Publications by authors named "Francesco Oliva"

206 Publications

Low-Dose NSAIDs Efficacy in Orthopedic Applications.

Sports Med Arthrosc Rev 2022 Sep 3;30(3):147-161. Epub 2022 Aug 3.

Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery.

Non-steroidal anti-inflammatory drugs (NSAIDs) [cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitors] and COXIBs (the COX-2 selective inhibitors) may induce several potentially severe and life-threatening issues especially in elderly patients. The use of low-dose NSAIDs is associated with lower risk of side effects compared to the standard dosage. Low-dose NSAIDs could minimize the side effects of these drugs while maintaining their clinical efficacy and effectiveness. The present study evaluates the effectiveness and safety of low-dose NSAIDs in musculoskeletal applications.
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http://dx.doi.org/10.1097/JSA.0000000000000353DOI Listing
September 2022

Vitamins C and D and COVID-19 Susceptibility, Severity and Progression: An Evidence Based Systematic Review.

Medicina (Kaunas) 2022 Jul 15;58(7). Epub 2022 Jul 15.

Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy.

: Starting in early December 2019, the novel Coronavirus Disease (COVID-19) from infection with COVID-19 has caused a global pandemic. Many aspects of its pathogenesis and related clinical consequences are still unclear. Early diagnosis and dynamic monitoring of prognostic factors are essential to improve the ability to manage COVID-19 infection. This study aimed to provide an account of the role played by vitamins C and D on the onset, progression and severity of COVID-19. Clinical features and infection-related risk factors are also briefly discussed. : In March 2022, the main online databases were accessed. All the articles that investigate the possible role of vitamins C and D on COVID-19 susceptibility, severity and progression were considered. : The current evidence on vitamin C and D supplementation in patients with COVID-19 infection is inconsistent and controversial. In some studies, vitamins were used as coadjuvant of a formal experimental therapy, while in others as main treatment. Ethnicity and hospital setting (inpatient/outpatient) were also variable. Moreover, there was no consensus between studies in administration protocol: high heterogeneity in dosage, administration, and duration of the treatment were evident. Finally, some studies administered vitamins pre- and/or during COVID infection, in patients with different risk factors and infection severity. : While waiting to develop a targeted, safe and effective therapy, it is important to investigate individual predisposition and proper disease management. Concluding, available data on the use of nutraceuticals in COVID-19 are inconsistent. However, there is a lack of evidence-based guidelines which recommend vitamin C and D supplementation in patients with COVID-19, and results from high quality randomised controlled trials (RCTs) are inconsistent. Current investigations so far are mostly observational, and include a relatively small sample size which can lead to biased results. Large-scale multicentre studies are therefore needed.
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http://dx.doi.org/10.3390/medicina58070941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318801PMC
July 2022

Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study.

J Clin Med 2022 Jun 27;11(13). Epub 2022 Jun 27.

Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy.

Achilles tendon ruptures are common. Metabolic disorders, such as diabetes mellitus, hypercholesterolemia, thyroid disorders, and obesity, impair tendons health, leading to Achilles tendinopathy and likely predisposing patients to Achilles tendon ruptures. Patients who visited the Orthopedic Outpatient Clinics and the Accident and Emergency Departments of five different hospitals in Italy were recruited. Through telephone interviews, we administered a questionnaire to all the patients who had undergone surgical ATR repair, evaluating their past medical history, sport- and work-related activities, drug use, and post-operative rehabilitation outcomes. "Return to work activities/sport" was negatively predicted by the presence of a metabolic disorder (β = -0.451; OR = 0.637) and 'open' surgery technique (β = -0.389; OR = 0.678). "Medical complications" were significantly predicted by metabolic disorders (β = 0.600 (0.198); OR = 1.822) and was negatively related to 'mini-invasive' surgery (i.e., not 'open' nor 'percutaneous') (β = -0.621; OR = 0.537). "Immediate weightbearing" and "immediate walking without assistance" were negatively predicted by 'open' technique (β = -0.691; OR = 0.501 and β = -0.359 (0.174; OR = 0.698)). Metabolic conditions can strongly affect post-operative outcomes following surgical repair of acute Achilles tendon tears.
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http://dx.doi.org/10.3390/jcm11133698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267833PMC
June 2022

Prevalence of Metabolic Syndrome and Insulin Resistance in a Sample of Adult ADHD Outpatients.

Front Psychiatry 2022 21;13:891479. Epub 2022 Jun 21.

Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.

Background: High prevalence of Metabolic Syndrome (MS) was found in patients with schizophrenia and bipolar disorders. Insulin Resistance (IR) seems to mediate MS role in developing cardiometabolic consequences.

Aims: To investigate the prevalence of MS, and the role of MS components and IR surrogate indexes in determining MS in adult ADHD outpatients.

Methods: In the present cross-sectional study, MS, defined according to the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III), and IR surrogate indexes were assessed on a consecutive sample of adult ADHD outpatients. Logistic regression analysis was performed to evaluate the effect of each ATP III component and IR surrogate index in determining MS.

