Publications by authors named "Nicola Maffulli"

1,102 Publications

  • Page 1 of 1

Placebo administration for dry eye disease: a level I evidence based systematic review and meta-analysis.

Int J Clin Pharm 2022 Aug 8. Epub 2022 Aug 8.

RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.

Background: The efficacy of various common treatment options for dry eye disease (DED) has been investigated against placebo. However, the potential beneficial effect of placebo in the management of DED is still unclear.

Aim: This meta-analysis investigated the impact of placebo administration in DED in Ocular Surface Disease Index (OSDI), Schirmer I test (SIT), tear breakup time (TBUT), corneal staining, and complications.

Method: This meta-analysis and systematic review was conducted according to the 2020 PRISMA guidelines. In March 2022, Pubmed, Web of Science, Google Scholar, and Embase were accessed. All the randomised clinical trials which investigated any active treatment against a placebo control group were considered. The following data were extracted at baseline and at last follow-up: Ocular Surface Disease Index (OSDI), tear breakup time test (TBUT), Schirmer I test (SIT), corneal staining.

Results: Data from 56 studies (12,205 patients) were retrieved. Placebo administration is not effective in improving TBUT (P = 0.3), OSDI (P = 0.2), SIT (P = 0.1) and corneal staining (P = 0.1) from baseline to last follow-up. Active treatment led to a higher TBUT and SIT compared to placebo administration (P < 0.0001). The active treatment resulted in a lower OSDI compared to placebo administration (P = 0.0005). Five studies reported data on the corneal staining. No difference was found between placebo administration and active treatment (P = 0.8).

Conclusion: Placebo administration does not impact symptoms of DED and can be successfully employed to evaluate the efficacy of active treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11096-022-01439-yDOI Listing
August 2022

Therapeutic ultrasound related pain threshold in elite track & field athletes with tibial bone stress injuries.

Surgeon 2022 Aug 1. Epub 2022 Aug 1.

Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; First Department of Orthopaedic Surgery, Aristotle University of Thessaloniki, Greece; Department of Orthopaedics, School of Medicine, Surgery and Dentistry, Salerno, Italy; Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, United Kingdom. Electronic address:

Objective: Tibial stress injuries are challenging in terms of early diagnosis, management strategy, and safe return-to-play. In the present study, pain production associated with the application of therapeutic ultrasound (TUS) was used as a primary diagnostic tool to assess tibial bone stress injuries, and the sensitivity of this procedure was compared with Magnetic Resonance Imaging (MRI).

Subject And Methods: The study was designed as a retrospective analysis of prospectively collected data on tibial bone stress injuries in elite Track and field athletes attending the National Track and Field Athletics Centre in Thessaloniki, Greece, in the period 1995-2007. All patients underwent evaluation by TUS, and the sensitivity of the procedure was compared with MRI.

Results: Four of 29 athletes showed a positive TUS examination for stress injury while MRI showed normal findings. Additionally, 5 athletes evidenced MRI findings typical of a tibial bone stress injury, while TUS evaluation was negative. Using MRI as the standard, TUS displayed a sensitivity of 79.2%.

Conclusion: Therapeutic ultrasound is a reproducible modality with satisfactory reliability and sensitivity related to MRI, and could represent a useful tool for clinicians to primarily assess suspected tibial bone stress injuries in high qualification Track and Field athletes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surge.2022.06.002DOI Listing
August 2022

Allogenic Umbilical Cord Tissue for Treatment of Knee Osteoarthritis.

Sports Med Arthrosc Rev 2022 Sep 3;30(3):162-165. Epub 2022 Aug 3.

Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano.

Interest in use of perinatal allogenic tissues including clinical-grade minimally manipulated umbilical cord tissue-derived allograft formulations to treat knee osteoarthritis (OA) patients is increasing. Limited studies have characterized these formulations and evaluated their safety and efficacy in knee OA patients. We developed such formulation and reported the presence of growth factors, cytokines, hyaluronic acid, and exosomes. We reported that its administration is safe, and resulted in 50% pain reduction and improvement in knee injury and osteoarthritis outcome score (over 10%) and 36-item short form survey (25%). Another study reported no adverse events post injection of similar formulation and statistically significant ( P <0.001) improvement in visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores and reduction in medication usage in patients (77.8%). We also summarized the clinical trials registered on ClinicalTrials.gov utilizing umbilical cord tissue for knee OA treatment. In conclusion, available studies are preliminary but pave the way to higher level appropriately powered investigations, and these formulations should be considered as nonoperative alternative to manage knee OA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSA.0000000000000350DOI Listing
September 2022

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSA.0000000000000353DOI Listing
September 2022

Biological Targets of Multimolecular Therapies in Middle-Age Osteoarthritis.

