Showing papers by "Nicola Maffulli published in 2019"
TL;DR: A systematic search of articles assessing the role of microRNA in physiopathology, diagnosis and therapy of OA was performed, giving a critical perspective of the possibilities for diagnostic and therapeutic use of miRNA in the management of Oa.
Abstract: Background Osteoarthritis (OA) is the most orthopedic condition. The pattern of gene expression and the transcription factors that exert control of chondrogenesis have been extensively studied. Sources of data A systematic search (up to July 2018) of articles assessing the role of microRNA (miRNA) in physiopathology, diagnosis and therapy of OA was performed, with the purpose of giving a critical perspective of the possibilities for diagnostic and therapeutic use of miRNA in the management of OA. Areas of agreement miRNAs are small noncoding RNAs that can regulate gene expression in human cells. miRNAs can be expressed in a different fashion in osteoarthritic compared to nonosteoarthritic cartilage. Areas of controversy The mechanisms that produce alteration of gene expression in OA are still not completely understood. miRNAs may be involved in the diagnosis of OA as well as in its treatment. Growing points There are complex interactions between miRNAs and their multiple target genes. These interactions may be important in gene regulation and the control of homeostatic pathways in OA. Areas timely for developing research miRNA could be useful for diagnostic or management purposes, but the issue of delivery of miRNA targeting agents needs to be overcome before miRNA can be applied in clinical practice.
98 citations
TL;DR: The identification of the genetic background related to susceptibility to injuries and physical performance of the athletes is challenging yet and further studies must be performed to establish the specific role of each gene and the potential effect of the interaction of these.
Abstract: PURPOSE: in the last two decades, several evidences have been provided to support the relationship between single nucleotide polymorphisms and the susceptibility to develop injuries participating in sport and performance related to sports activity. We report up-to-date review of the genetics factors involved in tendon injuries and athletic performance. METHODS: we searched PubMed using the terms "sports injuries", "athletic performance" and "genetics" over the period 1990 to the present day. We also included non-English journals. RESULTS: most of the currently established or putative tendinopathy susceptibility loci have been analyzed by candidate gene studies. The genes currently associated with tendon injuries include gene encoding for collagen, matrix metallopeptidase, tenascin and growth factors. Several genes have been related to the physical performance phenotypes affecting endurance capacity and muscle performance. The most studied include ACE and ACTN3 genes. CONCLUSIONS: genetics determines the response of an individual to the surrounding environment. Recently, some of the individual genetic variations contributing to the athletic performance and the onset of musculoskeletal injuries, particularly in tendon and ligament tissues, have been identified. However, the identification of the genetic background related to susceptibility to injuries and physical performance of the athletes is challenging yet and further studies must be performed to establish the specific role of each gene and the potential effect of the interaction of these. Language: en
70 citations
TL;DR: The DOSES tool, dubbed “DOSES,” is a standardized tool based on the reporting of 5 core items: donor, origin of tissue, separation from other cell types/preparation method, exhibited cell characteristics associated with behavior, and the site of delivery that can be utilized by researchers, clinicians, regulators, and industry professionals to improve standardization and transparency when describing cell therapies.
Abstract: Background:The lack of a standardized system for describing cell therapies acts as a barrier to advancement in clinical and basic research and practice. The aim of this study was to establish an international expert consensus on strategies to improve standardization and transparency when describing
66 citations
TL;DR: SVF provides a cellular and molecular microenvironment for regulation of ASC’ activities under different clinical conditions and novel point of care methods are emerging to refine SVF in ways that meet the regulatory requirements for minimal manipulation.
Abstract: Introduction: The heterogeneous pool of cells found in the stromal vascular fraction of adipose tissue (SVF) and the purified mesenchymal stromal/stem cells (ASCs) isolated from this pool have increasingly been used as therapeutic tools in regenerative medicine.Areas covered: As SVF and ASCs are different, and should be used in different manners according to various clinical and biological indications, we reviewed the current literature, and focused on the clinical use of SVF to appraise the main medical fields for development. Both enzymatic digestion and mechanical disruption have been used to obtain SVF for non-homologous use. The safety and/or benefits of SVF have been examined in 71 clinical studies in various contexts, mainly musculoskeletal conditions, wound healing, urogenital, and cardiovascular and respiratory diseases. The use of SVF as a therapy remains experimental, with few clinical trials.Expert opinion: SVF provides a cellular and molecular microenvironment for regulation of ASC' activities under different clinical conditions. SVF may enhance angiogenesis and neovascularization in wound healing, urogenital and cardiovascular diseases. In joint conditions, therapeutic benefits may rely on paracrine immune-modulatory and anti-inflammatory mechanisms. Novel point of care methods are emerging to refine SVF in ways that meet the regulatory requirements for minimal manipulation.
