16 results on '"Zaffagnini, Stefano"'
Search Results
2. Two-Dimensional and Three-Dimensional Biomechanical Factors During 90° Change of Direction are Associated to Non-Contact ACL injury in Female Soccer Players.
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Di Paolo, Stefano, Grassi, Alberto, Tosarelli, Filippo, Crepaldi, Matteo, Bragonzoni, Laura, Zaffagnini, Stefano, and Della Villa, Francesco
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PILOT projects ,SOCCER injuries ,CROSS-sectional method ,PHOTOGRAMMETRY ,COMPARATIVE studies ,ANTERIOR cruciate ligament injuries ,DESCRIPTIVE statistics ,BIOMECHANICS ,ATHLETIC ability ,MOTION capture (Human mechanics) ,DIGITAL diagnostic imaging ,VIDEO recording ,DIGITAL video ,LONGITUDINAL method ,KINEMATICS - Abstract
Background The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players. Hypothesis/Purpose The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female football players using both gold standard 3D motion capture and a qualitative scoring system based on 2D video-analysis. Study Design Prospective cohort study Methods Sixteen competitive female football (soccer) players (age 21.4 ± 4.3) performed a series of pre-planned 90° COD tasks. 3D motion data was recorded through 10 stereophotogrammetric cameras and a force platform. 2D frontal and transverse plane joint kinematics were computed through video-analysis from three high-speed cameras. A scoring system based on five criteria was adopted: limb stability, pelvis stability, trunk stability, shock absorption, and movement strategy. The players were prospectively followed for the next two consecutive football seasons and the occurrence of severe knee injuries was registered. Results Four players (25%) experienced an ACL injury. In 3D analysis, ACL-injured players showed greater knee valgus, knee internal rotation, and lower knee flexion (p= 0.017 - 0.029). Lower hip flexion coupled with greater external rotation (p= 0.003 - 0.042), ankle eversion, and contralateral pelvic drop (p<0.001) were also noted. In 2D analysis, ACL-injured players showed greater internal foot rotation, contralateral pelvic drop, lower knee flexion, and contralateral trunk tilt (moderate-to-large effect size). Pelvis stability and trunk stability showed the highest predictive value towards ACL injury. Total score was significantly lower in ACL-injured players with a moderate effect size (d=0.45). Conclusions Both 3D and 2D methodologies depicted biomechanical risk factors and offered predictive insights towards the ACL injury risk. Awareness should rise in women's football regarding the high risk of ACL injury and the strategies to assess and mitigate it. Level of Evidence 3 [ABSTRACT FROM AUTHOR]
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- 2023
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3. Assessment of the pivot shift using inertial sensors
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Zaffagnini, Stefano, Signorelli, Cecilia, Grassi, Alberto, Yue, Han, Raggi, Federico, Urrizola, Francisco, Bonanzinga, Tommaso, and Marcacci, Maurilio
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- 2016
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4. Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts
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Diermeier, Theresa, Meredith, Sean J, Irrgang, James J, Zaffagnini, Stefano, Kuroda, Ryosuke, Hochino, Yuichi, Samuelsson, Kristian, Smith, Clair Nicole, Popchak, Adam, Musahl, Volker, PIVOT Study Group, Sheean, Andrew, Burnham, Jeremy M, Lian, Jayson, Smith, Clair, Herbst, Elmar, Pfeiffer, Thomas, Araujo, Paulo, Oostdyk, Alicia, Guenther, Daniel, Ohashi, Bruno, Fu, Freddie H, Nagamune, Kouki, Kurosaka, Masahiro, Grassi, Alberto, Muccioli, Giulio, Lopomo, Nicola, Signorelli, Cecilia, Raggi, Federico, Horvath, Alexandra, Svantesson, Eleonor, Senorski, Eric Hamrin, Sundemo, David, Bjoernsson, Haukur, Ahlden, Mattias, Desai, Neel, Karlsson, Jon, UCL - SSS/LDRI - Louvain Drug Research Institute, Diermeier T., Meredith S.J., Irrgang J.J., Zaffagnini S., Kuroda R., Hochino Y., Samuelsson K., Smith C.N., Popchak A., Musahl V., Sheean A., Burnham J.M., Lian J., Smith C., Herbst E., Pfeiffer T., Araujo P., Oostdyk A., Guenther D., Ohashi B., Fu F.H., Nagamune K., Kurosaka M., Grassi A., Muccioli G.M.M., Lopomo N., Signorelli C., Raggi F., Horvath A., Svantesson E., Senorski E.H., Sundemo D., Bjoernsson H., Ahlden M., Desai N., and Karlsson J.
