Investigating the Differential Circulating microRNA Expression in Adolescent Females with Severe Idiopathic Scoliosis: A Proof-of-Concept Observational Clinical Study.

Adolescent Idiopathic Scoliosis (AIS) is the most common form of three-dimensional spinal disorder in adolescents between the ages of 10 and 18 years of age, most commonly diagnosed in young women when severe disease occurs. Patients with AIS are characterized by abnormal skeletal growth and reduced bone mineral density. The etiology of AIS is thought to be multifactorial, involving both environmental and genetic factors, but to date, it is still unknown. Therefore, it is crucial to further investigate the molecular pathogenesis of AIS and to identify biomarkers useful for predicting curve progression. In this perspective, the relative abundance of a panel of microRNAs (miRNAs) was analyzed in the plasma of 20 AIS patients and 10 healthy controls (HC). The data revealed a significant group of circulating miRNAs dysregulated in AIS patients compared to HC. Further bioinformatic analyses evidenced a more restricted expression of some miRNAs exclusively in severe AIS females. These include some members of the miR-30 family, which are considered promising regulators for treating bone diseases. We demonstrated circulating extracellular vesicles (EVs) from severe AIS females contained miR-30 family members and decreased the osteogenic differentiation of mesenchymal stem cells. Proteomic analysis of EVs highlighted the expression of proteins associated with orthopedic disease. This study provides preliminary evidence of a miRNAs signature potentially associated with severe female AIS and suggests the corresponding vesicular component may affect cellular mechanisms crucial in AIS, opening the scenario for in-depth studies on prognostic differences related to gender and grade.

Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series.

PURPOSE: The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. METHODS: We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. RESULTS: The average follow-up was 2.9 years (range 2-3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. CONCLUSIONS: Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw-bone interface and optimizing corrective potential.

Surgical repair for abductor lesion after revision total hip arthroplasty: a systematic review.

BACKGROUND: Abductor mechanism lesions represent a severe complication after revision total hip arthroplasty (rTHA). The resulting abductor insufficiency can cause limping, pain, instability, and a higher rate of failure, thus requiring further revision surgery. In case of severe degeneration and retraction of the abductor mechanism, several different surgical treatments are needed. AIM: To systematically review all studies reporting on surgical treatment of severe abductor lesion after rTHA, focusing on surgical techniques, and clinical and functional results. METHOD: Scientific databases were accessed in December 2018 to identify studies addressing the surgical management of severe abductor disruption after rTHA. The PRISMA guidelines were followed. Data were extracted from the identified articles and summarised. Only data about patients with symptoms of abductor insufficiency after rTHA were included in the database. RESULTS: 9 retrospective studies were included, all being retrospective case series reporting on a total of 92 patients. Several surgical strategies have been described and performed: a repair using a synthetic mesh was reported in 1 study; 2 studies reported on local muscle transfer (gluteus maximus transfer or advancement); vastus lateralis advancement was described in 4 studies while in 2 studies the injury was repaired with the use of an allograft. Overall positive results have been reported in terms of pain reduction, while poor to mild functional scores with persistent limping have often been observed in the postoperative period. CONCLUSIONS: The short follow-up time of the reviewed studies is inadequate to uncover any late dislocation, implant failure or different complications related to abductor mechanism reconstruction.

One-stage release by double surgical approach for neglected congenital vertical talus: results in a series of walking children in Tanzania.

Congenital vertical talus is an uncommon rigid flatfoot deformity present at birth, producing pain and disability if untreated. This study reports results and complications in a series of walking children affected by neglected congenital vertical talus treated by one-stage release through a double surgical approach in a hospital sited in the Tanzanian rural outback. Between 2009 and 2014, nine consecutive congenital vertical talus were observed in five patients (three males and two females) aged between 2 and 4 years. In two children, the deformity was idiopathic, in two it was associated to distal arthrogryposis and in one to Larsen syndrome. The surgical procedure was performed through a posteromedial and a lateral incision and included extensive soft tissue release and reduction of talo-navicular and subtalar joint, pinned with percutaneous Kirschner wires. The talar axis-first metatarsal base angle (TAMBA) was measured preoperatively and at follow-up. Results were summarized using the Adelaar score and the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire. The mean follow-up was 2.6 years (2-4). No major intraoperative complications were observed. The TAMBA passed from 74.4° (range 68-82°) to 20.2° (range 18-24°). No talar osteonecrosis was observed. The results were excellent in three cases, good in five cases and fair in one (Adelaar score). The mean postoperative PODCI score was 48 (range 38-60). None of the patients underwent further surgery. In case of neglected congenital vertical talus and limited health resources, this surgical technique has proved to be a viable option, providing satisfactory results, with low rate of surgical and postsurgical complications.

