Papers by Alessandro Castagna
Shoulder & Elbow, Apr 29, 2017
Background: Bone-grafting procedures for recurrent shoulder instability produce low recurrence ra... more Background: Bone-grafting procedures for recurrent shoulder instability produce low recurrence rates, although they are associated with complications such as graft non-union. Inadequate screw purchase is considered to play a causative role. However, excessive screw length can endanger neurovascular structures. The present study aimed to investigate how type and length of screws influences construct rigidity in a simplified glenoid model. Methods: Testing was performed on composite polyurethane foam models with material properties and abstract dimensions of a deficient glenoid and an bone graft. Three screw types (cannulated 3.75 mm and 3.5 mm and solid 4.5 mm) secured the graft in a bicortical-bicortical, bicortical-unicortical and unicortical-unicortical configuration. Biomechanical testing consisted of applying axial loads when measuring graft displacement. Results: At 200 N, graft displacement reached 0.74 mm, 0.27 mm and 0.24 mm for the unicortical-unicortical and 0.40 mm, 0.25 mm and 0.24 mm for the unicortical-bicortical configuration of the 3.75 mm, 3.5 mm and 4.5 mm screw types. The 3.75 mm screw incurred significant displacements in the unicortical configurations compared to the bicorticalbicortical method (p < 0.001). Conclusions: The present study demonstrates that common screw types resist physiological shear loads in a bicortical configuration. However, the 3.75 mm screws incurred significant displacements at 200 N in the unicortical configurations. These findings have implications regarding hardware selection for bone-grafting procedures.
Musculoskeletal Surgery, Apr 10, 2010
The study included 100 patients who underwent an arthroscopic rotator cuff repair. All patients s... more The study included 100 patients who underwent an arthroscopic rotator cuff repair. All patients suffered about a rotator cuff tear that was repaired arthroscopically with a suture anchor technique. Immediately postoperatively, patients were randomly allocated to one of two different postoperative physiotherapy regimens: passive self-assisted range of motion exercise (controls: 46 patients) versus passive self-assisted range of motion exercise associated with use of continuous passive motion (CPM) for a total of 2 h per day (experimental group: 54 patients), for 4 weeks. After this time, all the patients of both groups underwent the same physical therapy protocol. An independent examiner assessed the patients at 2.5, 6 and 12 months particularly about pain with the VAS scale (0-10) and the range of motion (ROM). Our findings show that postoperative treatment of an arthroscopic rotator cuff repair with passive self-assisted exercises associated with 2-h CPM a day provides a significant advantage in terms of ROM improvement and pain relief when compared to passive self-assisted exercise alone, at the short-term follow-up. No significant differences between the two groups were observed at 1 year postoperatively.
International Orthopaedics
Journal of Clinical Medicine
Background: The purpose of this study was to evaluate the impact of software updating on measurem... more Background: The purpose of this study was to evaluate the impact of software updating on measurements of the glenoid inclination and version, along with humeral head subluxation performed by an automated 3D planning program. The hypothesis was that the software update could significantly modify the values of the glenoid inclination and version, as well as of the humeral head subluxation. Methods: A comprehensive pool of 76 shoulder computed tomography (CT) scans of patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) were analyzed with the automated program Blueprint in 2018 and again in 2020 after a software update. Results: A statistically significant difference of 8.1 ± 8.2 and 5.4 ± 7.8 (mean difference of −2.8 ± 5.0, p < 0.001) was indeed reached when comparing the mean glenoid inclination achieved with Blueprint 2018 and Blueprint 2020, respectively. The glenoid version, as well as the humeral head subluxation evaluations, w...
BMC Musculoskeletal Disorders
Background Shoulder replacement (SR) constitutes the gold standard treatment for severe shoulder ... more Background Shoulder replacement (SR) constitutes the gold standard treatment for severe shoulder diseases, including osteoarthritis, rheumatoid arthritis, complex fractures, avascular necrosis and rotator cuff arthropathy. Although several countries have national registries, there is a lack of epidemiological data on SR. Sharing national statistics and correlating those to other countries could be helpful to compare outcomes and costs internationally. This paper aims to evaluate the trend of hospitalizations for SR (both first implants and revisions of anatomical and reverse prosthesis) in Italy from 2009 to 2019, based on the National Hospital Discharge Reports (S.D.O) provided by the Italian National Health Service (INHS). Moreover, the economic impact on the healthcare system of SR and SR revisions was assessed, providing a statistical prediction for the next ten years. Methods The data used in this paper were about patients who underwent Total Shoulder Replacement (TSR), Shoulde...