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Translation ,inertial sensor ,Anterior cruciate ligament reconstruction ,Anterior cruciate ligament ,medicine.medical_treatment ,Pivot shift ,Acceleration ,rotatory knee instability ,translation ,Article ,Image analysis ,Inertial sensor ,image analysis ,medicine ,Orthopedics and Sports Medicine ,Rotary knee instabiblity ,Orthodontics ,business.industry ,ACL ,anterior cruciate ligament ,acceleration ,medicine.anatomical_structure ,Hamstring tendon ,business ,image analysi ,pivot shift - Abstract
Background: The pivot-shift test has become more consistent and reliable and is a meaningful outcome measurement after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The purpose of this investigation was to assess patient-reported outcomes (PROs) and the quantitative pivot shift (QPS) preoperatively, at time zero immediately after anatomic ACLR, and after 24 months as well as the relationship between PROs and the QPS. It was hypothesized that anatomic ACLR would restore rotatory stability measured by the pivot-shift test and that QPS measurements would be positively correlated with PROs. Study Design: Cohort study; Level of evidence, 2. Methods: The ACL-injured and contralateral uninjured knees from 89 of 107 (83.2%) enrolled patients at 4 international centers were evaluated using a standardized pivot-shift test. Tibial acceleration was assessed with an inertial sensor, and lateral compartment translation was measured using an image analysis system preoperatively, at time zero immediately postoperatively, and at follow-up after 2 years. PROs were assessed at 12 and 24 months postoperatively with the International Knee Documentation Committee (IKDC) subjective knee form, Cincinnati Knee Rating System (CKRS), Marx activity rating scale, and activity of daily living score (ADLS). Results: The mean patient age at surgery was 27 years (range, 15-45 years). A positive pivot shift preoperatively (side-to-side difference in tibial acceleration, 2.6 ± 4.0 m/s2; side-to-side difference in anterior tibial translation, 2.0 ± 2.0 mm) was reduced at time zero postoperatively (side-to-side difference in tibial acceleration, –0.5 ± 1.3 m/s2; side-to-side difference in anterior tibial translation, –0.1 ± 1.0 mm). All PROs improved from preoperatively to final follow-up at 24 months: from 56.5 to 85.5 points for the IKDC ( P = .0001), from 28.8 to 32.4 points for the CKRS ( P = .04), from 11.2 to 7.9 points for the Marx ( P < .0001), and from 75.7 to 91.6 points for the ADLS ( P < .0001). Neither preoperative nor time zero postoperative rotatory laxity assessed by the pivot-shift test correlated with PROs at 24-month follow-up. A graft retear was observed in 4 patients (4.5%) within 2 years of follow-up. Conclusion: Anatomic ACLR resulted in significantly improved and acceptable PROs at 2-year follow-up and a low failure rate. Anatomic ACLR restored QPS measurements of anterior tibial translation and tibial acceleration to those of the contralateral knee immediately after surgery while still under anesthesia, but there was no correlation between the QPS preoperatively or at time zero after ACLR and PROs at 2-year follow-up.
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- 2020
5. Clinical Outcomes and Osteoarthritis at Very Long-term Follow-up After ACL Reconstruction: A Systematic Review and Meta-analysis.