Sports Med Arthrosc Rev 2022 Sep 3;30(3):141-146. Epub 2022 Aug 3.

Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy.

Knee osteoarthritis (OA) is a common condition, prevalent in middle-agedness, associated with chronic pain and impaired quality of life. Two interrelated biological processes fuel early OA progression: inflammation and structural tissues catabolism. Procatabolic and proinflammatory mediators are interconnected and form part of a self-perpetuating loop. They leverage OA research complexity because of the impossibility to discern certain spatiotemporal tissues' changes from others. Both are shared targets of versatile regenerative multimolecular therapies. In particular, platelet-rich plasma can interfere with inflammation and inflammatory pain. The therapeutic approach is to alter the vicious inflammatory loop by modifying the molecular composition of the synovial fluid, thereby paracrine cellular cross talk. Intra-articular injections of platelet-rich plasma can provide key factors balancing proinflammatory and anti-inflammatory factors, targeting macrophage dysfunction and modulating immune mechanisms within the knee.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSA.0000000000000349DOI Listing
September 2022

Osteoarthritis Risks and Sports: An Evidence-based Systematic Review.

Sports Med Arthrosc Rev 2022 Sep 3;30(3):118-140. Epub 2022 Aug 3.

Department of Orthopaedic and Trauma Surgery, University Hospital Mannheim, Mannheim, Germany.

Purpose: Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA.

Methods: A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale.

Results: A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 .

Conclusion: Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSA.0000000000000351DOI Listing
September 2022

Middle Aged, Everlasting Athletes, and Osteoarthritis: The Present and Future.

Authors:
Nicola Maffulli

Sports Med Arthrosc Rev 2022 Sep 3;30(3):117. Epub 2022 Aug 3.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSA.0000000000000352DOI 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/medicina58070941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318801PMC
July 2022

No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis.

Knee Surg Sports Traumatol Arthrosc 2022 Jul 21. Epub 2022 Jul 21.

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

Purpose: Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA.

Methods: This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered.

Results: Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis.

Conclusion: There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA.

Level Of Evidence: Level I.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-022-07065-5DOI Listing
July 2022

Neural decoding from surface high-density EMG signals: influence of anatomy and synchronization on the number of identified motor units.

J Neural Eng 2022 Aug 2;19(4). Epub 2022 Aug 2.

Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

High-density surface electromyography (HD-sEMG) allows the reliable identification of individual motor unit (MU) action potentials. Despite the accuracy in decomposition, there is a large variability in the number of identified MUs across individuals and exerted forces. Here we present a systematic investigation of the anatomical and neural factors that determine this variability.. We investigated factors of influence on HD-sEMG decomposition, such as synchronization of MU discharges, distribution of MU territories, muscle-electrode distance (MED-subcutaneous adipose tissue thickness), maximum anatomical cross-sectional area (ACSA), and fiber cross-sectional area. For this purpose, we recorded HD-sEMG signals, ultrasound and magnetic resonance images, and took a muscle biopsy from the biceps brachii muscle from 30 male participants drawn from two groups to ensure variability within the factors-untrained-controls (UT = 14) and strength-trained individuals (ST = 16). Participants performed isometric ramp contractions with elbow flexors (at 15%, 35%, 50% and 70% maximum voluntary torque-MVT). We assessed the correlation between the number of accurately detected MUs by HD-sEMG decomposition and each measured parameter, for each target force level. Multiple regression analysis was then applied.ST subjects showed lower MED (UT = 5.1 ± 1.4 mm; ST = 3.8 ± 0.8 mm) and a greater number of identified MUs (UT: 21.3 ± 10.2 vs ST: 29.2 ± 11.8 MUs/subject across all force levels). The entire cohort showed a negative correlation between MED and the number of identified MUs at low forces (= -0.6,= 0.002 at 15% MVT). Moreover, the number of identified MUs was positively correlated to the distribution of MU territories (= 0.56,= 0.01) and ACSA(= 0.48,= 0.03) at 15% MVT. By accounting for all anatomical parameters, we were able to partly predict the number of decomposed MUs at low but not at high forces.Our results confirmed the influence of subcutaneous tissue on the quality of HD-sEMG signals and demonstrated that MU spatial distribution and ACSAare also relevant parameters of influence for current decomposition algorithms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/1741-2552/ac823dDOI Listing
August 2022

Pregabalin administration in patients with fibromyalgia: a Bayesian network meta-analysis.

