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

Exploring the link between metformin use and adhesive capsulitis of the shoulder: a retrospective cohort study in Taiwan

The risk of adhesive capsulitis of shoulder in diabetic patients taking metformin has not been evaluated. We aimed for evaluating the relative risk of adhesive capsulitis of shoulder in diabetic patients taking metformin at the level of the whole country population. We conducted a retrospective cohort study using a national health insurance database in Taiwan from 2000 to2015. We used International Classification of Diseases, Ninth Revision, to categorise the medical condition for study group and comparison group. We used Cox proportional hazard regression analyses to determined adjusted hazard ratios (aHRs) of adhesive capsulitis of shoulder between study and comparison group after adjusting for sex, age, and comorbidities.Among 30,412 diabetic patients using metformin, 3020 patients were diagnosis with adhesive capsulitis of shoulder during follow up. Of the 121,648 patients without the use of metformin, 11,375 patients developed adhesive capsulitis of shoulder. Adhesive capsulitis of shoulder risk was elevated in patients taking metformin than in non-metformin group (adjusted hazard ratio [HR] 1.179, 95% confidence interval [95% CI] 1.022 to 1.268; p = 0.039). Risk of adhesive capsulitis of shoulder among the diabetic patients taking metformin was higher than those did not taking metformin.

Electrospinning technology: a promising approach for tendon-bone interface tissue engineering

The regeneration of tendon-bone interface tissue has become a topic of great interest in recent years. However, the complex nature of this interface has posed challenges in finding suitable solutions. Tissue engineering, with its potential to improve clinical outcomes and play a crucial role in musculoskeletal function, has been increasingly explored for tendon-bone interface regeneration. This review focuses on the research advancements of electrospinning technology in interface tissue engineering. By utilizing electrospinning, researchers have been able to fabricate scaffolds with tailored properties to promote the regeneration and integration of tendon and bone tissues. The review discusses the unique structure and function of the tendon-bone interface, the mechanisms involved in its healing, and the limitations currently faced in achieving successful regeneration. Additionally, it highlights the potential of electrospinning technology in scaffold fabrication and its role in facilitating the development of functional and integrated tendon-bone interface tissues. Overall, this review provides valuable insights into the application of electrospinning technology for tendon-bone interface tissue engineering, emphasizing its significance in addressing the challenges associated with regeneration in this complex interface.

Thickness and width of the menisci of adult knee joint: a descriptive cross-sectional observational study in cadavers

Background

The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and over the right- and left-sided specimens.

Methods

The present study included 50 adult cadaveric knee joints, and 100 menisci (50 medial menisci and 50 lateral menisci) were studied. The meniscus was distributed into anterior, middle and posterior parts. Thickness and width at the mid-point of these three parts were determined by using the Vernier caliper.

Results

The breadth of the medial meniscus was 8.38 ± 1.64 mm, 7.68 ± 1.92 mm and 13.93 ± 2.69 mm at the anterior, middle and posterior one-third regions. Same measurements for the lateral menisci at these regions were 9.84 ± 1.78 mm, 8.82 ± 2.01 mm and 10.18 ± 2.23 mm, respectively. The thickness of the medial meniscus was 4.49 ± 0.78 mm, 4.07 ± 0.81 mm and 4.79 ± 0.93 mm at these regions. The lateral meniscus thickness was 3.82 ± 0.69 mm, 4.43 ± 0.98 mm and 4.36 ± 0.8 mm, respectively.

Conclusion

It is believed that this data is enlightening to the arthroscopic surgeon during the meniscus transplantation either by using synthetic material or allograft as the proper sizing of the meniscus is important to prevent complications due to inaccurate sizing.

Functional autonomy and 12-month mortality in older adults with proximal femoral fractures in an orthogeriatric setting: risk factors and gender differences

BACKGROUND

Proximal femur fractures have a negative impact on loss of functional autonomy and mortality.

OBJECTIVE

The aim of this retrospective study was to evaluate functional autonomy and mortality in a group of older adults with hip fractures managed in an orthogeriatric setting 12 months after discharge and to determine if gender affected outcome.

METHODS

In all participants, we assessed clinical history, functional pre-fracture status using activities of daily living (ADL) and in-hospital details. At 12 months after discharge, we evaluated functional status, place of residence, hospital readmissions and mortality.

RESULTS

We studied 361 women and 124 men and we observed a significant reduction in the ADL score at 6 months (1.15 ± 1.58/p < 0.001 in women and 1.45 ± 1.66/p < 0.001 in men). One-year mortality (33.1% in men and 14.7% in women) was associated with pre-fracture ADL score and reduction in ADL at 6 months (HR 0.68/95%, CI 0.48-0.97/p < 0.05 and HR 1.70/95%, CI 1.17-2.48/p < 0.01, respectively) in women, and new hospitalisations at 6 months and polypharmacy in men (HR 1.65/95%, CI 1.07-2.56/p < 0.05 and HR 1.40/95%, CI 1.00-1.96/p = 0.05, respectively) in Cox's regression model.

DISCUSSION AND CONCLUSIONS

Our study suggests that functional loss in older adults hospitalised for proximal femur fractures is greatest in the first 6 months after discharge, and this increases the risk of death at 1 year. Cumulative mortality at 12 months is higher in men and appears to be related to polypharmacy and new hospital admissions 6 months after discharge.

Achilles tendon thickness reduces immediately after a marathon

BACKGROUND

The purpose of the present investigation was to evaluate the immediate effect of running a marathon on Achilles tendon anteroposterior thickness.

METHODS

In 25 runners who took part in the London marathon, ultrasonography was used to measure the Achilles tendon thickness pre- and immediately post-marathon and to identify any structural abnormalities indicating tendinopathy. Pain was recorded using a numerical rating scale at baseline and post-marathon. Twenty-one participants were included in the final analysis.

RESULTS

Running a marathon resulted in a significant decrease (- 13%, p < 0.01) in anteroposterior diameter of the Achilles tendon immediately following the marathon. There was no change in the proportion of Achilles tendons with structural abnormalities (34%) or pain (12%) following the marathon (p > 0.05).

CONCLUSION

Running a marathon resulted in an immediate reduction in anteroposterior diameter of the Achilles tendon. This finding may have implications for injury prevention and recovery following a marathon.

High-Fructose, High-Fat Diet Alters Muscle Composition and Fuel Utilization in a Juvenile Iberian Pig Model of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a serious metabolic condition affecting millions of people worldwide. A “Western-style diet” has been shown to induce pediatric NAFLD with the potential disruption of skeletal muscle composition and metabolism. To determine the in vivo effect of a “Western-style diet” on pediatric skeletal muscle fiber type and fuel utilization, 28 juvenile Iberian pigs were fed either a control diet (CON) or a high-fructose, high-fat diet (HFF), with or without probiotic supplementation, for 10 weeks. The HFF diets increased the total triacylglycerol content of muscle tissue but decreased intramyocellular lipid (IMCL) content and the number of type I (slow oxidative) muscle fibers. HFF diets induced autophagy as assessed by LC3I and LC3II, and inflammation, as assessed by IL-1α. No differences in body composition were observed, and there was no change in insulin sensitivity, but HFF diets increased several plasma acylcarnitines and decreased expression of lipid oxidation regulators PGC1α and CPT1, suggesting disruption of skeletal muscle metabolism. Our results show that an HFF diet fed to juvenile Iberian pigs produces a less oxidative skeletal muscle phenotype, similar to a detraining effect, and reduces the capacity to use lipid as fuel, even in the absence of insulin resistance and obesity.