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Grassi, Alberto, Pizza, Nicola, Al-zu'bi, Belal Bashar Hamdan, Fabbro, Giacomo Dal, Lucidi, Gian Andrea, and Zaffagnini, Stefano
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ONLINE information services ,PATIENT aftercare ,META-analysis ,MEDICAL databases ,INFORMATION storage & retrieval systems ,SYSTEMATIC reviews ,AGE distribution ,DISEASE incidence ,TREATMENT effectiveness ,TREATMENT failure ,RISK assessment ,SEX distribution ,OSTEOARTHRITIS ,ANTERIOR cruciate ligament surgery ,MEDLINE ,DISEASE risk factors - Abstract
Background: Few studies on outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have provided insight into the very long-term effects of this procedure. Purpose: To systematically review the outcomes, failure rate, incidence, and predictors of osteoarthritis (OA) for different ACLR techniques at a minimum 20-year follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, SCOPUS, and Cochrane databases was performed on June 2020 for studies of patients who underwent ACLR and had a minimum follow-up of 20 years. We extracted data on patient and surgical characteristics, patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee [IKDC] score, Knee injury and Osteoarthritis Outcome Score [KOOS], and Tegner score), clinical outcomes (IKDC grade, pivot shift, Lachman, and KT-1000 laxity), degree of OA (Kellgren-Lawrence, Ahlbäck, and IKDC OA grading), revisions, and failures. Relative risk (RR) of OA between the operated and contralateral knees was calculated as well as the pooled rate of revisions, failures, and conversion to total knee arthroplasty (TKA). Results: Included were 16 studies (N = 1771 patients; mean age, 24.8 years; mean follow-up, 22.7 years); 80% of the patients underwent single-bundle bone–patellar tendon–bone (BPTB) reconstruction. The average Lysholm (89.3), IKDC (78.6), and KOOS subscale scores were considered satisfactory. Overall, 33% of patients had "abnormal" or "severely abnormal" objective IKDC grade, 6.7% had KT-1000 laxity difference of ≥5 mm, 9.4% had Lachman ≥2+, and 6.4% had pivot shift ≥2+. Signs of OA were reported in 73.3% of patients, whereas severe OA was reported in 12.8%. The operated knee had a relative OA risk of 2.8 (P <.001) versus the contralateral knee. Identified risk factors for long-term OA were male sex, older age at surgery, delayed ACLR, meniscal or cartilage injuries, BPTB autograft, lateral plasty, nonideal tunnel placement, residual laxity, higher postoperative activity, and postoperative range of motion deficits. Overall, 7.9% of patients underwent revision, and 13.4% of ACLRs were considered failures. TKA was performed in 1.1% of patients. Conclusion: Most patients had satisfactory subjective outcomes 20 years after ACLR; however, abnormal anteroposterior or rotatory laxity was found in nearly 10% of cases. The presence of radiographic OA was high (RR 2.8 vs uninjured knee), especially in patients with concomitant meniscal or cartilage injuries, older age, and delayed surgery; however, severe OA was present in only 12.8% of cases, and TKA was required in only 1.1%. [ABSTRACT FROM AUTHOR]
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- 2022
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6. Epidemiology of Anterior Cruciate Ligament Injury in Italian First Division Soccer Players.
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Grassi, Alberto, Macchiarola, Luca, Filippini, Matteo, Lucidi, Gian Andrea, Della Villa, Francesco, and Zaffagnini, Stefano
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SOCCER ,DISEASE incidence ,DISEASE relapse ,ANTERIOR cruciate ligament surgery - Abstract
Background: The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury.Hypothesis: Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league.Study Design: Descriptive epidemiological study.Level Of Evidence: Level 4.Methods: Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated.Results: There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003).Conclusion: The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league.Clinical Relevance: Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors. [ABSTRACT FROM AUTHOR]- Published
- 2020
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7. Description and validation of a navigation system for intra-operative evaluation of knee laxity.
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Martelli, Sandra, Zaffagnini, Stefano, Bignozzi, Simone, Lopomo, Nicola, and Marcacci, Maurilio
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This paper describes the features of KIN-nav, a navigation system specifically dedicated to intra-operative evaluation of knee laxity, and assesses the reliability of the system during surgery. The acquisition protocol for its intra-operative use, the original user interface, and the computational methods for elaboration of kinematic data are described in detail. Moreover, an extensive and specific validation of the system was performed in order to evaluate its intra-operative performance and usability. KIN-nav's reliability and accuracy were analyzed in a series of 79 patients undergoing ACL reconstruction. The intra-surgeon repeatability computed for ACL-deficient and reconstructed knees at different flexion angles was less than 0.6° for varus-valgus (VV) rotation, less than 1 mm for AP translation, and less than 1.6° for IE rotation. The inter-surgeon repeatability is less than 2° for VV rotation, 5° for internal-external rotation, and less than 3 mm for AP translation. The proposed method was fast (requiring an additional 10 minutes of surgical time on average), required only a short learning period (5 cases), was minimally invasive, and was robust from the numerical perspective. Our system clearly shows that the use of navigation systems for kinematic evaluation provides useful and complete information on the knee state and test performance, and is simple and reliable to use. The good repeatability in manual kinematic tests is an improvement on the present ability to discriminate knee kinematics intra-operatively, and thus offers the possibility of better discrimination between knee pathologies and the prospect of new surgical applications. [ABSTRACT FROM AUTHOR]
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- 2007
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8. Poor Motor Coordination Elicits Altered Lower Limb Biomechanics in Young Football (Soccer) Players: Implications for Injury Prevention through Wearable Sensors.