55 citations
TL;DR: It is proposed that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotators cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator tendon disease.
Abstract: Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease.
51 citations
TL;DR: It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures.
Abstract: Microfracture is an established method to treat osteochondral defects of the talus. The value of the addition of an acellular matrix is still under debate. This study compared the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) in the management of articular cartilage defects of the talus. Patients with a minimum follow-up of 5 years after arthroscopic management for an articular cartilage defect of the talus with either microfracture alone or an additional acellular matrix were matched according to age, sex and BMI. The Hannover Scoring System for the ankle (HSS) and a Visual analog scale (VAS) for pain, function and satisfaction were used to evaluate the clinical outcome. Postoperative MRI was used to assess cartilage repair tissue based on the degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue, and subchondral bone alterations. Thirty-two patients (16 microfracture, 16 AMIC) were included. No significant between-group differences were observed in demographic data and preoperative score values. Both groups showed statistically significant improvement when comparing the pre- and postoperative score values. No statistically significant differences were identified between the median values of the groups with the HSS (microfracture: 82 (range 71–96) points; AMIC 88 (range 40–98) points). Accordingly, no significant differences were observed for the VAS pain (microfracture: 0.95 (range 0–3.8); AMIC: 1.0 (range 0–8.5)), VAS function (microfracture: 8.4 (range 3.5–10); AMIC: 9.0 (range 1.5–10)) and VAS satisfaction (microfracture: 8.9 (range 2.8–10); AMIC: 9.45 (range 1.5–10)). MRI showed regeneration of tissue in the treated area without differences between the two groups. Good clinical results were observed for arthroscopic microfracture with or without an additional acellular collagen I/III matrix in the treatment for articular cartilage defects of the talus. It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures. III.
47 citations
TL;DR: In this article, the authors describe regenerative medicine technologies, including cellular therapies, gene therapies and multimolecular preparations of growth factors and cytokines, which are expected to advance the field of orthopaedics and sports medicine.
Abstract: The practice of any sport is inherently associated with the risk of musculoskeletal lesions. We describe regenerative medicine technologies, including cellular therapies, gene therapies and multimolecular preparations of growth factors and cytokines, which are expected to advance the field of orthopaedics and sports medicine. Gene therapy involves the introduction of genetic information in the injured tissue to help that tissue to heal and, possibly, regenerate. Cell therapies used in clinical practice are based on the transplantation of adult human cells, which can be at different stages of differentiation. Currently, the stromal vascular fraction, containing stem cells and other niche components, has been injected in the articular cartilage of the knee or delivered via arthroscopy. Bone marrow concentrate (BMC) has been used to manage focal chondral defects via arthroscopy with promising clinical results. In addition, purified mesenchymal stem cells (MSCs) have been injected or delivered as an adjuvant to arthroscopic microfractures, and patients have shown improved clinical outcomes. Laboratory-expanded MSCs injected in osteoarthritis moderately improved pain and functional outcomes. MSC treatment in the form of stromal vascular fraction (SVF) or BMC or laboratory expanded adhesive cells (bone marrow and adipose derived stem cells, BM-MSCs and ADSCs) has been proven to be safe. Despite their safety, expensive regulatory complexities required to implement cell-based therapies make these treatments unavailable for most patients. At present, although some results are promising, all biological interventions are experimental, and cost/efficacy has not been demonstrated yet. Moreover, short follow-up in most studies questions the durability of treatments.
40 citations
TL;DR: This paper aims to demonstrate the efforts towards in-situ applicability of EMMARM, as to provide real-time information about the concrete mechanical properties of EMTs and their application to the human body.
Abstract: 1 Psychology, University e-Campus, Novedrate, Italy 2 Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Rome, Italy 3 Department of Physical and Rehabilitation Medicine, University of Padua, Italy 4 Department of Musculoskeletal Disoders, University of Salerno, Italy; Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, England
36 citations
TL;DR: The role of inflammation in tendon healing is still unclear, though it seems to affect the overall outcome, and a thorough understanding of the biochemical mediators of healing and their pathway of pain could be used to target tendinopathy and possibly guide its management.