Patellar Tendon Structural Adaptations Occur during Pre-Season and First Competitive Cycle in Male Professional Handball Players

Background: While there is evidence that tendon adapts to training load, structural alterations in the patellar tendon in response to training loads are still unclear. The aim of this study is to identify changes in patellar tendon structure throughout pre-season and after finalizing the first competitive cycle. Methods: Nineteen professional handball players participated in the aforesaid cross-sectional study, in which patellar tendon scan and counter movement jump (CMJ) performance were conducted. Measurements were taken on the first and last day of pre-season training, and at the end of the first competitive cycle. Results: The results revealed that variation on the tendon structure occurred, mainly at the end of pre-season training; for injured tendons this occurred at the proximal (Right p = 0.02), distal (Right p = 0.01), and (Left p = 0.02) tendon, while changes in healthy tendons occurred at the mid (Left p = 0.01) and distal tendon (Right p = 0.01). At the end of the first competitive cycle, changes were observed in the distal injured tendon (p = 0.02). Conclusion: Patellar tendon shows greater structural change after completing pre-season training than at the end of the first competitive cycle, from which it may be inferred that gradual loading during pre-season training allows the tendon to adapt and potentially decrease the onset of patellar tendinopathy.

Long Term Clinical-Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig

Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical-functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical-functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle-Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical-functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint

Introduction The collateral ligaments of the first metacarpophalangeal (MCP) joint provide stability to the thumb. Injury to these collateral ligaments occurs more commonly in sports accidents leading to joint instability, weakness in pinch and grip strength. Normal morphometric measurements of collateral ligaments are essential for primary repair or reconstruction of the injured ligament. Hence, the objective of the study is to give the detailed morphometric profile of the proper collateral ligaments of the MCP joint of the thumb. Materials and Methods A total of 55 adult cadaveric hands were included in the study taken from 18 male (36 hands) and 10 female (19 hands) cadavers. Out of 55 hands, 28 belonged to the left side, while 27 were of the left side. The MCP joints were dissected to expose the collateral ligament complex. The length and width of the proper ligaments were measured. Results Both the proper collateral ligament attachments and the direction of the fibers were defined. Overall length and the width of both the proper collateral ligaments showed no statistically significant difference of mean between the left and the right sides. However, the length of both the proper collateral ligaments is significantly less in females compared with the males. Conclusion The morphometric details of the proper collateral ligaments obtained from this study would be useful for hand surgeons during surgical correction of the injured collateral ligaments either by primary repair or reconstruction with a tendon graft.

Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning

Background

This study assessed magnetic resonance imaging (MRI) of acute and chronic partial anterior cruciate ligament (ACL) tears using maximum knee flexion in the lateral decubitus position compared with routine knee positioning in 204 patients at a single center.

Material/Methods

Based on the time interval from injury to MRI examination, the 204 patients in this study were divided into 3 groups: subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (>1 year). All patients received both routine MRI (MRI R) and maximum knee flexion in the lateral decubitus position MRI (MRI S) examination, followed by knee arthroscopy. Three radiologists blinded to patient groups evaluated the MRI scans and made a diagnosis. Results of knee arthroscopy were referenced as the criterion standard. The sensitivity and specificity of MRI R and MRI S groups were calculated and compared.

Results

The MRI S diagnostic rate was comparable to that of knee arthroscopy. MRI S had significantly higher sensitivity than MRI R for partial ACL tears, especially in the intermediate group (P<0.01).

Conclusions

MRI of partial ACL tears using maximum knee flexion in the lateral decubitus position improved the diagnostic rate relative to routine MRI examination, particularly in patients in the intermediate group.

Lower Limb Strength Profile in Elderly with Different Pathologies: Comparisons with Healthy Subjects

Sarcopenia and muscle strength reduction are a frequent disorder in non-communicable chronic diseases. The aims of this study are: a) to verify if the absolute and relative to body weight muscle strength of lower limb is affected by the presence of pathology; b) to verify if the trends are different among knee and ankles joints. One-hundred and forty-five elderly were recruited (16 liver transplant recipients, 48 kidney transplant recipients, 52 elderly with obesity, 30 healthy elderly). Muscular strength of lower limb was evaluated. Evaluation protocol included maximal isometric knee extension, maximal isokinetic knee extension and flexion, maximal isokinetic ankle (both right and left) extension and flexion. A statistically significant interaction between measurement and group membership was found for absolute strength measure (F(4.23, 170.56) = 3.316, p = 0.011, partial η2 (η2p) = 0.076), and relative strength measure(F(4.44, 174.72) = 16.407, p < 0.01, partial η2 (η2p) = 0.294). Elderly patients living with kidney transplants showed the lower level of absolute muscular strength, while relative muscular strength is mainly lacking in the elderly with obesity. The strength profile of elderly subjects is affected by obesity, liver transplantation, and kidney transplantation.

Research and Publication Ethics in Journal of Functional Morphology and Kinesiology

Research is required to minimize uncertainty and to be reproducible, that is, the design, implementation, evaluation, interpretation, and reporting of the presented data, must follow a good practice. An appropriate experimental design, an accurate execution of the study, a strict criticism of the obtained data while avoiding overestimation, as well as a suitable interpretation of main outcomes, represent key aspects in reporting and disseminating research to the scientific community. Furthermore, author contribution, responsibility, funding, acknowledgement, and adequately declaring any conflict of interest play important roles in science. The Journal of Functional Morphology and Kinesiology (JFMK), a member of the Committee on Publication Ethics (COPE), is committed to the highest scientific and ethical standards and encourages all authors to take into account and to comply, as much as possible, with the contents and issues reported in this technical note. This could be useful to improve the quality of the manuscripts and avoid misconduct, as well as to stimulate interest and debate, reflecting upon uses and misuses within our disciplines belonging to the medicine area (sports medicine and movement sciences) categories: anatomy, histology, orthopedics and sports medicine, rheumatology, sports sciences, physical therapy, sports therapy, and rehabilitation.

Effectiveness of a novel hydrolyzed collagen formulation in treating patients with symptomatic knee osteoarthritis: a multicentric retrospective clinical study

PURPOSE

Knee osteoarthritis (OA) is a musculoskeletal disorder that may have a heavy impact on the patients' quality of life. Intra-articular collagen injection may be a safe adjuvant. Recently, CHondroGrid (CG), a hydrolyzed (< 3 kDa) bovine collagen injectable formulation, has been placed on the market. The aim of this study was to investigate the safety and performance profile of CG.

METHODS

Patients affected by Kellgren Lawrence grade 1 to 4 knee OA and BMI < 30 were treated by administering three CG injections of 2 ml (4 mg) each (at 15 days and 45 days from the first one, respectively) and were followed up for six months after the last administration. Clinical records were retrospectively assessed to compare VAS, Lequesne and WOMAC total, pain, stiffness, and physical function scores collected at baseline and 15, 45, and 225 days after the first injection.

RESULTS

At the last follow-up, 70 patients (37 men and 33 women, aged 57.1 ± 14.5 years) treated with CG showed a 50% reduction in their median Lequesne score, a 50% reduction in their VAS score at rest and moving, and a ≥ 50% reduction for all other scores under consideration.

CONCLUSIONS

CG may be a safe and effective adjuvant in the treatment of symptomatic knee OA.

The rule of twos: Technical note on consistent anatomical landmarks for hamstring graft harvesting

We describe a novel hamstring harvesting technique using the "Rule of Twos" as an aide-memoire to dissect the conjoint tendon in an Asian population undergoing anterior cruciate ligament reconstruction. In a prospective study performed on 17 patients to validate this technique, a 2cm incision is placed 2cm distal and medial to the tip of the tibial tubercle. The surgeon then measured the following variables and calculated their means: 1) Distance from the tip of the tibial tuberosity to the proximal edge of the conjoint tendon (19.4 ± 1.4mm), 2) Width of the conjoint tendon insertion (18.8 ± 1.0mm), 3) Conjoint tendon length (20.1 ± 1.0mm).