Sci Rep 2022 Jul 15;12(1):12148. Epub 2022 Jul 15.

Department of Cardiothoracic Surgery, RWTH Aachen University Clinic, 52074, Aachen, Germany.

Several studies investigated the effectiveness and the safety of different doses of pregabalin in fibromyalgia. However, the optimal protocol remains controversial. A Bayesian network meta-analysis comparing 300, 450, and 600 mg/daily of pregabalin for fibromyalgia was conducted. The literature search was conducted in January 2022. All the double-blind randomised clinical trials comparing two or more dose protocols of pregabalin for fibromyalgia were accessed. Studies enrolling less than 50 patients were not eligible, nor were those with a length of follow-up shorter than eight weeks. The outcomes of interests were: Fibromyalgia Impact Questionnaire (FIQ), sleep quality, and adverse events. The network meta-analyses were performed using the routine for Bayesian hierarchical random-effects model analysis, with log odd ratio (LOR) and standardized mean difference (SMD) effect measure. Data from 4693 patients (mean age 48.5 years) were retrieved. 93.1% (4370 of 4693 patients) were women. The median follow-up was 14.8 weeks. Pregabalin 450 mg/daily resulted in greater reduction in Fibromyalgia Impact Questionnaire (SMD - 1.83). Pregabalin 600 demonstrated the greatest sleep quality (SMD 0.15). Pregabalin 300 mg/daily evidenced the lowest rate of adverse events (LOR 0.12). The dose of pregabalin must be customised according to patients' characteristics and main symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-022-16146-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287452PMC
July 2022

Selective versus non-selective NSAIDs as prophylaxis for heterotopic ossification following hip arthroplasty: a meta-analysis.

J Orthop Traumatol 2022 Jul 9;23(1):30. Epub 2022 Jul 9.

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

Background: Some patients have demonstrated evidence of heterotopic ossification (HO) following total hip arthroplasty (THA). Selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are used as prophylaxis for HO following THA. This meta-analysis compared selective versus non-selective NSAIDs as prophylaxis for HO following THA.

Material And Methods: The present study was conducted according to the PRISMA 2020 guidelines. All the clinical investigations comparing selective versus non-selective NSAIDs as prophylaxis for HO following THA were accessed in February 2022. An assessment of the methodological quality and statistical analyses were performed through the risk of bias summary tool of the Review Manager 5.3 software (Cochrane Collaboration, Copenhagen). The modified Brooker staging system was used to rate the efficacies of the interventions.

Results: Data from 8 studies and 1526 patients were collected. 60.8% were female. No difference was found in the sample size, mean age, and percentage of females between the two groups at baseline. No statistically significant difference was found between selective and non-selective NSAIDs in term of efficacy. 72% (1078 of 1502) of the patients were classified as Brooker 0, 21% (322 of 1502) as Brooker I, 5% (80 of 1502) as Brooker II, 1% (16 of 1502) as Brooker III, and 0.1% (2 of 1502) as Brooker IV.

Conclusion: Selective and non-selective NSAIDs were equally effective when used as prophylaxis for HO following THA.

Level Of Evidence: Level III, systematic review and meta-analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s10195-022-00646-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9271145PMC
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm11133698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267833PMC
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-022-07040-0DOI Listing
July 2022

Functionalised High-Performance Oxide Ceramics with Bone Morphogenic Protein 2 (BMP-2) Induced Ossification: An In Vivo Study.

Life (Basel) 2022 Jun 9;12(6). Epub 2022 Jun 9.