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Di Paolo, Stefano, Zaffagnini, Stefano, Pizza, Nicola, Grassi, Alberto, and Bragonzoni, Laura
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MOTOR ability , *PREVENTION of injury , *KNEE , *ANTERIOR cruciate ligament , *BIOMECHANICS , *HIP joint , *VERTICAL jump - Abstract
Motor coordination and lower limb biomechanics are crucial aspects of anterior cruciate ligament (ACL) injury prevention strategies in football. These two aspects have never been assessed together in real scenarios in the young population. The present study aimed to investigate the influence of motor coordination on lower limb biomechanics in young footballers during an on-the-pitch training. Eighteen juvenile football players (10 y ± 2 m) were enrolled. Each player performed a training drill with sport-specific movements (vertical jump, agility ladders, change of direction) and the Harre circuit test (HCT) to evaluate players' motor coordination. Wearable inertial sensors (MTw Awinda, Xsens) were used to assess lower limb joint angles and accelerations. Based on the results of the HCT, players were divided into poorly coordinated (PC) and well-coordinated (WC) on the basis of the literature benchmark. The PC group showed a stiffer hip biomechanics strategy (up to 40% lower flexion angle, ES = 2.0) and higher internal-external hip rotation and knee valgus (p < 0.05). Significant biomechanical limb asymmetries were found only in the PC group for the knee joint (31–39% difference between dominant and non-dominant limb, ES 1.6–2.3). Poor motor coordination elicited altered hip and knee biomechanics during sport-specific dynamic movements. The monitoring of motor coordination and on-field biomechanics might enhance the targeted trainings for ACL injury prevention. [ABSTRACT FROM AUTHOR]
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- 2021
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9. Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors.
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Di Paolo, Stefano, Lopomo, Nicola Francesco, Della Villa, Francesco, Paolini, Gabriele, Figari, Giulio, Bragonzoni, Laura, Grassi, Alberto, Zaffagnini, Stefano, Aminian, Kamiar, Munoz-Organero, Mario, Capodaglio, Paolo, and Cimolin, Veronica
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ANTERIOR cruciate ligament injuries ,ANTERIOR cruciate ligament ,KINEMATICS ,ANATOMICAL planes ,JOINT injuries ,REHABILITATION technology - Abstract
The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson's correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes. [ABSTRACT FROM AUTHOR]
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- 2021
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10. Objective laxity and subjective outcomes are more influenced by meniscal treatment than anterior cruciate ligament reconstruction technique at minimum2 years of follow-up
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Alberto Grassi, Stefano Di Paolo, Giacomo Dal Fabbro, Osman Nuri Eroglu, Luca Macchiarola, Gian Andrea Lucidi, Stefano Zaffagnini, Grassi, Alberto, Di Paolo, Stefano, Dal Fabbro, Giacomo, Eroglu, Osman Nuri, Macchiarola, Luca, Lucidi, Gian Andrea, and Zaffagnini, Stefano
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Laxity ,Meniscu ,Anterior Cruciate Ligament Reconstruction ,ACL ,Anterior Cruciate Ligament Injurie ,Anterior Cruciate Ligament Injuries ,Pain ,Knee Injuries ,Follow-Up Studie ,Lateral plasty ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Double bundle ,Patient-reported outcome ,Human ,Follow-Up Studies ,Meniscectomy - Abstract
Objective: The purposes of this study were: (1) to compare three different surgical techniques for anterior cruciate ligament (ACL) reconstruction at a minimum 2 years of follow-up in terms of objective laxity and patient-reported outcomes; (2) to inspect the role of meniscal tears and treatment alongside with ACL reconstruction.Methods: 59 patients were randomly assigned to one of the three reconstruction groups according to the ACL reconstruction technique: Double Bundle, Single Bundle, Single Bundle with Lateral Plasty. Autologous hamstring tendons were used in all the ACL reconstruction techniques. Objective laxity tests and KOOS were collected before surgery as a baseline and at a minimum of 2 years of follow-up and compared through a Repeated measure ANOVA. Secondary analysis to evaluate the effect of meniscal treatment on laxity reduction and scores improvement was also