Biomedical subjects
Publications and source records attributed to N Maffulli.
Three different adhesive and two non-adhesive tapes were used by three operators to assess the compressive action exerted on the ankle at the moment of strapping, during different phases of gait, and after some days of treatment in ten volunteers. Only the adhesive tapes were still able to prevent swelling after five days. They should be used if a prolonged compressive action is required.
A survey of glove perforation in 16 orthopedic surgeons during a 6-month period was carried out. During this time, the surgeons performed 304 elective operations. In 1,398 pairs of gloves tested, evidence of perforation was found in 26 percent.
Twelve patients who had suffered a subcutaneous rupture of the tendo calcaneous underwent real-time ultrasonography using a 5 MHz sectorial probe. The main findings were the disappearance of the path of the tendon, haematoma formation, and alterations of the echogenicity of the Kager's triangle.
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The great upsurge in popularity of running activities has increased the number of athletes presenting with pathology of the Achilles tendon. A clinical and ultrasonic study was performed on 47 middle and long distance runners referred to the Authors with such problems. The results of this study can be grouped as follows: 1. paratendonitis: enlargement of the antero-posterior diameter of the tendon, and hyperechogenicity of Kager's triangle; 2. tendonitis (with or without paratendonitis): thickening of the tendon, with the presence of degenerative nodules; 3. enthesopathy: thickening of the distal part of the tendon, enlargement of the hypoechogenic area behind the tendon itself and microcalcification.
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UNLABELLED: Most injuries in children's sports are minor and self-limiting, suggesting that children and youth sports are safe. A child's skeletal system shows pronounced adaptive changes to intensive sports training. Sports injuries affect both growing bone and soft tissues and could result in damage of the growth mechanisms with subsequent life-lasting damage. During growth there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Epiphyseal injuries are usually due to shearing and avulsion forces, although compression also plays a significant role. Given the remarkable healing potential of bone in youngsters, fractures that initially united with some deformity can completely remodel and appear totally normal in later life. CONCLUSION: As the risk of injuries sustained by young athletes can be significant, it is essential that training programmes take into account their physical and psychological immaturity, so that growing athletes can adjust to their own body changes.
In overuse clinical conditions in and around tendons, frank inflammation is infrequent, and is associated mostly with tendon ruptures. Tendinosis implies tendon degeneration without clinical or histological signs of intratendinous inflammation, and is not necessarily symptomatic. Patients undergoing an operation for Achilles tendinopathy show similar areas of degeneration. When the term tendinitis is used in a clinical context, it does not refer to a specific histopathological entity. However, tendinitis is commonly used for conditions that are truly tendinoses, and this leads athletes and coaches to underestimate the proven chronicity of the condition. Paratenonitis is characterized by acute edema and hypermia of the paratenon, with infiltration of inflammatory cells, possibly with production of a fibrinous exudate that fills the tendon sheath, causing the typical crepitus that can be felt on clinical examination. The term partial tear of a tendon should describe a macroscopically evident subcutaneous partial tear of a tendon, an uncommon acute lesion. Most articles describing the surgical treatment of 'partial tears' of a given tendon in reality deal with degenerative tendinopathies. The combination of pain, swelling, and impaired performance should be labeled tendinopathy. According to the tissues affected, the terms tendinopathy, paratendinopathy, or pantendinopathy should be used.
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In the period 1988 through 1993, 6351 pregnant women were referred to the Department of Obstetrics and Gynaecology, University "La Sapienza", Roma, for suspected fetal anomalies or maternofetal problems. All underwent serial transabdominal and/or transvaginal ultrasound scanning, which revealed a total of 235 fetuses with hydrocephalus, cardiac, or musculoskeletal malformations. Forty-one clubfeet were detected in 27 pregnancies in the early part of the second trimester of pregnancy. Of these, 14 feet in eight patients were isolated, and were classified as idiopathic. A clubfoot was associated with neural tube defects in six patients, with anomalies of the urinary and/or digestive system in a further six, with a cystic hygroma in two, and with other musculoskeletal abnormalities in the other six patients. Amniocentesis revealed an abnormal karyotype in six fetuses (22.2%). In only two cases was oligohydramnios present. In both these patients, a fetal urinary tract malformation was present Polyhydramnios was found in 18 cases, and a normal amount of amniotic fluid was found in the remaining seven cases. Polyhydramnios was present in six of the eight idiopathic clubfoot fetuses. Clubfoot is associated with musculoskeletal and visceral anomalies in a high proportion of cases. The association of clubfoot with polyhydramnios in a high proportion of cases does not support the hypothesis of intrauterine moulding as an etiological factor in its development. Ultrasonographical prenatal detection of a clubfoot should prompt amniocentesis, as the condition is associated with an abnormal karyotype in a significant proportion of cases.
