Showing papers by "Nicola Maffulli published in 2016"

Muscles, Ligaments and Tendons Journal - Basic principles and recommendations in clinical and field Science Research: 2016 Update.

Abstract: The proper design and implementation of a study as well as a balanced and well-supported evaluation and interpretation of its main findings are of crucial importance when reporting and disseminating research Also accountability, funding acknowledgement and adequately declaring any conflict of interest play a major role in science Since the Muscles, Ligaments and Tendons Journal (MLTJ) is committed to the highest scientific and ethical standards, we encourage all Authors to take into account and to comply, as much as possible, to the contents and issues discussed in this official editorial This could be useful for improving the quality of the manuscripts, as well as to stimulate interest and debate and to promote constructive change, reflecting upon uses and misuses within our disciplines belonging to the field of "Clinical and Sport - Science Research"

The management of osteomyelitis in the adult.

Abstract: Background and purpose Osteomyelitis (OM) is considered one of the most challenging medical conditions an orthopaedic surgeon has to face. Much debate is present concerning diagnosis and treatment, especially about differences between acute and chronic forms of the condition. The main aim of the present work is to show the key points where research should be implemented. Methods Online database were searched to find evidence about the clinical management of osteomyelitis. Clinical randomized trials, case series, prospective cohort studies reporting on diagnosis and treatment of acute and chronic osteomyelitis were taken into consideration. Cadaveric studies, laboratory studies, case reports, review articles and meta-analyses were excluded. Furthermore, studies concerning implant related OM were excluded. Studies in English, Spanish and French were considered in this process of inclusion. The cohorts of all the included studies were composed of adult patients. Results The main growpoints concerning OM are the identification of a correct laboratory test array to allow a prompt diagnosis and provide a sensitive and specific detection of the bacterial species involved, along with antibiotic drug resistance; optimal imaging techniques, according to the phase of the infection, have to be performed, to avoid unnecessary medical expenses; the identification of a suitable compromise between intravenous and oral drugs administration. A flow chart is proposed for optimal clinical management of this pathology. Conclusion More work should be carried out to clarify the main issues concerning the clinical management of osteomyelitis in adult patients.

Hormones and tendinopathies: the current evidence.

Abstract: Background Tendinopathies negatively affect the quality of life of millions of people, but we still do not know the factors involved in the development of tendon conditions. Sources of data Published articles in English in PubMed and Google Scholar up to June 2015 about hormonal influence on tendinopathies onset. One hundred and two papers were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Areas of agreement In vitro and in vivo, tenocytes showed changes in their morphology and in their functional properties according to hormonal imbalances. Areas of controversy Genetic pattern, sex, age and comorbidities can influence the hormonal effect on tendons. Growing points The increasing prevalence of metabolic disorders prompts to investigate the possible connection between metabolic problems and musculoskeletal diseases. Areas timely for developing research The influence of hormones on tendon structure and metabolism needs to be further investigated. If found to be significant, multidisciplinary preventive and therapeutic strategies should then be developed.

Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature

Abstract: Purpose To evaluate clinical outcomes, rate of recurrence, and complications following distal realignment procedures (Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and other distal realignment procedures) performed alone or in combination with proximal procedures for the management of patellar dislocation. Methods A systematic literature review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A search in PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Google Scholar databases using various combinations of the keywords "patellar," "dislocation," "tibial transfer," "Elmslie-Trillat," "Roux Goldthwait," "tibial tubercle osteotomy," "Fulkerson," "Maquet," "procedure," "clinical," and "outcome." Results Thirty-eight articles were included in the systematic review. A total of 1,182 knees belonging to 1,023 patients were grouped according to the duration of the follow-up period. The overall rate of recurrence was 7% (83 of 1,182 knees). Approximately 5.3% (28 of 520 knees) of the redislocation occurred in the short-medium term, and 8.3% (55 of 662 knees) occurred in the long-term. Conclusions Distal realignment procedures performed alone or in combination with proximal procedures for the management of patellar dislocation have shown good clinical outcomes and a low rate of recurrence highlighting the efficacy of these procedures. To date no randomized controlled clinical trials are available on the topic. Level of Evidence Level IV, systematic review of Level III and IV studies.

Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis.