conducted using ANOVA. Three laxity evaluations were performed: anterior/posterior displacement at 30 degrees of knee flexion (AP 30), anterior/posterior displacement at 90 degrees of knee flexion (AP 90), and pivot-shift test.Results: Objective laxity and KOOS showed statistically significant improvement at follow-up in all three groups (p < 0.0001) without differences among the techniques. A higher AP 30 (mean difference 2.4 mm, p = 0.0333, ES = 0.66) was found at baseline for the patients with irreparable medial meniscal tear compared to the patients with isolated ACL tear; a statistically significant difference in pain score at two-year follow-up was found between patients who underwent lateral meniscectomy and patients with either meniscal repair (mean difference 6.9 +/- 12.5) or isolated ACL tear (mean difference 6.8 +/- 16.1); patients with reparable meniscal tear had a sta-tistically significant pain score improvement compared to the patients who underwent medial and lateral meniscectomy (mean difference of 9.5 +/- 14.53 and 23.4 +/- 19.2 respectively).Conclusion: Comparable objective laxity and subjective outcomes were found among the three ACL reconstruction techniques at a minimum of 2 years of follow-up. The presence of irreparable medial meniscal tear increased pre-operative laxity (AP 30, mean difference 2.4 +/- 3.6 mm). Patients with meniscal repair presented higher pain relief between baseline and follow-up compared with patients undergoing medial or lateral meniscectomy (mean dif-ference of 9.5 +/- 14.53 and 23.4 +/- 19.2, respectively).
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- 2022
11. The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns
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Pieter D’Hooghe, Alberto Grassi, Francesco Della Villa, Khalid Alkhelaifi, Emmanouil Papakostas, Raouf Rekik, Theodorakys Marin, Filippo Tosarelli, Stefano Zaffagnini, D'Hooghe, Pieter, Grassi, Alberto, Villa, Francesco Della, Alkhelaifi, Khalid, Papakostas, Emmanouil, Rekik, Raouf, Marin, Theodoraky, Tosarelli, Filippo, and Zaffagnini, Stefano
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Pivot-shift ,ACL ,Soccer ,Football ,Video-analysis ,Clinical sciences ,Orthopedics and Sports Medicine ,Surgery ,Bone bruise ,MRI - Abstract
Purpose To analyze the MRI features, in particular bone bruises pattern, of Anterior Cruciate Ligament (ACL) injured footballers, and to correlate them with the characteristics of injury mechanism and situation obtained from direct video footage. Methods Nineteen professional football (soccer) players that sustained ACL injury while playing during an official match of First League Championship were included in the study. The video of injury was obtained from the Television broadcast. Knee Magnetic Resonance (MRI) was obtained within 7 days from the injury. BB and meniscal lesions were analyzed on MRI, while a video-analysis of mechanisms of ACL injury and injury dynamic were assessed from the videos. Results The most commonly involved Bone Bruise areas in the knee were the Posterior Lateral Tibial Plateau (LTp) in 16 cases (84%) and the Central Lateral Femoral Condyle (LFc) in 11 cases (58%). Three patients (16%) had bone bruise in the Posterior Medial Tibial Plateau (MTp) while none (0%) had bone bruise in the Medial Femoral Condyle. Based on the bone bruise pattern, 11 (58%) had simultaneous LFc and LTp and were defined “Typical” while 8 (42%) had other locations or no bone bruise and were defined “Atypical”. 9 out of 11 injuries (82%) of athletes with “Typical” pattern occurred with a “Pivoting” action”, in contrast to only 1 case (12%) in those with “Atypical” bone bruise pattern (p = 0.0055). The most common situational mechanism pattern on video analysis was “pressing” (n = 7) accounting for the 47% of the “indirect” ACL injuries. In terms of movement pattern, ten injuries (52%) occurred during a “Pivoting” movement (7 pressing, 1 dribbling, 1 tackled, 1 goalkeeping), whereas the remaining were classified as “Planting” in four cases, “Direct Blow” in four cases and “Landing”. Conclusion A well-defined and consistent bone bruise pattern involving the posterior tibial plateau and central femoral condyle of lateral compartment is present in footballers that sustained non-contact and indirect ACL injuries during pivoting with sudden change of direction/deceleration, while heterogeneous patterns were present in those with direct contact or injury mechanisms involving high horizontal velocity. Level of evidence Level IV.