Results: Seventeen out of 158 patients (10.8%, 95%CI = 0.064/0.167) fulfilled the ATP-III criteria for MS. A comprehensive comparison with prevalence in the reference population was hindered by the lack of patients over 60 in the study sample, however under this age no significant differences were found. Among MS components, blood triglycerides level (OR = 1.02, 95%CI=1.01/1.03, = 0.001) was the main predictor for MS, followed by diastolic blood pressure (OR = 1.08, 95%CI=1.01/1.16, = 0.024) and waist circumference (OR = 1.06, 95%CI=1.01/1.13, = 0.029). Lipid Accumulation Product (LAP, OR = 1.0006, 95%CI=1.0003/1.0009, < 0.001) outperformed Triglyceride-Waist Circumference (TG-WC, OR=1.03, 95%CI=1.01/1.04, < 0.001) in predicting MS.

Conclusions: More attention should be paid not only to MS but also to each ATP III component of MS and LAP in ADHD patients both at first assessment and during follow-up process.
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http://dx.doi.org/10.3389/fpsyt.2022.891479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253578PMC
June 2022

The double posteromedial portals endoscopy for posterior ankle impingement syndrome in athletes.

J Orthop Traumatol 2022 Jul 6;23(1):28. Epub 2022 Jul 6.

Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.

Background: Posterior ankle impingement syndrome (PAIS) may result from flexor hallucis longus tendinopathy, compression of the posterior process of the talus from the presence of an os trigonum, soft-tissue impingement, or a combination of these. Posterior extra-articular endoscopy performed with the patient supine through the double posteromedial portals, with excision of adhesions, excision of the posterior process of the talus or an os trigonum, and decompression of the tendon of the flexor hallucis longus (FHL), can be used in athletes with PAIS.

Methods: Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals. The patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner scale, and the simple visual analogue scale. Time of surgery, return to sports, patient satisfaction, and complications were recorded and analysed. The average length of postoperative follow-up was 26.7 ± 12.6 (range 24 to 72) months.

Results: The mean Tegner activity scale score improved to 9 ± 0.2 postoperatively (p < 0.05), while the mean American Orthopaedic Foot and Ankle Society scale score improved to 96 ± 5.1 (range 87 to 100) postoperatively, with 29 of 34 patients (85.3%) achieving a perfect score of 100 (p < 0.05). The mean time to return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. The complication rate was low, with no superficial wound infections or venous thromboembolism events; only two patients (5.9%) reported pain and tenderness by 3 months after the index procedure.

Conclusion: Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS.
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http://dx.doi.org/10.1186/s10195-022-00651-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259767PMC
July 2022

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review.

Knee Surg Sports Traumatol Arthrosc 2022 Jul 1. Epub 2022 Jul 1.

Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.

Purpose: It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review.

Methods: This systematic review was conducted according to the 2020 PRISMA statement. All the level I RCTs which investigated the efficacy of AMP were accessed. Studies which included elderlies with severe OA were not eligible, nor were those in which APM was combined with other surgical intervention or in patients with unstable knee or with ligaments insufficiency. The risk of bias was assessed using the software Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). To rate the quality of evidence of collected outcomes, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used.

Results: Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The mean age of the patients was 52.7 ± 3.9 years, the mean BMI 27.0 ± 1.3 kg/m. The current evidence suggests no difference in functional PROMs (quality of the evidence: high), clinical PROMs (quality of the evidence: high), pain (quality of the evidence: high), quality of life (quality of the evidence: high), physical performance measures (quality of the evidence: moderate), and OA progression (quality of the evidence: moderate).

Conclusions: The benefits of APM in adults with degenerative and nonobstructive meniscal symptoms are limited. The current evidence reports similarity in the outcome between APM and PT. Further long-term RCTs are required to investigate whether APM and PT produce comparable results using validated and reliable PROMs. Moreover, future RCTs should investigate whether patients who might benefit from APM exist, clarifying proper indications and outcomes. High quality investigations are strongly required to establish the optimal PT regimes.

Level Of Evidence: Level I.
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http://dx.doi.org/10.1007/s00167-022-07040-0DOI Listing
July 2022

A comprehensive update on the pharmacological management of heterotopic ossification following hip arthroplasty: a level I evidenced based expert opinion.

Expert Opin Pharmacother 2022 Jul 13;23(10):1195-1203. Epub 2022 Jun 13.

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.

Introduction: Heterotopic ossification (HO) of the hip joint may happen accompanying skeletal muscle trauma or surgical procedures. The pharmacological prophylaxis of heterotopic ossification (HO) following total hip arthroplasty (THA) is debated.

Areas Covered: This expert opinion aims to systematically investigate the efficacy of current pharmacological options as prophylaxis for HO following THA.