Abstract: Background Tendinopathy is a common musculoskeletal condition affecting subjects regardless of their activity level. Multiple inflammatory molecules found in ex vivo samples of human tendons are related to the initiation or progression of tendinopathy. Their role in tendon healing is the subject of this review. Sources of data An extensive review of current literature was conducted using PubMed, Embase and Cochrane Library using the term 'tendon', as well as some common terms of tendon conditions such as 'tendon injury OR (tendon damage) OR tendonitis OR tendinopathy OR (chronic tendonitis) OR tendinosis OR (chronic tendinopathy) OR enthesitis' AND 'healing' AND '(inflammation OR immune response)' as either key words or MeSH terms. Areas of agreement An environment characterized by a low level of chronic inflammation, together with increased expression of inflammatory cytokines and growth factors, may influence the physiological tendon healing response after treatment. Areas of controversy Most studies on this topic exhibited limited scientific translational value because of their heterogeneity. The evidence associated with preclinical studies is limited. Growing points The role of inflammation in tendon healing is still unclear, though it seems to affect the overall outcome. A thorough understanding of the biochemical mediators of healing and their pathway of pain could be used to target tendinopathy and possibly guide its management. Areas timely for developing research We require further studies with improved designs to effectively evaluate the pathogenesis and progression of tendinopathy to identify cellular and molecular targets to improve outcomes.
31 citations
TL;DR: The difference between conventional and fast-track pathways does not lie in the contents of blood management, which are related to surgeons/surgeries, materials used and patients, but in the way these contents are integrated into each other, since elective orthopedic procedures offer significant room for planning.
Abstract: Innovations able to maintain patient safety while reducing the amount of transfusion add value to orthopedic procedures. Opportunities for improvement arise especially in elective procedures, as long as room for planning is available. Although many strategies have been proposed, there is no consensus about the most successful combination. The purpose of this investigation is to identify information to support blood management strategies in fast-track total joint arthroplasty (TJA) pathway, to (i) support clinical decision making according to current evidence and best practices, and (ii) identify critical issues which need further research. We identified conventional blood management strategies in elective orthopedic procedures. We performed an electronic search about blood management strategies in fast-track TJA. We designed tables to match every step of the former with the latter. We submitted the findings to clinicians who operate using fast-track surgery protocols in TJA at our research hospital. Preoperative anemia detection and treatment, blood anticoagulants/aggregants consumption, transfusion trigger, anesthetic technique, local infiltration analgesia, drainage clamping and removals, and postoperative multimodal thromboprophylaxis are the factors which can add best value to a fast-track pathway, since they provide significant room for planning and prediction. The difference between conventional and fast-track pathways does not lie in the contents of blood management, which are related to surgeons/surgeries, materials used and patients, but in the way these contents are integrated into each other, since elective orthopedic procedures offer significant room for planning. Further studies are needed to identify optimal regimens.
31 citations
TL;DR: There are potential benefits using a combination of AA and T3 to accelerate tendon healing and the group treated with AA combined with T3 displayed the lowest Svensson, Soslowsky, and Cook total score value of all tissue sections at histopathological examination.
Abstract: This pilot study aimed to ascertain whether the local application of ascorbic acid (AA), of T3, and of rat (r) bone marrow mesenchymal stem cells (BMSCs), alone or in all possible combinations, promoted healing after an Achilles tendon injury in a rat model. An Achilles tendon defect was produced in 24 6–8-week-old male inbred Lewis rats. The animals were then randomly divided into eight groups of three rats each. The tendon defect was filled with 50 μL of phosphate-buffered saline (PBS) containing (1) 50 μg/mL AA (AA group), (2) 10−7 M T3 (T3 group), (3) 4 × 106 rBMSCs (rBMSC group), (4) 50 μg/mL AA + 10−7 M T3 (AA + T3 group), (5) 4 × 106 rBMSCs + 50 μg/mL AA (rBMSC + AA group), (6) 4 × 106 rBMSCs + 10−7 M T3 (rBMSC + T3 group), (7) 4 × 106 rBMSCS + 50 μg/mL AA + 10−7 M T3 (rBMSC + AA + T3 group), and (8) PBS only (control group: CTRL). All treatments were administered by local injection immediately after the tendons had been damaged; additionally, AA was injected also on the second and fourth day from the first injection (for groups 1, 4, 5, and 7), and T3 was injected again every day for 4 days (for groups 2, 4, 6, and 7). At 30 days from initial treatment, tendon samples were harvested, and the quality of tendon repair was evaluated using histological and histomorphological analysis. The structure and morphology of the injured Achilles tendons were evaluated using the modified Svensson, Soslowsky, and Cook score, and the collagen type I and III ratio was calculated. The group treated with AA combined with T3 displayed the lowest Svensson, Soslowsky, and Cook total score value of all tissue sections at histopathological examination, with fiber structure close to regular orientation, normal-like tendon vasculature, and no cartilage formation. AA + T3 also showed the highest collagen I and the lowest collagen III values compared to all other treatments including the CTRL. There are potential benefits using a combination of AA and T3 to accelerate tendon healing.
