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Biomedical subjects

Nicola Maffulli

Publications and source records attributed to Nicola Maffulli.

At least 37 records · Page 2Linked to original sources
PubMed2006

Management of recurrent subluxation of the peroneal tendons.

Recurrent peroneal subluxation occurs when an acute injury is misdiagnosed or not adequately managed. The primary pathology is failure of the SPR, the principal restraint to the peroneal tendons. Several surgical techniques have been described. Determining the most effective technique from the small case series and reports in the literature is impossible. If an anatomic approach to treating the pathology is used, reattachment of the SPR, as we have described, seems a most appropriate technique. Rarely, the retinaculum in recurrent cases may not be robust enough to withstand repair, and a different approach to the problem may be required. In the future, there may be an emerging role for minimally invasive SPR repair with the use of endoscopic techniques.

Ankle↗
PubMed2006

Epidemiology of sprains of the lateral ankle ligament complex.

Lateral ankle sprains account for 85% of all ankle sprains. This common injury is most frequently sustained during sporting activity. The ATFL is the weakest of the lateral ankle ligament complex, and is most frequently injured. Ankle sprains are often undertreated, resulting in chronic pain, muscular weakness, and instability. The consequence of this common injury for professional sports clubs is days lost in training and matches missed due to injury as well as the cost of rehabilitation. In the UK, an estimated 302,000 ankle sprains are seen each year in Accident and Emergency Departments.

Athletic Injuries↗
PubMed2006

Conservative management of chronic ankle instability.

Chronic ankle instability is a significant cause of morbidity. There are well-documented and effective surgical options for managing this condition. However, conservative management can be a viable option in selected patients. Failure of conservative management can be an indication for surgery if morbidity warrants it. Surgery can be delayed without necessarily affecting outcome.

Ankle Joint↗
PubMed2006

Anatomic repair for chronic lateral ankle instability.

Symptomatic ankle instability will develop in upto 20% of patients after inversion injury. Although most patients can be successfully managed with rehabilitation and bracing, some will continue to suffer recurrent ankle instability with activities of daily living, work on uneven terrain, or sports. For this group of patients, we advocate direct anatomic surgical repair with the Brostrom procedure with or without its modifications.

Chronic Disease↗
PubMed2006

Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients.

OBJECTIVE: To report the outcome of surgery for chronic recalcitrant Achilles tendinopathy in nonathletic and athletic subjects. DESIGN: Case-control study. SETTING: University teaching hospitals. PATIENTS: We matched each of the 61 nonathletic patients with a diagnosis of tendinopathy of the Achilles tendon with an athletic patient with tendinopathy of the main body of the Achilles tendon of the same sex and age (+/-2 years). A match was possible for 56 patients (23 males and 33 females). Forty-eight nonathletic subjects and 45 athletic subjects agreed to participate. INTERVENTIONS: Open surgery for Achilles tendinopathy. MAIN OUTCOME MEASURE: Outcome of surgery, return to sport, complication rate. RESULTS: Nonathletic patients were shorter and heavier than athletic patients. They had greater body mass index, calf circumference, side-to-side calf circumference differences, and subcutaneous body fat than athletic patients. Of the 48 nonathletic patients, 9 underwent further surgery during the study period, and only 25 reported an excellent or good result. Of the 45 athletic subjects, 4 underwent further surgery during the study period, and 36 reported an excellent or good result. The remaining patients could not return to their normal levels of activity. In all of them, pain significantly interfered with daily activities. CONCLUSIONS: Nonathletic subjects experience more prolonged recovery, more complications, and a greater risk of further surgery than athletic subjects with recalcitrant Achilles tendinopathy.

Achilles Tendon↗
PubMed2006

Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom.

OBJECTIVE: To investigate current practice in the diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg among orthopedic surgeons in the United Kingdom. DESIGN: Questionnaire survey. SETTING: Secondary care (NHS and private). PARTICIPANTS: Two hundred six orthopedic surgeons affiliated with one of the following specialist associations: British Association of Sports and Exercise Medicine (BASEM), United Kingdom Association of Doctors in Sport (UKADIS), British Orthopedic Sports and Trauma Association (BOSTA) and British Orthopedic Foot Surgery Society (BOFSS). INTERVENTIONS: Self-administered questionnaire. MAIN OUTCOME MEASURES: Current practice in diagnosis and treatment of CECS. RESULTS: Sixty percent (124/206) of the surveyed population replied and 53% (66/124) see patients with CECS. To confirm the diagnosis, 83% (55/66) use intra-compartmental pressure measurements (ICPs). Of these, 42% use maximal ICP during exercise greater than 35 mmHg as a criterion for anterior CECS diagnosis and 35% use Pedowitz's modified criteria. Of all the respondents, 88% would be willing to adopt a National Framework document for diagnosis, 30% (20/66) always try conservative treatment following diagnosis, 93% (57/60) perform superficial fasciotomy as the first line surgical procedure, 55% (33/60) use a one incision technique for anterior fasciotomy and 60% (36/60) undertake a repeat fasciotomy following failed decompression. CONCLUSIONS: There is agreement among orthopedic surgeons on the role of ICPs for diagnosis and the choice of fasciotomy as a first-line surgical procedure. In contrast, there is a divergence of opinions regarding the ICP diagnostic thresholds, the role of conservative management and the surgical techniques for fasciotomy and failure of decompression.