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

This study investigated the in vivo osseointegration potential of high-performance oxide ceramics (HPOCs) with peptide bone morphogenic protein 2 (BMP-2), comparing them with titanium implants. Histomorphometry was conducted around the distal, proximal, medial, and lateral sides of the implants to quantify the amount of mature and immature ossification within the bone interface. We hypothesised that HPOCs functionalised with BMP-2 promote ossification. HPOCs functionalised with BMP-2 were manufactured at the Department of Dental Materials Science and Biomaterial Research of the RWTH University Aachen, Germany. Histomorphometry was conducted by a professional pathologist in all samples. The region of interest (ROI) represented the percentage of the surrounding area of the implant. The percentages of ROI covered by osteoid implant contact (OIC) and mature bone-implant contact (BIC) were assessed. The surrounding presence of bone resorption, necrosis, and/or inflammation was quantitatively investigated. A total of 36 rabbits were used for the experiments. No bone resorption, necrosis, or inflammation was found in any sample. At the 12-week follow-up, the overall BIC was significantly increased ( < 0.0001). No improvement was evidenced in OIC ( = 0.6). At the 6-week follow-up, the overall OIC was greater in the BMP-2 compared to the titanium group ( = 0.002). The other endpoints of interest evidenced similarity between the two implants at various follow-up time points ( > 0.05). In conclusion, alumina HPOCs functionalised with peptide BMP-2 promote in vivo ossification in a similar fashion to titanium implants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/life12060866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9227568PMC
June 2022

EFAS Score - Validation of Portuguese Version by the Score Committee of the European Foot and Ankle Society (EFAS).

Foot Ankle Surg 2022 Aug 16;28(6):709-713. Epub 2022 Jun 16.

Hospital de Cascais Dr. José de Almeida, Alcabideche, Portugal.

Background: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in ten languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish, Portuguese). From other languages under validation, the Portuguese version completed data acquisition and underwent further validation.

Methods: The Portuguese version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Portuguese version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.

Results: The internal consistency was confirmed in the Portuguese version (Cronbach's Alpha 0.84). The Standard Error of Measurement (SEM) was 0.27 and is similar to other language versions. Between baseline and follow-up, 69.4% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 0.64).

Conclusions: The Portuguese EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fas.2022.06.003DOI Listing
August 2022

Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis.

J Orthop Surg Res 2022 Jun 20;17(1):319. Epub 2022 Jun 20.

Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074, Aachen, Germany.

Background: This Bayesian network meta-analysis investigated the available randomized control trials (RCTs) to point out which acupuncture protocol is the most effective for chronic aspecific low back pain (LBP). Efficacy was measured in terms of pain (Visual Analogic Scale, VAS) and disability (Roland Morris Disability Questionnaire, RMQ), Transcutaneous Electrical Nerve Stimulation (TENS).

Methods: PubMed, Google scholar, Embase, and Scopus were accessed in March 2022. All the RCTs comparing two or more acupuncture modalities for aspecific chronic LBP were accessed. Only studies which investigated the efficacy of acupuncture on patients with symptoms lasting a minimum of 1.5 months, or with at least three episodes in the previous 12 months, were considered eligible. The Review Manager Software (The Nordic Cochrane Collaboration, Copenhagen) was used for the methodological quality assessment. The STATA Software/MP, Version 14.1 (StataCorporation, College Station, Texas, USA), was used for the statistical analyses. The NMA was performed through the STATA routine for Bayesian hierarchical random-effects model analysis.

Results: Data from 44 RCTs (8338 procedures) were retrieved. 56% of patients were women. The mean age of the patients was 48 ± 10.6 years. The mean BMI was 26.3 ± 2.2 kg/m. The individual group (95% confidence interval (CI) 2.02, 7.98) and the standard combined with TENS (95% CI 2.03, 7.97) demonstrated the highest improvement of the RMQ. The VAS score was lower in the standard combined with TENS group (95% CI 3.28, 4.56). Considering the standard acupuncture group, different studies used similar protocols and acupuncture points and the results could thus be compared. The equation for global linearity did not find any statistically significant inconsistency in any of the network comparison.

Conclusion: Verum acupuncture is more effective than sham treatment for the non-pharmacological management of LBP. Among the verum protocols, individualized acupuncture and standard acupuncture with TENS were the protocols that resulted in the highest improvement in pain and quality of life.

Level Of Evidence: Level I, Bayesian network meta-analysis of RCTs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-022-03212-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208133PMC
June 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14656566.2022.2088280DOI Listing
July 2022

Magnetically controlled growing rods in the management of early onset scoliosis: a systematic review.