Abstract: Introduction Osteonecrosis of femoral head (ONFH) leads to hip osteoarthritis (HOA); among joint preserving treatments (JPT), the role of core decompression (CD) is still debated We assessed the efficacy of CD compared with all other JPT in delaying the natural osteonecrosis evolution to HOA Sources of data Following the PRISMA checklist, the Medline and Scopus databases were searched Fifteen- to 70-year-old subjects with ONFH with a minimum follow-up of 24 months were considered The outcomes evaluated were patient clinical status, radiographic progression and total hip arthroplasty (THA) or further surgery (FS) need Risk ratio (RR) was calculated for every outcome reported RCT, CCT and prospective studies were included Areas of agreement A total of 12 studies (776 patients) met the inclusion criteria Clinical outcome (RR = 114; 95% CI 058-232; P = 005), radiographic progression (RR = 164; 95% CI 114-235; P = 005) and the need for THA/FS (RR = 152; 95% CI 095-245; P = 005) suggested a slight superiority of other JPT compared with CD Areas of controversy High heterogeneity of the primary investigations was the main limitation of our study Growing points The efficacy and effectiveness of core decompression for ONFH are, at best, no better than other joint preserving strategies The more recent scientific evidence seems to suggest that such procedure is less successful than other joint preserving strategies Areas timely for developing research Further studies are needed to identify the best therapeutic approach to the ONFH

Regeneration techniques for bone-to-tendon and muscle-to-tendon interfaces reconstruction

Abstract: Introduction The complex structure of the bone-tendon and muscle-tendon junctions makes their reproduction for tissue engineering applications very difficult. Relatively few studies have investigated the characteristics of these regions from a tissue engineering view point. Sources of data PubMed, Thomson Reuters, Scopus and Google Scholar databases were searched using various combinations of the keywords 'Tendon', 'Myotendinous junction', 'Osteotendinous junction', 'Tissue engineering' and 'Scaffold'. Areas of agreement The available studies can be divided according to whether the objective is to build an entire composite tissue unit or to assist the recreation of interfaces, such as improving integration of autografts with the surrounding bone or with the muscle. The most used techniques are based on the electrospinning and the self-reorganized constructs process, which were applied to both bone-to-tendon junction (BTJ) and muscle-to-tendon junction (MTJ) regeneration. The use of nanofibers that mimic the hierarchical structure of the extracellular matrix (ECM), eventually functionalized by encapsulation of bioactive components, allowed cell attachment and differentiation. Areas of controversy There have been no translational investigations. Growing points There is a need to devise suitable techniques that allow suitable tissue engineering of BTJ and MTJ. Areas timely for developing research Appropriately planned studies are needed to translate tissue engineering from a scientific challenge to a clinically applicable technique.

Bone loss in patients with posterior gleno-humeral instability: a systematic review.

Abstract: The aim of this systematic review was to analyse outcomes of surgical procedures for glenoid and/or humeral bony defects, performed singularly or in combination, in patients with posterior gleno-humeral instability. A secondary aim was to establish in clinical settings which percentage of glenoid or humeral bone loss should be treated with a bony procedure to avoid recurrence of dislocation. A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid, and Google Scholar databases was performed using various combinations of the keywords “shoulder”, “posterior instability”, “dislocation”, “bone loss”, “reversed bony Bankart”, “osseous glenoid defects”, “glenoid bone grafting”, “glenoid”, “humeral head”, “surgery”, “gleno-humeral”, “reversed Hill–Sachs”, over the years 1966–2014. Data were independently extracted by all the investigators: demographics, previous surgery, imaging assessment, bone defect measurement, diagnosis, surgical management, return to sport, complications, and outcome measurements. The outcome parameters were recurrence of dislocation and clinical scores. Nineteen articles, describing patients with glenoid bony defects, humeral bony defects, or both in the setting of posterior gleno-humeral instability were included. A total of 328 shoulders in 321 patients were included, with a median age at surgery of 33.4 years, ranging from 14 to 79 years. Patients were assessed at a median follow-up period of 3.6 years (ranging from 8 months to 22 years). A redislocation event occurred in 32 (10 %) shoulders. The redislocation event occurred in 2 (10 %) of 20 shoulders with glenoid bony defect and in 12 (11 %) of 114 shoulders with humeral bony defect. Even though the general principle of treating recognized glenoid and humeral bone defects in patients with posterior gleno-humeral instability is widely accepted, to date few studies in the literature accurately establish which bone defects should be treated with bony procedures and the exact correlation between percentage of bone loss and higher risk of redislocation in clinical settings. A limitation to the present systematic review is the small number of included patients, due to the rare entity of posterior bone defects/reversed Hill–Sachs. The clinical relevance is that the results of this systematic review can be helpful to guide clinicians in the management of patients with posterior gleno-humeral instability and glenoid and/or humeral bony defects. This manuscript also highlights the need for accurate description of results in further investigations. The main drawback of the available articles in the topic is that they rarely clarify the percentage of bone loss in patients undergoing a redislocation event. IV.

Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods.

Abstract: Introduction Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. Source of data PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. Areas of agreement An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization. Areas of controversy The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing. Growing points Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation. Areas timely for developing research Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.

Double-Row Repair Lowers the Retear Risk After Accelerated Rehabilitation

Abstract: Background:Recently, an accelerated rehabilitation protocol after rotator cuff (RC) repair has been proposed for patients at risk of postoperative stiffness.Purpose:To investigate, in patients undergoing early accelerated mobilization, whether double-row (DR) repair provides better clinical outcomes and a lower retear rate compared with single-row (SR) configurations.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 58 patients were randomized to undergo either SR or DR repair. After 2 years of follow-up, 12 men and 13 women (mean age, 61.8 years; range, 52-67 years) in the SR group and 15 men and 10 women (mean age, 58.9 years; range, 51-69 years) in the DR group were evaluated. To assess the retear rate, magnetic resonance imaging of the shoulder was performed at 2-year follow-up. The clinical evaluation was based on the modified University of California, Los Angeles (UCLA) shoulder score and range of motion (ROM) measurements.Results:Magnetic resonance arthrography showe...

Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg

Abstract: Chronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity. The study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded. The median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded. Minimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term.

High-Volume Image-Guided Injection for Recalcitrant Patellar Tendinopathy in Athletes.

Abstract: OBJECTIVE To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy DESIGN Case series study; Level of evidence, 4 SETTING All tertiary referrals, public, and private healthcare PATIENTS Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included INTERVENTION Tendon injection of a mixture of 10 mL of 05% bupivacaine hydrochloride, 62 500 international units of aprotinin, and 40 mL of normal saline solution MAIN OUTCOME MEASURES The Victorian Institute of Sport Assessment-patellar tendon (VISA-P), visual analogue scale, and Roles and Maudsley were assessed at baseline and at the last follow-up RESULTS The baseline VISA-P score of 46 ± 182 (range, 28-75) improved to 753 ± 192 (range, 68-100) by 15 months (P = 0003) The mean pain visual analogue scale changed from 91 mm (range, 66-92 mm) before the injection to 28 mm (2-52 mm) (P = 001) Of 32 physically active patients, 23 (72%) had returned to sport at the same level practiced before the onset of symptoms Thirty-five of the 44 patients (80%) rated their condition as good or excellent CONCLUSIONS High-volume injection at the interface between the deep surface of the patellar tendon and Hoffa body improves in the short-term symptoms and function of the knee CLINICAL RELEVANCE This procedure is minimally invasive, safe, and effective in the short term in athletes

Wrist arthroscopy in the management of articular distal radius fractures

Abstract: Introduction Fractures of the distal radius account for 15% of all fractures. The use of arthroscopy is increasingly popular in the last years, with the goal to achieve a better anatomical reduction of the articular fragments. Sources of data We searched the literature on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'wrist', 'distal radial fracture', 'distal radius fracture' and 'arthroscopy'. Twenty-eight studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. Areas of agreement Arthroscopy allows to detect intra-articular, ligamentous and triangular fibrocartilage complex injuries in an acute setting with a better prognosis. Arthroscopy increases the quality of the intra-articular reduction compared to fluoroscopy. Areas of controversy The main limitation of the selected studies is the short follow-up: the average follow-up in 20 studies was 12 months, a period long enough to assess functional outcomes, but not to assess the occurrence of post-traumatic degenerative changes and their impact on function. Better stratification of the fracture population is needed. Growing points The shorter recovery time and the low incidence of adverse effects are the main advantages of this new technology. Areas timely for developing research There is need to perform randomized controlled trials reporting on the use of volar locking plates as, at the present time, they are the standard management for these fractures. In addition, the different pattern of fracture should be better classified to manage the patients who will benefit after the management.

Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review.

Abstract: Introduction In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform. Sources of data A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. Areas of agreement The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective. Areas of controversy Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials. Growing points The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology. Areas timely for developing research There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time.

Apophyseal injuries in children's and youth sports.

Abstract: Introduction The authors reviewed the current English literature regarding apophyseal injuries affecting young athletes, to highlight the frequency and characteristics of these injuries, to clarify risk factors and specific prevention measures, and to identify future research objectives. Sources of data The authors performed a comprehensive search of the medical literature, using the Medline database, including all English articles. Various combinations of the Keywords 'injury', 'sports', 'athletic injuries', 'avulsion fractures', 'physeal', 'physis', 'apophysis', 'apophysitis', 'growth plate' were used. Areas of agreement Growth benefits from a moderate physical activity. Areas of controversy Growth deficit may occur in young athletes involved in intensive practice of sport following apophysitis. Growing points Apophyseal injuries occurring during sport are less common than overall rate of injuries affecting the adolescent population. Growth disturbance occurs only rarely after an apophyseal injury. Areas timely for developing research Further studies should consider analytical as well as descriptive components of apophyseal injuries, to allow the identification of new possible risk factors and preventive measures and to help early detection and proper treatment as well.

Subtalar Arthroereisis Implant Removal in Adults: A Prospective Study of 100 Patients.

Abstract: Subtalar joint arthroereisis (STA) can be used in the management of adult acquired flatfoot deformity (AAFD), including posterior tibial tendon dysfunction. The procedure is quick and normally causes little morbidity; however, the implant used for STA often needs to be removed because of sinus tarsi pain. The present study evaluated the rate and risk factors for removal of the implant used for STA in adults treated for AAFD/posterior tibial tendon dysfunction, including patient age, implant size, and the use of endoscopic gastrocnemius recession. Patients undergoing STA for adult acquired flatfoot were prospectively studied from 1996 to 2012. The inclusion criteria were an arthroereisis procedure for AAFD/posterior tibial tendon dysfunction, age >18 years, and a follow-up period of ≥2 years. The exclusion criteria were hindfoot arthritis, age <18 years, and a follow-up period of <2 years. A total of 100 patients (average age 53 years) underwent 104 STA procedures. The mean follow-up period was 6.5 (range 2 to 17) years. The overall incidence of implant removal was 22.1%. Patient age was not a risk factor for implant removal (p = .09). However, implant size was a factor for removal, with 11-mm implants removed significantly more frequently (p = .02). Endoscopic gastrocnemius recession did not exert any influence on the rate of implant removal (p = .19). After STA for AAFD, 22% of the implants were removed. No significant difference was found in the incidence of removal according to patient age or endoscopic gastrocnemius recession. However, a significant difference was found for implant size, with 11-mm implants explanted most frequently.

Viscosupplementation with intra-articular hyaluronic acid for hip disorders: a systematic review and meta-analysis

Abstract: Background Hip joint diseases are common in adult population and their prevalence increases with age. Osteoarthritis, rheumatoid arthritis and femoroacetabular impingement are the most common chronic diseases in the hip joint. Viscosupplementation with exogenous hyaluronic acid (HA) is one of the most widely used conservative treatment aiming to improve synovial fluid properties and to decrease pain. There is no global consensus on the type of HA, method of injection and frequency, or on its efficacy in hip joint. Methods We selected published data in English in the PubMed and Google Scholar electronic databases up to March 2016 about hyaluronic acid injections in hip disorders. Results 26 articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Conclusion There is a lack of standardization of HA injections for hip conditions. Our results suggest that this is the best conservative therapy before surgery and it can act on pain relief and function however there is no evidence to prove its ability to modify the morphological structure of the pathological hip and the natural history of the disease. There are few data about the use of HA in other hip disorders rather than osteoarthritis. The most relevant evidence seems to show the utility of HA injections in improving synovial inflammation, but only a few studies have been conducted. Level of evidence I.

Surgical repair of chronic patellar tendon rupture in total knee replacement with ipsilateral hamstring tendons.

