Showing papers by "Nicola Maffulli published in 2018"

Overuse injuries in sport: a comprehensive overview.

Abstract: The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load. The musculoskeletal system, if subjected to excessive stress, can suffer from various types of overuse injuries which may affect the bone, muscles, tendons, and ligaments. We performed a search (up to March 2018) in the PubMed and Scopus electronic databases to identify the available scientific articles about the pathophysiology and the incidence of overuse sport injuries. For the purposes of our review, we used several combinations of the following keywords: overuse, injury, tendon, tendinopathy, stress fracture, stress reaction, and juvenile osteochondritis dissecans. Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration. Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures. A frequent cause of pain in adolescents is juvenile osteochondritis dissecans (JOCD), which is characterized by delamination and localized necrosis of the subchondral bone, with or without the involvement of articular cartilage. The purpose of this compressive review is to give an overview of overuse injuries in sport by describing the theoretical foundations of these conditions that may predispose to the development of tendinopathy, stress fractures, stress reactions, and juvenile osteochondritis dissecans and the implication that these pathologies may have in their management. Further research is required to improve our knowledge on tendon and bone healing, enabling specific treatment strategies to be developed for the management of overuse injuries.

A contemporary view of platelet-rich plasma therapies: moving toward refined clinical protocols and precise indications.

Abstract: The positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP + cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies.

Advances with platelet rich plasma therapies for tendon regeneration.

Abstract: Introduction: PRPs can be used in the management of tendinopathy if we improve our understanding of pathophysiology and to integrate molecular knowledge about PRP participation in healing mechanism...

Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature.

Abstract: Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management. Different surgical options have been also described, but they should be reserved to recalcitrant cases. In this review, a critical analysis of the literature about athletic osteitis pubis is performed, especially focusing on its diagnostic and therapeutic management.

Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders.

Abstract: The Kujala, Fulkerson, Larsen and Lysholm questionnaires have been demonstrated to be reliable and sensitive in assessing patients with patellofemoral pathology The purpose of this study is to translate and cross-culturally adapt into Italian the English versions of the Kujala, Fulkerson, Larsen and Lysholm questionnaires, and undertake reliability and validity evaluations of the Italian versions of these scores in patients with patellofemoral pathology The cross-cultural adaptation process was carried out following the simplified Guillemin criteria The questionnaires were administered to 63 patients with either patellar instability or painful patella syndrome To assess the validity of the questionnaires, they were compared with the Oxford knee score The questionnaires were administered to a subsample of 33 patients 5 days later to assess test–retest reliability The interclass coefficient correlation was 096 for the Kujala score, 092 for the Larsen score, 096 for the Lysholm score, 094 for the Fulkerson score (P < 001), and 083 for the Oxford score Pearson’s correlation was096 between the Kujala and Oxford scores, 090 between the Larsen and Oxford scores, 094 between the Lysholm and Oxford score, and 093 between the Fulkerson and Oxford scores Responsiveness, calculated by standardized response mean, was 12, and effect size was 14 The Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scoring systems were shown to be equivalent to their English versions and demonstrated good validity, reliability and responsiveness to surgical treatment of patellofemoral pathology To the best of the authors’ knowledge, this is the first attempt to adapt four of the most common patellofemoral-specific scoring scales to the Italian language Level II

Hamstring and other thigh injuries in children and young athletes.

Abstract: Background In adults, hamstring injuries may lead to long periods of rehabilitation and carry a definite risk of recurrence. However, no studies detail how these injuries affect young athletes. Objective To describe and analyze injuries in the hamstring area in young athletes. To identify risk factors for injuries to the hamstring area in this age group, which will make it possible to design and optimize prevention plans. Methods The study population consisted of 1157 young athletes with an average age of 13.56 years, all members of the Barcelona Football Club. Injuries to the hamstring area over three consecutive seasons (from July 2007 to June 2010) were analyzed. Results The 50 injuries in the hamstring muscle complex included 14 injuries to the biceps femoris, 17 to the semitendinosus-semimembranosus complex, 10 cases of delayed onset muscle soreness (DOMS), and nine avulsion of the ischial tuberosity. Hamstring injuries were first identified in young athletes starting from age nine, with an age-related increased rate up to the age of 15, and a lower incidence at age 14, 16, and 18. The average time lost following an hamstring injury was 21 days and 43.4 days following avulsion from the ischium. The highest incidence of injuries occurred in football players. Conclusions Hamstring injuries in this group of young athletes are less prevalent than in adults.