ACL reconstruction using a bone patellar tendon bone (BPTB) allograft or a hamstring tendon autograft (GST): a single-center comparative study

Background and aim of the work: There is still debate on which graft is better indicated for anterior cruciate ligament (ACL) surgical reconstruction. The objective of this study was to evaluate the medium-term clinical outcomes of ACL reconstruction comparing patients managed with bone patellar tendon bone allograft (BPTB) versus patients treated with hamstring autograft (GST). Methods: Patients enrolled during the period 2013-2016 underwent a personal interview with the use of specific evaluation questionnaires (Tegner e Lyshom, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee), a clinical evaluation with the use of objective functional tests (Lachman test, pivot-shift) and a physical examination of the knee. Results: In this study 43 patients were enrolled: 21 patients were treated by autograft and 22 patients by allograft. Patients who received allograft ACL reconstruction returned to normal sport activity earlier than patients operated on using autograft (11.7±10.3 vs 17.9±14.6 weeks, p<0.05). Data obtained with subjective tests, clinical and physical examination were positive overall, with no differences observed between the two groups. Finally, 15 allograft patients and 12 autograft patients accepted to perform the proprioceptive tests: no difference was found between the two groups. Conclusions: At follow-up evaluation after ACL reconstruction, both BPTB allograft and GST autograft patient groups showed similar results at subjective, objective clinical evaluation and proprioceptive properties of the limb. In particular, the use of allogenic BPTB allowed the patients to return earlier to normal activities of daily-living and sport activity. (www.actabiomedica.it)

Comparison of implant failure rates of different plates for midshaft clavicular fractures based on fracture classifications

Backgrounds

The aim of our study was to investigate failure rates of reconstruction plate and non-reconstruction plate, and find the best strategy for implant selection for different fracture types for midshaft clavicular fractures.

Patients and methods

Two hundred twenty-six consecutive patients with midshaft clavicular fractures who received open reduction and plate fixation during Jan 2012 to July 2017 were reviewed. The correlations between implant failure rates and risk factors including demographic data, fracture classifications, and implant types were analyzed.

Results

AO/OTA fracture classification and plate types are the most important factors affecting implant failure for midshaft clavicular fractures. Reconstruction plate had a significantly higher failure rate (53%) than that of non-reconstruction plates (3%) in comminuted midshaft clavicular (AO/OTA 15-2C) fractures (P value < 0.01). However, the difference was not significant in AO/OTA 15-2A and 2B classifications.

Conclusion

Patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates had very high implant failure rates compared to non-reconstruction plates. We suggested that patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates need more protection and more frequent follow-up in the postoperative period.

Lower limb strength, but not sensorial integration, explains the age-associated postural control impairment

Introduction

The aging process leads to functional decline of sensorial organs, muscle mass and strength, as well as the sensorimotor integration, culminating in age-associated postural control impairments. The purpose of this study was to compare the balance, the sensorial integration process and the lower limb strength among three old aged groups.

Methods

Eighty-one community-dwelling healthy old people (58% women), assigned into three age groups [60-69 years (n=30), 70-79 years (n=40), and ≥80 years (n=11)], participated in this study. All participants were submitted to anthropometric and stabilometric evaluation, and carried out a Chair stand test. Stabilometric parameters obtained from time [amplitude displacement of center of pressure (CoP)] and frequency (oscillations of CoP at sub 0.3 Hz and 1-3 Hz bands) domain analysis were used as the indicators of balance performance and sensorial integration, respectively.

Results

Our results revealed that the CoP amplitude displacement was significantly greater in the older aged group, without differences in spectral bands, while the performance in the Chair stand test was smaller in the older aged group.

Conclusion

These data indicate that the age-associated postural control impairment is explained by the lower limb strength declines, but not by the age-associated changes in sensorial integration.

Level of evidence

III.

The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study

Introduction

The purpose of this study was to evaluate the effects of deep shoulder infections after RCR on patient outcomes.

Methods

A retrospective chart review was conducted involving all patients with deep shoulder infections after arthroscopic RCR (study group). Another group of patients who were matched with the study group by age, gender and rotator cuff tear size, and did not develop deep shoulder infections after arthroscopic RCR were randomly identified (control group). The two groups were compared in terms of time to start physiotherapy, shoulder function, and delay in return to work.

Results

There were 10 patients in each group. The mean time to start physiotherapy after surgery was 145.3 (SD=158.8) days for the study group and 40.0 (SD=13.7) days for the control group (p=.051). The average forward elevation of the operated shoulder was 133 (SD=33.4) degrees for the study group, and 172 (SD=12.0) degrees for the control group (p=0.003). The average time to return to work at preoperative level was 5.6 months for the study group and 3 months for the control group.

Conclusion

Deep shoulder infections after RCR significantly impedes time to start physiotherapy, shoulder function, and patients' ability to return to work.

Level of evidence

III b [retrospective comparative (case-control) study].

Finite element comparison between the human and the ovine lumbar intervertebral disc

Introduction

Nowadays it is still not clear which loading conditions are responsible for lumbar intervertebral disc failure. Many studies have been conducted to investigate the effect of different loading conditions on the herniation processes, and many of them were based on the ovine model. However, the biomechanical similarities between the human and the ovine lumbar disc have been demonstrated in the main planes only, whereas it is not known if they are comparable under complex loading conditions too. The aim of this study was to compare the mechanical response of the ovine and the human lumbar intervetebral disc under complex loading conditions, in order to investigate differences and similarities between the species.The loading scenarios described in a finite element study on a human lumbar segment were applied to a model of the ovine disc, and the results were then compared.It has been shown that combined loads generated highest strains in both the models, and the maximum strains had the same location in the posterior or in the postero-lateral region of the annulus, according to the loading scenario.

Conclusion

The ovine disc can be used in spinal research to investigate herniation process under any loading conditions.

Level of evidence

V.

Flexibility responses to different stretching methods in young elite basketball players

Introduction

The aims of study were: 1) to verify the effectiveness of different stretching methods and training; 2) to compare the effects with only training on the flexibility of joints in basketball players.

Methods

30 males basketball players (age: 17±1yrs; BMI: 23.4±3.1), divided into 2 groups (15 experimental group - EG - and 15 control group, CG), participated to study. EG performed 5 different stretching method: passive stretching, active stretching, postural protocol, PNF and dynamic stretching. To assess differences (p<0.05) between groups, an ANOVA was applied to anthropometrics characteristic (age; height; weight and BMI) and flexibility performances (leg raise in a supine position; forward trunk bending). ANOVA for repeated measurements was conducted to asses differences in each group with time (i.e., pre-post).

Results

Results showed a variation linked to time (F=21.9; p<0.0001) and an effect of the treatment of the leg raise in a supine position test (F=25.1; p<0.0001). Also in flexion test of trunk, the average values could be linked to time of measurement (F=9.96; p<0.0001) and group (F=8.65; p<0.0001).

Conclusion

The results suggest that a specific different stretching protocol should be used in different part of body to offer performance benefit and decreasing of the incidents of injuries.

Level of evidence

IV.

Tripled semitendinosus with single harvesting is as effective but less invasive compared to standard gracilis-semitendinosus harvesting

Introduction

The anterior cruciate ligament (ACL) reconstruction with pes anserinus tendons has been increasingly used throughout the last years. Although less invasive compared to other autologous grafts, a reduction of internal rotation and flexion strength after gracilis and semitendinosus harvesting has been reported. Harvesting one tendon instead of two from the pes anserinus can reduce the deficit of the knee flexor strength and improve the functional recover without weakening the reconstructed ligament.