Expert Opinion: The current evidence identified celecoxib, naproxen, and diclofenac as best option for the prevention of HO in patients who undergo primary THA. The most appropriate pharmacotherapy for the prevention of HO is still debated and should be customized according to patients' comorbidities and medical history. For patients with cardiovascular comorbidities, naproxen, or diclofenac should be considered along with proton pump inhibitors to prevent gastrointestinal complications. For patients with history of gastrointestinal disease, celecoxib can be recommended. These conclusions must be considered within the limitations of the present investigation. Between studies, heterogeneities in the administration protocols were evident. In some RCTs, the length of the follow-up was shorter than 12 months. The current clinical practice would benefit of high-quality recommendations and the development of the shared official guidelines.
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http://dx.doi.org/10.1080/14656566.2022.2088280DOI Listing
July 2022

Antiresorptive treatments for corticosteroid-induced osteoporosis: a Bayesian network meta-analysis.

Br Med Bull 2022 Jun 1. Epub 2022 Jun 1.

Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.

Introduction: Corticosteroid-induced osteoporosis (CIO) is the most common type of secondary osteoporosis, leading to fractures, and increased morbidity and mortality.

Source Of Data: Pubmed, EMBASE, Scopus and Google Scholar databases.

Areas Of Agreement: Prolonged glucocorticoids administration leads to secondary osteoporosis.

Areas Of Controversy: The optimal management for CIO is controversial.

Growing Points: The present study compared bone mineral density, fractures and adverse events in patients undergoing treatment with risedronate, alendronate, zoledronate, denosumab or etidronate for CIO.

Areas Timely For Developing Research: For selected patients with CIO, alendronate performed better overall. These results must be interpreted within the limitations of the present study.

Level Of Evidence: I, Bayesian network meta-analysis of randomized clinical trials.
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http://dx.doi.org/10.1093/bmb/ldac017DOI Listing
June 2022

The Neural Signature of Psychological Interventions in Persons With Cancer: A Scoping Review.

Integr Cancer Ther 2022 Jan-Dec;21:15347354221096808

Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.

Objective: People diagnosed with cancer have to deal with the debilitating psychological implications of this disease. Although the clinical efficacy of psychological interventions is well documented, relatively little has been written on the neural correlates of these treatments in the context of oncology. The present work is the first to provide an overall perspective of the existing literature on this topic. It also considers the potential directions for future research.

Methods: This scoping review was carried out across 5 databases (EMBASE, PsycINFO, OVID MEDLINE, CINAHL, COCHRANE CENTRAL), from conception dates until 3 December 2021.

Results: From an initial set of 4172 records, 13 papers were selected for this review. They consisted of 9 randomized controlled studies (RCTs), 1 quasi-experiment, 2 single case studies, and 1 secondary quantitative analysis. The studies were also heterogeneous in terms of the patient and control populations, psychological interventions, and neuroimaging methodologies used. The findings from these few studies suggest that psychological interventions in oncology patients may modulate both cortical and subcortical brain activity, consistent with the brain areas involved in distress reactions in general and to cancer specifically. The implications of this scoping review in terms of future research are also discussed.

Conclusions: The literature on the neural correlates of psychological interventions in cancer patients is very limited, and thus requires further exploration. The provision of psychological interventions offers cancer patients a more integrated approach to care, which may in turn help preserve both the physical and the psychological wellbeing of individuals with cancer.
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http://dx.doi.org/10.1177/15347354221096808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9158410PMC
June 2022

Immune Checkpoint Inhibitors as a Neoadjuvant/Adjuvant Treatment of Muscle-Invasive Bladder Cancer: A Systematic Review.

Cancers (Basel) 2022 May 21;14(10). Epub 2022 May 21.

Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy.

Bladder cancer is the ninth most common cancer worldwide. Over 75% of non-muscle invasive cancer patients require conservative local treatment, while the remaining 25% of patients undergo radical cystectomy or radiotherapy. Immune checkpoint inhibitors represent a novel class of immunotherapy drugs that restore natural antitumoral immune activity via the blockage of inhibitory receptors and ligands expressed on antigen-presenting cells, T lymphocytes and tumour cells. The use of immune checkpoint inhibitors in bladder cancer has been expanded from the neoadjuvant setting, i.e., after radical cystectomy, to the adjuvant setting, i.e., before the operative time or chemotherapy, in order to improve the overall survival and to reduce the morbidity and mortality of both the disease and its treatment. However, some patients do not respond to checkpoint inhibitors. As result, the capability for identifying patients that are eligible for this immunotherapy represent one of the efforts of ongoing studies. The aim of this systematic review is to summarize the most recent evidence regarding the use of immune checkpoint inhibitors, in a neoadjuvant and adjuvant setting, in the treatment of muscle-invasive bladder cancer.
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http://dx.doi.org/10.3390/cancers14102545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9139497PMC
May 2022

Factors influencing the outcomes of minimally invasive total hip arthroplasty: a systematic review.

J Orthop Surg Res 2022 May 18;17(1):281. Epub 2022 May 18.

Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.

Introduction: The present systematic review investigated possible factors which may influence the surgical outcome of minimally invasive surgery for total hip arthroplasty (MIS THA).

Methods: In January 2022, the Embase, Google Scholar, PubMed, and Scopus databases were accessed. All the clinical trials investigating the clinical outcome of MIS THA were considered.