Top orthopedic sports medicine procedures

Abstract: Orthopedic sports medicine is a subspecialty of Orthopedics that focuses on managing pathological conditions of the musculoskeletal system arising from sports practice. When dealing with athletes, timing is the most difficult issue to face. Typically, athletes aim to return to play as soon as possible and at the pre-injury level. This means that management should be optimized to combine the need for prompt return to sport and to the biologic healing time of the musculo-skeletal. This poses a great challenge to sport medicine surgeons, who need to follow with attention to the latest scientific evidence to offer their patients the best available treatment options. We briefly review the most commonly performed orthopedic sports medicine procedures, outlining the presently available scientific evidence on their indications and outcomes.

Effectiveness of tissue engineered three-dimensional bioactive graft on bone healing and regeneration: an in vivo study with significant clinical value

Abstract: Several strategies have been used to promote bone repair; with many failing due to the lack of osteoinduction. We describe our approach for promoting bone healing that attempts to overcome prior shortcomings. First, we compared the role of different concentrations of Gelatin (Gel), nanostructured-hydroxyapatite (nHA), Simvastatin (Sim) and nHA-Sim particles on healing of small femoral bone defects in rabbits. The effective concentration of each of them was studied, and then a three-dimensional porous scaffold was designed using Gel, nHA and Sim which was then cross-linked with Genipin. Morphology, degradation profile and Sim delivery properties of the scaffolds were evaluated in vitro. Then, the scaffolds were subcutaneously tested in vivo to determine their biocompatibility, biodegradability and osteogenic properties. Finally, the scaffolds were implanted in a large radial bone defect model in rabbits and their effect on bone regeneration was investigated. The Gel, nHA and Sim with concentrations of 1, 1 and 5 mg/femoral hole were effective during bone healing respectively, and the Sim showed the most osteoinduction and osteoconduction when compared to controls. The Gel-Sim and Gel-nHA-Sim scaffolds continuously and homogenously released Sim into the simulated body fluid in vitro. Subcutaneously, the scaffolds were biocompatible, biodegradable and able to produce ectopic bone after 30 days. Thirty and sixty days after implantation of the scaffolds in radial bone defects, they were completely degraded and replaced with the new bone that had significantly superior morphology, mineral density, bioelectrical, biophysical and micromechanical properties compared with controls. Such bioactive grafts may be a suitable option for bone reconstruction, healing and repair.

Osteoarthritis of the hip and knee in former male professional soccer players.

Abstract: Background Professional soccer (PS) players are at great risk of osteoarthritis (OA) of the knee and hip. Sources of data Following the PRISMA guidelines, the key words 'osteoarthritis' and 'soccer' or 'football' were matched with 'players' or 'former' or 'retired' and with 'hip' or 'knee' on December 24, 2017 in the following databases: PubMed, Cochrane, Google scholar, Embase and Ovid. Only comparative studies reporting the prevalence rate of OA of both hip and knee joint in former PS athletes (fPSa) and age and sex matched controls were considered. Areas of agreement In fPSa, the prevalence rate of OA of both hip and knee is significantly higher compared to age and sex matched controls. Areas of controversy The pathological pathways responsible for the development of OA of the hip and knee in PS athletes (PSa) are still not clearly understood. Growing points The prevalence rate of clinical OA of the hip was 8.6% in fPSa and 5.6% in controls (odd ratio (OR) = 1.5; 95% CI: 1.06-2.31). The radiographic rate of OA was 21.2% in fPSa and 9.8% in controls (OR = 2.4; 95% CI: 1.66-3.69). A total of 14.6 and 53.7% of fPSa presented clinical and radiographic signs of OA of the knee, respectively, vs 12.9% (OR = 1.16; 95% CI: 0.86-1.55) and 31.9% (OR = 2.47; 95% CI: 2.03-3.00) of controls. Sonographic evidence of OA of the knee was found in 52% of fPSa and 33% of controls (OR = 2.2; 95% CI: 1.24-3.89). Areas timely for developing research Preventive training programmes should be developed to reduce the number of fPSa presenting early OA.