J Orthop Surg Res 2022 Jun 11;17(1):309. Epub 2022 Jun 11.

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

Background: Early onset scoliosis (EOS) presents in patients younger than 10 years. Magnetically controlled growing rods (MCGR) were developed as an outpatient distraction system for EOS, allowing to avoid multiple surgeries. This systematic review investigated the efficacy and feasibility of MCGR in EOS.

Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus were accessed in May 2022. All the clinical trials which investigate the role of MCGR for early onset scoliosis were accessed. Only studies reporting data in patients younger than 10 years with a preoperative Cobb Angle greater than 40° were eligible. The following data was extracted at baseline and at last follow-up: mean kyphosis angle, overall mean Cobb angle, mean T1-S1 length. Data from complication were also collected.

Results: Data from 23 clinical studies (504 patients) were included in the present study. 56% (282 of 504) were females. The average length of the follow-up was 28.9 ± 16.0 months. The mean age of the patients was 8.7 ± 1.9 years old. The mean BMI was 17.7 ± 7.6 kg/m. The mean kyphosis angle had reduced by the last follow-up (P = 0.04), as did the overall mean Cobb angle (P < 0.0001), while the overall T1-S1 length increased (P = 0.0002). Implant-associated complications, followed by spinal alignment failure, wound healing ailments, pulmonary complications, progressive trunk stiffness, persistent back pain, and fracture.

Conclusion: The management of EOS remains challenging. The current evidence indicates that MCGR may be effective to distract the spine and model the curve in EOS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-022-03200-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188689PMC
June 2022

Cell therapies for chondral defects of the talus: a systematic review.

J Orthop Surg Res 2022 Jun 11;17(1):308. Epub 2022 Jun 11.

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

Background: This systematic review investigated the efficacy and safety of surgical procedures augmented with cell therapies for chondral defects of the talus.

Methods: The present systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus databases were accessed in March 2022. All the clinical trials investigating surgical procedures for talar chondral defects augmented with cell therapies were accessed. The outcomes of interest were to investigate whether surgical procedures augmented with cell therapies promoted improvement in patients reported outcomes measures (PROMs) with a tolerable rate of complications.

Results: Data from 477 procedures were retrieved. At a mean follow-up of 34.8 ± 9.7 months, the Visual Analogic Scale (VAS) improved of 4.4/10 (P = 0.002) and the American Orthopaedic Foot and Ankle Score (AOFAS) of 31.1/100 (P = 0.0001) points. No improvement was found in Tegner score (P = 0.4). Few articles reported data on complications. At last follow-up, the rate of reoperation and failure were 0.06% and 0.03%, respectively. No graft delamination or hypertrophy was observed.

Conclusion: The current evidence suggests that cell therapies may be effective and safe to enhance surgical procedures for chondral defects of the talus. These results should be considered within the limitations of the present study. The current literature should be enriched with randomized controlled clinical trials with larger population size and longer follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-022-03203-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188715PMC
June 2022

Fibrin glue does not assist migration and proliferation of chondrocytes in collagenic membranes: an in vitro study.

J Orthop Surg Res 2022 Jun 11;17(1):311. Epub 2022 Jun 11.

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

Background: Some authors secured the membrane during matrix-induced autologous chondrocyte implantation (mACI) with fibrin glue or did not use a formal fixation. The real impact of fibrin glue addition on chondrocytes migration and proliferation has not yet been clarified. This study evaluated the impact of fibrin glue on a chondrocyte loaded collagenic membrane.

Methods: A resorbable collagen I/III porcine derived membrane commonly employed in AMIC was used for all experiments. Chondrocytes from three difference donors were used. At 1-, 2-, 3-, 4-, 6-, and at 8-week the membranes were embedded in Mounting Medium with Dapi (ABCAM, Cambridge, UK). The Dapi contained in the mounting medium ties the DNA of the cell nucleus and emits a blue fluorescence. In this way, the spreading of the cells in the membrane can be easily monitored. The outcomes of interest were to evaluate (1) cell migration and (2) cell proliferation within the porous membrane layer. DAPI/nuclei signals were analysed with fluorescence microscope under a magnification of 100-fold.