Athletic Injuries↗
PubMed2006

Steady-state acid-base response at exercise levels close to maximum lactate steady state.

OBJECTIVE: To study acid-base status during a constant-load treadmill test at exercise levels close to the maximum lactate steady-state. DESIGN: Two tests were performed: one maximal and one steady-state at a load corresponding to the mean of the two ventilatory thresholds observed in the first test. SETTING: University Sports Science Laboratory. PARTICIPANTS: Twenty-three male Sports Science students, aged 26.7 (+/- 4.9 SD) years, 176.1 (+/- 6.3) cm in height, and weighing 72.8 (+/- 6.7) kg. MAIN OUTCOME MEASURES: Capillary blood gases, metabolites, electrolytes. RESULTS: Acid-base status variables declined significantly during the maximal test. Lactate concentrations were above the values observed at onset of blood lactate accumulation. All the blood variables did not vary significantly at the various experimental times, except pH values and PCO2 values. Bicarbonate concentration remained constant. Plasma potassium, chlorine and sodium concentration did not increase. CONCLUSION: During a steady-state test at a load corresponding to approximately 80% of VO2max, the acid-base status in capillary blood remained constant even though the lactate concentration was over 4 mmol/L. However, despite the maintenance of a constant acid-base status, other physiological variables did not behave in the same fashion.

Acid-Base Equilibrium↗
PubMed2006

Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon.

OBJECTIVE: To ascertain whether tendon samples harvested from patients with calcific insertional Achilles tendinopathy showed features of failed healing response, and whether abnormal quantities of type II collagen had been produced in that area by these tenocytes. DESIGN: Comparative laboratory study. DESIGN: University teaching hospitals. PATIENTS: Tendon samples were harvested from eight otherwise healthy male individuals (average age 47.5+/-8.4 years, range 38 to 60) who were operated for calcific insertional Achilles tendinopathy and from nine male patients who died of cardiovascular events (mean age 63.1+/-10.9 years) while in hospital. INTERVENTIONS: Open surgery for calcific insertional Achilles tendinopathy. MAIN OUTCOME MEASURE: Semi-quantitative histochemical, immunohistochemical, and immunocytochemical methods to ascertain whether tendinopathic tendons were morphologically different from control tendons, and whether abnormal types of collagen were produced. RESULTS: Tenocytes from tendons from patients with calcific insertional Achilles tendinopathy exhibit chondral metaplasia, and produce abnormally high quantities of collagen type II and III. CONCLUSIONS: The altered production of collagen may be one reason for the histopathological alterations described in the present study. Areas of calcific insertional Achilles tendinopathy have been subjected to abnormal loads. These tendons may be less resistant to tensile forces. Further studies should investigate why some tendons undergo these changes.

Achilles Tendon↗
PubMed2006

Incidence and distribution of pediatric sport-related injuries.

OBJECTIVE: To provide a critical review of the available literature on the descriptive epidemiology of pediatric sport-related injuries. DATA SOURCES: MEDLINE (1966 to 2006) and SPORTDiscus (1975 to 2006) were searched to identify potentially relevant articles. A combination of medical subject headings and text words was used (epidemiology, children, adolescents, athletic injuries, sports, injury, and injuries). Additional references from the bibliographies of retrieved articles were also reviewed. STUDY SELECTION: Published research reports on the incidence and distribution of injury in children's and youth sports. Specific emphasis was placed on reviewing original studies, which report incidence rates (rate of injuries per unit athlete time). Forty-nine studies were selected for this review. DATA EXTRACTION: Data summarized include incidence of injury relative to who is affected by injury (sport, participation level, gender, and player position), where injury occurs (anatomical and environmental location), when injury occurs (injury onset and chronometry), and injury outcome (injury type, time loss, clinical outcome, and economic cost). DATA SYNTHESIS: There is little epidemiological data on injuries for some pediatric sports. Many of the studies retrieved were characterized by methodological short-comings and study differences that limit interpretation and comparison of findings across studies. Notwithstanding, the studies reviewed are encouraging and injury patterns that should be studied further with more rigorous study designs to confirm original findings and to probe causes of injury and the effectiveness of preventive measures. CONCLUSIONS: Incidence and severity of injury are high in some child and youth sports. This review will assist in targeting the relevant groups and in designing future research on the epidemiology of pediatric sports injuries. Well-designed descriptive and analytical studies are needed to identify the public health impact of pediatric sport injury.