Higher frequency of hamstring injuries in elite track and field athletes who had a previous injury to the ankle - a 17 years observational cohort study

Abstract: Inversion injury to the ankle and hamstring injuries are common problems in most sports. It is not known whether these injuries constitute a predisposing factor or a precursor of injury or re-injury of these anatomical locations. Therefore, we wished to test the hypothesis that a previous inversion ankle injury exerted a significant effect on the chance of an athlete suffering from a subsequent ipsilateral hamstring injury and vice versa. In an observational cohort study over 17 years (1998–2015), 367 elite track and field athletes, were grouped according to their first traumatic isolated ankle or hamstring injury. Fifty athletes experienced both injuries. The Mann-Whitney U and Chi-square tests (p < 0.05) were performed to test possible associations of ankle and hamstring injury with age, gender, athletics discipline, grade, and type of antecedent injury. Athletes with a preceding ankle injury had a statistically significantly higher chance of experiencing a subsequent hamstring injury compared with athletes who had experienced a hamstring injury as their first traumatic event (x2 = 4.245, p = 0.039). The proportion of both ankle and hamstring injury events was not statistically different between female (18%) and male (11%) athletes. Age and grade of injury did not influence the proportion of ankle and/or hamstring injury events. There is a statistically significantly higher frequency of hamstring injuries in elite track and field athletes having experienced a previous ankle ligament injury.

Platelet-rich Plasma and Mesenchymal Stem Cells: Exciting, But … are we there Yet?

Abstract: Joint conditions incapacitate free movement driving to a sedentary lifestyle, a major risk factor for chronic diseases Regenerative procedures, involving the use of mesenchymal stem/stromal cells along with platelet-rich plasma (PRP), can help patients with these conditions We describe the main characteristics of cellular products (bone marrow concentrate, stromal vascular fraction of adipose tissue, and mesenchymal stem/stromal cells derived from these tissues), and the potential benefits of combination with PRP in 3 scenarios: PRP lysates used during laboratory cell expansion; PRP to prime cellular products or the host tissue before cell implantation; PRP used as a vehicle for cell transplantation and to provide trophic signals Clinical studies exploring the benefits of combination products are limited to case series and few controlled studies, involving either arthroscopy or percutaneous injections Combination products are making their way to clinics but further experimental and clinical research is needed to establish protocols and indications

Genetics of rotator cuff tears: no association of col5a1 gene in a case-control study

Abstract: The incidence of RC tears increases with aging, affecting approximately 30 to 50% of individuals older than 50 years, and more than 50% of individuals older than 80 years. Intrinsic factors (age or gender), extrinsic factors (sports activity or occupation), and biological factors were identified in the onset and progression of RC tears. The attention in the study of aetiology of RC tendinopathy has shifted to the identification of gene variants. Genes encoding for proteins regulating the concentration of pyrophosphate in the extracellular matrix and genes encoding for fibroblastic growth factors, defensin beta 1 and estrogen-related receptor-beta were analyzed. However, only in one study the role of variants of collagen type V alpha 1 (col5a1) gene in RC tears was assessed. The objective of this study was to determine whether a col5a1 DNA sequence variant, rs12722 (C/T) was associated with rotator cuff (RC) tears in a case-control study. The study included 93 Caucasian patients undergoing surgery for RC tears and 206 patients with no history and sign of RC disease as evaluated by MRI. Patients were divided into two groups. Group 1 included patients with RC tear diagnosed on clinical and imaging grounds and confirmed at the time of surgery. Group 2 (control group) included patients without history or clinical symptoms of RC disorders and with a MRI negative for RC disease. DNA was obtained from approximately 1.2 ml of venous blood using the MagCore extractor system H16 with a MagCore Genomic DNA Large Volume Whole Blood Kit (RBC Bioscience Corp., Taiwan). All study participants were genotyped for SNPs rs12722. We first estimated that our study had 92% power at p < 0.05 to detect a genetic effect size of 2.05 in the RT tears (93 individuals) and healthy population (206 individuals) cohorts, assuming a minor allele frequency for col5a1 variant rs12722 of 0.5707 in the Italian population (gnomAD frequency). No significant difference in allele and genotype frequencies was observed between RT tears patients and healthy controls. Similarly, no significant association was seen between the RT tears and healthy controls participants in the combined genotype distributions. In conclusion, no correlations between the SNP rs12722 of col5a1 gene and RC tears susceptibility was found.