Results: The no-fibrin group demonstrated greater migration of the cells within the membrane. Although migration resulted higher in the no-fibrin group at every follow-up, this difference was significant only at week 1 (P < 0.001), 2 (P = 0.004), and 3 (P = 0.03). No difference was found at week 3, 6, and 8. The no-fibrin group demonstrated greater proliferation of the chondrocytes within the membrane. These differences were significant at week 4 (P < 0.0001), 6 (P < 0.0001), 8 (P < 0.0001).

Conclusion: The use of fibrin glue over a resorbable membrane leads to lower in vitro proliferation and migration of chondrocytes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-022-03201-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188690PMC
June 2022

Short-term results of intra-articular injections of stromal vascular fraction for early knee osteoarthritis.

J Orthop Surg Res 2022 Jun 11;17(1):310. Epub 2022 Jun 11.

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

Background: In knee osteoarthritis, progressive degeneration of the articular cartilage surface produces disability and chronic pain. Intra-articular injections of stromal vascular fraction (SVF) could be an innovative approach to manage patients with early knee osteoarthritis.

Methods: Between June 2019 and November 2020, 123 patients were recruited to receive intra-articular injection of SVF. Radiographic evidence of degenerative joint disease was classified according to Kellgren and Lawrence grades. Knee injury and osteoarthritis outcome score (KOOS) and visual analog scale (VAS) were collected preoperatively, at 1 month, and after 6 months from injection.

Results: There was a statistically significant improvement of KOOS and VAS of all patients to 6 months (p < 0.05). The mean KOOS before injection was 51.4 ± 16.5, after 1 month it was 75.5 ± 15.8, and at 6 months it was 87.6 ± 7.7. Stratifying the mean KOOS according to Kellgren-Lawrence Grades, the difference remained statistically significant (p < 0.05). The patients' mean VAS before injection was 6.5, after 1 month it was 3.5, and after 6 months it was 2.4. No complications were observed.

Conclusions: Intra-articular knee injection of SVF is safe and effective to ameliorate the clinical and functional scores in patients with early knee osteoarthritis for 6 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-022-03196-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188722PMC
June 2022

Allogenic perinatal tissue for musculoskeletal regenerative medicine applications: a systematic review protocol.

J Orthop Surg Res 2022 Jun 11;17(1):307. Epub 2022 Jun 11.

Future Biologics, Lawrenceville, GA, 30043, USA.

Background: Musculoskeletal ailments impact the lives of millions of people, and at times necessitate surgery followed by physiotherapy, drug treatments, or immobilization. Regenerative musculoskeletal medicine has undergone enormous progress over the last few decades. Sources of tissues used for regenerative medicine purposes can be grouped into autologous or allogenic. Although autologous sources are promising, there is a wide range of limitations with the treatment, including the lack of randomized controlled studies for orthopaedic conditions, donor site morbidity, and highly variable outcomes for patients. Allogenic sources bypass some of these shortcomings and are a promising source for orthopaedic regenerative medicine applications.

Methods: A systematic search will be performed using PubMed, Elsevier, ScienceDirect, and Google Scholar databases for articles published in English before May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and guidelines will be used. Studies will be eligible if they apply to acute and chronic orthopaedic musculoskeletal complications or animal or human disease models. Publications must include the use of MSCs and/or tissue obtained from amniotic/chorionic membrane, amniotic fluid, umbilical cord, and/or umbilical cord-derived Wharton's jelly as an intervention. Placebos, noninjury models, acute injury models, non-injury models, and gold standard treatments will be compared. The study selection will be performed by two independent reviewers using a dedicated reference management software. Data synthesis and meta-analysis will be performed separately for preclinical and clinical studies.

Discussion: The results will be published in relevant peer-reviewed scientific journals. Investigators will present results at national or international conferences.

Trial Registration: The Protocol will be registered on PROSPERO international prospective register of systematic reviews prior to commencement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-022-03197-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188718PMC
June 2022

Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee.

Sci Rep 2022 06 4;12(1):9328. Epub 2022 Jun 4.

