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Glossary

Anterior drawer test

It is performed when an anterior cruciate ligament (ACL) injury is suspected. In this case, the patient is placed supine (lying down with the head and the torso facing up), with the hip flexed at 45° and the knee at 90°. The orthopedist blocks the foot and pulls the tibia anteriorly just below the tibial plateau. In case of injury, it will cause a forward displacement of the proximal epiphysis of the tibia with a well perceptible click. This test is mainly used in the case of lesions no longer in the acute phase, in which the swelling has resolved.

Arthroscope

It is a fiberoptic device connected to a high-resolution camera that allows the observation of the joint, amplifying diagnostic capabilities and accuracy of execution.

Arthroscopy

Arthroscopy is a minimally invasive procedure without making a large incision through the skin and other soft tissues. It is a direct inspection of the knee through two small incisions – about 1 cm in diameter each – at the front of the knee and on the sides of the patellar tendon. It is a surgical procedure used for the treatment of pathologies affecting the joints and which is evaluated based on the type of injury, the age of the patient and the functionality requirements/level of activity necessary.

Autologous Chondrocyte Implantation (ACI)

Also known as the ACI technique, it is a technique that takes the patient’s healthy cartilage cells arthroscopically which are treated and then cultured in the laboratory over a period of 3 to 5 weeks. After this step, the new cells are implanted into the patient via arthrotomy. The ACI technique is usually recommended for younger patients who have single defects larger than 2 cm.

Axial deviations

Axial deviations affecting the lower limbs are mainly recognized in the varus knee (where the knees are bent inwards) and the valgus knee (where the knees are bent outwards), can have different degrees and can be related to the femur, the tibia or both bones.

CT Lionese

This examination, identical to Computed Tomography Scan (CT Scan), involves the creation of images obtained on the axial plane that passes through the femoral heads, the condyles at the height of the patella, on the tibial plates and on the surface of the ankles, following a specific protocol called Lionese. It allows the analysis of any rotational defects of the lower limbs, trochlear dysplasia, alterations of any parameters that may increase the risk of patellar dislocation or patellar maltracking.

Computed Tomography Scan (CT Scan)

Also commonly called computed axial tomography (CAT Scan), it is a diagnostic procedure that consists of a digital examination of the human body analyzed section by section. Using X-rays, three-dimensional images are processed through a computerized system. It is used to examine those areas of the body that are difficult to observe with other methods. CT with contrast is used for the study of neoplastic, neurological, cardiovascular, musculoskeletal and orthopedic pathologies.

Deep Vein Thrombosis (DVT)

DVT can occur in the large veins of the lower limbs due to the formation of blood clots (thrombus) within them. One consequence is pulmonary embolism (blood clot in the lung), which is extremely rare and it is even more rare to be fatal.

Dysplasia

Dysplasia is a general term to describe abnormal cells within a tissue or organ. The difference from normal cells could be qualitative, morphological and sometimes quantitative. In other words, the differences in structure, shape and quantity. Unlike cancer, affected cells can return to their original shape if the cause is eliminated. There are three types of dysplasia, classified as mild, moderate and severe based on the number of altered cells.

Ehlers-Danlos syndrome (EDS)

Usually abbreviated as EDS, it encompasses an inherited group of diseases of the connective tissue – the system that provides support to the body. This group of diseases come in six different types, all of which share defects in collagen production. The consequence is excessive joint laxity, skin hypersensitivity and abnormal scars formation on the skin caused by fragile tissues.

Gout

Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It is an acute inflammatory disease due to the high levels of uric acid crystals in the blood resulting in joint pain, redness and swelling. The most often affected joint is the metatarsal phalangeal of the big toe, but uric acid can settle in other places and tissues generating tophi — swellings of uric acid.

Hemochromatosis

It belongs to a group of hereditary diseases and is determined by a defect in the iron regulation mechanisms, i.e. this happens when too much iron is built up in the body. If accumulated too much, it might have serious consequences affecting other organs.

Hyaluronic acid

A type of thick fluid similar to gel that is injected into the joints with the aim of lubricating them. This method may help the patient to reduce painful symptoms and regain movement. There are different types and are chosen on the basis of the pathology afflicting the patient.

Jerk Test

This test (also called “pivot-shift”) reproduces the abnormal movement that a knee does in the absence of the anterior cruciate ligament (ACL), demonstrating rotational instability of the knee. In this case, the test is obviously positive and pathognomonic of a complete lesion of the ACL.

Juvenile idiopathic arthritis (JIA)

Also known as juvenile rheumatoid arthritis or chronic juvenile arthritis, it is a group of inflammatory pediatric diseases caused by inflammation of the joints.

Mesenchymal cells (MSCs)

Mesenchymal cells are adult stem cells, defined with the acronym MSCs (Mesenchymal Stem Cells), are used in regenerative medicine and are cells capable of reproducing different types of skeletal tissue cells, such as cartilage, bone and fat. They are therefore used in the treatment of bones and cartilages.

Lachmann test

This test is performed when an anterior cruciate ligament (ACL) injury is suspected. The patient is placed in the supine position, with the knee in flexion between 15° and 30°. A hand is placed on the femur or lower thigh to stabilise it and the other hand is below the tibia just after the knee, to pull it forward. The injury is evident if the tibia moves beyond its normal range without resistance.