Adolescent↗
PubMed2006

Fracture strain and stability with additional locking screws in intramedullary nailing: a biomechanical study.

BACKGROUND: We studied the effect of additional locking screws on fracture strain and stability in tibial intramedullary nailing. METHODS: We drilled an additional diaphyseal locking hole into 8-mm solid tibial nails 185 mm from the proximal end of the nail, and locked it proximally and distally. An osteotomy was produced 4.5 cm distal to the additional hole, and the construct loaded axially, in flexion, extension, and torsion. The nails were also tested for their fatigue strength. RESULTS: With the additional locking screw, strain increased proximally during loading in neutral and flexion. Strain decreased on loading in extension. The extra locking screw decreased strain close to the osteotomy site in all loading positions. A significant reduction in angular motion at the osteotomy site occurred with the addition of the extra locking screw. The nails survived the fatigue test, although the stress increased around the additional locking hole CONCLUSIONS: Nails with additional locking options, by altering strain and motion at the fracture site, may have the clinical potential to affect fracture healing.

Biomechanical Phenomena↗
PubMed2006

Lack of seasonal variation in idiopathic talipes equinovarus.

BACKGROUND: One proposed etiology of idiopathic talipes equinovarus is an in utero enterovirus infection. Enterovirus infections demonstrate seasonal variation in temperate climates. METHODS: We collected data on 1202 children with idiopathic talipes equinovarus born in the Northeastern United States, Midwestern United States, and the United Kingdom to investigate a seasonal variation in this congenital deformity. Birth date, gestational age at the time of delivery, gender, race, and laterality were tabulated and subjected to univariate and bivariate analyses. RESULTS: There were 774 boys and 428 girls with idiopathic talipes equinovarus. The birth location was the United Kingdom (458 children), the Midwestern United States (426 children), and the Northeastern United States (318 children). No significant differences were detected among the geographic groups with respect to gender, race, or laterality, and no variation in month of birth or month of conception was noted. CONCLUSIONS: This study does not support an in utero enterovirus infection as an etiology of idiopathic talipes equinovarus in industrialized populations.

Clubfoot↗
PubMed2006

Recurrent subluxation of the peroneal tendons.

Recurrent peroneal tendon subluxation is an uncommon sports-related injury. The retrofibular groove is formed not by the concavity of the fibula itself, but by a relatively pronounced ridge of collagenous soft tissue blended with the periosteum that extends along the posterolateral lip of the distal fibula. The shape of the groove is primarily determined by this thick fibrocartilagenous periosteal cushion, and not by the bone itself. The superior peroneal retinaculum is extremely variable in width, thickness and insertional patterns. Peroneal tendon subluxation is commonly associated with longitudinal splits in the peroneus brevis tendon and lateral ankle instability. Disruption of the lateral collateral ankle ligaments places considerable strain on the superior peroneal retinaculum. This explains why the two conditions commonly coexist. In recurrent subluxation, patients usually give a history of previous ankle injury, which may have been misdiagnosed as a sprain. An unstable ankle that gives way or is associated with a popping or snapping sensation is another common complaint. The peroneal tendons may actually be seen subluxing anteriorly on the distal fibula during ambulation. The role of imaging has been debated, and the diagnosis and management plan are based on clinical evidence. Conservative management may be attempted in acute dislocations, and can be successful in up to 50% of patients, although there is a trend for operative management in athletes. Recurrent dislocations should be managed surgically. Five basic categories of repair have been described: (i) anatomical reattachment of the retinaculum; (ii) bone-block procedures; (iii) reinforcement of the superior peroneal retinaculum with local tissue transfers; (iv) rerouting the tendons behind the calcaneofibular ligament; and (v) groove deepening procedures. However, it is impossible to determine from the relatively small series which procedure is superior. If an anatomical approach to treating the pathology is utilised, reattachment of the superior retinaculum seems a most appropriate technique. Randomised controlled trials may be the way forward in determining the best surgical management method. However, the relative rarity of the condition and the large number of techniques described make such study difficult.

Ankle Injuries↗
PubMed2006

Peroneal retinaculoplasty with anchors for peroneal tendon subluxation.

Recurrent subluxation of the peroneal tendons is rare but can produce marked functional impairment in athletes. We describe a technique for the reconstruction of the superior peroneal retinaculum using anchors. This procedure is safe and effective in managing instability.

Ankle Injuries↗