Cross-cultural adaptation and validation of the VISA-A questionnaire for Chilean Spanish-speaking patients

Abstract: The purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population. According to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH. The resulting Chilean version was tested for validity on 60 patients: 20 healthy individuals (group 1), 20 patients with a recently diagnosed AT (group 2), and 20 with a severe AT that already initiated conservative treatment with no clinical improvement (group 3). The questionnaire was completed three times by each participant: at the time of study enrollment, after an hour, and after a week of the initial test. All six steps were successfully completed for the translation and cultural adaptation of the VISA-A-CH. VISA-A-CH final mean scores in the healthy group was significantly higher than those in the other groups. Group 3 had the lowest scores. Validity showed excellent test-retest reliability (rho c = 0.999; Pearson’s r = 1.000) within an hour and within a week (rho c = 0.837; Pearson’s r = 0.840). VISA-A was translated and validated to Chilean Spanish speakers successfully, being comparable to the original version. We believe that VISA-A-CH can be recommended as an important tool for clinical and research settings in Chilean and probably Latin-American Spanish speakers.

Development of the Italian version of the High-Activity Arthroplasty Score (HAAS-I) following hip and knee total arthroplasty: cross-cultural adaptation, reliability, validity and sensitivity to change

Abstract: The number of physically active individuals who develop knee and hip arthritis and who undergo arthroplasties of these joints ie ever increasing. It has become necessary to develop evaluation scales which address the specific issues raised by such individuals. The High Activity Arthroplasty Score is one such scales, originally developed in English. The HAAS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included reliability by means of internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficients) and construct validity by Pearson’s correlations with a pain intensity numerical rating scale (NRS), the Western Ontario and McMaster University index (WOMAC, for THA subjects), the Knee injury and Osteoarthritis Outcome Scale (KOOS; for TKA subjects) and the Short-Form 36 Health Survey (SF-36). The questionnaire was administered to 67 subjects with THA and 61 with TKA and proved to be acceptable. The questionnaire showed good internal consistency (0.85 for THA and 0.91 for TKA) and a high level of test–retest reliability (ICC = 0.97 with 95% CI 0.95–0.98 for THA; ICC = 0.95 with 95% CI 0.92–0.98 for TKA). There was a moderate correlation between the HAAS-I and NRS (r = − 0.40), there was a high correlation between the HAAS-I and WOMAC (r = − 0.68) and there were moderate to high correlations between the HAAS-I and SF-36 subscales (r = 0.34 to 0.63) for THA. There was a moderate correlation between the HAAS-I and NRS (r = − 0.77); there was a high correlation between the HAAS-I and KOOS subscales (r = − 0.79 to r = − 0.91); and there were low correlations between the HAAS-I and SF-36 subscales (r = 0.01 to 0.29) for TKA. The HAAS-I was successfully translated into Italian and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes.

Making Them Commit: Strategies to Influence Phenotypic Differentiation in Mesenchymal Stem Cells.

Abstract: Tendon injuries, bone defects, and cartilage defects are complex clinical conditions leading to pain and dysfunctions. Tendon, bone, and cartilage are highly specialized and organized tissues, and the self-healing may be limited by their histologic features, or impaired by the local conditions. Furthermore, the resultant tissue often shows inferior properties compared with native tissue, leading to high rates of reruptures and revision surgeries. A growing field of research has explored tendon, bone, and cartilage regeneration using mesenchymal stem cells (MSCs), because of their multipotency, and because they are relatively easy to harvest. Great expectations arose from the use of MSCs in regenerative medicine in the last decade, although both the potential and the drawbacks of this method remain under reflection. This is a narrative review of the literature about different strategies to differentiate MSCs into tenocytes, osteoblasts, and chondrocytes. Challenges and limitations on the use of MSCs in vivo and in clinical practice are also discussed.

Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip-apex distance (TAD) and a calcar referenced TAD greater than 25 mm.

Abstract: To ascertain whether the tip–apex distance (TAD), calcar referenced TAD (CalTAD), and the sum of both (TADcalTAD) are predictive measurements of mobilisation of the cephalic screw in patients with trochanteric hip fractures. Between 2014 and 2015, 68 patients (mean age 86 years, 45 females, 23 males) with a trochanteric hip fracture underwent intramedullary nailing. The TAD and CalTAD were measured, and for each parameter, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). There is evidence of a statistically significant association between a TAD and CalTAD greater than 25 mm and a TADcalTAD greater than 50 mm and mobilisation of the cephalic screw. All measurements have similar sensitivity, but the TAD presents the highest specificity (p < 0.01). To avoid the risk of mobilisation of the cephalic screw and possible subsequent failure of the construct, surgeons should strive for a TAD and CalTAD less than 25 mm and a TADcalTAD less than 50 mm when using intramedullary fixation.

Single dose cefazolin is safe and effective for pre-operative prophylaxis in orthopaedic oncology.

Abstract: Surgical site infections (SSI) are a common potentially preventable complication after surgical procedures. A standardized antibiotic prophylaxis in elective orthopaedic surgery plays a major role in lowering SSI. At present, there is little published evidence regarding standardized antibiotic prophylaxis in orthopaedic oncological surgery. We introduced a prophylactic antibiotic protocol for orthopaedic oncological surgery in our hospital. The proposed protocol consists in "one-shot" intravenous administration of Cefazolin 2g, 30 min before surgery. In our setting, this preoperative antibiotic prophylaxis regimen was associated with a markedly lower rate of SSI's. There is no current evidence in favour of greater effectiveness of prophylaxis beyond 24/48 h after surgery compared to our pre-surgical "one-shot" administration; by contrast, prolonged post-surgical prophylaxis is likely to undermine the patient's bacterial flora and select resistant pathogens. These results are preliminary and should be used to start planning a standardised prophylactic protocol to prevent SSI's after orthopaedic oncological surgery.

Microcapsule Technology for Controlled Growth Factor Release in Musculoskeletal Tissue Engineering.

Abstract: Tissue engineering strategies have relied on engineered 3-dimensional (3D) scaffolds to provide architectural templates that can mimic the native cell environment. Among the several technologies proposed for the fabrication of 3D scaffold, that can be attractive for stem cell cultivation and differentiation, moulding or bioplotting of hydrogels allow the stratification of layers loaded with cells and with specific additives to obtain a predefined microstructural organization. Particularly with bioplotting technology, living cells, named bio-ink, and additives, such as biopolymer microdevices/nanodevices for the controlled delivery of growth factors or biosignals, can be organized spatially into a predesigned 3D pattern by automated fabrication with computer-aided digital files. The technologies for biopolymer microcarrier/nanocarrier fabrication can be strategic to provide a controlled spatiotemporal delivery of specific biosignals within a microenvironment that can better or faster address the stem cells loaded within it. In this review, some examples of growth factor-controlled delivery by biopolymer microdevices/nanodevices embedded within 3D hydrogel scaffolds will be described, to achieve a bioengineered 3D interactive microenvironment for stem cell differentiation. Conventional and recently proposed technologies for biopolymer microcapsule fabrication for controlled delivery over several days will also be illustrated and critically discussed.

Alternatives to Biologics in Management of Knee Osteoarthritis: A Systematic Review.

Abstract: Background:Knee osteoarthritis (KOA) is a common condition encountered by physicians. KOA is addressed by a wide array of modalities including a number of nonbiological treatments.Methods:PubMed, ISI Web of Science, and SPORTDiscus were searched for level 1 to 4 studies published from inception to A

Electromagnetic transduction therapy and shockwave therapy in 86 patients with rotator cuff tendinopathy: A prospective randomized controlled trial.

Abstract: Rotator cuff (RC) tendinopathy is the most common cause of shoulder pain. The effectiveness of electromagnetic transduction therapy (EMTT), a high energetic pulsed electromagnetic field therapy in ...

Cell Therapies in Tendon, Ligament, and Musculoskeletal System Repair.

Abstract: In the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects

The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature.

Abstract: Introduction Currently, no therapeutic intervention is universally accepted, and the most effective management for restoring motion and diminishing pain in patients with shoulder stiffness has yet to be defined. This systematic review analyses outcomes of conservative and surgical interventions to treat shoulder stiffness. Source of data A systematic review of literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'shoulder stiffness', 'stiff shoulder', 'conservative', since inception of databases to June 2018 was performed. Areas of agreement Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications, corticosteroid injections, or transcutaneous electrical nerve stimulation, manipulation under anaesthesia, and arthroscopic capsular release. Areas of controversy No therapeutic intervention is universally accepted, and the most effective management to restore motion and diminish pain in patients with shoulder stiffness has yet to be defined. Growing points The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group. Areas timely for developing research There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness. Prospective, randomized studies are needed to establish whether surgical or conservative management produce a clinically relevant difference in functional outcome.

How far have biological therapies come in regenerative sports medicine

Abstract: Introduction: Regular engagement in sports produces many health benefits, but also exposes to increased injury risk. The quality of medical care available is crucial not only for sports tra...

Matrix metalloproteinase-1 (MMP-1) and (MMP-8) gene polymorphisms promote increase and remodeling of the collagen III and V in posterior tibial tendinopathy.

Abstract: Posterior tibial tendinopathy (PTT) can lead to acquired flatfoot in adults. Many patients develop PTT without any identifiable risk factors. Molecular changes in extracellular matrix (ECM) and matrix metalloproteinase (MMP) polymorphism may influence the risk of developing PTT. We aim to investigate the association between matrix metalloproteinase-1 (MMP-1) and (MMP-8) gene polymorphisms with changes in collagen I, III and V in PTT. A case-control study with 22 patients and 5 controls was performed. The MMP-1 (2G/2G) and MMP-8 (T/T) genotypes were determined by PCR-restriction fragment length polymorphism. Tendon specimens were evaluated by a histologic semiquantitative score, immunofluorescence and histomorphometry for collagen I, III and V. Tendon specimens from PTT demonstrated marked distortion of the architecture with necrosis, large basophilic areas with disruption of the normal linear orientation of collagen bundles, infiltration of inflammatory cells, dystrophic calcification and ossification. Under immunofluorescence, PTT tendon specimens showed weak green fluorescence and diffuse distribution of collagen I fibers, but strong fluorescence of collagen III and V. The collagen I fibers were significantly decreased whereas an increase of collagen III and V were found in PTT compared to control groups. In addition, PTT group presented a significant association with MMP-1 and MMP-8 gene polymorphisms. Patients with PTT matrix metalloproteinase-1 (MMP-1) and (MMP-8) gene polymorphisms presented an increase of the collagen III and V ratio, suggesting that the higher proportion in degenerated tendons could contribute to a decrease in the mechanical resistance of the tissue. Still, functional and association studies are needed to elucidate evident roles of MMPs in PTT.

Some patients (and some of us) respond better to some biological therapies: the as yet unsolved conundrum.

Abstract: Very often, treatment for many common musculoskeletal conditions is only palliative, or involves surgery with major shortcomings. Biological interventions—in particular, platelet-rich plasma (PRP) therapies—may well provide more effective treatments, but their actual efficacy is under scrutiny. PRP is biologically unique to each individual depending on endogenous and exogenous factors, including, but not limited to, demographic factors (i.e. age), immune status (i.e. microbiota), metabolic diseases and concomitant medications. All these potential modifiers of the ultimate effects of PRP have been poorly explored, and their relationship with efficacy has not been established.

Surgery in Tendinopathies.

Abstract: Tendinopathies are challenging. The term "tendinopathy" refers to clinical condition characterized by pain, swelling, and functional limitations of tendons and nearby structures. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed conservatively and surgically. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively higher rate of success with low complication.

Intratendinous tears of the achilles tendon: a new pathology? analysis of a large four-year cohort

Abstract: IntroductionAn additional pathology should be considered for Achillodynia differentials – the intratendinous tear (ITT) – for which we describe symptoms, ultrasound findings and co-presenting pathology.Materials and MethodsExaminations of 740 Achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively.Results5% (29 males, 8 females) of 740 patients had an ITT. Patients typically presented with a history of sudden onset localised pain and the ability to train but not reach maximal loading. Average age was 36.3 years (range 20–64), significantly lower than mid-tendon tendinopathy (8.48 years; p<0.01); no pathology (5.81 years; p<0.05) and full tear (11.74 years; p<0.01). 92%...

Dubious space for Artelon joint resurfacing for basal thumb (trapeziometacarpal joint) osteoarthritis. A systematic review.

Abstract: Introduction Trapeziometacarpal arthritis is a common and disabling condition. There is no evidence in the literature of superiority of one surgical procedure over others. Several prosthetic implants have been introduced to preserve joint mobility. Sourced of data We searched the on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'artelon', 'thumb', 'carpometacarpal', 'trapeziometacarpal' and 'rhizoarthrosis'; 11 studies were identified. Areas of agreement The use of Artelon implant is not recommended because of its high revision rate and worse outcomes compared to conventional techniques. Areas of controversy Inert materials subjected to compressive and shearing forces could produce debris and subsequent inflammatory response. There is debate in the published scientific literature regarding the role of preoperative antibiotic profilaxis and post-surgery inflammatory response. Growing points Standard techniques such as trapeziectomy alone or combined with interposition or suspensionplasty offer effective treatment for thumb basal joint arthritis. Areas timely for developing research Several prosthetic implants show promising results in terms of pain relief and functional request, but there is a need of long-term randomized controlled trials to demonstrate their equivalence, and eventually superiority, compared to standard techniques.