TL;DR: This research presents a novel probabilistic procedure called “spot-spot analysis” that allows for real-time analysis of the response of the immune system to natural catastrophes.
Abstract: Background amnion-derived stem cells are considered a promising alternative source for tendon tissue regeneration. Purpose aims of this paper were to illustrate the ultrasound and histological outcomes following the treatment of acute and chronic superficial digital flexor tendon spontaneous lesions in horses with ovine amniotic epithelial cells xenotransplantation. Methods six adult horses suffering from unilateral acute (4 cases) and chronic (2 cases) tendinopathy (clinical and ultrasound diagnosis) were enrolled. At baseline, ovine amniotic epithelial cells were grafted, in sterile conditions and under ultra-sound control, into the most damaged area. Ultra-sound controls were performed at 30, 60, 90, 120, 150 and 180 days after cells implantation; after horse euthanasia (180 days) tendon samples were collected and submitted to histological examination (cellularity, extracellular matrix fiber organization, blood vessels). Results at baseline, in the acute cases, the ultra-sound exam showed a focal, dis-homogeneous, hypo-echoic area into the superficial digital flexor tendon, with loss of the normal fibrillar pattern, while in the chronic cases the damaged tendon area appeared thickened and completely hyper-echoic. At the final follow-up tendon echotexture was more regular, the cross-sectional area similar to the contra-lateral limb, and the collagen fibers were oriented in parallel to the longitudinal axis of the tendon both in the acute and chronic cases, suggesting a positive healing response. These findings were supported by the histological analyses which showed an almost complete restoration of normal tendon architecture with an optimal alignment of tendon fibers. Conclusions the present pilot study supports the hypothesis that amniotic epithelial cells are provided of an excellent healing potential and shows a very good correlation between the ultrasound findings and the histologic features.
TL;DR: This work shows a case of a pure vastus medialis muscle laceration surgically repaired at 6 years of follow-up, and different suture techniques have been described but still the best suture is debated.
Abstract: Muscle injuries are challenging problems for surgeons Muscle trauma is commonly treated conservatively with excellent outcome results while surgical repair is advocated for larger tears/lacerations, where the optimal goal is restore of function Repair of muscle belly lacerations is technically demanding because the sutures pull out and the likelihood of clinical failure is high Different suture techniques have been described but still the best suture is debated We show a case of a pure vastus medialis muscle laceration surgically repaired at 6 years of follow-up
TL;DR: Patients need better evidence on functional outcomes, including a return to sport, and there are calls for a shake-up in the way research is funded and funded for evidence of long-term benefits.
Abstract: Patients need better evidence on functional outcomes, including a return to sport
TL;DR: Stage 1 and stable Stage 2 Lisfranc injuries show good results with nonoperative management and Percutaneous Reduction Internal Fixation offers the best RR and RT from the operative methods, though this may not be possible with high-energy injuries.
Journal Article•
TL;DR: A better understanding of the genetic influence on the function of the musculoskeletal system and healing of its ailments is needed to plan and develop patient specific management strategies.