Methods

Forty-five (45) patients who had ACL reconstruction with triple semitendinosus graft (ST3) have been compared with other 45 similar patients who had ACL reconstruction with double gracilis-semitendinosus tendons (GST). Patients have been evaluated at a minimum of 12 months after surgery: IKDC scale, KT-1000, One Leg Hop Test for the objective stability; Isokinetic test for the strength; Tegner scale, Lysholm and IKDC subjective evaluation form for the function.

Results

No differences have been detected between the groups for the objective item assessed. Male patients' subjective IKDC score was statistically better for the ST3 group. Recreational soccer players showed a higher Lysholm and subjective IKDC score in ST3 group compared to GST group. There was no difference regarding the return to sport.

Conclusion

ST3 guarantees the same objective knee stability compared to a GST. It is a viable option for ACL reconstruction that allows a better preservation of patient's anatomy and a less invasive harvesting surgery.

Level of evidence

III b, case control study.

Tibiofemoral wear in standard and non-standard squat: implication for total knee arthroplasty

Introduction

Due to the more resilient biomaterials, problems related to wear in total knee replacements (TKRs) have decreased but not disappeared. In the design-related factors, wear is still the second most important mechanical factor that limits the lifetime of TKRs and it is also highly influenced by the local kinematics of the knee. During wear experiments, constant load and slide-roll ratio is frequently applied in tribo-tests beside other important parameters. Nevertheless, numerous studies demonstrated that constant slide-roll ratio is not accurate approach if TKR wear is modelled, while instead of a constant load, a flexion-angle dependent tibiofemoral force should be involved into the wear model to obtain realistic results.

Methods

A new analytical wear model, based upon Archard's law, is introduced, which can determine the effect of the tibiofemoral force and the varying slide-roll on wear between the tibiofemoral connection under standard and non-standard squat movement.

Results

The calculated total wear with constant slide-roll during standard squat was 5.5 times higher compared to the reference value, while if total wear includes varying slide-roll during standard squat, the calculated wear was approximately 6.25 times higher. With regard to non-standard squat, total wear with constant slide-roll during standard squat was 4.16 times higher than the reference value. If total wear included varying slide-roll, the calculated wear was approximately 4.75 times higher.

Conclusions

It was demonstrated that the augmented force parameter solely caused 65% higher wear volume while the slide-roll ratio itself increased wear volume by 15% higher compared to the reference value. These results state that the force component has the major effect on wear propagation while non-standard squat should be proposed for TKR patients as rehabilitation exercise.

Trapeziometacarpal joint osteoarthritis: a prospective trial on two widespread conservative therapies

Introduction

The trapeziometacarpal (TMC) joint osteoarthritis (OA) is at the origin of important secondary functional disability to pinch as well as a painful grip. Several conservative therapies are often considered in the early stages of TMC OA to decrease pain, recover function and slow the evolution of OA. They include massage therapy, heat applications, stretching of the first web span and assisted mobilization of the TMC joint. However, as with other arthritic joints, many physicians often suggest administering intra-articular corticosteroids. The aim of this study was to assess the effect of 10 sessions of physiotherapy versus a single corticoid intra-articular injection. Both treatments were associated with TMC splinting.

Methods

Two groups of twenty-five patients received either physiotherapy or a corticoid injection. They were followed over a one-year period. All of them were assessed for pain, function, strength at 2, 6 and 12 months and overall satisfaction at the end of the study.

Results

With the infiltrative therapy, the parameters improve more quickly, whereas patients treated with physiotherapy show longer persistence regarding remission of pain. The final functional evaluation scores at one year are similar to pretreatment scores.

Conclusion

In early stages of TMC OA, corticosteroids articular injections and physiotherapy treatments can improve the painful symptoms but treatment with corticosteroids is faster. Although hand functions return to average scores similar to those of pre-treatment, physiotherapy program is associated with a longer remission of pain.

Unicompartmental knee replacement in patients aged 70 years and older

Introduction

The management of isolated unicompartmental osteoarthritis in the patient aged 70 years and older is an issue of debate. The purpose of the present study was to retrospectively evaluate the outcomes of patients aged over 70 years who underwent unicompartmental knee replacement (UKR) for the treatment of isolated unicompartmental osteoarthritis. The hypothesis was that this represents a safe and viable procedure leading to improved functional outcome in elderly patients affected by isolated unicompartmental osteoarthritis.

Methods

22 consecutive medial compartment UKRs performed between 1998 and 2008 were retrospectively evaluated. Mean age was 74 years (range 70-93 years). Patients were evaluated preoperatively and after an average follow-up of 6.2 years (range 2 to 8). Assessment included KOOS score, WOMAC score, Knee Society Score. Standard X-rays were performed prior to surgery and at follow-up.

Results

Twenty patients showed a statistically significant improvement in all parameters. One patient who was 93 years old at the time of surgery died for unrelated causes. One patient required conversion to a total knee arthroplasty.

Discussion

UKR is a safe and clinically effective procedure, which has been proven valuable for the treatment of elderly patients with isolated unicompartmental osteoarthritis and with initial degenerative signs in the other compartments.

Conclusion

Age more than 70 does not appear to be a contraindication to the procedure.

Level of evidence

IV (case series).

Full-field in vitro investigation of hard and soft tissue strain in the spine by means of Digital Image Correlation

Introduction

The spine deserves careful biomechanical investigation, because of the different types of degeneration deriving from daily stress, trauma, and hard and soft tissue pathologies. Many biomechanical studies evaluated the range of motion, structural stiffness of spine segments under different loading conditions, without addressing the strain distribution. Strain gauges have been used to measure strain in the vertebral body, in a pointwise way.What is currently missing is a method to measure the distribution of strain in the soft tissues (intervertebral discs and ligaments), and an integration between measurements in the hard and soft tissues. Digital Image Correlation (DIC) is a recently developed optical technique, which allows measuring the distribution of displacements and deformation in a contact-less way. It can provide a full-field view of the examined surface under load. DIC can therefore give a more complete knowledge of the biomechanics of the spine.

Methods

This study was performed multisegmental porcine spine specimens with two loading configurations (flexion and lateral bending), while DIC was used to measure the strain distribution. The tests showed the different deformation in the vertebral body, intervertebral discs and ligaments in compression and tension. At the same time it was possible to visualize the growth plates, which are Conclusion: Significantly softer than the vertebral bone.This work showed the feasibility of investigating the spine in a full-field way, and to quantify the strain inhomogeneity in the vertebrae and soft tissues. Therefore DIC can help improve implantable devices and the surgical technique.

Multibody modelling of ligamentous and bony stabilizers in the human elbow

The elbow ligamentous and bony structures play essential roles in the joint stability. Nevertheless, the contribution of different structures to joint stability is not yet clear and a comprehensive experimental investigation into the ligament and osseous constraints changes in relation to joint motions would be uphill and somehow unattainable, due to the impossibility of obtaining all the possible configurations on the same specimen. Therefore, a predictive tool of the joint behavior after the loss of retentive structures would be helpful in designing reconstructive surgeries and in pre-operative planning. In this work, a multibody model consisting of bones and non-linear ligamentous structures is presented and validated through comparison with experimental data. An accurate geometrical model was equipped with non-linear ligaments bundles between optimized origin and insertion points. The joint function was simulated according to maneuvers accomplished in published experimental studies which explored the posteromedial rotatory instability (PMRI) in coronoid and posterior medial collateral ligament (PB) deficient elbows. Moreover, a complete design of experiments (DOE) was explored, investigating the influence of the elbow flexion degree, of the coronoid process and of the medial collateral ligaments (MCL) structures (anterior and posterior bundles) in the elbow joint opening. The implemented computational model accurately predicted the joint behavior with intact and deficient stabilizing structures at each flexion degree, and highlighted the statistically significant influence of the MCL structures (P<0.05) on the elbow stability. The predictive ability of this multibody elbow joint model let foresee that future investigations under different loading scenarios and injured or surgically reconstructed states could be effectively simulated, helping the ligaments reconstruction optimization in terms of bone tunnel localizations and grafts pre-loading.