Skeletal Radiology, Apr 5, 2022
The archives of bone and joint surgery, 2019
Background Distal humeral fractures accounts for approximately 2% of all fractures and nearly one... more Background Distal humeral fractures accounts for approximately 2% of all fractures and nearly one-third of humeral fractures in adults. In this regard, Modified Tension Bind Wiring (MTBW) technique was used for the fixation of the distal humeral fractures type A2 and C1 (AO) to evaluate the early movement and complications of the patients. Methods This study was conducted on 25 patients, who were subjected to open reduction and internal fixation using MTBW techniques, to evaluate the incidence of complications. Results The mean age of the participants was 53.7 years. Out of 25 patients, 16 cases had C1 and 6 individuals suffered from A2. The mean tourniquet time was 43 min. The mean union time was 12.24 weeks and the mean duration of the follow-ups was 13.72 months. The mean values for the lack of extension, flexion, and range of motion were 18o, 124o, and 106o, respectively. Wound haematoma and dehiscence were observed in two cases, who were treated after conservative treatment. Du...
Muscle Ligaments and Tendons Journal, 2019
Background. This placebo-controlled, double-blind study evaluated the short-term effects of betam... more Background. This placebo-controlled, double-blind study evaluated the short-term effects of betamethasone valerate (BMV) 2.25mg medicated plaster in patients with chronic lateral elbow tendinopathy (LET). Methods. Adult outpatients with LET and on-movement pain intensity ≥50 mm at a 0-100mm visual analogue scale (VAS) were randomised to receive BMV (N=101) or placebo (N=98), 12 hours/day for 4 weeks. Pain decrease from baseline to Day 28 was the primary endpoint. Other endpoints were: patient-rated tennis elbow evaluation (PRTEE), use of rescue paracetamol, tolerability at the application site. Results. Decrease in mean pain VAS from baseline to Day 28 was significantly higher with BMV vs. placebo: the difference between groups (intent-to-treat) was-8.57 mm (95% CI:-16.19 to-0.95 mm; p=0.028). Higher pain decreases in the BMV group over placebo were reported weekly during each control visit and daily in patients' measurements on diaries. Treatment with BMV also led to higher decreases vs. placebo in PRTEE total, pain and functional disability score. Use of paracetamol was minimal. BMV plaster was well tolerated for general and local adverse events. Conclusions. BMV 2.25mg plaster was superior to placebo and well tolerated in patients with painful chronic LET.
BioMed Research International, 2018
Background. Recurrent shoulder dislocations occur much more frequently in adolescents than in the... more Background. Recurrent shoulder dislocations occur much more frequently in adolescents than in the older population but a clear explanation of this incidence does not exist. The aim of the present study was to define the age-related distribution of the elastic fibers (EFs) in the shoulder capsule’s extracellular matrix as a factor influencing shoulder instability. Materials and Methods. Biopsy specimens were obtained from the shoulder capsule of patients divided preoperatively into three groups: Group 1 consisted of 10 male patients undergoing surgery for unidirectional traumatic anterior instability (TUBS); Group 2 consisted of 10 male patients undergoing surgery for multidirectional instability (MDI); Group 3 represents the control, including 10 patients with no history of instability. In addition to the group as a whole, specific subgroups were analyzed separately on the basis of the age of subjects: > 22 or < to 22 years. All the samples were analyzed by histochemical (Weig...
Orthopedic Reviews, 2019
The aim of the study was to investigate whether subscapularis muscle atrophy is a negative progno... more The aim of the study was to investigate whether subscapularis muscle atrophy is a negative prognostic factor leading to increased risk of retears in patients treated with an arthroscopic subscapularis tendon repair. We hypothesized that fatty infiltration of the subscapularis muscle deteriorates the clinical and sonographic outcome of the arthroscopic repair and inhibits reparability of the ruptured tendons. A double- center, multinational, retrospective, blind (in the follow-up) clinical study regarding 32 patients who underwent an arthroscopic subscapularis repair was conducted. Patients were divided into two groups according to the preoparative fatty infiltration grade of subscapularis muscle (group A: grade
International Journal of Physical Medicine & Rehabilitation, 2018
Purpose: To investigate the diagnostic value of the most commonly used clinical tests in the diag... more Purpose: To investigate the diagnostic value of the most commonly used clinical tests in the diagnosis of subscapularis tendon re-tears after arthroscopic repair. Methods: A retrospective (prospectively collected data) case series involving 37 patients suffering from symptomatic complete subscapularis tendon tear was conducted. All patients underwent an all-arthroscopic subscapularis repair with the same operative technique. They were postoperatively evaluated (final end point of follow-up: 12 months) with the use of ultrasound, Constant score, bear hug test, internal rotation lag sign, Napoleon test and lift-off tests. Sensitivity, specificity, accuracy, and positive and negative prognostic values were calculated for each test. Results: Shoulder function was significantly improved according to the final Constant scores. The internal rotation lag sign was the most sensitive in the diagnosis of postoperative subscapularis retears, while the Napoleon sign had the highest specificity. Although postoperative clinical tests concerning subscapularis retear yielded no false negative findings, they were poorly predictive as for new tendon ruptures. Ten patients (27%), who were found with a positive (for re-rupture), postoperative, clinical test, had a sonographically intact subscapularis tendon repair. Conclusions: We strongly support the use of the subscapularis-specific clinical tests as a composite, in combination with a specific interpretation of their results. If all tests are found negative for retear, then we could safely assume that the arthroscopic repair remains intact and no further diagnostic examination is necessary. On the contrary, if at least one subscapularis-specific clinical test is positive for retear the patient will likely require an ultrasound or MRI for definite diagnosis.
Muscles, ligaments and tendons journal
Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator c... more Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.
La Radiologia medica, 2013
This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct ident... more This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct identification of complex tears of the biceps pulley and their possible correlation with anterosuperior impingement (ASI) development. MR arthrography examinations of 23 athletes with clinical suspicion of ASI were reviewed. All examinations were obtained with a 1.5-T unit (Signa Horizon, GE Healthcare). The shoulders were studied with a dedicated surface coil with the patient's arm in the neutral position and in internal and external rotation. In five patients, images in abduction-external rotation (ABER) were obtained. Within 2 month after MR arthrography, the athletes underwent arthroscopic surgery. MR arthrography images showed a spectrum of tears that, according to the Habermeyer classification, were subdivided into four groups: type 1 in three patients; type 2 in five; type 3 in seven; type 4 in eight. At arthroscopic evaluation, one patient presented type 1 lesion, five type 2, fiv...
Archivio di Ortopedia e Reumatologia, 2011
Abstract Fractures of the proximal humerus may be treated either conservatively or surgically. T... more Abstract Fractures of the proximal humerus may be treated either conservatively or surgically. The Authors discuss every detail of the fracture and the patient and give their own guidelines based on over 250 cases operated on. The surgical approach and the device used should be chosen in accord to classification of the fracture, bone quality and functional level of the patient. When there is an indication for open reduction and internal fixation, locking plates are the best device. The indication for a prosthetic implant is reserved to elder patients with high comminution of the humeral head or to cases of fracture-dislocation related to a high incidence of necrosis of the head.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2006
The Journal of Bone and Joint Surgery. British volume, 2010
Total shoulder replacement is a successful procedure for degenerative or some inflammatory diseas... more Total shoulder replacement is a successful procedure for degenerative or some inflammatory diseases of the shoulder. However, fixation of the glenoid seems to be the main weakness with a high rate of loosening. The results using all-polyethylene components have been better than those using metal-backed components. We describe our experience with 35 consecutive total shoulder replacements using a new metal-backed glenoid component with a mean follow-up of 75.4 months (48 to 154). Our implant differs from others because of its mechanism of fixation. It has a convex metal-backed bone interface and the main stabilising factor is a large hollow central peg. The patients were evaulated with standard radiographs and with the Constant Score, the Simple Shoulder Test and a visual analogue scale. All the scores improved and there was no loosening, no polyethylene-glenoid disassembly and no other implant-related complications. We conclude that a metal-backed glenoid component is a good option ...
Knee Surgery, Sports Traumatology, Arthroscopy, Nov 10, 2006
Long head biceps (LHB) tendon pathologies are becoming increasingly recognized causes of shoulder... more Long head biceps (LHB) tendon pathologies are becoming increasingly recognized causes of shoulder pain in the published literature. Instability of LHB presenting as dislocation or subluxation has been recently recognized as a possible cause of disabling pain or discomfort of the shoulder. A clinical diagnosis of LHB instability is very difficult and often confounding because of association with other shoulder pathologies. However, an early diagnosis of LHB instability is important in order to prevent the evolution of lesions of the biceps pulley until an internal anterosuperior impingement of the shoulder (ASI) and subscapular tear occur. The advent of arthroscopy contributed to enhance understandings. The goal of this article is to describe an arthroscopic sign, the chondral print on the humeral head, associated with a LHB instability, that when present can be very useful to help the surgeon to make the diagnosis of unstable LHB tendon.
Musculoskeletal Surgery, Aug 2, 2017
athletes were able to end the season without any shoulder discomfort. Conclusions The dynamic bra... more athletes were able to end the season without any shoulder discomfort. Conclusions The dynamic brace combined to the rehabilitation protocol represents the solution that allows a quick start of resumption of training while maintaining a stable pain-free shoulder. Level of evidence Level 4.
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Papers by Alessandro Castagna