Results: Data from 9486 procedures were collected. Older age was moderately associated with greater Visual Analogue Scale (VAS) (P = 0.02) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (P = 0.009) at last follow-up, and shorter surgical duration (P = 0.01). Greater body mass index (BMI) at baseline was moderately associated with greater cup anteversion (P = 0.0009), Oxford Hip Score (OHS) at last follow-up (P = 0.04), longer surgical duration (P = 0.04), increased leg length discrepancy (P = 0.02), and greater rate of infection (P = 0.04). Greater VAS at baseline was weakly associated with greater VAS at last follow-up (P < 0.0001), total estimated blood lost (P = 0.01), and lower value of Harris Hip Score (HHS) (P = 0.0005). Greater OHS at baseline was associated with greater post-operative VAS (P = 0.01). Greater WOMAC at baseline was associated with lower cup anteversion (P = 0.009) and greater VAS (P = 0.02). Greater HHS at baseline was associated with shorter hospitalisation (P = 0.001).

Conclusion: Older age and greater BMI may represent negative prognostic factors for MIS THA. The clinical outcome is strongly influenced by the preoperative status of patients.
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http://dx.doi.org/10.1186/s13018-022-03168-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118783PMC
May 2022

Intensive Physical Activity Increases the Risk of Knee and Hip Arthroplasty: A Systematic Review.

Sports Med Arthrosc Rev 2022 Jun 4;30(2):111-116. Epub 2022 May 4.

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi.

Purpose: The present study investigated the type of sport and activity level of athletes before they underwent knee and/or hip arthroplasty for osteoarthritis (OA), and compared them with a control group of subjects who did not undergo knee and hip arthroplasty. We hypothesed athletes exposed to high physical loads during sports had the highest risk of developing OA requiring arthroplasty.

Materials And Methods: This systematic review was conducted according to the PRISMA guidelines. All the comparative clinical trials to August 2021 investigating the sport activity level between subjects who underwent arthroplasty versus those who did not undergo arthroplasty for OA were considered.

Results: Data from 5 studies and 3638 patients were collected. The mean age for both groups was 47.61±15.5 years, and the mean body mass index was 24.6±2.1 kg/m2 17.6% were women. The Newcastle-Ottawa scale attested good quality of the methodology of the investigations included in the present study.

Conclusion: Intense physical exercise, implying a high cumulative number of hours of exercise which can lead to excessive joint overload, in both sexes is associated with greater likelihood of early knee and hip OA which may lead to prosthetic surgery. Moderate and recreational exposure to sport has minor degenerative effects, and is not associated with early onset OA requiring arthroplasty.
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http://dx.doi.org/10.1097/JSA.0000000000000340DOI Listing
June 2022

Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence.

Sports Med Arthrosc Rev 2022 Jun 4;30(2):102-110. Epub 2022 May 4.

Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi.

Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.
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http://dx.doi.org/10.1097/JSA.0000000000000341DOI Listing
June 2022

The Influence of Athletes' Age in the Onset of Osteoarthritis: A Systematic Review.

Sports Med Arthrosc Rev 2022 Jun 4;30(2):97-101. Epub 2022 May 4.

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.

Purpose: Whether sport participation is a risk factor for osteoarthritis (OA) development or progression is controversial. Mechanical overload, injuries, genetics, and acquired disorders concur to the onset of OA, with high variability between sports and participants. This study investigated the association between participation in specific sports and the risk of developing knee and hip OA in athletes at different ages. We hypothesized that young athletes who are exposed to high levels of physical activities have a greater risk of developing OA.

Materials And Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Google scholar, EMABSE, and Web of Science were accessed in October 2021. No time constrains were used for the search. All the published clinical studies reporting data about relationship between physical activity, OA, and age were included.

Results: The Newcastle-Ottawa Scale resulted in a final score ≥7 for all studies, attesting good quality of the methodological assessment. Data from 27,364 patients were retrieved. The mean age was 48.2±16.7 years. In all, 21.8% were women.

Conclusions: Our systematic review suggests an association between high levels of physical activities and knee and hip OA in men younger than 50 years. People who practice intense physical activity, such as professional athletes or heavy workers, are more prone to develop early-onset OA.
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http://dx.doi.org/10.1097/JSA.0000000000000345DOI Listing
June 2022

Elderly Runners and Osteoarthritis: A Systematic Review.

Sports Med Arthrosc Rev 2022 Jun 4;30(2):92-96. Epub 2022 May 4.

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.

Purpose: The impact of running on the onset of osteoarthritis (OA) is controversial. This study compared the incidence of OA in elderly runners versus nonrunners.

Material And Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Web of Science databases were accessed in January 2022. All the published clinical studies investigating OA onset in runners versus non-runners were considered. Studies reporting data on OA and participants in other sports were excluded. Only studies investigating patients with a mean age older than 55 years were considered. The methodological quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS).

Results: Data from 3001 participants and 6674 joints were retrieved. The mean age was 59.4±2.7 years. The mean body mass index was 24.6±2.5 kg/m2. The 5 included articles (963 runners, 2038 nonrunners) did not report significant differences in runners compared with controls.