Abstract: DNA holds genetic information in the nucleus of eukaryotic cells; and has three different functions: replication, storage of hereditary information, and regulation of cell division. Most studies described the association of single nucleotide polymorphism (SNP) to common orthopaedics diseases and the susceptibility to develop musculoskeletal injuries. Several mutations are associated with osteoporosis, musculoskeletal ailments and other musculoskeletal deformity and conditions. Several strategies, including gene therapy and tissue engineering with mesenchymal stem cells (MSC), have been proposed to enhance healing of musculoskeletal tissues. Furthermore, a recent technique has revolutionized gene editing: clustered regulatory interspaced short palindromic repeat (CRISPR) technology is characterized by simplicity in target design, affordability, versatility, and high efficiency, but needs more studies to become the preferred platform for genome editing. Predictive genomics DNA profiling allows to understand which genetic advantage, if any, may be exploited, and why a given rehabilitation protocol can be more effective in some individual than others. In conclusion, a better understanding of the genetic influence on the function of the musculoskeletal system and healing of its ailments is needed to plan and develop patient specific management strategies.
TL;DR: New discovery are reviewed that revisit the current thinking on the tendon biology focusing on thyroid hormones T3 and T4, and their possible role on human tenocyte.
Abstract: Thyroid hormones (THs) T3 and T4, play an essential role in the development and metabolism of many tissues and organs, and have profound metabolic effects in adult life. THs action is mediated mainly by the thyroid hormone receptor (TRs) which seem to be ubiquitous. To-date thyroid-associated disease are not thought to be related in tendinopathies and tendons tears. Recent study demonstrated the presence of TRs in tendons and their possible role in the proliferation and apoptosis of human tenocyte isolated from tendon. We review new discovery that revisit our current thinking on the tendon biology focusing on thyroid hormones (THs) T3 and T4, and their possible role on human tenocyte
TL;DR: The current evidence supporting NMES as an effective physical exercise substitute for inducing myokine production and its potential applications in health and disease is reviewed.
Abstract: Myokines are peptides known to modulate brain neuroplasticity, adipocyte metabolism, bone mineralization, endothelium repair and cell growth arrest in colon and breast cancer, among other processes. Repeated skeletal muscle contraction induces the production and secretion of myokines, which have a wide range of functions in different tissues and organs. This new role of skeletal muscle as a secretory organ means skeletal muscle contraction could be a key player in the prevention and/or management of chronic disease. However, some individuals are not capable of optimal physical exercise in terms of adequate duration, intensity or muscles involved, and therefore they may be virtually deprived of at least some of the physiological benefits induced by exercise. Neuromuscular electrical stimulation (NMES) is emerging as an effective physical exercise substitute for myokine induction. NMES is safe and efficient and has been shown to improve muscle strength, functional capacity, and quality of life. This alternative exercise modality elicits hypertrophy and neuromuscular adaptations of skeletal muscles. NMES stimulates circulating myokine secretion, promoting a cascade of endocrine, paracrine, and autocrine effects. We review the current evidence supporting NMES as an effective physical exercise substitute for inducing myokine production and its potential applications in health and disease.
TL;DR: This systematic review investigates the biological and chemical mechanisms that affect the health and structure of tendons following the use of fluoroquinolones (FQs) and identifies five mechanisms.
Abstract: Introduction The present systematic review investigates the biological and chemical mechanisms that affect the health and structure of tendons following the use of fluoroquinolones (FQs). Sources of data A total of 12 articles were included, organized, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Areas of agreement Five mechanisms were identified: arrest of proliferation through a decreased activity of cyclin B, CDK-1, CHK-1, and increased PK-1; decrease tenocytes migration through decreased phosphorylation of FAK; decrease type I collagen metabolism through increased MMP-2; chelate effect on ions that influence epigenetics and several enzymes; fluoroquinolones-induced ROS (radical oxygen species) production in mitochondria. Areas of controversy There is no definite structure-damage relationship. The dose-effect relationship is unclear. Growing points Knowing and defining the damage exerted by FQs plays a role in clinical practice, replacing FQs with other antibacterial drugs or using antioxidants to attenuate their pathological effects. Areas timely for developing research Clinical and basic sciences studies for each FQs are necessary.
TL;DR: Novel tissue engineering strategies focus on the development of cartilaginous biomimetic materials able to repair cartilage lesions in association to cell, trophic factors and gene therapies.