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

Focal chondral defects of the knee are common and their management is challenging. This study investigated the efficacy and safety of Autologous Matrix-Induced Chondrogenesis (AMIC) for focal chondral defects of the knee. A systematic review and meta-analysis was conducted (according to the 2020 PRISMA statement) to investigate the efficacy of AMIC in improving symptoms and to compare AMIC versus microfracture (MFx). In January 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. No time constrain was used for the search. All the clinical trials investigating AMIC and/or those comparing AMIC versus MFx for focal chondral defects of the knee were accessed. Only studies published in peer reviewed journals were considered. Studies which investigated other locations of the defects rather than knee were not eligible, nor those reporting data form mixed locations. Studies which reported data on revision settings, as well as those investigating efficacy on kissing lesions or multiple locations, were not suitable. The mean difference (MD) and odd ratio (OR) effect measure were used for continuous and binary data, respectively. Data from 18 studies (548 patients) were retrieved with a mean follow-up of 39.9 ± 26.5 months. The mean defect size was 3.2 ± 1.0 cm. The visual analogue scale (VAS) decreased of - 3.9/10 (95% confidence interval (CI) - 4.0874 to -3.7126), the Tegner Activity Scale increased of + 0.8/10 (95% CI 0.6595 to 0.9405). The Lysholm Knee Scoring System increased of + 28.9/100 (95% CI 26.8716 to 29.1284), as did the International Knee Documentation Committee (IKDC) + 33.6/100 (95% CI 32.5800 to 34.6200). At last follow-up no patient showed signs of hypertrophy. 4.3% (9 of 210) of patients underwent revision procedures. The rate of failure was 3.8% (9 of 236). Compared to MFx, AMIC demonstrated lower VAS score (MD: - 1.01; 95% CI - 1.97 to 0.05), greater IKDC (MD: 11.80; 95% CI 6.65 to 16.94), and lower rate of revision (OR: 0.16; 95% CI 0.06 to 0.44). AMIC is effective for focal chondral defects of the knee. Furthermore, AMIC evidenced greater IKDC, along with a lower value of VAS and rate of revision compared to MFx.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-022-13591-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9167289PMC
June 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/bmb/ldac017DOI Listing
June 2022

Histomorphometry of Ossification in Functionalised Ceramics with Tripeptide Arg-Gly-Asp (RGD): An In Vivo Study.

Life (Basel) 2022 May 20;12(5). Epub 2022 May 20.

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

The present study investigated the osseointegration promoted by functionalised ceramics with peptide Arg-Gly-Asp (RGD) in a rabbit model in vivo. Histomorphometry of the RGD functionalised ceramic implants was conducted by a trained pathologist to quantify the amount of mature and immature ossification at the bone interface, and then compared to titanium alloy implants. The region of interest was the area surrounding the implant. The percentage of ROI covered by osteoid implant contact and mature bone implant contact were assessed. The presence of bone resorption, necrosis, and/or inflammation in the areas around the implant were quantitatively investigated. All 36 rabbits survived the experimental period of 6 and 12 weeks. All implants remained in situ. No necrosis, bone resorption, or inflammation were identified. At 12 weeks follow-up, the overall mean bone implant contact ( = 0.003) and immature osteoid contact ( = 0.03) were improved compared to the mean values evidenced at 6 weeks. At 6 weeks follow-up, the overall osteoid implant contact was greater in the RGD enhanced group compared to the titanium implant ( = 0.01). The other endpoints of interest were similar between the two implants at all follow-up points ( ≥ 0.05). Functionalised ceramics with peptide RGD promoted ossification in vivo. The overall osteoid and bone implant contact improved significantly from 6 to 12 weeks. Finally, RGD enhanced ceramic promoted faster osteoid implant contact in vivo than titanium implants. Overall, the amount of ossification at 12 weeks is comparable with the titanium implants. No necrosis, bone resorption, or inflammation were observed in any sample.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/life12050761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146276PMC
May 2022

Mobile Bearing versus Fixed Bearing for Unicompartmental Arthroplasty in Monocompartmental Osteoarthritis of the Knee: A Meta-Analysis.

J Clin Med 2022 May 17;11(10). Epub 2022 May 17.

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

Introduction: Whether mobile-bearing (MB) unicompartmental knee arthroplasty (UKA) performs better than fixed-bearing (FB) implants in patients with monocompartmental osteoarthritis (OA) still remains unclear. Therefore, a meta-analysis comparing MB versus FB for UKA was conducted to investigate the possible advantages of MB versus FB in patient-reported outcome measures (PROMs), range of motion (ROM), and complications. We hypothesised that the MB design performs better than FB.