Conclusion: Middle aged runners did not present greater imaging or clinical signs of OA compared with nonrunner controls. Running at elite or recreational level did not increase the rate of OA progression in individuals older than 50 years.
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http://dx.doi.org/10.1097/JSA.0000000000000347DOI Listing
June 2022

The Association Between Sex and Osteoarthritis in the Physically Active Population: A Systematic Review.

Sports Med Arthrosc Rev 2022 Jun 4;30(2):87-91. Epub 2022 May 4.

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.

Purpose: Intense sporting activity and certain types of work increase the risk of early osteoarthritis (OA). OA can be idiopathic or associated to certain predisposing factors: female sex, obesity, history of joint injury, and joint overuse. The role of gender among the active population as a predisposing factor for OA is not well clear. This study investigated whether the risk of OA changes with age in both sexes in physically active individuals.

Materials And Methods: This systematic review was conducted according to the PRISMA guidelines 2020. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in April 2021. No time constrains were used for the search. All the published clinical studies reporting data about relationship between physical activity and OA were included.

Results: Data from 7 articles were retrieved including 360,053 patients (271,903 males; 88,150 females). The mean age was 48.2±16.7 years. Males, under the age of 60 had a higher risk of developing OA. People undertaking intense physical activity, such as professional athletes or heavy workers, are more prone to develop early OA.

Conclusion: Physically active males demonstrated a higher risk of developing OA.
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http://dx.doi.org/10.1097/JSA.0000000000000346DOI Listing
June 2022

Osteoarthritis in Athletes Versus Nonathletes: A Systematic Review.

Sports Med Arthrosc Rev 2022 Jun 4;30(2):78-86. Epub 2022 May 4.

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.

Introduction: Joint overload and sport-related injuries may accelerate the development of osteoarthritis (OA). A systematic review of the literature was performed to establish the risk of athletes to develop premature OA compared with nonathletes.

Materials And Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Web of Science databases were accessed in June 2021. All the published clinical studies investigating OA onset in athletes versus nonathletes were considered. Studies reporting data on secondary and/or post-traumatic OA were excluded.

Results: Data from 32 articles (20,288 patients) were retrieved. The mean age was 67.8±10.0 years and the mean body mass index was 25.0±2.5 kg/m2. 74% (6859 patients) of the athletes suffered from premature OA. Of them, 21% were active in soccer, 11% in handball, 11% in ice-hockey, 3% in football, and 0.3% in rugby. 26% of the athletes reported no significant differences in OA progression compared with healthy controls. Of these athletes, 47% were runners, 5% dancers, and 1% triathletes.

Conclusion: Certain sports, such as soccer, handball, ice-hockey, and rugby are more likely to be associated with premature knee and hip OA. Conversely, runners and ballet dancers do not evidence significant increase in OA. Moderate and recreational exposure to aerobic sports does not accelerate the development of OA.
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http://dx.doi.org/10.1097/JSA.0000000000000339DOI Listing
June 2022

Ligament Advanced Reinforcement System (LARS) synthetic graft for PCL reconstruction: systematic review and meta-analysis.

Br Med Bull 2022 May 4. Epub 2022 May 4.

Department of Orthopaedics, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy.

Introduction: Several strategies are available for posterior cruciate ligament (PCL) reconstruction.

Source Of Data: Recently published literature in PubMed, Google Scholar and Embase databases.

Areas Of Agreement: The Ligament Advanced Reinforcement System (LARS) is a scaffold type artificial ligament, which has been widely used for ligament reconstruction of the knee.

Areas Of Controversy: Current evidence on the reliability and feasibility of LARS for primary isolated PCL reconstruction is limited.

Growing Points: The primary outcome of interest of the present work was to investigate the outcomes of PCL reconstruction using the LARS. The secondary outcome of interest was to compare the LARS versus four-strand hamstring tendon (4SHT) autograft for PCL reconstruction.

Areas Timely For Developing Research: LARS for primary isolated PCL reconstruction seems to be effective and safe, with results comparable to the 4SHT autograft.
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http://dx.doi.org/10.1093/bmb/ldac011DOI Listing
May 2022

Small interfering RNAs in the management of human rheumatoid arthritis.

Br Med Bull 2022 07;142(1):34-43

Department of Trauma and Orthopaedic Surgery, AOU San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, Salerno 84131, Italy.

Background: Rheumatoid arthritis (RA) has unclear pathogenesis, but the molecules that feed its inflammatory state are known. Small interfering RNAs (siRNAs) are useful to identify molecular targets and evaluate the efficacy of specific drugs, and can themselves be used for therapeutic purposes.

Sources Of Data: A systematic search of different databases to March 2022 was performed to define the role of siRNAs in RA therapy. Twenty suitable studies were identified.

Areas Of Agreement: Small interfering RNAs can be useful in the study of inflammatory processes in RA, and identify possible therapeutic targets and drug therapies.

Areas Of Controversy: Many genes and cytokines participate in the inflammatory process of RA and can be regulated with siRNA. However, it is difficult to determine whether the responses to siRNAs and other drugs studied in human cells in vitro are similar to the responses in vivo.