Abstract: Background Given the limited regenerative capacity of injured articular cartilage, the absence of suitable therapeutic options has encouraged tissue-engineering approaches for its regeneration or replacement. Sources of data Published articles in any language identified in PubMed and Scopus electronic databases up to August 2019 about the in vitro and in vivo properties of cartilage engineered constructs. A total of 64 articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Areas of agreement Regenerated cartilage lacks the biomechanical and biological properties of native articular cartilage. Areas of controversy There are many different approaches about the development of the architecture and the composition of the scaffolds. Growing points Novel tissue engineering strategies focus on the development of cartilaginous biomimetic materials able to repair cartilage lesions in association to cell, trophic factors and gene therapies. Areas timely for developing research A multi-layer design and a zonal organization of the constructs may lead to achieve cartilage regeneration.
01 Jan 2019
TL;DR: To improve the knowledge about Insertional Achilles tendinopathy, more evidence should be provided concerning innovative treatments, especially considering growth factors injections and percutaneous surgery.
Abstract: Achilles tendon pathology is a most common musculoskeletal condition in active individuals and athletes. Almost 6% of the general population will suffer from such ailment in their lifetime. Insertional Achilles tendinopathy (IAT) differs in its physiopathology, clinical features and treatment from midportion tendinopathy. The literature has mainly focused on assessment, outcome evaluation and treatment of IAT, although differences in management according to different geographical regions have not been addressed. The principles of clinical evaluation and imaging assessment of IAT are well established, with a major role of clinical assessment and soft tissue imaging, including ultrasonography and MRI. Conservative management options include eccentric training, extracorporeal shockwave therapy and prolotherapy, or a combination of these modalities. Recently, regenerative medicine has been more widely used, with at times dubious results. Surgery is advocated where conservative treatment is not beneficial within 6 months. Surgery includes more or less extensive debridement of peritendinous bony and soft tissue structures. To improve our knowledge about IAT, more evidence should be provided concerning innovative treatments, especially considering growth factors injections and percutaneous surgery.
TL;DR: Although many scoring systems have been used to evaluate hip function, there is still far from a single outcome evaluation system which is reliable, valid and sensitive.
Abstract: Introduction During the past decades, several rating scales have been developed to assess the functional status of patients with hip pain. Source of data A search in Medline, PubMed, Cochrane and CINAHL was performedusing combinations of the following'hip', 'scoring system', 'scale', 'scores', 'outcome assessment', 'arthroplasty', 'arthroscopy' and 'clinical evaluation'. Areas of agreement A total 16 scoring systems are currently available for the evaluation of the hip. Areas of controversy Two types of questionnaires are available: physician-rated and patient-rated questionnaires. Growing points Each hip score consists of different domains. Interpreting these domains becomes sometimes difficult, because, even though they can be common to more than one scoring system, each stresses them in a different way. Areas timely for developing research Although many scoring systems have been used to evaluate hip function, we are still far from a single outcome evaluation system which is reliable, valid and sensitive.
TL;DR: Individually-prescribed home-based exercise programs were cost effective, safe and resulted in modest improvements in body composition, strength, and total body water distribution with little to no adverse effect on cardiac function.
Abstract: BACKGROUND Aerobic and resistance exercises have been promoted recently to improve quality of life in cancer patients. Most cancer survivorship rehabilitation programs consist of supervised exercise programs; however, less data is available on the effects of unsupervised or home-based exercise interventions. The study aimed to compare the physical and physiologic changes in a group of cancer survivors (CS) and a control group of non-cancer, health controls (HC) who participated in individualized home-based aerobic and resistance exercises for 12 months. METHODS Thirty-three surviving cancer survivors (CS) aged 55.6±3 years were enrolled for 1 year of unsupervised exercise prescription programs. Anthropometric parameters hydration status, fitness, and echocardiographic examination were measured every six month and compared to10 HC (aged 52.6±7.7 years) individuals prior to starting the program (t0) and at 6 (t6) and 12 (t12) months. RESULTS Among the CS subjects, a significant reductions in waist circumference (t0: 97.5±15.2 cm, t6: 86.6±13.5 cm, t12: 85.8±13.9 cm; P<0.05), body cell mass (t0: 50.9±4.7%, t6: 52.3±4.4%, t12: 53.7±3.7%; P<0.05), and extracellular mass (t0: 49.1±4.7%, t6: 47.6±4.4%, t12: 46.2±3.7%; P<0.05) were observed, as well significant improvements in lower body muscle strength (chair test t0: 13.3±4.1, t6: 14.2±3.5, t12: 15.1±3.2; P<0.05). Changes in functionality and heart function were similar between CS and HC. CONCLUSIONS Individually-prescribed home-based exercise programs were cost effective, safe and resulted in modest improvements in body composition, strength, and total body water distribution with little to no adverse effect on cardiac function.