Acute Presentation of Lumbar Spinal Stenosis Due to Ossified Ligamentum Flavum: The Possible Role of Spondylolisthesis: A Case Report.

CASE: A 64-year-old woman with a history of low back pain, presented with acute gait impairment and lower limbs numbness without any history of trauma. Imaging studies revealed ossification of the ligamentum flavum (OLF) at L4-L5 and concomitant spondylolisthesis. Decompression surgery with en-bloc removal including the laminae, the ossified ligamentum flavum, and the medial facet and posterior stabilization was performed resulting in complete immediate recovery. CONCLUSIONS: This report is the first to describe a case of an acute nontraumatic presentation of OLF associated with spondylolisthesis. OLF pathogenesis in still unknown, although several factors have been considered. According to the literature, operative treatment has demonstrated to be effective.

Wilhelm Schulthess, Pioneer in the Treatment of Spinal Deformities: The Testimony of the Rizzoli Orthopedic Institute.

: Wilhelm Schulthess was a pioneer in the treatment of spinal deformities. The Rizzoli Orthopedic Institute in Bologna, Italy, awarded him in 1911 for his work: "pathology and treatment of spinal deformities". In this paper the Swiss Clinician is remembered through the documentation still preserved at the Rizzoli institute.

Preoperative valgus deformity has twice the risk of failure as compared to varus deformity after total knee arthroplasty.

PURPOSE: The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population. METHODS: The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years. RESULTS: Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%). CONCLUSIONS: Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure. LEVEL OF EVIDENCE: Prognostic study, level III.

Correction to: Surgical correction of double major adolescent idiopathic scoliosis.

Unfortunately, the affiliation of the author group has been incorrectly published in original version. The complete correct affiliation of all authors should read as follows.

Correction to: Triplanar correction of adolescent idiopathic scoliosis by asymmetrically shaped and simultaneously applied rods associated with direct vertebral rotation: clinical and radiological analysis of 36 patients.

Unfortunately, the affiliation of the author group has been incorrectly published in original version. The complete correct affiliation of all authors should read as follows.

Correction to: Spino-pelvic balance and surgical treatment of L5-S1 isthmic spondylolisthesis.

Unfortunately, the affiliation of the author group has been incorrectly published in original version. The complete correct affiliation of all authors should read as follows.

Triplanar correction of adolescent idiopathic scoliosis by asymmetrically shaped and simultaneously applied rods associated with direct vertebral rotation: clinical and radiological analysis of 36 patients.

PURPOSE: Aim of this study was to investigate the effectiveness of a new surgical corrective manoeuvre for adolescent idiopathic scoliosis (AIS) by asymmetrically shaped and simultaneously applied rods and in combination with direct vertebral rotation, to control both the triplanar deformity and the kyphosis apex location. METHODS: We retrospectively reviewed 36 patients who undergo surgical treatment using simultaneous translation on two differently contoured rods, in combination with direct vertebral rotation. Patients were divided into three main groups according to the scoliotic curve type. RESULTS: The average follow-up was 1.8 years (range 1-3 years). Mean thoracic Cobb angle decreased from 64.6° to 17.0 (p < 0.05). Mean lumbar Cobb angle decreased from 54.9 to 13°. T5-T12 kyphosis values improved from 16.2 to 22.8° (p < 0.05). Apical vertebral rotation decreased from 25.3 to 9.7°. Mean total SRS-22 score values improved from 2.3 on pre-operative to 3.8 at the last available follow-up. Two major and two minor perioperative complications were recorded. Nor deformity progression or screw pull-out or non-union was recorded at the last available follow-up. CONCLUSIONS: The corrective manoeuvre using two differently contoured rods simultaneously in combination with direct vertebral rotation can provide a good triplanar deformity correction and improve patient's quality of life and self-image perception in mild-to-moderate AIS. Moreover, the described technique allows the positioning of the desired kyphosis apex at a different level from the scoliosis apex. This procedure allows a better sagittal contour restoration while maintaining a comparable amount of correction on the frontal and axial plane of the already available techniques. These slides can be retrieved under Electronic Supplementary Material.