Level of evidence

V.

Automatic characterization of soft tissues material properties during mechanical tests

Introduction

The estimation of the non-linear viscoelastic characteristics of human soft tissues, such as ligaments and tendon, is often affected by the implemented procedure. This study aims at developing and validating a protocol, associated with a contactless and automatic procedure, enabling the determination of the material behavior and properties of any soft tissues.

Methods

Several markers were drawn onto the soft tissue specimen analyzed under uniaxial tensile test. An automatic contactless procedure, that uses a camera for recording the position of the markers during the test, was developed to compute the displacement, and the force applied, enabling the calculation of the true-stress/strain curve of the material. Young's modulus and Poisson's ratio can be calculated, on demand, for selected regions of interest of the soft tissues. The repeatability and reproducibility of the procedure were analyzed. The procedure was initially tested and verified on an artificial silicone material and later applied for investigating the mechanical behavior of a pig Achilles tendon and of a human patellar tendon.

Results

The procedure show a high repeatability, independent by the operator, reliability and accuracy for the tested synthetic material (with a maximum error of 3.7% for Young's modulus). Additionally, the developed protocol was also suitable for the analysis of animal and human soft tissues.

Conclusion

A protocol to automatically and accurately determine material properties in soft tissues was developed, tested and validated. Such approach could successfully be implemented for the mechanical characterization of any biological soft-tissue.

Level of evidence

V.

Sensitivity analysis of the material properties of different soft-tissues: implications for a subject-specific knee arthroplasty

Introduction

While developing a subject-specific knee model, different kinds of data-inputs are required. If information about geometries can be definitely obtained from images, more effort is necessary for the in vivo properties. Consequently, such information are recruited from the literature as common habit. However, the effects of the combined sources still need to be evaluated.

Methods

This work aims at developing an intact native subject-specific knee model for performing a sensitivity analysis on soft-tissues. The impacts on the biomechanical outputs were analysed during a daily activity for which articular knee kinetics and kinematics were compared among the different configurations. Prior to the sensitivity analysis, experimental and literature data were checked for the model reliability.

Results

Average values of mixed sources allowed the agreement with experimental data for personalized outputs. From the sensitivity analysis, knee kinematics did not significantly change in the selected ranges of properties for the soft-tissues (in rotation less than 0.5°), while contact stresses were greatly affected, especially for the articular cartilage (with differences in the results more than 100%).

Conclusion

In conclusion, during the development of a personalized knee model, the selection of the correct material properties is fundamental because wrong values could highly affect the numerical results.

Level of evidence

III a.

Differences between the sexes in athletes' body composition and lower limb bioimpedance values

Introduction

The differences between the sexes in body composition are well established, although sports activity at an elite level seems to reduce them. The aim of this study is a comparison of the sexes in terms of athletes' body composition with a three-compartment model and a localized bioimpedance analysis in elite soccer players.

Methods

18 female and 18 male elite soccer players of the same age were matched (female=26.2±2.4, male 26.9±2.5; p=0.87). An assessment of body composition was performed through the integration of anthropometrics parameters, skinfold thickness and bioimpedance data. The evaluations were carried out in the morning on a group of athletes who were in a rested condition, having not exercised in the previous 12 hours and having fasted for breakfast.

Results

A body composition assessment shows higher values in females for hip circumference/ height (female: 0.55±0.03, male: 0.52±0.02; p<0.01) and fat mass index (female: 3.7±0.7 kg/m², male: 2.4±0.4 kg/m²; p<0.001), while there is no difference between the genders in the extra cellular mass index (female: 7.1±1.2 kg/m², male: 7.6±0.4 kg/m²; p=0.11). A localized bioimpedance analysis describes well-defined differences in the thighs, while in the calves these differences are reversed for the reactance values.

Conclusion

Sports activity seems to slightly reduce differences in the whole body. The different adaption at the same physical effort appears to be mainly related to cellular mass. This study shows for the first time localized bioimpedance values in female athletes.

Level of evidence

II b.

Prevalence, techniques and knowledge of rapid weight loss amongst adult british judo athletes: a questionnaire based study

Background

No investigation has analysed the RWL approaches since new rules by the International Judo Federation (IJF) regarding weigh-ins have been implemented in international competitions in 2014. The current study analyses the prevalence, most common methods and knowledge surrounding the effects of rapid weight loss (RWL) amongst adult UK judo athletes. Additionally, it examines differences in rapid weight loss behaviour (RWLB) between gender, weight-class, competitive level, age RWL began and "high"/"low" knowledge athletes.

Methods

A previously validated questionnaire developed to assess RWL in judo athletes was modified by adding a knowledge section and revalidated for content. The questionnaire provided a RWLB score (higher score equated to more aggressive RWL) and a knowledge score (out of 10). 256 athletes (189 males and 66 females, aged 18-67 years) completed the questionnaire between February and April 2015. Unpaired t test, one-way ANOVA-tests and Chi-squared tests were used to test differences of mean RWLB scores and prevalence between groups.

Results

The prevalence of RWL was 84%. The most common methods of RWL were increased exercise and decreased food/fluid intake. The mean knowledge score was 6.2±2.8, with most incorrect answers regarding physiological effects of RWL. No significant differences in RWLB scores were found between gender, "high"/"low" knowledge athletes or weight-classes. Statistically significant differences in RWLB scores were found between different competitive levels (p=0.014) and age RWL began (p<0.01) in males but not in females.

Conclusion

RWL is highly prevalent in the UK adult judo population and athletes have moderate knowledge surrounding its effects. In males, RWLB is most aggressive in elite level athletes and those that began RWL at a younger age. Therefore, updated rulings to target elite and youth level athletes should be implemented to reduce dangerous RWL.

Level of evidence

IV.

Sciatic nerve stiffness is not changed immediately after a slump neurodynamics technique

Background

Neurodynamics techniques aim to assess and improve neural mechanosensitivity. However, there is no in vivo evidence regarding the mechanical effects of these techniques in the nerve stiffness. This study examined the immediate effects of a slump neurodynamics technique in the sciatic nerve shear wave velocity (SWV. i.e. an index of stiffness) using ultrasound-based elastography.

Methods

Fourteen healthy participants were included in this experiment. Sciatic SWV and ankle passive torque were measured during a passive ankle dorsiflexion motion (2°/s), before and immediately after 3 minutes of slump neurodynamics technique, randomly applied to one lower limb. The contralateral limb served as control.

Results

The slump intervention did not change the sciatic SWV (P=0.78), nor the dorsiflexion passive torque (P=0.14), throughout the ankle dorsiflexion motion. Excellent values of intra-rater repeatability (ICC=0.88, 0.68-0.96), and low values of standard error of measurement (0.59 m/s, 0.35-1.15m/s), were observed for the SWV measurements.

Conclusions

The sciatic nerve stiffness of healthy participants did not change immediately after a slump neurodynamics technique, suggesting a compliance of the neural tissue to tensile loads. However, these results ought to be confirmed using other neurodynamics techniques and in other populations (e.g. peripheral neuropathies).

Level of evidence

III.

Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation

Background

The aim of the study was to compare the mini-open to the classic open repair techniques for Achilles tendon ruptures.

Methods

We retrospectively evaluated at a minimum of 2 years follow-up 32 subcutaneous Achilles tendon ruptures; 17 underwent mini-open surgery (Group A) and 15 the open technique (Group B).

