[Function recovery in patients with knee arthroplasty: role of proprioceptive rehabilitation]. / Il recupero funzionale del ginocchio artroprotesizzato: ruolo dell'allenamento propriocettivo.

This study evaluates the outcome of proprioceptive rehabilitation in 18 patients who underwent knee joint prosthetic replacement using the dynamic electronic plate Pro-kin_machine. The proprioceptive performance was determined by having the patients trace a set of three outlines (horizontal, vertical and circular) using the foot of the operated limb. The measures of outcome parameters were: 1) time taken to do the test; 2) score of accuracy of the test measured in percentage. Tests were performed on admission, half way through rehabilitation and on discharge. Each patient had 15 sittings of physiotherapy. Our results demonstrate a significant improvement of both parameters at the end of the treatment. After prosthetic knee joint replacement, not only is it important to re-establish mechanical stability but also dynamic stability. The latter can be achieved through active virtual taping by the stabilizer muscles. Prompt management of instability of the joint in the rehabilitation phase is extremely important in the re-activating of the control mechanisms that are compromised by the surgical operation.

[Changes in phospho-calcium metabolic factors in function of the rate of bone turnover. Epidemiologic study of osteoporosis (part 2)]. / Variazioni di fattori del metabolismo fosfo-calcico in funzione della velocità di turnover osseo. Studio epidemiologico sull osteoporosi (parte seconda).

BACKGROUND: The recent development of highly accurate and precise osseous mass quantitative evaluation methodology, permits the conduction, in the sphere of osteoporosis, of epidemiologic investigations no longer limited solely to fracture complications, but also based on the definition of osseous mass. Fractures being only complications, possible but not certain, of the advanced stages of the disease, the studies based on their incidence allow one to underestimate the global entity of prevalence and incidence, besides building only a partially useful reference in view of primary and secondary prevention. METHODS: The main points of our study are the following: 1) evaluation of the incidence of the primary risk factors for osteoporosis as they appear in the literature, on the bone mass values of examined subjects, utilizing static mineralometric data as a reference standard; 2) study of biohumoral data relative to phospho-calcium metabolism and to sexual function, to show the possibility of their use as early identifying markers of subjects at risk; reference values represented by dynamic mineralometric data. The principal conclusions that emerged in the course of the study are the following. RESULTS: In relation to the use of phospho-calcium metabolic biohumoral and hormonal variables, as a predictive function on the variations of bone turnover, the variables; osteocalcin, alkaline phosphatase, alkaline phosphatase bone isoenzyme, hydroxyprolinuria/ creatininuria, have resulted significantly different in the comparison between high and low turnover subjects. The degree of quantitative correlation of such variables with the entity of percentage decrement of bone mass has been modest. The overall value of R-square of the predictive model, besides the variables mentioned the value of bone mass at 1 degree control visit, was 0.38 (osteocalcin: 0.27; osteocalcin+hydroxyprolinuria/ creatininuria: 0.33; preceding variables+bone mass at 1st control: 0.36; preceding variables+alkaline phosphatase: 0.37; preceding variables+alkaline phosphatase bone isoenzyme: 0.38). CONCLUSIONS: The single value osteocalcin may furnish indications on the future variations of bone turnover and consequently on the early identification of the subjects at risk for osteoporosis at high turnover; the addition of the other variables indicated in our predictive model allows an increase of the possibilities of individualizing of these subjects.

[Correlation between risk factors and bone mass in pre- and postmenopause. Epidemiologic study on osteoporosis (Part one)]. / Correlazioni fra fattori di rischio e massa ossea in periodo pre- e post-menopausale. Studio epidemiologico sull'osteoporosi (Parte prima).

The recent development of highly accurate and precise osseous mass quantitative evaluation methodology, permits the conduction, in the sphere of osteoporosis, of epidemiologic investigations no longer limited solely to fracture complications but also based on the definition of osseous mass. Fractures being only complications, possible but not certain, of the advanced stages of the diseases, the studies based on their incidence allow one to underestimate the global entity of prevalence and incidence, besides building only a partially useful reference in view of primary and secondary prevention. The main points of our study are the following: 1) evaluation of the incidence of the primary risk factors for osteoporosis as they appear in the literature, on the bone mass values of examined subjects, utilizing tatic mineralometric data as a reference standard; 2) study of biohumoral data relative to phospho-calcium metabolism and to sexual function, to show the possibility of their use as early identifying markers of subjects at risk; references values represented by dynamic mineralometric data. The principal conclusions that emerged int he course of the study are the following. In regard to the evaluation of the principal risk factors, they prove to be correlated to the osseous mass values registered at the first control: physical activity (highly positive action). Favorable levels of correlation were also discovered for the variables of increased body weight (positive action) and increased age (negative action). In multivariate analysis, the R-square value (index of the variation fraction of osseous mass values due to the risk factors) has reached a total value of 0.65 (physical) activity: 0.46; physical activity + dietary calcium: 0.55; history + increased age: 0.58; history + smoking: 0.62; history + increased weight: 0.64; history + pre- or post-menopausal: (0.65). Such analysis furnishes useful indications on the modalities to employ in the anamnestic framing of the patients at risk for osteoporosis, and on the importance attributable to single risk factors.