Patient-perceived outcomes after subtalar arthroereisis with bioabsorbable implants for flexible flatfoot in growing age: a 4-year follow-up study.

PURPOSE: Results of subtalar arthroereisis in flexible flatfoot have been mainly reported in the literature using clinical or radiographical findings. However, the aim of this study is to evaluate the patient-perceived quality of life using self-reported questionnaires after subtalar arthroereisis using a bioabsorbable implant. METHODS: Italian modified FFI and the SEFAS scores were submitted to a consecutive series of 173 patients who underwent surgical treatment for flatfoot deformity using a bioabsorbable endo-orthotic implant. Postoperative complication rates were assessed. Time needed to resume normal sports activities was recorded. RESULTS: Mean population age was 11.2 years with slight variability between males and females. At a mean follow-up of 4 years, arthroereisis with bioabsorbable implants showed excellent results for the perception of the quality of life with an average result for FFI score of 4.5 and an average SEFAS score of 47.19. Time needed to resume sport activities was 4.7 months ± 0.2 with almost no difference between the groups. Four patients needed a second procedure for implant removal. CONCLUSION: Arthroereisis using a bioabsorbable implant offers good results in terms of satisfaction and quality of life with a negligible rate of failures and patient complaints based on self-reported questionnaires. The patient reported high degrees of satisfaction, and their quality of life was not compromised at all by the procedure.

Surgical treatment of stage II posterior tibialis tendon dysfunction: ten-year clinical and radiographic results.

INTRODUCTION: Grade II chronic tibialis posterior tendon dysfunction (PTTD) poses a reconstructive challenge to the orthopaedic surgeon. Aim of this retrospective study is to report the clinical and radiographical results of a case series of 63 patients (102 ft) affected by grade II PTTD who underwent tailored surgical treatment at 10-year mean follow-up. MATERIALS AND METHODS: Sixty-three patients (102 ft) were available for clinical and radiological evaluation and were retrospectively reviewed at a mean follow-up of 125.1 ± 14.9 months. Tibialis posterior (PTT) treatment was based on the pathological anatomy of the degenerated tendon. PTT repair was performed in 53 cases. Flexor digitorum longus transfer was performed in the remaining 49. Associated procedures were represented by medial displacement calcaneal osteotomy (MDCO) and lateral column lengthening (LCL) depending on the main clinical feature of the foot (hindfoot valgus and forefoot abduction, respectively). Patients' evaluation included AOFAS score and radiographic examination with measure of lateral talus-first metatarsal angle (LTFMA) and talo-navicular coverage angle (TNCA). RESULTS WE OBSERVED FOUR FAILURES: AOFAS hindfoot score was 89 ± 10 points at final follow-up. Eighty-six per cent of the patients declared to be satisfied or satisfied with minor reservations. An overall statistical significant decrease was observed in both LTFMA and TNCA values. A better TNCA correction was observed in case of associated LCL with respect to MDCO. DISCUSSION: Tailored PTT treatment associated with MDCO or LCL seems provide long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction.

Two-stage surgical treatment for septic non-union of the forearm.

AIM: To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union. METHODS: Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years (19-57 years) and a mean follow-up of 6 years (2-10 years). All patients presented an atrophic non-union with a mean length of the bone defect of 1.8 cm (1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS: Mean time to resolution of the infectious process was 8.2 wk (range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo (range 2-10 mo) after the second step surgery. Cultures on intraoperative samples were positive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5 (27.8%) patients, satisfactory in 10 (55.5%) and unsatisfactory in 3 (16.7%) patients. No activities of daily living (ADLs) limitations were reported by 12 (66.6%) patients, slight by 3 (16.6%) and severe limitation by 3 (16.6%) patients. Mean visual analog scale at the last follow-up was 1 (0-3). CONCLUSION: The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good functional results and low rate of complications.