Growing Points: Inflammatory processes can be affected by the gene dysregulation of siRNAs on inflammatory cytokines.

Areas Timely For Developing Research: To date, it is not possible to determine whether the pharmacological response of siRNAs on cells in vitro would be similar to what takes place in vivo for the diseases studied so far.
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http://dx.doi.org/10.1093/bmb/ldac012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351475PMC
July 2022

Hamstring, bone-patellar tendon-bone, quadriceps and peroneus longus tendon autografts for primary isolated posterior cruciate ligament reconstruction: a systematic review.

Br Med Bull 2022 07;142(1):23-33

Department of Orthopaedics, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Salerno (SA) 84081, Italy.

Introduction: Several autografts are available to reconstruct the posterior cruciate ligament (PCL).

Source Of Data: Current scientific literature published in PubMed, Google scholar, Embase and Scopus.

Areas Of Agreement: Hamstring, bone-patellar tendon-bone (BPTB), quadriceps and peroneus longus (PLT) are the most common tendon autografts used for primary isolated PCL reconstruction.

Areas Of Controversy: The optimal tendon source for PCL reconstruction remains nevertheless debated. Identifying the most suitable tendon autograft could assist the surgeon during primary PCL reconstruction.

Growing Points: The present study compared the outcome of PCL reconstruction using hamstring, BPTB, quadriceps and PLT autografts. The focus was on patient-reported outcome measures (PROMs), joint laxity, range of motion and complications.

Areas Timely For Developing Research: All autografts are viable options for PCL reconstruction, with BTB and hamstring autografts demonstrating superior PROMs. However, further clinical investigations are required to determine the ideal autograft construct.
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http://dx.doi.org/10.1093/bmb/ldac010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351477PMC
July 2022

The Cincinnati incision is safe and effective for revision surgery for insertional tendinopathy of the Achilles tendon.

Sci Rep 2022 04 22;12(1):6653. Epub 2022 Apr 22.

Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.

The present study reports the outcomes of revision surgery using a Cincinnati incision with tendon debridement and calcaneoplasty for insertional Achilles tendinopathy (IAT) in a cohort of patients at 24-month follow-up. Patients undergoing revision surgery following failed previous surgery for IAT were prospectively recruited. Patients were assessed pre-operatively and at 3, 6,12 and 24 months. The Victorian Institute of Sport Assessment Scale for Achilles Tendinopathy (VISA-A), the EQ5D questionnaire and the visual analogue scale (VAS) were used for evaluation. Data from 33 patients with a mean age of 43.9 years old are reported. 27% (9 of 33 patients) were female. The left side was involved in 58% (19/33) of patients. No clinically relevant complications were reported in any of the patients. Most of subscales of EQ5D improved at last follow-up: Usual Activities (P = 0.01), Mobility (P = 0.03), Pain/Discomfort (P = 0.001), Thermometer (P = 0.04). No statistically significant change for the subscales Self-Care (P = 0.08) and Anxiety-Depression (P = 0.1) was evidenced. The VISA-A score improved significantly at last follow-up (P < 0.0001), as did the VAS score (P < 0.0001). These results indicated that a Cincinnati incision followed by tendon debridement and calcaneoplasty for revision surgery for IAT is feasible and reliable, achieving clinically relevant improvement in the VISA-A, EQ5D and VAS at 24 months follow-up.
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http://dx.doi.org/10.1038/s41598-022-10730-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033808PMC
April 2022

Imageless navigation for primary total hip arthroplasty: a meta-analysis study.

J Orthop Traumatol 2022 Apr 15;23(1):21. Epub 2022 Apr 15.

Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.

Background: There has been a growing interest in imageless navigation for primary total hip arthroplasty (THA). Its superiority over standard THA is debated. This meta-analysis compared surgical duration, implant positioning, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA.

Methods: The present study was conducted according to the PRISMA 2020 guidelines. All the clinical trials comparing imageless navigation versus conventional for primary THA were accessed. In January 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. The outcomes of interest were to compare cup inclination and anteversion, leg length discrepancy, surgical duration, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA.

Results: Twenty-one studies (2706 procedures) were retrieved. Fifty-two percent of patients were women. There was between-group comparability at baseline in terms of age, body mass index (BMI), visual analogue scale, Harris Hip Score and leg length discrepancy (P > 0.1). Compared with conventional THA, the navigated group demonstrated slightly lower leg length discrepancy (P = 0.02) but longer duration of the surgical procedure (P < 0.0001). Cup anteversion (P = 0.6) and inclination (P = 0.5), Harris Hip Score (P = 0.1) and rate of dislocation (P = 0.98) were similar between the two interventions.

Conclusion: Imageless navigation may represent a viable option for THA.
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http://dx.doi.org/10.1186/s10195-022-00636-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9012775PMC
April 2022

Minimally invasive simple prostatectomy: Robotic-assisted versus laparoscopy. A comparative study.

Arch Ital Urol Androl 2022 Mar 28;94(1):37-40. Epub 2022 Mar 28.

Department of Urology, San Bassiano Hospital, Bassano del Grappa.