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- 2022
12. Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion
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Jeremy M. Burnham, Cécile Batailler, Andrew N Williams, Andrew A. Amis, Philippe Neyret, Stefano Zaffagnini, Steven Claes, Jon Karlsson, Alan Getgood, Volker Musahl, Bertrand Sonnery-Cottet, Musahl, Volker, Getgood, Alan, Neyret, Philippe, Claes, Steven, Burnham, Jeremy M., Batailler, Cecile, Sonnery-Cottet, Bertrand, Williams, Andy, Amis, Andrew, Zaffagnini, Stefano, and Karlsson, Jón
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Anterolateral ligament ,Meniscu ,Knee Joint ,Meniscus (anatomy) ,Anterolateral complex ,0302 clinical medicine ,Medicine and Health Sciences ,Orthopedics and Sports Medicine ,1106 Human Movement And Sports Science ,030222 orthopedics ,Anterior Cruciate Ligament Injurie ,Biomechanics ,Instability ,musculoskeletal system ,Biomechanical Phenomena ,Rotatory ,Dissection ,medicine.anatomical_structure ,Ligaments, Articular ,Anterior cruciate ligament ,Human ,Joint Instability ,medicine.medical_specialty ,Laxity ,Rotation ,Extra-articular tenodesi ,03 medical and health sciences ,Physical medicine and rehabilitation ,Revision acl ,medicine ,Humans ,Meniscus ,Extra-articular tenodesis ,business.industry ,ACL ,Anterior Cruciate Ligament Injuries ,1103 Clinical Sciences ,030229 sport sciences ,Evidence-based medicine ,Alc ,medicine.disease ,ACL injury ,Orthopedics ,Pivot shift ,Orthopedic surgery ,Physical therapy ,Surgery ,Reconstruction ,All ,business ,human activities - Abstract
© 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). Persistent rotatory knee laxity is increasingly recognized as a common finding after anterior cruciate ligament (ACL) reconstruction. While the reasons behind rotator knee laxity are multifactorial, the impact of the anterolateral knee structures is significant. As such, substantial focus has been directed toward better understanding these structures, including their anatomy, biomechanics, in vivo function, injury patterns, and the ideal procedures with which to address any rotatory knee laxity that results from damage to these structures. However, the complexity of lateral knee anatomy, varying dissection techniques, differing specimen preparation methods, inconsistent sectioning techniques in biomechanical studies, and confusing terminology have led to discrepancies in published studies on the topic. Furthermore, anatomical and functional descriptions have varied widely. As such, we have assembled a panel of expert surgeons and scientists to discuss the roles of the anterolateral structures in rotatory knee laxity, the healing potential of these structures, the most appropriate procedures to address rotatory knee laxity, and the indications for these procedures. In this round table discussion, KSSTA Editor-in-Chief Professor Jón Karlsson poses a variety of relevant and timely questions, and experts from around the world provide answers based on their personal experiences, scientific study, and interpretations of the literature. Level of evidence V.
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- 2017
13. Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression
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Christian Candrian, Stefano Zaffagnini, Giuseppe Filardo, Luca Andriolo, Giorgio di Laura Frattura, Francesca Napoli, Filardo, Giuseppe, Andriolo, Luca, Di Laura Frattura, Giorgio, Napoli, Francesca, Zaffagnini, Stefano, and Candrian, Christian
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Cartilage, Articular ,medicine.medical_specialty ,Anterior cruciate ligament ,Contusions ,Knee Injuries ,Bone bruise ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Osteoarthritis ,medicine ,Prevalence ,Humans ,Clinical significance ,Knee ,Orthopedics and Sports Medicine ,Femur ,Prospective Studies ,030222 orthopedics ,Anterior Cruciate Ligament Reconstruction ,Tibia ,business.industry ,Anterior Cruciate Ligament Injuries ,ACL ,Bone contusion ,030229 sport sciences ,medicine.disease ,ACL injury ,Magnetic Resonance Imaging ,Surgery ,Bruise ,medicine.anatomical_structure ,Systematic review ,Orthopedic surgery ,Athletic Injuries ,Ligament ,Disease Progression ,medicine.symptom ,Joint Diseases ,business - Abstract
Purpose: During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. Methods: A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. Results: The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. Conclusion: This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. Levels of evidence: IV, Systematic review of level I–IV studies.