Elite adult athletes are known to have physical and physiological characteristics specifically suited to their sport. However, it is not clear whether the observed adult differences arise because of training or whether the sport selects the individual with the appropriate characteristics. The purpose of this prospective study was to compare and contrast the physical development of young athletes (8-19 years), and in so doing provide a possible response to this question. Development of anthropometric characteristics and sexual maturation were assessed in a group of 232 male athletes for three consecutive years. Parental heights were used to predict target heights. The subjects were a randomly selected group of young British athletes, from four sports: soccer, gymnastics, swimming and tennis. Using a linked longitudinal cohort study design (age cohorts 8, 10, 12, 14 and 16 years) it was possible to estimate a consecutive 11-year development pattern, over the 3-year testing period. The adjusted mean (ANCOVA) height, accounting for age and pubertal status, of male swimmers (161.6 +/- 0.6 cm) was found to be significantly greater (p < 0.01) than gymnasts (150.7 +/- 0.8 cm) and soccer players (158.7 +/- 0.6 cm), and their adjusted mean body mass (51.3 +/- 0.6 kg) significantly greater (p < 0.01) than the other groups. When testicular volumes were compared, it was found that swimmers had significantly larger volumes than gymnasts and tennis players from 14 to 16 years of age (p < 0.05). Gymnasts' growth curve of testis size was characteristic of late maturers, the swimmers' curve was characteristic of early maturers. As all the young athletes started training prior to puberty the observed late sexual maturation of gymnasts and early maturation of swimmers suggests some form of sports-specific selection. Training did not appear to have affected these young athletes' growth and development; rather their continued success in sport appeared to be related to inherited traits.
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Three hundred eighty-three pairs of gloves were tested for punctures after 100 consecutive pediatric orthopaedic operations to assess the rate, site, procedure, and maneuver during which glove puncture accidents took place. Evidence of perforation was found in 14% of the gloves used. Surgeons appear to be significantly more at risk for glove perforation than do other members of the operating team.
We report the long-term follow-up of lesions of the articular surface of the elbow joint in a group of 12 young gymnasts. There was a high incidence of osteochondritic lesions, intraarticular loose bodies, and precocious signs of joint aging. The prognosis of elbow joint articular surface lesions in these athletes is not good, with only one athlete being able to continue high-level activity at maturity.
We report the results of nonoperative and operative management of patellar tendinopathy in 42 athletes with Blazina stage 2 (26 patients) or stage 3 (16 patients) patellar tendinopathy. All patients were initially managed nonoperatively with nonsteroidal antiinflammatory drugs, physical therapy, and a progressive rehabilitation program based on isometric exercises, stretching, and eccentric exercises. After 6 months, 33 patients showed symptomatic improvement and were able to resume their sports. In nine patients with Blazina stage 3 tendinopathy, nonoperative measures failed, and surgery was performed. Operative treatment consisted of removal of the degenerated areas of the tendon, multiple longitudinal tenotomies, and drilling of the lower pole of the patella at the site of tendon attachment. Histologic examination of the excised tendon tissue showed areas of necrosis and mucoid degeneration, and alterations of the bone-tendon junction. After a mean follow-up of 4.8 years, clinical results were excellent or good in all patients. In the group treated nonoperatively, results were better in the patients who had stage 2 tendinopathy than in those with stage 3.
Type I collagen is the main collagen in tendons; type III collagen is present in small amounts. Ruptured Achilles tendons contain a significantly greater proportion of type Ill collagen, which predisposes them to rupture. We used an in vitro model to determine whether tenocytes from Achilles tendons that were ruptured (N = 22), nonruptured (N = 7), tendinopathic (N = 12), and fetal (N = 8) show different behavior. Samples of Achilles tendon were digested with collagenase and the released tenocytes were collected. Primary tenocyte cultures were established and subsequently cultured onto glass coverslips. Once a confluent monolayer was obtained, the cell populations were "wounded" by scraping a pipette tip along the surface. The cultures were further incubated for either 1, 4, 8, 12, 16, or 24 hours, and production of types I and II collagen was assessed by immunostaining. In cultures from ruptured and tendinopathic tendons, there was increased production of type Ill collagen. Athletic participation places excess stress on the Achilles tendon, which could potentially lead to areas of microtrauma within the tendon. These areas may heal by the production of type III collagen, which is an abnormal healing response. Accumulation of such episodes of microtrauma could resuit in a critical point where the resistance of the tissue to tensile forces is compromised and tendon rupture occurs.
We studied biopsies from the Achilles tendons of patients undergoing open repair for a subcutaneous rupture of their Achilles tendons (27 men, 11 women; mean age, 45.3 +/- 13.8 years) and specimens of Achilles tendons from persons with no known tendon ailments (43 men, 3 women; mean age, 64.2 +/- 9.7 years). Histologic examination was performed using stained slides that were interpreted using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, hyalinization, and glycosaminoglycan. We gave up to three marks for each of these variables, with 0 being normal and 3 being maximally abnormal. All the histology slides were assessed twice in a blinded manner; the agreement between two readings ranged from 0.56 to 0.87 (kappa statistics). The score of ruptured tendons was significantly greater than the average score of control tendons (20.5 +/- 3.6 versus 6.5 +/- 2.1), and there was significantly higher degeneration in the ruptured tendons. Nonruptured Achilles tendons, even at an advanced age, and ruptured Achilles tendons are clearly part of two distinct populations. Using these staining techniques, light microscopic degeneration is not a feature of tendons from healthy, older persons.