Purpose: Robotic-assisted simple prostatectomy (RASP) is a novel surgical procedure for the management of obstructive symptoms caused by enlarged prostate glands. Before the introduction of minimally invasive techniques, the standard approach was the open simple prostatectomy (OSP). The aim of our study was to compare intraoperative and perioperative outcomes of robotic (RASP) and laparoscopic (LSP) simple prostatectomy.

Methods: We retrospectively analyzed data from patients who underwent minimally invasive simple prostatectomy at the Urological Department of Portogruaro Hospital, Portogruaro, and at the Urological Department of "San Bassiano" Hospital, in Bassano del Grappa, from March 2015 to December 2020. Data collected from medical records included age, body mass index, prostate volume, operative time, preoperative International Prostatic Symptoms Score (IPSS), postoperative IPSS, time with drainage, blood transfusion, intraoperative complications, perioperative complications and length of hospital stay.

Results: Robotic-assisted (n = 25) and laparoscopic simple prostatectomy (n = 25) were performed with a transvesical approach. No significant differences were observed regarding baseline characteristics, body mass index, prostate volume and IPSS. Operative time was lower in the laparoscopic group (122 min vs 139 min) (p = 0.024), while hospital stay was lower in the robotic group (4 days vs 6 days) (p = 0.047).

Conclusions: Robotic-assisted simple prostatectomy is a safe technique with results comparable to laparoscopic simple prostatectomy, encompassing the advantage of a shorter hospitalization. Considering the costs and the limited availability of robotic-assisted simple prostatectomy, laparoscopic simple prostatectomy is a valid and safe alternative for experienced surgeons.
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http://dx.doi.org/10.4081/aiua.2022.1.37DOI Listing
March 2022

Muscle herniae: Conservative and surgical management. Systematic review.

Surgeon 2022 Mar 12. Epub 2022 Mar 12.

Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK; Keele University, Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK. Electronic address:

Background: Muscle herniae are often unrecognized. The primary objective of this systematic review is to evaluate the outcomes of conservative and surgical management for muscle herniae. The secondary objective is to define the most appropriate management for muscle herniae depending on aetiology and size of the fascial defect.

Methods: The PRISMA guidelines were used to organize this systematic review to assess the different management modalities and identify possible criteria useful to guide the management of muscle herniae. An electronic search of PubMed and Scopus databases was performed.

Results: A total of 132 patients were identified. Conservative management was carried out in 22 (16.7%) patients, and 110 (83.3%) patients underwent surgical procedures. Pain was reported in 3/22 (13.6%) patients managed conservatively. Post-surgical pain was reported in 0/5 (0%) patients treated with autologous graft repair, 1/15 (6.7%) patient with mesh repair, 2/13 (15.4%) patients with direct repair and 11/77 (14.3%) patients with fasciotomy. Return to normal activity was possible in 16/22 (72.7%) patients treated conservatively, 5/5 (100%) patients undergoing autologous graft repair, 13/15 (86.7%) with mesh repair, 62/77 (80.52%) with fasciotomy and 4/12 (33.3%) with direct repair.

Conclusion: In congenital muscle herniae, fasciotomy should be considered the surgical choice to prevent complications. In post-traumatic muscle hernia, a small fascial defect can be treated with the direct suture repair, while mesh repair and autologous graft repair should be considered the most appropriate procedures to avoid severe complications such as compartment syndrome.
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http://dx.doi.org/10.1016/j.surge.2022.02.003DOI Listing
March 2022

Single versus double bundle in posterior cruciate ligament (PCL) reconstruction: a meta-analysis.

Sci Rep 2022 03 9;12(1):4160. Epub 2022 Mar 9.

Department of Orthopaedics, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.

Posterior cruciate ligament (PCL) reconstruction can be performed using single bundle (SB) and double bundle (DB) techniques. The present study investigated whether DB PCL reconstruction is superior to SB reconstruction in terms of patient reported outcome measures (PROMs) and joint stability. In December 2021 Embase, Google Scholar, Pubmed, Scopus databases were accessed. All clinical trials comparing SB versus DB reconstruction to address PCL insufficiency in skeletally mature patients were considered. Data from 483 procedures were retrieved. The mean follow-up was 31.0 (28.0 to 107.6) months, and the mean timespan between injury and surgery was 11.3 (6 to 37) months. The mean age of the patients was 29.3 ± 3.8 years. 85 of 483 patients (18%) were women. At a mean of 31.0 months post reconstruction, ROM (P = 0.03) was slightly greater in the SB group, while the Tegner score (P = 0.03) and the Telos stress (P = 0.04) were more favorable in the DB cohort. Similarity was found in instrumental laxity (P = 0.4) and Lysholm score (P = 0.3). The current evidence does not support the use of DB techniques for PCL reconstruction. Both methods could restore knee stability and motion with satisfactory short term patient reported outcome measures. Further high quality clinical trials are required to validate these results on a larger scale.
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http://dx.doi.org/10.1038/s41598-022-07976-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907238PMC
March 2022

Operative Management of Avascular Necrosis of the Femoral Head in Skeletally Immature Patients: A Systematic Review.