Methods: This systematic review was conducted according to the 2020 PRISMA guidelines. In December 2021, PubMed, Web of Science, Google Scholar, and Embase were accessed, with no time constraints. All the clinical investigations comparing MB versus FB bearing for UKA were accessed. Only studies published in peer-reviewed journals were considered. Studies reporting data on revision settings were excluded, as were those combining unicompartmental and total knee arthroplasty.

Results: Data from 25 studies (4696 patients) were collected; 58% (2724 of 4696 patients) were women. The mean length of follow-up was 45.8 ± 43.2. The mean age of the patients was 65.0 ± 5.6 years. No difference was found in range of motion ( = 0.05), Knee Scoring System ( = 0.9), function subscale ( = 0.2), and Oxford Knee Score ( = 0.4). No difference was found in the rate of revision ( = 0.2), aseptic loosening ( = 0.9), deep infections ( = 0.99), fractures ( = 0.6), and further extension of OA to the contralateral joint compartment ( = 0.2).

Conclusion: The present meta-analysis failed to identify the possible superiority of the MB implants over the FB for UKA in patients with monocompartmental knee osteoarthritis. Long observational investigations are required to evaluate possible long-term complications and implant survivorship. These results should be interpreted within the limitations of the present study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm11102837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9143434PMC
May 2022

Tensiomyography Allows to Discriminate between Injured and Non-Injured Biceps Femoris Muscle.

Biology (Basel) 2022 May 13;11(5). Epub 2022 May 13.

Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.

The hamstring muscle group is the most frequently injured muscle group in non-contact muscle injuries in sports involving high-speed running. A total of 84% of hamstring injuries affect the biceps femoris (BF) muscle. Clinical assessments and magnetic resonance imaging (MRI) are routinely used for diagnosis and plan management. MRI-negative scans for clinically diagnosed hamstring injuries range from 14% to 45%. We tested the hypothesis that the functional differences between injured and non-injured BF assessed by tensiomyography can be used for diagnostic and classification purposes. We compared an injured group of 53 international-level soccer players and sprinters with 53 non-injured international-level soccer players and sprinters of both sexes. Comparing the injured vs. non-injured athletes and the left vs. right side in all of the athletes, we used the percentage of absolute differences in the BF contraction time (Tc) to classify non-injured and injured BF muscles. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) and the precision-recall curve (PRC) were used to measure the classification accuracy and to identify cut-off limits using the Tc differences. There was a very high ROC AUC value of 0.981 (SE = 0.009, < 0.000), with 98.11% of the injured muscles being correctly classified (cut-off point 12.50% on Tc differences), and an AUPRC value of 0.981, with association classification criteria at >9.87. Tensiomyography has a high predictive ability to discriminate between injured and non-injured BF non-invasively and functionally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/biology11050746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9138955PMC
May 2022

Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures.

Am J Sports Med 2022 May 25:3635465221094014. Epub 2022 May 25.

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

Background: The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated.

Purpose: To determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes.

Study Design: Systematic review; Level of evidence, 4.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through March 2021 to identify studies reporting on surgically managed Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the return to play (RTP) rate and time to RTP, whereas the secondary outcomes were time to union, union rate, and refractures. Data were presented by type of treatment (biologically augmented fixation or fixation alone).

Results: In the biologically augmented fixation group, successful RTP was reported in 195 (98.98%) of 197 fractures (odds ratio [OR], 97.5%; 95% CI, 95.8%-100%; = 0), with a mean time to RTP of 10.3 weeks (95% CI, 9.5-11.1 weeks; = 99%). In the group that received fixation without biological augmentation, successful RTP was reported in 516 (99.04%) of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; = 0], with a mean time to RTP of 9.7 weeks (95% CI, 7.84-11.53 weeks; = 98.64%]. In the biologically augmented fixation group, fracture union was achieved in 194 (98.48%) of 197 fractures (OR, 97.6%; 95% CI, 95.5%-99.7%; = 0%), with a mean time to fracture union of 9.28 weeks (95% CI, 7.23-11.34 weeks; = 98.18%). In the group that received fixation without biological augmentation, fracture union was achieved in 407 (93.78%) of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; = 0%), with a mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; = 98.81%).

Conclusion: Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone but similar rates of RTP and time to RTP. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high quality comparative studies are required to establish the indication for orthobiologic augmentation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465221094014DOI Listing
May 2022
-->