Results

No difference in Achilles Tendon Total Rupture Score and in modified Leppillahti score was observed. With respect to the contralateral side the width of the operated Achilles tendon was 4.07 mm thicker in Group A and 7.67 mm in Group B (p<.05); the calf circumference reduction was respectively 10 mm and 23.75 mm (p<.05). Iso-kinetic peak force measurement of the calf muscle strength showed a loss of 8.21% in Group A versus 17.25% in Group B (p <.05). The mean Patient Satisfaction Score was 96.76 in Group A and 88.67 in Group B (p<.01); respectively 82.3% vs 66.7% of patients were able to return to previous levels of sporting activity. There were two post-operative complications in Group B and one in Group A.

Conclusion

Mini-open technique minimizes the risk of complications, leads to an improved tendon healing process and functional recovery with higher patient satisfaction.

Level of evidence

IV.

Three-dimensional architecture of the ligamentum teres in the human hip joint

Background

We aimed to investigate the three-dimensional structure of the collagenous fibers of the ligamentum teres (LT) of the human hip and clarify the LT micro-anatomy at the attachment of the femoral head.

Methods

Femoral heads and LT were collected during hip arthroplasty. Specimens were cut into 5-10-mm squares, prepared, developed, and observed under a light microscope. Next, specimens were prepared and examined under a scanning electron microscope (SEM).

Results

Under optical microscope, LT adhered to the artificial cartilage at the attachment of the femoral head. Under SEM, LT comprised parallelly arranged collagenous fibers and the fine collagenous fibrils were twisted. While the central collagenous fibers of the LT at the attachment of the femoral head penetrated the articular cartilage tissue and reached the ring-shaped bone, fibers at the margin traversed and adhered to the cartilage surface.

Conclusion

Articular cartilage and subchondral bone are present at the LT attachment to the femoral head. Although collagenous fibers of the LT show parallel arrangement at the main trunk, they are dispersed at the cartilage surface and not all reach the thin subchondral bone of the femoral head. This could possibly weaken ligament strength at the attachment of the femoral head.

Level of evidence

IV.

Assessment of patient functional performance in different knee arthroplasty designs during unconstrained squat

Background

In this paper, squat named by Authors unconstrained because performed without constrains related to feet position, speed, knee maximum angle to be reached, was tested as motor task revealing differences in functional performance after knee arthroplasty. It involves large joints ranges of motion, does not compromise joint safety and requires accurate control strategies to maintain balance.

Methods

Motion capture techniques were used to study squat on a healthy control group (CTR) and on three groups, each characterised by a specific knee arthroplasty design: a Total Knee Arthroplasty (TKA), a Mobile Bearing and a Fixed Bearing Unicompartmental Knee Arthroplasty (respectively MBUA and FBUA). Squat was analysed during descent, maintenance and ascent phase and described by speed, angular kinematics of lower and upper body, the Center of Pressure (CoP) trajectory and muscle activation timing of quadriceps and biceps femoris.

Results

Compared to CTR, for TKA and MBUA knee maximum flexion was lower, vertical speed during descent and ascent reduced and the duration of whole movement was longer. CoP mean distance was higher for all arthroplasty groups during descent as higher was, CoP mean velocity for MBUA and TKA during ascent and descent.

Conclusions

Unconstrained squat is able to reveal differences in the functional performance among control and arthroplasty groups and between different arthroplasty designs. Considering the similarity index calculated for the variables showing statistically significance, FBUA performance appears to be closest to that of the CTR group.

Level of evidence

III a.

Time to recovery of sciatic function index after induced tibialis anterior strain in rats

Background

Muscle strain is a common injury with a high recurrence rate. Due to the heterogeneity of strain injuries, experimental animals provide controlled and reproducible models to investigate such injuries. Sciatic Function Index (SFI) is a clinically feasible method to assess hind limb recovery in rodents after induced injuries.

Objectives

To investigate time to recovery of SFI after induced-strain in tibialis anterior (TA) muscle in rats.

Methods

Sixteen adult male Wister rats were randomly and equally divided to a normal control group that received no intervention, and TA induced muscle strain group. Muscle strain was induced using an external weight that corresponded to 150% of the animal body weight. SFI was tested only once in the control group. For the muscle strain group, SFI was tested on the 1^st, 2^nd, 3^rd, 4^th, 7^th, 11^th, 20^th and 24^th days after strain induction.

Results

Comparisons between group showed significant difference in SFI on the 1^st, 2^nd, 3^rd and 4^th days (p= 0.012, 0.012, 0.012 and 0.028, respectively).

Conclusions

In a rat animal model of TA induced muscle strain, functional recovery measured by SFI is evident on the 7^th day post-injury, which corresponds to the sub-acute phase of injury.

Level of evidence

V.

Ultrasonographic assessment of the anterolateral ligament of the knee in healthy subjects

Objective

The aim of our study was to determine inter-observer agreement in the ultrasonographic identification of the anterolateral ligament (ALL) and in the evaluation of its length and thickness in healthy subjects.

Methods

80 healthy volunteers (160 knees) (42 males and 38 females) were enrolled in the study. All subjects underwent ultrasound (US) examination of both knees, performed by two physicians with over ten years of musculoskeletal US experience. In order to keep the ALL under optimal tension, the knee was flexed at approximately 30-35°, slightly internally rotated and length and thickness of the ligament were measured.

Results

ALL was identified in 93.8% (150 out of 160) and in 92.5% (148 out of 160) of the knees by Evaluator 1 and Evaluator 2, respectively. Interobserver agreement was substantial to almost perfect for the visualization of the ALL ( =0.90) and for measurements of its length (ICC = 0.83), and strong for measurements of its thickness (ICC = 0.75).

Conclusion

In our study on healthy subjects, ALL has been visualized with a high rate of reproducibility. Further studies are needed to see if US may be a reliable and reproducible diagnostic tool in patients with traumatic or degenerative knee disorders.

Level of evidence

II, evidence obtained from cohort study.

Operative treatment for the painful posterior thigh after hamstring autograft harvesting

Background

Semitendinosus (ST) is widely used autograft in anterior cruciate ligament reconstructions (ACLR). Although tendon harvesting is a common procedure, some patients exhibit pain, cramping and dysfunctional at posterior thigh after the ACLR. The formation of the newly regenerated neotendon could be compromised by a new injury or too rapid rehabilitation. We present this clinical entity and the developed surgical technique and share our experience in treatment of these patients.

Methods

Ten patients underwent operation where the harvested, retracted and loose muscle (9 ST, 1 gracilis) was reattached again. The delay to the diagnosis and the outcome of the procedure were recorded. Cases were followed and magnetic resonance images (MRI) were included from 2 cases for the demonstration of postoperative healing.

Results

Six ST and the gracilis patients with prolonged symptoms had good results and returned to their normal activity level. Preoperative MRI showed increased signal intensity and edema of the harvested and retracted muscles as the sign of compromised healing of the neotendon. Postoperatively, these MRI findings were resolved.

Conclusions

In high activity level patients with chronic posterior thigh pain and cramping of the harvested muscle, the stabilization procedure of the poorly healed muscle belly could lead to beneficial outcome.

Level of evidence

IV. Case series.

Correlation between time from injury to surgery and the prevalence of ramp and hidden lesions during anterior cruciate ligament reconstruction. A new diagnostic algorithm

Background

Anterior cruciate ligament tears (ACL) are associated with meniscal lesions, that could involve the posterior horn of the medial meniscus (PHMM). A variety of techniques has been proposed to better visualise the postero-medial (PM) compartment. The aim of the study is to evaluate the prevalence of longitudinal tears of peripheral attachment of the PHMM during arthroscopic ACL reconstruction, and to describe a diagnostic algorithm.

Methods

115 patients who underwent arthroscopic ACL reconstruction were enrolled for the study. An anterior and an intercondylar notch visualisation were ordinarily performed. A postero-medial (PM) portal was performed when the instability of the posterior horn was detected. Statistical significance was assessed by a Chi-squared or Fisher's Exact Test for categorical variables, and by a Mann-Whitney U test for continuous variables.

Results

We recorded a 9.6% prevalence of lesions of the peripheral attachment of PHMM. Nine ramp lesions and two hidden lesions were diagnosed. Patients treated within 6 months from injury, revealed a statistically significant correlation with a higher prevalence of these lesions.

Conclusion

Ramp and hidden lesions are very common ACL rupture associated injuries. Our diagnostic algorithm is a valid and safe option to diagnose these kinds of lesions. A correlation between a longer time from injury than 6 months and a reduced prevalence of these lesions was recorded in our population.

Level of evidence

IV.

Side-to-side differences in Achilles tendon geometry and mechanical properties following achilles tendon rupture

Background

Recovery of tendon structure has been suggested to play a role in clinical success following Achilles tendon rupture. The purpose of this study was to identify side-to-side differences in tendon geometry and mechanical properties following Achilles tendon rupture and investigate the relationship of tendon structure with clinical outcomes.

Methods

Participants within 1 year post complete rupture were included. Tendon geometry and mechanical properties were quantified using B-mode ultrasound imaging and continuous shear wave elastography (cSWE). Clinical outcomes included the heel-rise test. Participant self-reported function was measured using the Achilles tendon Total Rupture Score, Foot and Ankle Outcome Score - quality of life subscale, and the Physical Activity Scale.

Results

Twenty participants [mean (SD) age: 42.7(13.6) years, 13 managed surgically] were included. Tendon thickness was greater on the ruptured side (p <0.001) [median (IQR) rupture: 1.38(1.21-1.56) cm, non-rupture: 0.49(0.40-0.52)]. Tendon length to the gastrocnemius was longer (p <0.001) on ruptured [22.8 (21.71-24.31) cm] than non-ruptured [21.66(20.74-23.62) cm] sides. Viscosity was lower on the ruptured side (p <0.001) [median (IQR) rupture: 37.7(30.6-43.3) Pa*s, non-rupture: 53.5(48.4-59.6) Pa*s]. Shear modulus was not different between sides. Tendon thickness (rho = 0.675, p = 0.002) and shear modulus (rho = -0.791, p = 0.001) related to total work on the heel-rise test.

Conclusion

Ultrasound imaging, including cSWE, can be used to detect side-to-side differences in tendon structure in individuals with Achilles tendon rupture and tendon structure relates to clinical performance.

Level of evidence

III b.

MRI evaluation to predict tendon size for knee ligament reconstruction

Background

The aim of this study is to evaluate a possible correlation between specific anthropometric parameters and sizes of knee tendons commonly used for ACL reconstruction. We hypothesized that specific clinical and radiological knee measurements could be better tendon sizes predictors than age, gender, height and weight.

Materials and methods

100 consecutive patients were enrolled and 77 patients met the inclusion criteria of the study. All patients underwent a MRI of the knee with a 1.5 T super conducting MR System. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. Specific MRI knee measurements were performed on each study: patellar tendon (PT) thickness and length, quadriceps tendon (QT) thickness, semitendinosus tendon (ST) diameter, gracilis tendon (GR) diameter, the largest patella and intercondylar width.

Results

The mean ST diameter, QT thickness and PT thickness were higher in males than in females. No significant differences were noted between males and females concerning GT diameter and the knee circumference. In addition, male knees had greater patellar and intercondylar width than female knees. Significant, but only weak correlations were found between patient anthropometric data and hamstrings diameter, PT length, and QT and PT thickness. Intercondylar and patellar width present a moderate correlation between PT thickness, PT length and ST diameter.

Conclusion

The intercondylar and patellar width presented a moderate correlation with PT thickness, PT length and ST diameter. Further, weak correlations were found between patient anthropometric data (gender, weight, height, BMI) and GR and ST diameter, PT length, and QT and PT thickness. This results may help surgeons during preoperative planning, specifically regarding graft choice and size.

Level of evidence

III.

Quantitative analysis of patellar tendon size and structure in asymptomatic professional players: sonographic study

Background

Ultrasonographic abnormalities of the patellar tendon frequently occur in asymptomatic athletes and it is not always clear whether they precede (and may predict) the development of tendinopathy.

Objective

This study aimed to investigate by ultrasonography the prevalence of patellar tendon abnormalities in players of "pallapugno" and to establish whether structural tendon abnormalities predict tendinopathy development.

Methods

Ultrasound B-mode images of the patellar tendon of both sides were acquired in fourteen throwers. Qualitative assessments of tendon structure and neovascularization and quantitative assessments of tendon thickness, cross sectional area (CSA), and echo-intensity were performed.

Results

Qualitative assessments showed a subclinical tendinopathy of the non-dominant tendon in 5 out of 14 throwers (35% of cases), while quantitative assessments showed abnormalities of the non-dominant tendon in 8 out of 14 players (57% of cases). Echo-intensity and CSA were the quantitative variables most discriminant between asymptomatic players without structural tendon abnormalities and those with tendon abnormalities. Two players (2 out of 8 cases: 25%) developed a clinical tendinopathy after a follow-up of six months.

Conclusion

The prevalence of subclinical tendinopathy in the non-dominant patellar tendon of throwers was high. Patellar tendon abnormalities at baseline seem to increase the risk of development of subsequent patellar tendinopathy.

Level of evidence

II b (individual cohort study).

Early radiographic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures: cast vs functional bandage

Background

The purpose of this non-randomized retrospective study was to investigate outcomes of minimally displaced, proximal 5MTB fractures, treated by a below-knee walking cast or a functional elasticated bandage with a support of a flat hard-soled shoe.

Methods

A consecutive patient series was divided into two groups: the cast group (CG) and the functional group (FG). The subjects were radiologically and clinically evaluated according to Mehlhorn and Lawrence-Botte classification, and AOFAS Midfoot score, respectively.

Results

154 patients were followed up for a median of 15 months (range 12-24). There was no significant difference (p > 0.05) among the outcomes of each fracture pattern regarding the treatment choice. However, an earlier return to sports was noted in the FG, while Type-3 fractures achieved the worst results.

Conclusion

Type-1 and 2 minimally displaced 5MTB proximal fractures can be successfully treated conservatively without weight-bearing restriction and without benefit of a cast with respect to a functional elasticated bandage.

Level of clinical evidence

level III retrospective comparative study.

The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process

This narrative and literature review discusses the relevance of Rate of Force Development (RFD) (the slope of the force time curve) for Return To Sport (RTS), its determinants and the influence of training practices on it expression, with the purpose to enhance clinicians' awareness of how RFD training may enhance RTS success. RFD is considered functionally more relevant than maximal muscle strength during certain very fast actions including rapid joint stabilisation following mechanical perturbation. Deficits in RFD are reported following conventional rehabilitation programmes despite full restoration of maximal strength, which may contribute to the less than satisfactory RTS outcomes reported in the literature. RFD determinants vary as a function of time from force onset with a diminishing role of maximal strength as the time available for force development decreases. Factors such as neural activation, fibre type composition and muscle contractile properties influence RFD also and to a much greater extent during the early periods of rapid force development. Conventional resistance training using moderate loads typical of most rehabilitation programmes is insufficient at restoring or enhancing RFD, thus incorporating periodised resistance training programmes and explosive training techniques in the final stages of rehabilitation prior to RTS is recommended.

Level of evidence

V.

Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review

Background

Sonoelastography (SE) is a new ultrasound-based method adopted in an increased number of scientific reports to analyse normal and pathological tendons. The aim of this study is to provide a systematic overview of clinical applications of SE in normal and pathological tendons.

Methods

A systematic research of PubMed, Ovid, and Cochrane Library electronic databases was performed according to PRISMA guideline. Two Authors searched and evaluated the articles independently; a third Author was involved to solve any disagreement. The Oxford Level of Evidence (LoE) was used to assess each article.

Results

There is an increasing interest in the application of SE in the evaluation of healthy and diseased tendons. Many different tendons are amenable for SE evaluation, such as the Achilles and patellar tendons, rotator cuff, common extensor tendons, quadriceps tendon, and the plantar fascia.

Conclusion

SE appears to be a very useful diagnostic tool, in particular in tendon pathology. This is a dynamic examination, provides an immediate evaluation of the tissue elasticity, and may be useful in recognizing tendon abnormalities and in implementing the information available with conventional US.

Level of evidence

IV.

Evaluation of the isokinetic muscle function, postural control and plantar pressure distribution in capoeira players: a cross-sectional study

Background

Capoeira is a cultural practice with Brazilian roots that combines several elements including dance, fighting and body rhythm. Because of the diverse elements involved in its practice, capoeira is excellent at developing the physical and social abilities of its players. The aim of this study was to compare the biomechanical profile of muscle strength, plantar pressure distribution, and postural balance between players and non-players of capoeira.

Methods

We evaluated 51 subjects who were allocated into two groups: capoeira group and control group. Subjects were evaluated using a baropodometer (Diasu^®) and an isokinetic dynamometer (Biodex^®).

Results

When comparing plantar pressure distribution between groups and limbs, there were significant differences in mean load of forefoot (p=0.008) and total load (p=0.001). There were no significant differences between groups and limbs in balance and muscle strength; however, a significant difference was found in quadriceps torque peak (p=0.001) and agonist/antagonist ratio (p=0.001) when comparing these variables between the groups.

Conclusion

Capoeira players displayed a tendency to have an asymmetric profile in plantar pressure distribution. No difference was found in balance between groups. Despite the fact that capoeira players showed increased strength of the quadriceps muscle, their agonist/antagonist ratio was more asymmetrical than the control group.

Level of evidence

IV.

Spheroid formation and modulation of tenocyte-specific gene expression under simulated microgravity

Background

For tendon tissue engineering, tenocyte-seeded scaffolds are a promising approach. Under conventional 2D culture however, tenocytes show rapid senescene and phenotype loss. We hypothesized that phenotype loss could be counteracted by simulated microgravity conditions.

Methods

Human tenocytes were exposed to microgravity for 9 days on a Random Positioning Machine (RPM). Formation of 3D-structures (spheroids) was observed under light microscopy, gene expression was measured by real-time PCR. Cells under conventional 2D-culture served as control group.

Results

Simulated microgravity reached a value of as low as 0.003g. Spheroid formation was observed after 4 days, and spheroids showed stable existance to the end of the observation period. After 9 days, spheroids showed a significantly higher gene expression of collagen 1 (Col1A1) compared to adherent cells under microgravity (4.4x, p=0.04) and compared to the control group (5.6x, p=0.02). Gene expression of collagen 3 (COL3A1) was significantly increased in spheroids compared to the control group (2.3x, p=0.03). Gene expressions of the extracellular matrix genes Tenascin C und Fibronectin (TNC and FN) were increased in adherent cells under microgravity compared to the 1g-control group, not reaching statistical significance (p=0.1 and p=0.3). For the gene expression of vimentin, no significant alteration was observed both in the adherent cells and in the spheroids compared to the 1g control group. Gene expression of the tenocyte-specific transcription factor scleraxis (SCX) was significantly increased in spheroids compared to the control group (3.7x, p=0.03).

Conclusion

Simulated microgravity could counteract tenocyte senescence in vitro and serve as a promising model for scaffold-free 3D cell culturing and tissue engineering.

Level of evidence

V (laboratory study).

Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study

Background

Meniscal subluxation results in the natural history of knee osteoarthritis (OA). Periarticular infiltration should minimize possible complications related to penetration of corticosteroids into the joint space in the treatment of knee OA.According to pain relief and improvement of function, the aim of this study is to evaluate the effectiveness of perimeniscal corticosteroid ultrasound guided injection in knee OA.

Methods

Thirty-two patients received an injection of 0.5 ml of methylprednisolone-acetate around perimeniscal tissues. Outcome measures were pain relief and knee function, assessed by Visual Analogue Scale (VAS) [24, 29, 30] measured at rest (VAS-R) and during stairs climbing (VAS-C) and by Italian-Western Ontario and McMaster Universities (WOMAC) scale. Clinical evaluation was performed at baseline, at 1 and 4 weeks of follow-up.

Results

Mean baseline values of VAS-R and VAS-C were 6.79 ± 1.17 and 7.6 ± 1.39, respectively. All subjects showed a significant reduction in pain over time (p<0.001). Mean baseline values of WOMAC pain, stiffness and physical function were 5.56 ± 1.32, 4.39 ± 1.91 and 4.63 ± 2.31, respectively. According to WOMAC stiffness and physical function was not found a significant improvement over time (p> 0.05).

Conclusion

Corticosteroid perimeniscal ultrasound guided injection can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA.

Level of Evidence

IV.

Functional leg length discrepancy between theories and reliable instrumental assessment: a study about newly invented NPoS system

Background

In spite the instinct social&financial impact of Leg Length Discrepancy (LLD), controversial and conflicting results still exist regarding a reliable assessment/correction method. For proper management it's essential to discriminate between anatomical&functional Leg Length Discrepancy (FLLD). With the newly invented NPoS (New Postural Solution), under the umbrella of the collaboration of PRM Department, Tor Vergata University with Baro Postural Instruments srl, positive results were observed in both measuring& compensating the hemi-pelvic antero-medial rotation in FLLD through personalized bilateral heel raise using two NPoS components: Foot Image System (FIS) and Postural Optimizer System (POS). This led our research interest to test the validity of NPoS as a preliminary step before evaluating its implementations in postural disorders.

Methods

After clinical evaluation, 4 subjects with FLLD have been assessed by NPoS. Over a period of 2 months, every subject was evaluated 12 times by two different operators, 48 measurements in total, results have been verified in correlation to BTS GaitLab results.

Results

Intra-Operator&inter-operator variability analysis showed statistically insignificant differences, while inter-method variability between NPoS and BTS parameters expressed a linear correlation.

Conclusion

Results suggest a significant validity of NPoS in assessment&correction of FLLD, with high degree of reproducibility with minimal operator dependency. This can be considered a base for promising clinical implications of NPoS as a reliable cost effective postural assessment/corrective tool.

Level of evidence

V.

Arthroscopic ACL reconstruction using patellar bone tendon autograft and Rigidfix fixation - A midterm functional outcome

Background

Arthroscopic reconstruction of torn Anterior Cruciate Ligament (ACL) with bone patellar tendon bone autograft (BTB) has become the gold standard in treating ACL tear with high success rate. The purpose of this study was to prospectively evaluate the functional outcome after arthroscopic ACL reconstruction using BTB via Rigidfix femoral fixation.

Materials and method

We evaluated the result of 21 knees that have been treated with arthroscopic ACL reconstruction using BTB autograft for femoral fixation and bioabsorbable interference screw for tibia from March 2014 to August 2015. The mean follow up period was 18 months.

Results and conclusion

The Lysholm score postoperatively was 89.04. 23.8% of the 21 patients have good to excellent outcome, 66.7% patients have good to fair outcome and 9.5% patient have fair outcome.

Level of Evidence

IV.