Abstract: Purpose Patellar tendon rupture is a serious complication of total knee arthroplasty (TKA). Its reconstruction in patients with chronic ruptures is technically demanding. This article reports the results of surgical reconstruction of neglected patellar tendon rupture in TKA using autologous hamstring tendons.

Arthroscopic debridement of the ankle for mild to moderate osteoarthritis: a midterm follow-up study in former professional soccer players

Abstract: The aim of this study is to report the clinical and functional outcomes following arthroscopic management of anterior impingement, grade III–IV cartilage lesions, and mild to moderate osteoarthritis of the ankle in former soccer players. The study included 15 former male professional soccer players with mild to moderate degenerative changes of the ankle who had undergone arthroscopic debridement and management of secondary injuries of the ankle. Preoperatively and at the last follow-up, at an average of 7.4 years, the American Orthopaedic Foot and Ankle Society (AOFAS) and the Kaikkonen scales and visual analogue scale (VAS) assessment were administered to all patients. Ankle osteoarthritis was assessed from weightbearing anteroposterior and lateral radiographs of both ankles. At the last follow-up, the average AOFAS score had increased significantly from 48 (range, 29–69) to 86 (range, 63–94) (P < 0.0001), with good to excellent scores in 11 patients (74 %). The average Kaikkonen preoperative score of 43 (range, 28–70) had significantly improved to 85 (range, 61–95) (P < 0.0001), with good excellent scores in 11 patients (74 %). VAS values were also improved at the last follow-up. At the last appointment, only one (7 %) patient had abandoned altogether any sport, as he did not feel safe with his ankle and he felt too old to continue. Anterior ankle arthroscopy for management of mild to moderate ankle arthritis is safe, effective, and low cost and allows former athletes to safely return to ordinary daily activities and recreational sport activities.

Endoscopic Flexor Hallucis Longus Tendon Transfer for Chronic Achilles Tendon Rupture.

Abstract: Chronic Achilles tendon rupture posed significant disability to the patients. Flexor hallucis longus (FHL) transfer can be used to restore the plantarflexion power of the ankle. Traditionally, a long medial incision with extensive soft tissue dissection is needed for FHL transfer. With the advance in flexor hallucis tendoscopy, endoscopic FHL tendon transfer can be performed without extensive soft tissue dissection.

Sexual Activity before Sports Competition: A Systematic Review

Abstract: Sexual activity before competition has been considered as a possible cause for reduced performance since ancient Greece and Rome. Recently, the hypothesis that optimal sport performance could be influenced by a variety of factors including sexual activity before competition has been investigated. However, few scientific data are available, with the exception of anecdotal reports of individual experiences. The present systematic review focused on the current scientific evidence on the effects of sexual activity on sport performance regardless of sport type. Data were obtained following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, using PubMed/MEDLINE, ISI/Web of Science, the Cochrane Collaboration Database, Cochrane Library, Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, ProQuest, and Scopus, all searched from inception further, to broaden the search, no time filter nor language restriction have been applied. Also, the gray literature was mined using Google Scholar. Only relevant scientific articles reporting outcomes of athletic performance after sexual activity were considered. The impact of sexual activity before a sport competition is still unclear, but most studies generally seem to exclude a direct impact of sexual activity on athletic aerobic and strength performance. The most important aspect seems to be the interval from the time of the sports competition that affects negatively the performance if it is shorter than 2 h. There are possible negative effects from some possible concurrent wrong behaviors such as smoking or alcohol abuse. There are no investigations about the effect of masturbation in this context. There is a need to clarify the effects of sexual activity on competition performance. The present evidence suggests that sexual activity the day before competition does not exert any negative impact on performance, even though high-quality, randomized controlled studies are urgently needed.

Influence of Thyroid Hormones on Tendon Homeostasis.

Abstract: Tendinopathies have a multifactorial etiology driven by extrinsic and intrinsic factors. Recent studies have elucidated the importance of thyroid hormones in the alteration of tendons homeostasis and in the failure of tendon healing after injury. The effects of thyroid hormones are mediated by receptors (TR)-α and –β that seem to be ubiquitous. In particular, T3 and T4 play an antiapoptotic role on tenocytes, causing an increase in vital tenocytes isolated from tendons in vitro and a reduction of apoptotic ones; they are also able to influence extra cellular matrix proteins secretion in vitro from tenocytes, enhancing collagen production. From a clinical point of view, disorders of thyroid function have been investigated only for rotator cuff calcific tendinopathy and tears. In this complex scenario, further research is needed to clarify the role of thyroid hormones on the onset of tendinopathies.