Life (Basel) 2022 Jan 26;12(2). Epub 2022 Jan 26.

Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy.

Purpose: Osteonecrosis of the femoral head (ONFH) is common in skeletally immature patients. The management of ONFH is controversial, with limited evidence and unpredictable results. This study systematically reviewed the current operative modalities and clinical outcomes of surgical management for ONFH in skeletally immature patients.

Methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in October 2021. All the published clinical studies reporting data concerning the surgical management of ONFH in skeletally immature patients were included.

Results: This review included 122 patients (127 hips). 38.2% (46 of 122) were female. The mean age of the patients was 14.2 ± 2.3 years. The mean duration of the follow-up was 55.3 ± 19.6 months. The Harris Hip Score improved from 68.8 ± 11.9 at baseline to 90.5 ± 6.5 at last follow-up ( < 0.0001). Femoral head collapse and secondary hip degeneration were the most common complications.

Conclusion: Several surgical techniques are available and effective for the management of ONFH in skeletally immature patients. This study evidenced high heterogeneity of the surgical procedures and eligibility criteria. Further high-quality investigations are required to establish proper indications and surgical modalities.
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http://dx.doi.org/10.3390/life12020179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8879936PMC
January 2022

Minimally invasive fasciotomy for symptomatic tibialis anterior muscle hernia.

Surgeon 2022 Feb 12. Epub 2022 Feb 12.

Department of Medical Imaging, The London Independent Hospital, London, UK. Electronic address:

Background: Symptomatic muscle herniae are an uncommon cause of chronic exercise induced leg pain. The most common site for muscle hernia is the tibialis anterior muscle. This study evaluates the outcome of a minimal incision fasciotomy in patients with a symptomatic muscle hernia of the tibialis anterior muscle, and their return to normal daily activities including sport.

Methods: The study reports mid-term results in a series of 22 consecutive patients (17 males and 5 females, median age: 22 years) with a unilateral tibialis anterior MH who had undergone minimally invasive fasciotomy between 2008 and 2019. Clinical outcomes were assessed with SF-36 and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery, and the time to return to training (RTT) and to sport (RTS) were recorded.

Results: At a median follow up after surgery of 23 months, both questionnaires showed a statistically significant improvement (P < 0.005). At the latest follow up, 16 of patients (73%) had returned to pre-injury or higher levels of sport/activity. The median time to return to training and to return to sport was 7 and 11 weeks respectively. No severe complications and no recurrence of symptoms were recorded.

Conclusion: Minimally invasive fasciotomy is effective and safe for patients suffering from muscle hernia of the tibialis anterior muscle with good results in the mid-term.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.surge.2022.01.005DOI Listing
February 2022

Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis.

J Orthop Traumatol 2022 Feb 7;23(1). Epub 2022 Feb 7.

Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.

Background: The efficacy and safety of platelet-rich plasma (PRP) augmentation for arthroscopic meniscal repair is controversial. This meta-analysis compared arthroscopic meniscal repair performed in isolation or augmented with PRP.

Methods: The present study was conducted according to PRISMA 2020 guidelines. Pubmed, Web of Science, Google Scholar and Embase were accessed in August 2021. All the clinical trials which compared arthroscopic meniscal repair performed in isolation or augmented with PRP were included.

Results: Eight hundred thirty-seven patients were included: 38% (318 of 837 patients) were women; the mean age of the patients was 35.6 (range, 20.8-64.3) years; the mean follow-up was 26.2 (range, 6-54) months. Similarity was found in analogue scale (VAS) (P = 0.5) and Lysholm (P = 0.9), and International Knee Documentation Committee (IKDC) scores (P = 0.9). Similarity was found in the rate of failure (P = 0.4) and rate of revision (P = 0.07).

Conclusion: The current published scientific evidence does not support PRP augmentation for arthroscopic meniscal repair.
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http://dx.doi.org/10.1186/s10195-022-00630-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8821738PMC
February 2022

Knee intra-articular administration of stromal vascular fraction obtained from adipose tissue: A systematic review.

J Clin Orthop Trauma 2022 Feb 22;25:101773. Epub 2022 Jan 22.

Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.

Osteoarthritis is a debilitating chronic degenerative disease of cartilage joint surfaces and the knee is the weight-bearing joint most frequently plagued. Intra-articular cell therapies have recently emerged as a method to manage knee osteoarthritis. A literature search identifying all articles involving use of SVF to treat knee osteoarthritis was performed, consulting several databases. In conclusion, 24 clinical trials analysed report good to excellent clinical and radiographic results for the treatment of knee OA with the use of intraarticular administration of SVF.
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http://dx.doi.org/10.1016/j.jcot.2022.101773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808153PMC
February 2022

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair.

J Orthop Surg Res 2022 Feb 3;17(1):69. Epub 2022 Feb 3.

Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.

Background: The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients.

Methods: This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups.

Results: Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups.

Conclusion: In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome.

Level Of Evidence: Level III, a retrospective comparative study.
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http://dx.doi.org/10.1186/s13018-022-02968-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811990PMC
February 2022
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