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25. Meniscus Biomechanics

Author

Grassi, Alberto, Dal Fabbro, Giacomo, Di Paolo, Stefano, Lucidi, Gian Andrea, Macchiarola, Luca, Al-Khelaifi, Khalid, Zaffagnini, Stefano, Koh, Jason, editor, Zaffagnini, Stefano, editor, Kuroda, Ryosuke, editor, Longo, Umile Giuseppe, editor, and Amirouche, Farid, editor

Published
2021
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26. Clinical Outcomes of Medial Meniscal Allograft Transplantation With or Without High Tibial Osteotomy: A Case-Control Study Up to 8 Years of Follow-up.

Author

Grassi, Alberto, Lucidi, Gian Andrea, Di Paolo, Stefano, Altovino, Emanuele, Agostinone, Piero, Dal Fabbro, Giacomo, Romandini, Iacopo, Filardo, Giuseppe, and Zaffagnini, Stefano

Subjects
*MENISCUS surgery, *MENISCUS (Anatomy), *QUESTIONNAIRES, *HOMOGRAFTS, *TREATMENT effectiveness, *DESCRIPTIVE statistics, *OSTEOTOMY, *LONGITUDINAL method, *KAPLAN-Meier estimator, *CASE-control method, *REOPERATION, *DATA analysis software, *TREATMENT failure
Abstract

Background: Satisfactory clinical results of meniscal allograft transplantation (MAT) have been reported in recent years. However, it remains unclear whether the clinical outcomes of MAT when combined with an osteotomy are inferior to those of isolated MAT. Purpose: To compare the survival rates and clinical outcomes of patients who received isolated medial MAT with those of patients undergoing medial MAT combined with high tibial osteotomy (HTO). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients underwent arthroscopic medial MAT using the soft tissue technique and HTO (mean age, 41.3 ± 10.4 years; 9 female); after fuzzy case-control matching on demographics, 55 controls who underwent isolated medial MAT were also included. Survival analyses were performed using the Kaplan-Meier method with surgical failure, clinical failure (Lysholm score, <65), and reoperation as endpoints. Subjective clinical scores were collected preoperatively and at the final follow-up. Results: The mean follow-up time was 5.4 years, up to 8 years. All outcomes significantly improved at the last follow-up (P <.001). No differences were identified between MAT and MAT + HTO groups preoperatively and at the last follow-up (P >.05). At the final follow-up, 8 of 55 (14.5%) of the MAT + HTO patients and 9 of 55 (16.4%) of the MAT patients had a Lysholm score <65 (P =.885). Overall, 90% of the patients declared they would repeat the surgery regardless of the combined procedure. Surgical failure was identified in 6 of 110 (5.5%) patients: 5 of 55 (9.1%) in the MAT + HTO group and 1 of 55 (1.8%) in the MAT group (P =.093). Clinical failure was identified in 19 of 110 (17.3%) patients: 11 of 55 (20%) in the MAT + HTO group and 8 of 55 (14.5%) in the MAT group (P =.447). A significantly lower survivorship from surgical failure was identified in the MAT + HTO group (hazard ratio, 5.1; P =.049), while no differences in survivorship from reoperation and clinical failure were identified (P >.05). Conclusion: Patients undergoing medial MAT + HTO showed similar clinical results to patients undergoing isolated medial MAT at midterm follow-up, and thus a surgically addressed malalignment does not represent a contraindication for medial MAT. However, the need for a concomitant HTO is associated with a slightly higher failure rate over time. [ABSTRACT FROM AUTHOR]

Published
2024
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28. A Lateral Extra-articular Procedure Reduces the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Surgery Without Increasing Complications: A Systematic Review and Meta-analysis

Author

Grassi, Alberto, primary, Olivieri Huerta, Rodrigo A., additional, Lucidi, Gian Andrea, additional, Agostinone, Piero, additional, Dal Fabbro, Giacomo, additional, Pagano, Anna, additional, Tischer, Thomas, additional, and Zaffagnini, Stefano, additional

Published
2024
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38. Editorial Commentary: The Number One Cause of Anterior Cruciate Ligament Reconstruction Graft Failure Is a Misplaced Femoral Tunnel: Over-the-Top Technique Plus Lateral Extra-Articular Tenodesis Is Recommended.

Author

Lucidi, Gian Andrea, Roberti di Sarsina, Tommaso, and Zaffagnini, Stefano

Abstract

Patient factors (notably high tibial slope and narrow femoral intercondylar notch width) and surgical factors (including meniscus treatment and anterior cruciate ligament [ACL] tunnel position) contribute to ACL reconstruction failure. The number one cause of failure is a misplaced ACL femoral tunnel. Tunnel malposition leads to a higher incidence of postoperative meniscal lesions, inferior clinical outcomes, and higher revision rates. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Increasing the posterior tibial slope lowers in situ forces in the native ACL primarily at deep flexion angles.

Author

Winkler, Philipp W., Chan, Calvin K., Lucidi, Gian Andrea, Polamalu, Sene K., Wagala, Nyaluma N., Hughes, Jonathan D., Debski, Richard E., and Musahl, Volker

Subjects
ANTERIOR cruciate ligament, COMPRESSION loads, AXIAL loads, POSTEROLATERAL corner, KINEMATICS, ARTICULAR ligaments, ANGLES
Abstract

High tibial osteotomy is becoming increasingly popular but can be associated with unintentional posterior tibial slope (PTS) increase and subsequent anterior cruciate ligament (ACL) degeneration. This study quantified the effect of increasing PTS on knee kinematics and in situ forces in the native ACL. A robotic testing system was used to apply external loads from full extension to 90° flexion to seven human cadaveric knees: (1) 200 N axial compressive load, (2) 5 Nm internal tibial + 10 Nm valgus torque, and (3) 5 Nm external tibial + 10 Nm varus torque. Kinematics and in situ forces in the ACL were acquired for the native and increased PTS state. Increasing PTS resulted in increased anterior tibial translation at 30° (1.8 mm), 60° (1.7 mm), and 90° (0.9 mm) flexion and reduced in situ force in the ACL at 30° (57.6%), 60° (69.8%), and 90° (75.0%) flexion in response to 200 N axial compressive load. In response to 5 Nm internal tibial + 10 Nm valgus torque, there was significantly less (39.0%) in situ force in the ACL at 90° flexion in the increased compared with the native PTS state. Significantly less in situ force in the ACL at 60° (62.8%) and 90° (67.0%) flexion was observed in the increased compared with the native PTS state in response to 5 Nm external tibial + 10 Nm varus torque. Increasing PTS affects knee kinematics and results in a reduction of in situ forces in the native ACL during compressive and rotatory loads at flexion angles exceeding 30°. In a controlled laboratory setting PTS increase unloads the ACL, affecting its natural function. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System

Author

Zaffagnini, Stefano, primary, Dal Fabbro, Giacomo, additional, Belvedere, Claudio, additional, Leardini, Alberto, additional, Caravelli, Silvio, additional, Lucidi, Gian Andrea, additional, Agostinone, Piero, additional, Mosca, Massimiliano, additional, Neri, Maria Pia, additional, and Grassi, Alberto, additional

Published
2022
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