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- 2019
14. Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons Restores Quantitative Pivot Shift
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Alicia Oostdyk, Federico Raggi, Elmar Herbst, Daniel Guenther, Jon Karlsson, Eric Hamrin Senorski, Eleonor Svantesson, Giulio Maria Marcheggiani Muccioli, Yuichi Hoshino, Nicola Lopomo, Neel Desai, Kristian Samuelsson, Kouki Nagamune, David Sundemo, Alberto Grassi, Darren de Sa, Jeremy M. Burnham, Volker Musahl, Jayson Lian, Cecilia Signorelli, Adam Popchak, Andrew J. Sheean, Masahiro Kurosaka, James J. Irrgang, Haukur Bjoernsson, Ryosuke Kuroda, Paulo Amarante de Araújo, Thomas R. Pfeiffer, Mattias Ahldén, Stefano Zaffagnini, Bruno Ohashi, Freddie H. Fu, Clair N. Smith, Zaffagnini, Stefano, Signorelli, Cecilia, Grassi, Alberto, Hoshino, Yuichi, Kuroda, Ryosuke, de SA, Darren, Sundemo, David, Samuelsson, Kristian, Musahl, Volker, Karlsson, Jon, PIVOT Study Group, Marcheggiani Muccioli, Giulio Maria, and Raggi, Federico
- Subjects
Orthodontics ,030222 orthopedics ,inertial sensor ,Anterior cruciate ligament reconstruction ,business.industry ,image-based technique ,medicine.medical_treatment ,Anterior cruciate ligament ,ACL ,Pivot shift ,030229 sport sciences ,inertial sensors ,Article ,03 medical and health sciences ,pivot shift ,quantitative measurement of rotatory knee laxity ,Orthopedics and Sports Medicine ,0302 clinical medicine ,medicine.anatomical_structure ,Medicine ,Hamstring Tendons ,business - Abstract
Background: It is still uncertain how surgical reconstruction of the anterior cruciate ligament (ACL) is able to restore rotatory laxity of the involved joint. The desired amount of restraint applied by the ACL graft, as compared with the healthy knee, has not been fully clarified. Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using hamstring tendons in reducing the pivot-shift phenomenon immediately after surgery under anesthesia. Study Design: Case series; Level of evidence, 4. Methods: An inertial sensor and image analysis were used at 4 international centers to measure tibial acceleration and lateral compartment translation of the knee, respectively. The standardized pivot-shift test was quantified in terms of the side-to-side difference in laxity both preoperatively and postoperatively with the patient under anesthesia. The reduction in both tibial acceleration and lateral compartment translation after surgery and the side-to-side difference were evaluated using the Wilcoxon signed-rank test. Alpha was set at P < .05. Results: A total of 107 patients were recruited for the study, and data were available for 89 patients. There was a statistically significant reduction in quantitative rotatory knee laxity between preoperatively (inertial sensor, 2.55 ± 4.00 m/s2; image analysis, 2.04 ± 2.02 mm) and postoperatively (inertial sensor, –0.54 ± 1.25 m/s2; image analysis, –0.10 ± 1.04 mm) between the involved and healthy joints, as measured by the 2 devices ( P < .001 for both). Postoperatively, both devices detected a lower rotatory laxity value in the involved joint compared with the healthy joint (inertial sensor, 2.45 ± 0.89 vs 2.99 ± 1.10 m/s2, respectively [ P < .001]; image analysis, 0.99 ± 0.83 vs 1.09 ± 0.92 mm, respectively [ P = .38]). Conclusion: The data from this study indicated a significant reduction in the pivot shift when compared side to side. Both the inertial sensor and image analysis used for the quantitative assessment of the pivot-shift test could successfully detect restoration of the pivot shift after anatomic single-bundle ACL reconstruction. Future research will examine how pivot-shift control is maintained over time and correlation of the pivot shift with return to full activity in patients with an ACL injury.
