp;</p> <p>Level of evidence: 5° - Narrative review<span class="Apple-converted-space">&nbsp;</span></p> Riccardo Compagnoni alfonso liccardi chiara fossati pietro randelli Copyright (c) 2021 Riccardo Compagnoni; alfonso liccardi, chiara fossati, pietro randelli https://creativecommons.org/licenses/by-nc-nd/4.0 2021-02-16 2021-02-16 1 1 27 34 10.13130/AMSUM/14953 Augmented Reality in Orthopedic surgery: state of the art and future prospectives https://riviste.unimi.it/index.php/AMSUM/article/view/14955 <p><strong>Purpose</strong></p> <p>Quality and results of orthopedic surgery have been vastly improved by the technological advances of these last few years. Progress in surgical instruments and implants have aimed at the improvement of the surgical outcome. More recently, computer assisted surgery (CAS) has revolutionized our approach to surgery in a more comprehensive way, in an attempt to make surgery better not only for the patient but also for the operator and the whole surgical team.<span class="Apple-converted-space">&nbsp;</span></p> <p>Of the many parts that constitutes CAS, augmented reality is one of the most promising ones.</p> <p>This narrative review describes current knowledge and prospects of augmented reality in orthopedic surgery.</p> <p><strong>Methods</strong></p> <p>A narrative review of current literature has been performed in September 2020 to find articles focused on augmented reality in orthopedic surgery in Scopus and PubMed/Medline with the following keywords: (augmented reality) AND (orthopedic). Inclusion criteria were articles published in the last 20 years, reviews, clinical and educational articles. The authors collected the data described in these articles and analyzed them to find the most relevant informations on this topic.</p> <p><strong>Results</strong></p> <p>145 articles on augmented reality in surgery were found. The majority of these studies were focused on the potential use of this technology for improvements in surgical training, technique, operating time and x-rays exposures.</p> <p><strong>Conclusion</strong></p> <p>Augmented reality is a significant help for the practice and training of the orthopedic surgeon: it can reduce the operating time, the exposure to harmful radiation and can help improve precision and reproducibility of surgeries.</p> Riccardo Compagnoni gianluca coccioli filippo calanna paolo ferrua pietro randelli Copyright (c) 2021 Riccardo Compagnoni; gianluca coccioli, filippo calanna, pietro randelli, paolo ferrua https://creativecommons.org/licenses/by-nc-nd/4.0 2021-02-05 2021-02-05 1 1 35 37 10.13130/AMSUM/14955 An unusual presentation of isolated polydactyly: four limbs hexadactyly https://riviste.unimi.it/index.php/AMSUM/article/view/13402 <p class="s4"><span class="s12">Purpose:</span> <span class="s13">Hexadactyly </span><span class="s13">is a congenital physical anomaly</span><span class="s13">, potentially affecting the hand or the food. Aim of this study is to report two case reports of hexadactyly involving the four limbs, with a literature review focused on this pathology. </span></p> <p class="s4"><span class="s12">Methods</span><span class="s12">: </span><span class="s13">This article describes the treatment proposed in t</span><span class="s13">wo </span><span class="s13">patients with hexadactyly,</span><span class="s13"> from the birth to one year follow-up</span><span class="s13">. A literature search was performed</span><span class="s13"> to </span><span class="s13">compare</span><span class="s13"> the different treatment choices.</span></p> <p class="s4"><span class="s12">Result: </span><span class="s13">The </span><span class="s13">treatments </span><span class="s13">described for </span><span class="s13">hexadactyly</span><span class="s13"> can be conservative or surgical</span><span class="s13">, </span><span class="s13">with good results in both cases. </span><span class="s13">The main aspect to consider is the functionality of the extra-digits. </span></p> <p class="s4"><span class="s12">Conclusion: </span><span class="s7">Hexadactyly of the four limbs is a</span><span class="s7"> relevant</span><span class="s7"> clinical condition under many aspects and requires a careful multidisciplinary evaluation.</span></p> <p class="s4">&nbsp;</p> <p class="s4"><span class="s14">Level of evidence: V</span></p> Sonia Maggi Cristina Viganò Pierluigi Colombo Alessandra Menon Riccardo Compagnoni Francesca Cortinovis Francesco Morandi Alessandro Crosio Pietro Simone Randelli Copyright (c) 2020 Sonia Maggi, Cristina Viganò, Pierluigi Colombo, Alessandra Menon, Riccardo Compagnoni, Francesca Cortinovis, Francesco Morandi, Alessandro Crosio, Pietro Simone Randelli https://creativecommons.org/licenses/by-nc-nd/4.0 2020-05-03 2020-05-03 1 1 17 21 10.13130/AMSUM/13402 Allograft in the chronic lesions of the lateral compartment of the ankle https://riviste.unimi.it/index.php/AMSUM/article/view/13424 <p><strong>Abstract</strong></p> <p>In this retrospective study authors present the cases treated with allograft transplantation for ligament reconstruction in chronic ankle instability.</p> <p><strong>Methods</strong></p> <p>From January 1999 to December 2016, 72 patients were operated , including 29 women and 43 men, aged between 22 and 47 (average 29.5). Of the 72 patients treated, 61 were evaluated in the follow up (12 months-12 years, with an average of 59 months) with clinical and radiographic evaluation, AFASS score (American Foot and Ankle Society Scoring System) and grading according to Good et al.</p> <p><strong>Results</strong></p> <p>There were no cases of transplant infection or rejection. Based on the criteria of Good et al., the results were excellent or good in the 57 patients operated with semitendinosus or frozen fresh gracil, sufficient in the 3 transplant cases of freeze-dried semitendinosus and 1 case of bad result.</p> <p><strong>Conclusion</strong></p> <p>Transplantation with allograft in chronic ankle instability represents an "innovative" technique that has achieved good results even in young patients with sporting needs.</p> <p><strong>Level of Evidence: </strong>3. Retrospective study</p> Luigi Di Palma Cecilia Pasquali Riccardo Compagnoni Pietro Simone Randelli Alberto Branca Copyright (c) 2020 Luigi Di Palma, Cecilia Pasquali, Riccardo Compagnoni, Pietro Simone Randelli, Alberto Branca https://creativecommons.org/licenses/by-nc-nd/4.0 2020-05-05 2020-05-05 1 1 22 26 10.13130/AMSUM/13424