Lesion of the Anterior cruciate ligament (ACL)

The injury of this ligament (or ACL) is one of the most frequent and is due to twisting movements on the vertical axis with anterior dislocation of the knee or excessive extension. The most frequent trauma is when the knee is rotated outwards with a lot of stress while the foot is fixed to the ground (an injury that often also affects the medial-lateral ligament). The ACL, once injured does not regenerate. Rather, it degenerates. The medical procedure, in this case, is surgical for athletes and for people under 40 and is performed under arthroscopy. After the operation, a physiotherapy program is required. Strenuous activities can be resumed after about 6-9 months.

Lesion of the Lateral collateral ligament

The lateral collateral ligament (LCL) is the knee ligament located on the outside of the knee. This is one of the rarest injuries since the LCL is very elastic and protected by the presence of secondary stabilizers on the outside of the knee. The causes of this injury are traumas of the varus, i.e, outwards, and from the rotation of the knee.

Lesion of the Medial collateral ligament (MCL)

The medial collateral ligament (or MCL) is the ligament of the knee located on the inner side, it can be injured or broken when the leg is pushed inwards with an abnormal movement. For this type of injury, both conservative and surgical treatment can be chosen, depending on the extent of the damage. The MCL is able to regenerate itself spontaneously since it is very innervated and vascularized.

Lesion of the Posterior cruciate ligament (PCL)

The injury of this ligament (or PCL) is quite rare when compared to that of its anterior counterpart, and is mainly caused by sports injuries or car accidents. Symptoms are similar to those of anterior cruciate injury, so nuclear magnetic resonance imaging (MRI) is required for an accurate diagnosis. Arthroscopy would be the recommended surgical therapy but requires a considerable effort in rehabilitation.

Marfan syndrome

This syndrome is a genetic disorder of connective tissue and can affect the cardiovascular (heart), ocular (eyes) and musculoskeletal systems. When it affects the musculoskeletal system, there may be malformations of the sternum, pectus carinatum / keeled chest (i.e. chest is displaced outwards) or pectus excavatum (i.e. chest is caved in), as well as giving hypersensitivity to the joints, flat feet, kyphosis, inguinal and diaphragmatic hernias.

Membrane-induced autologous chondrocyte implantation (MACI)

Called MACI, this technique is used to treat full-thickness cartilage defects of the knee and the ankle. It consists of taking the autologous chondrocytes arthroscopically, which are then cultured in vitro in autologous serum and seeded on a collagen membrane. This is then applied in a second operation to the chondral defect using fibrin sealant.

Nuclear Magnetic Resonance (NMR)

Nuclear Magnetic Resonance imaging is the use of a magnetic field and radiofrequency electromagnetic waves, which provides detailed images of the human body to diagnose it. Through NMR, the soft tissues are clearly visible and their types can be identified. It does not use X-rays or other radioactive sources but its prescription is carefully evaluated. The patient is introduced into an MR machine: a long tube that is open at the ends in which the patient is irradiated by a high-intensity magnetic field. The duration of the exam is approximately 30 minutes. There are also dedicated MR machines for individual joints.

Osteochondritis dissecans

It is an inflammatory disease, also called osteochondrosis, which alters the ossification of growing cartilages in children and teenagers. Patients suffering from osteochondritis have a defect in the vascularization (blood vessel formation) of the cartilage, which, if poorly nourished, detaches itself from its position and wedges into the joint creating the “joint tophus”. Osteochondritis dissecans is classified differently according to the affected bone and is usually idiopathic, meaning it has no definite causes. In its most serious stage, it gives rise to osteonecrosis.

Osteonecrosis

Otherwise called Avascular necrosis (AVN), aseptic necrosis, or ischemic bone necrosis, osteonecrosis is caused by a lack of blood supply to a particular area that causes the death of the tissue, resulting in pain and problems related to any movement linked to that tissue. It can be due to traumatic causes, such as accidents or compressions, or non-traumatic causes (i.e. not related to trauma), such as corticosteroids (about 70% of the case) or alcohol abuse. To a lesser extent, osteonecrosis is related to embolism, coagulopathies, hemoglobinopathies and compression diseases.

Platelet Rich Plasma (PRP)

Most commonly known by the abbreviation PRP, it consists of taking a few blood samples from the patient and run them through a centrifuge to obtain liquid-rich platelets. When the platelets are activated, they are then injected back into the patient’s joint. This liquid is rich in anti-inflammatory factors and has the ability to help reduce joint pain, improve movement, and help resume daily life activities.

Radiography with Rosenberg view

This x-ray examination is done often as a complement to the standard anteroposterior and latero-lateral knee examination. The method developed by Rosenberg consists of a weight-bearing x-ray view: a posteroanterior view with the knee bent to 45°. It allows to evaluate the relationship between femur and tibia with the knee in partial flexion and helps the detection of arthrosis at the posterior part of the femoral condyles.

Rheumatoid arthritis (RA)

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that affects the joints. Among the osteoarticular diseases, it is the most severe form. The immune system (antibodies) attacks the synovial fluid, causing its gradual destruction, which extends to the cartilage until it reaches the bones.

Scleroderma

Systemic sclerosis or scleroderma is a chronic autoimmune disease characterized by the thickening of skin and internal organs, changes in the vascular area and abnormalities of the immune system. Females between 45 and 65 years of age are most affected. Its cause is unknown and is recognized by an initial thickening of the skin, which can lead to progressive deformity.

Spondyloarthritis

Also called osteoarthritis of the spine, it is a degenerative disease of the cartilage of the intervertebral discs and can be cervical or lumbar. The cartilages, losing their elasticity, are no longer able to cushion the shocks generated by the movement of the body. The main cause is ageing; it affects those above 30 or 40 years of age and mostly women.

Trauma

Trauma is defined as a lesion produced in the body, caused by any sudden, rapid and violent action which can produce a localised or general changes in the body.

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