TL;DR: A systematic search will be conducted in Medline, Embase, Cochrane Library, Scopus and relevant trial databases of English, Japanese, Korean, German, French, Italian, Spanish and Portuguese language papers published or in press to June 2018, with no restrictions on publication year applied.
Abstract: Osteoarthritis is a progressive multifactorial condition of the musculoskeletal system with major symptoms including pain, loss of function, damage of articular cartilage and other tissues in the affected area. Knee osteoarthritis imposes major individual and social burden, especially with the cost and complexity of surgical interventions. Mesenchymal stem/stromal cells have been indicated as a treatment for degenerative musculoskeletal conditions given their capacity to differentiate into tissues of the musculoskeletal system. A systematic search will be conducted in Medline, Embase, Cochrane Library, Scopus and relevant trial databases of English, Japanese, Korean, German, French, Italian, Spanish and Portuguese language papers published or in press to June 2018, with no restrictions on publication year applied. References will be screened and assessed for eligibility by two independent reviewers as per PRISMA guidelines. Cohort, cross-sectional or case controlled studies will be included for the analysis. Data extraction will be conducted using a predefined template and quality of evidence assessed. Statistical summaries and meta-analyses will be performed as necessary. Results will be published in relevant peer-reviewed scientific journals and presented at national or international conferences by the investigators. The protocol was registered on the PROSPERO international prospective register of systematic reviews prior to commencement, CRD42018091763
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TL;DR: The direct intraligamentary stabilization technique was the most widely and accurately reported technique, with acceptable success and improvement of functional outcomes, in comparison with ACL reconstruction and no sufficient evidence was available to support these techniques.
Abstract: Background The most common procedure to manage a torn anterior cruciate ligament (ACL) is surgical reconstruction. Primary repair of the ACL is returning on the forefront in the management of acute ACL, aiming to be less invasive and preserve the original ligament. Several techniques have been reported; the present systematic review investigates the clinical outcomes of ACL primary repair in adults. Sources of data Following an electronic search through Medline, Cochrane and Google Scholar databases, articles of interest were retrieved and evaluated, including case series, retrospective studies, case-control studies and randomized controlled trials. The main outcome data were extracted and summarized in tables and text. The methodology of the studies was assessed using the Coleman methodology score (CMS). Areas of agreement Of the articles included, one was of level I, two of level III and the remaining of level IV. The direct intraligamentary stabilization technique was the most widely and accurately reported technique, with acceptable success and improvement of functional outcomes. The CMS averaged 58.75 (range 48 to 69), with no significant association with year of publication (Pearson's regression r = -0.397, P = 0.207). Areas of controversy Concerning stump sutures and suture anchors repair, although leading to good results, also in comparison with ACL reconstruction, no sufficient evidence was available to support these techniques. Growing points The overall good results were reported also for other techniques are not supported by adequate evidence. More and better trials are required to improve our knowledge and understanding in this controversial area.
TL;DR: This paper aims to demonstrate the efforts towards in-situ applicability of EMMARM, which aims to provide real-time information about the physical activity-related musculoskeletal disorders of the knee and hip.
Abstract: 1 Department of Orthopaedic and Traumatology, University of Rome ‘‘Tor Vergata”, School of Medicine, Rome, Italy 2 Fondazione IBSA for scientific research, Pambio, Switzerland 3 Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy, and Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
TL;DR: There is a need for a validated reproducible method of rotator cuff tendon biopsy evaluation and further studies with improved designs are required to effectively evaluate the histological and immunohistochemical features of rotators cuff tendinopathy.