[Chronic chondromalacia of the patella: comparison of morphological (magnetic resonance) and functional findings (isokinetic parameters) after rehabilitation]. / Sofferenze condrali rotulee croniche: confronto fra dati morfologici (Risonanza Magnetica) e funzionali (parametri isocinetici) dopo rieducazione.

The knee is a common site for injuries of the cartilage, capsule and ligament, which calls for the use of noninvasive techniques to assess injury severity properly and to plan adequate rehabilitation. Our study was aimed at comparing MR with isokinetic findings. To this purpose, 40 patients were examined; they were all affected with chondromalacia patellae, grades I-III, previously diagnosed at arthroscopy. Namely, 8 patients had grade I and 32 grades II and III chondromalacia. After MR and isokinetic exams, all patients were submitted to a standardized rehabilitation program. Our results indicate a marked decrease in quadriceps strength, especially in the most severe cases; in less severe cases, recovery was complete at 6 months, while the deficit remained in grades II and III injuries. MR yield was not relevant in 4 of 8 cases, while isokinetic findings were negative in one case. Both methods were positive in the most severe cases. At 6 months, both functional and MR findings were normal in grade I injuries, while some alterations remained in the others.

[Isokinetic evaluation and gait study in patients undergoing arthroplasty of the knee: verification of the efficacy of rehabilitation]. / Valutazione isocinetica e studio del passo in pazienti sottoposti ad artroprotesi di ginocchio: verifica di efficacia riabilitativa.

In this work the Authors have studied the efficacy of a standardized rehabilitative trial in patients with knee arthroplasty using an isokinetic technique and walking evaluation. 20 patients affected by gonarthrosis were evaluated: each of them underwent on one side an isokinetic evaluation before and 60 days after surgery, and on the other side a step evaluation, at the begin of limb charging and 60 days after surgery. The isokinetic parameters (strength, work, power) showed a sharp decrease of absolute values as compared to the preoperative situation, while in the walking evaluation the time reduction still remains in the first impact of the foot.

[Control of muscle reinforcement with the isokinetic endurance test in patients undergoing reconstruction of the anterior cruciate ligament of the knee]. / Controllo del rinforzo muscolare con il test di endurance isocinetico in pazienti sottoposti a ricostruzione di legamento crociato anteriore di ginocchio.

In the present study authors analyzed a group of fifty patients (mean age 24.3 years) affected by a chronic lesion of the anterior cruciate ligament of the knee, who underwent a ACL reconstruction by free patellar tendon in arthroscopy. Each of these patients carried out a standardized rehabilitative training and underwent an isokinetic evaluation immediately before and at 3, 4 and 6 months after ACL reconstruction. The considered parameters were the increasing of both strength and work in the standardized times at the angular speed of 60 and 180 degrees/sec. Our results, compared to the pre surgery, showed a high decrease of both strength and work at the third month after surgery, especially regarding the extensor muscles (-44% and -38% respectively); we observed an increase between the third and the fourth month, even if the parameters of the extensors still remain much lower than the controlateral healthy side.

[Medium- and long-term effects of various treatment schedules with nasal S-calcitonin spray]. / Effetti a medio e lungo termine di diversi schemi di trattamento con S-calcitonina spray nasale.

188 patients with high-turnover type post-menopausal osteoporosis were treated for 18 months with 4 different treatment regimens of S-calcitonin nasal spray. For a total of 18 months group 1 was given 100 IU/day, continuously; group 2, 100 IU/day daily for 30 days every other month ("ciclically"); group 3, 200 IU/day continuously, and group 4, 200 IU/day, ciclically. To monitor the effects of treatment, MOC of L2-L4, as well as serum osteocalcin and urinary hydroxyproline: creatinine levels were measured, on initiation of therapy, then at 9, 12 and 18 months, and finally at 6 and 12 months after completion of therapy. Analysis of the results yields the following major points: (A) The peak increase in bone mass occurs at 9 months the continuous therapy groups, and at 18 months in the cyclic therapy groups. In absolute values, the peak are higher in the continuous groups than in the cyclic groups. (B) The long-term increase in bone mass (measured at one year after completion of therapy) does not differ significantly between cyclic and continuous treatment groups at the same dosage. (C) During treatment, a dose-effect relationship exist when comparing dosages of 100 IU/day and 200 IU/day. However, this disappears by one year after completion of therapy. (D) There seems to be a "rebound effect" on osseous turnover after cessation of S-calcitonin therapy. The magnitude and rapidity of onset of this effect appear to correlate directly with the dosage of S-calcitonin administered.