Chronic Psychosocial Stress Impairs Bone Homeostasis: A Study in the Social Isolation Reared Rat.

Abstract: Chronic psychosocial stress is a key player in the onset and aggravation of mental diseases, including psychosis. Although a strong association between this psychiatric condition and other medical co-morbidities has been recently demonstrated, few data on the link between psychosis and bone homeostasis are actually available. The aim of this study was to investigate whether chronic psychosocial stress induced by 4 or 7 weeks of social isolation in drug-naive male Wistar rats could alter bone homeostasis in terms of bone thickness, mineral density and content, as well as markers of bone formation and resorption (sclerostin, cathepsin K, and CTX-I). We found that bone mineral density was increased in rats exposed to 7 weeks of social isolation, while no differences were detected in bone mineral content and area. Moreover, 7 weeks of social isolation lead to increase of femur thickness with respect to controls, suggesting the development of a hyperostosis condition. Isolated rats showed no changes in sclerostin levels, a marker of bone formation, compared to grouped animals. Conversely, bone resorption markers were significantly altered after 7 weeks of social isolation in terms of decrease in cathepsin K and increase of CTX-I. No alterations were found after 4 weeks of isolation rearing. Our observations suggest that chronic psychosocial stress might affect bone homeostasis, more likely independently from drug treatment. Thus, the social isolation model might help to identify possible new therapeutic targets to treat the burden of chronic psychosocial stress and to attempt alternative therapy choices.

Cardiovascular Fitness and Energy Expenditure Response during a Combined Aerobic and Circuit Weight Training Protocol.

Abstract: Objectives The present study describes the oxygen uptake and total energy expenditure (including both aerobic and anaerobic contribution) response during three different circuit weight training (CWT) protocols of equivalent duration composed of free weight exercises, machine exercises, and a combination of free weight exercises intercalating aerobic exercise. Design Controlled, randomized crossover designs. Methods Subjects completed in a randomized order three circuit weight training protocols of the same duration (3 sets of 8 exercises, 45min 15s) and intensity (70% of 15 repetitions maximum). The circuit protocols were composed of free weight exercises, machine exercises, or a combination of free weight exercises with aerobic exercise. Oxygen consumption and lactate concentration were measured throughout the circuit to estimate aerobic and anaerobic energy expenditure respectively. Results Energy expenditure is higher in the combined exercise protocol (29.9±3.6 ml/kg/min), compared with Freeweight (24.2±2.8ml/kg/min) and Machine (20.4±2.9ml/kg/min). The combined exercise protocol produced the highest total energy expenditure but the lowest lactate concentration and perceived exertion. The anaerobic contribution to total energy expenditure was higher in the machine and free weight protocols compared with the combined exercise protocol (6.2%, 4.6% and 2.3% respectively). Conclusions In the proposed protocols, the combined exercise protocol results in the highest oxygen consumption. Total energy expenditure is related to the type of exercise included in the circuit. Anaerobic contributions to total energy expenditure during circuit weight training may be modest, but lack of their estimation may underestimate total energy expenditure. Trial registration ClinicalTrials.gov NCT01116856.

Development of the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS BrP): a cross-cultural adaptation with reliability and construct validity evaluation

Abstract: There is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles tendon rupture. The purpose of this study was to undertake a cross-cultural adaptation of the Achilles Tendon Total Rupture Score (ATRS) into Brazilian Portuguese, determining the test-retest reliability and construct validity of the instrument. A five-step approach was used in the cross-cultural adaptation process: initial translation (two bilingual Brazilian translators), synthesis of translation, back-translation (two native English language translators), consensus version and evaluation (expert committee), and testing phase. A total of 46 patients were recruited to evaluate the test-retest reproducibility and construct validity of the Brazilian Portuguese version of the ATRS. Test-retest reproducibility was performed by assessing each participant on two separate occasions. The construct validity was determined by the correlation index between the ATRS and the Orthopedic American Foot and Ankle Society (AOFAS) questionnaires. The final version of the Brazilian Portuguese ATRS had the same number of questions as the original ATRS. For the reliability analysis, an ICC(2,1) of 0.93 (95 % CI: 0.88 to 0.96) with SEM of 1.56 points and MDC of 4.32 was observed, indicating excellent reliability. The construct validity showed excellent correlation with R = 0.76 (95 % CI: 0.52 to 0.89, P < 0.001). The ATRS was successfully cross-culturally validated into Brazilian Portuguese. This version was a reliable and valid measure of function in patients who suffered complete rupture of the Achilles Tendon.

Elastin: a possible genetic biomarker for more severe ligament injuries in elite soccer. A pilot study.

Abstract: Background The study of new genetic biomarkers in genes related to connective tissue repair and regeneration may help to identify individuals with greater predisposition to injury, who may benefit from targeted preventive measures, and those who require longer recovery time following a muscle, ligament or tendon injury. The present study investigated whether single nucleotide polymorphisms of the Elastin gene could be related to MCL injury. Methods 60 top class football players were studied to identify single nucleotide polymorphisms for the Elastin (ELN) gene using Allelic Discrimination analysis. Each player was followed for 7 seasons, and each MCL injury was noted. Results Ligament injury rate, severity and recovery time are related to specific genotypes observed in the elastin gene, especially the ELN-AA (16 MCL) and the ELN-AG (3 MCL). Players with the ELN-GG genotype sustained no MCL injury during the 7 seasons of the study. Conclusions The identification of polymorphisms in the ELN gene may be used as a novel tool to better define an athlete's genotype, and help to plan training and rehabilitation programmes to prevent or minimize MCL ligament injuries, and optimize the therapeutic and rehabilitation process after soft tissue injuries, and manage the workloads during trainings and matches.

Tendinopathy

Abstract: Chronic tendon injuries are a common cause of pain and of restriction of sports or daily life. Even though a number of published studies have focused on tendon injuries, healing and treatment, the pathogenesis still remains enigmatic. The pathogenesis of chronic tendon injuries is considered multifactorial, however the precise role of each predisposing factor remains incompletely understood. The association between tendinopathy and pain should also be clarified, as the presence of tendinopathic lesions does not always lead to symptoms, but they are the necessary pre-existing conditions for spontaneous tendon ruptures. In this article, the histological features, the pathogenetic theories of tendinopathy, and the possible sources of pain are reviewed.

History of Total Ankle Replacement in North America

Abstract: Attempts at total ankle replacement (TAR) have existed for at least 55 years. Time has essentially eliminated constrained, cemented, first-generation prostheses. Although some two-component, more anatomical designs are still used and with varying success, it seems that three-component mobile-bearing ankle prostheses are the predominant design utilized in Europe and in North America despite two-component designs being more prevalent. Not only did the prostheses change over the years but also the patients and surgeons. Surgeons specialize in foot and ankle surgery, improving their surgical outcomes and expanding the indications for TAR, in technically demanding, “complex” ankles. The future will set the limits, as enthusiasm over bright ideas was often followed by skepticism. We provide a thorough review on the history of TARs that have been and are currently in use in North America.

Female athletes and menstrual disorders: a pilot study.

Abstract: BACKGROUND There is a greater incidence of menstrual disorders in female athletes than in their sedentary counterparts. The menstrual disorder is reported in female athletes suffering from athletic triad syndrome, while few data in those free of this syndrome are available. The study aims to ascertain the presence of menstrual disorders and the eventual relationship with myocardial performance in female athletes practicing different sports. METHODS A sample of 64 subjects aged 18.5±2 was selected and divided into 3 groups (37 subjects practicing rhythmic gymnastics, 11 swimmers, and 16 volleyball players). All underwent echocardiography, biompendance analysis, and answered a questionnaire. RESULTS All anthropometrics parameters were normal. Few athletes reported menstrual disorders. No association between the presence of menstrual disorders and BMI. All echo results were within the normal range. Cardiac Mass Index (CMI) was normal for all athletes despite in swimmers significantly higher values (90.64±14.9 g/m2) compared to the volleyball players (78.25±14.0 g/m2; p<.04) and rhythmic gymnasts (77.89±13.4 g/m2; p<.009) were found. CONCLUSIONS Despite menstrual disorders are represented among female athletes, the eventual relationship with the sport practiced is not so evident. Questionnaire should be used to identify menstrual disorders in non-elite athletically active females.