Abstract: Background Rotator cuff tendinopathy is a common musculoskeletal ailment in sedentary and athletic individuals. Various mediators of inflammation have been detected in human tendons: they are thought to initiate or progress the course of tendinopathy. Sources of data An online search was conducted using AMED, CINAHL, Embase, The Cochrane Library, PEDro and Pubmed, using the terms tendinopathy, tendon, tendinitis, tendinosis, histology, histopathology, immunohistochemistry, immunohistochemical, rotator cuff and pain. Areas of agreement Histological examination of tendinopathic tendons shows degeneration of the collagen structure and infiltration of fat and vessels, together with increased expression of inflammatory cytokines, MMP-1, 2, 3, 9, 13, vascular endothelial growth factor and Hypoxia inducible factor (HIF). Areas of controversy Most of the studies about this topic exhibited limited validity because of lack of appropriately matched controls and no inclusion or exclusion criteria. The evidence associated with the histopathological analysis of the rotator cuff is limited. Growing points The histochemical and immunohistochemical features of rotator cuff tendinopathy are still unclear. A thorough understanding of the vascularity, innervation and biochemical mediators of pain could be used to target rotator cuff pathology, and possibly guide the therapy of painful rotator cuff disorders. Areas timely for developing research There is a need for a validated reproducible method of rotator cuff tendon biopsy evaluation. We require further studies with improved designs to effectively evaluate the histological and immunohistochemical features of rotator cuff tendinopathy.
TL;DR: The action of ozone is unclear, but it is a promising therapeutic modality capable of impacting, favourably, function and quality of life and the lack of a clear protocol of use is a major limitation.
Abstract: Background Osteoarthritis (OA) is a most common orthopaedic condition, often complicated by inflammatory features. Sources of data A systematic search in PubMed, Embase, Google Scholar and Scopus databases (to January 2019) was performed to define the effect obtained in patients with OA of the knee by injections of ozone, on pain and physical function. Six RCTs and 353 patients were included. Areas of agreement Recently, an increasing number of physicians have used ozone therapy to alleviate the symptoms of acute and chronic OA of the knee. Ozone can allow greater mobility of the knee joint, pain relief and decrease in effusion. Areas of controversy The volume and concentration of ozone injected are different in the various treatment protocols published. Growing points The action of ozone is unclear, but it is a promising therapeutic modality capable of impacting, favourably, function and quality of life. Areas timely for developing research The lack of a clear protocol of use is a major limitation, and to date there is no clear evidence of long-term efficacy.
TL;DR: 1 Department of Physical and Rehabilitation Medicine, University ofPadova, Padova, Italy 2 Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery,University of Salerno, Baronissi, Salerno; and Clinical Research Department, Fidia Farmaceutici S.p.A.
Abstract: 1 Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy 2 Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy 3 Department of Physical and Rehabilitation Medicine, Policlinico San Marco, Mestre, Italy 4 Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy 5 Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy 6 Clinical Research Department, Fidia Farmaceutici S.p.A., Abano Terme, Padua, Italy
TL;DR: There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm.
Abstract: Repair of full-thickness rotator cuff (RC) tears is routinely performed using suture anchors, which produce secure and effective soft tissue fixation to bone. The aim of this prospective study is to compare the long-term outcomes of single row arthroscopic rotator cuff repair (RCR) performed using metal or biodegradable suture anchors. The null hypothesis is that there is no difference in shoulder function using metal or biodegradable suture anchors as evaluated by UCLA shoulder score, Wolfgang criteria, and Oxford shoulder score. Arthroscopic RCR was performed in 110 patients included in this case control study. They were divided into 2 groups of 51 and 59 patients respectively. Metal suture anchors were used in group 1, and biodegradable suture anchors in group 2. Results were obtained at a mean follow up of 4.05 + 2 years. Clinical outcomes and functional outcomes were evaluated. The mean modified UCLA shoulder score was 26.9 + 7.1 in group 1, and 27.7 + 6.5 in group 2 (P = 0.5); the mean Wolfgang score was 13.3 + 3.3 in group 1, and 14 + 2.6 in group 2 (P = 0.3); the mean OSS was 23.7 + 11.4 in group 1, and 20.7 + 9.2 points in group 2 (P = 0.1). The mean active anterior elevation was 163.5° + 28.2° in group 1 and 163.6° + 26.9 in group 2 (P = 0.9); the mean active external rotation was 46° + 19.7° in group 1 and 44.6° + 16.3° in group 2 (P = 0.7). The mean strength in anterior elevation was 4.8.02 + 23.52 N in group 1, and 43.12 + 17.64 N in group 2 (P = 0.2); the mean strength in external rotation was 48.02 + 22.54 N in group 1 and 46.06 + 17.64 N in group 2 (P = 0.6); the mean strength in internal rotation was 67.62 + 29.4 N in group 1, and 68.6 + 25.48 N in group 2 (P = 0.9). There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm.