Browsing by Author "Zaffagnini, Stefano"
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Publication Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus(2022) Figueroa, David; Arce, Guillermo; Espregueira, Joao; Maestu, Rodrigo; Mosquera, Manuel; Williams, Andy; Parker, David; Cohen, Moises; Karahan, Mustafa; Ochoa, Germán; Zaffagnini, Stefano; Neyret, Philippe; Karlsson, Jon; Musahl, Volker; Radice, Fernando; Van der Merwe, Willem; Landreau, Philippe; Imhoff, Andreas; Menetrey, Jacques; Ayeni, Olufemi; Arliani, Gustavo; Sherman, Seth; Monllau, Joan; D'Hooghe, Pieter; Pinczewski, Leo; Feller, Julian; Patnaik, SarthaIntroduction: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. Methods: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. Results: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. Conclusions: The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.Publication Simultaneous medial unicompartmental knee replacement and anterior cruciate ligament reconstruction: a narrative review and technical note(2023) Macchiarola, Luca; Espinosa, Maximiliano; Pirone, Massimo; Lucidi, Gian Andrea; Cucurnia, Ilaria; Grassi, Alberto; Marín Fermín, Theodorakys; Zaffagnini, StefanoBackground and Objective: Reconstruction of the anterior cruciate ligament (ACL) simultaneously with medial unicompartmental knee arthroplasty (UKA) has been suggested as an alternative treatment in patients with ACL deficiency and localized osteoarthritis (OA) in young patients. The objectives of this review were to report the current concepts on the topic and describe an original surgical technique of simultaneous medial UKA and ACL reconstruction. Methods: A literature search was performed on PubMed, including articles written in English until June 2021. The articles regarding ACL reconstruction and UKA were reviewed using the narrative approach. Inclusion criteria: (I) original articles about ACL reconstruction and unicompartmental knee replacement; (II) written in English; (III) involving three or more cases. Two non-blinded authors reviewed the titles and abstracts of each article identified in the literature search. Key Content and Findings: The articles regarding ACL reconstruction and UKA were reviewed using the narrative approach. Conclusions: There is controversial evidence about performing the UKA simultaneously with an ACL reconstruction. Biomechanical and clinical studies show that the benefits of restoring good joint stability outweigh the possible risks associated with performing both surgeries at the same time. With this strategy, it is possible to obtain good clinical results with a high survival rate of the implant and patient satisfaction.Item Treatment of Meniscal Deficiency with Meniscal Allograft Transplantation and Femoral Osteotomy in a Patient with History of Lateral Discoid Meniscus(2020) Zaffagnini, Stefano; Espinosa, Maximiliano; Marcacci, Maurilio; Neri, Maria Pia; Grassi, AlbertoCase: A 15-year-old woman with multiple arthroscopic procedures for left lateral discoid meniscus since the age of 9 presented with pain, swelling, and mechanical symptoms. A meniscal allograft transplantation (MAT) and lateral openingwedge femoral osteotomy was performed. At the 6-year follow-up, the patient presented a visual analog scale (VAS) score of 0, subjective International Knee Documentation Committee (IKDC) of 88, and Lysholm of 95. At 15-year follow-up, the VAS score was 0, subjective IKDC 85.1, and Lysholm 86. Conclusions: MAT associated with femoral osteotomy was an effective procedure in this patient with pain and functional limitation after total meniscectomy in the setting of discoid meniscus and valgus malalignment. Good clinical and magnetic resonance imaging-related outcomes were achieved at the intermediate and long-term follow-up.