- Published
- 2018
15. After revision anterior cruciate ligament reconstruction, who returns to sport? A systematic review and meta-analysis
- Author
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Giulio Maria Marcheggiani Muccioli, Stefano Della Villa, Alberto Grassi, Maria Pia Neri, Maurilio Marcacci, Stefano Zaffagnini, Grassi, Alberto, Zaffagnini, Stefano, Marcheggiani Muccioli, Giulio Maria, Neri, Maria Pia, Della Villa, Stefano, and Marcacci, Maurilio
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Adult ,Joint Instability ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,Anterior cruciate ligament reconstruction ,Anterior cruciate ligament ,medicine.medical_treatment ,MEDLINE ,Physical Therapy, Sports Therapy and Rehabilitation ,Knee Injuries ,Review ,Young Adult ,medicine ,Humans ,Knee ,Orthopedics and Sports Medicine ,Competitive sport ,Sport ,Rate of return ,Anterior Cruciate Ligament Reconstruction ,business.industry ,Anterior Cruciate Ligament Injuries ,ACL ,General Medicine ,Middle Aged ,Return to Sport ,Treatment Outcome ,medicine.anatomical_structure ,Pooled variance ,Knee laxity ,Meta-analysis ,Athletic Injuries ,Physical therapy ,Female ,business ,human activities - Abstract
BACKGROUND: Return to sport and to pre-injury level represents an important outcome after both primary and revision anterior cruciate ligament (ACL) reconstructions. PURPOSE: The aim of the present meta-analysis was to determine the return to sport rate after revision ACL reconstruction. MATERIAL AND METHODS: A systematic search was performed of the MEDLINE, Embase and the Cochrane Central Register of Controlled Trials Databases. All the studies that reported return to sport, return to pre-injury sport level and return to high level/competitive sport was considered for the meta-analysis. The overall pooled mean of post-operative knee laxity and pooled rate of positive pivot-shift and objective International Knee Documentation Committee (IKDC) categories was calculated as well. RESULTS: Overall, 472 abstracts were identified and screened for inclusion and only 16 studies reported the rate of return to any level of sport activity at the final follow-up of 4.7 years (range 1.0-13.2 years), showing a pooled rate of 85.3% (CI 79.7 to 90.2). The return to pre-injury sport level was achieved in 53.4% (CI 37.8 to 68.7) of cases. Normal or quasi-normal objective IKDC, less than 5 mm of side-to-side difference at arthrometric evaluations and grade I-II pivot-shift test were reported in 84%, 88% and 93% patients, respectively. CONCLUSIONS: In spite of almost 8 patients out of 10 returning to sport after revision ACL reconstruction and showing good stability, only half of the patients returned to the same pre-injury sport level. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
- Published
- 2015
16. Assessment of the pivot shift using inertial sensors
- Author
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Maurilio Marcacci, Cecilia Signorelli, Federico Raggi, Tommaso Bonanzinga, Alberto Grassi, Francisco Urrizola, Stefano Zaffagnini, Han Yue, Zaffagnini, Stefano, Signorelli, Cecilia, Grassi, Alberto, Yue, Han, Raggi, Federico, Urrizola, Francisco, Bonanzinga, Tommaso, and Marcacci, Maurilio
- Subjects
030222 orthopedics ,business.industry ,Anterior cruciate ligament ,ACL ,Pivot shift ,Acceleration ,Clinical grade ,030229 sport sciences ,Kinematics ,Pivot-shift test ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Inertial measurement unit ,Quantification ,ACL Update: Objective Measures on Knee Instability (V Musahl, Section Editor) ,medicine ,Orthopedics and Sports Medicine ,Data mining ,business ,computer ,Simulation - Abstract
The pivot shift test is an important clinical tool used to assess the stability of the knee following an injury to the anterior cruciate ligament (ACL). Previous studies have shown that significant variability exists in the performance and interpretation of this manoeuvre. Accordingly, a variety of techniques aimed at standardizing and quantifying the pivot shift test have been developed. In recent years, inertial sensors have been used to measure the kinematics of the pivot shift. The goal of this study is to present a review of the literature and discuss the principles of inertial sensors and their use in quantifying the pivot shift test.
- Published
- 2016
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