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Objective: Femoroacetabular impingement (FAI) is a condition that has been increasingly recognized as a source of hip pain and a possible risk factor to early development of hip osteoarthritis (OA). To our knowledge, the use of HA in the treatment of femoroacetabular FAI has been investigated only by two studies, both using a high molecular weight HA. The aim of this study was to evaluate the efficacy of two weekly injections of an hexadecylamide derivative of HA (HYADD4-G, HYMOVIS, Fidia Farmaceutici) in FAI., Methods: All patients received two weekly intra-articular injections of Hymovis at baseline and after 7 days. Clinical and functional assessments were performed at baseline and was repeated after 1, 3, 6 and 12 months. Functional measures included visual analogue scale (VAS) for pain, Harris Hip score (HHS), Lequesne Index (LI), Tegner activity level scale (TALS) and monthly consumption of nonsteroidal anti-inflammatory drugs (NSAIDs)., Results: Twenty-one hips (19 patients, 2 bilateral cases) were treated. The variables VAS, HHS as well as Lequesne improved significantly from T0 to T4 (at 12 months) with the best improvement between T0 and T1. At the same time, a reduction in NSAIDs monthly intake was registered. On the other hand, a significant improvement in Tegner scale was not observed. No adverse events were registered., Conclusion: This study states that one cycle of HYADD4-G could be a safe and effective treatment in patients with FAI, showing significative results in term of pain control as well as hip functionality and quality of life up to 1 year., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objective: The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods: Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4 weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results: Our results show an improvement of all the evaluation scales at 6 months follow-up. Particularly, VAS scales among all patients decreased by 35.8% ( p  = .00148), KSS functional scores improved by 38.2% ( p  = .00148), KSS clinical scores improved by 28.9% ( p  = .00236) and WOMAC scores were reduced by 19.8% ( p  = .00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intra-articular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion: Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objectives: The efficacy of platelet rich plasma in the treatment of Achilles tendinopathy is controversial. Despite positive results observed in open studies, randomized controlled trials failed to show difference against saline or rehabilitation. Aims of this retrospective observational study were to compare the efficacy of platelet-rich plasma and dry needling and to assess possible differences age and sex-related., Methods: Groups of 46 and 38 patients with non-insertional Achilles tendinopathy were treated with platelet-rich plasma and dry needling (once a week for 3 weeks), respectively. At baseline, 3 and 6 months, pain and function scores and the percentage of satisfactory outcomes were evaluated. Sub-group analyses were performed according to age and sex., Results: At 3 and 6 months no differences in terms of pain and function between groups were observed, but the percentage of subjects reporting satisfactory results, at 6 months, was higher in platelet rich plasma group. Better results were observed in younger subjects, with a greater reduction of pain, improvement of function, and accordingly of the percentage of positive outcomes. A trend toward better results was also observed in males., Conclusion: Beneficial effects of platelet rich plasma and dry needling in non-insertional Achilles tendinopathy have been observed only in some subjects, but not in others; platelet rich plasma shows a slight superiority against dry needling, mainly in younger persons; finally, a gender difference in the therapeutic response can be hypothesized.

Introduction: local glucocorticoids injections are widely administered for the treatment of tendinopathies. positive results have been observed in some tendinopathies but not in others. moreover, worsening of symptoms, and even spontaneous tendon ruptures has been reported. the characteristics of the tendinopathies, the clinical peculiarities of the patient, and the technique used to administer glucocorticoids, can influence the therapeutic response. Areas covered: After reviewing the pertinent literature on the clinical results, basic information, both on the pathogenesis of tendinopathies and the effects of glucocorticoids on tendons, is reported. The pharmacological properties of glucocorticoids are useful to counteract some pathogenetic mechanisms of tendinopathies. However, several experimental studies suggest that the direct action of glucocorticoids on tendons is detrimental. Loss of collagen organization, impaired viability of fibroblasts, depletion of stem cells pool, and reduced mechanical properties have been observed. Expert opinion: Drawbacks of local glucocorticoids injections could be predicted on an individual basis, after a careful appraisal of patient characteristics and concomitant medications, along with the specific stage of tendon disease.

This study evaluated the that effects a pathology of the knee, due to an anterior cruciate ligament (ACL) injury, has on muscular activity of neck, head, and trunk muscles. Twenty-five (25) subjects (mean age 28+/-9 years) with ACL injury of the left knee were compared with a control no-pathology group. Surface electromyography (sEMG) at mandibular rest position and maximal voluntary clenching (MVC) wasused to evaluate muscular activity of the areas: masseter, anterior temporalis, posterior cervicals, sternocleidomastoid (SCM), and upper and lower trapezius. The sEMG activity of each muscle, as well as the asymmetry index between the right and the left sides, were compared between the two groups. Subjects in the study group showed a significant increase in the asymmetry index of the sEMG activity of the anterior temporalis at mandibular rest position (p<0.05). At rest, the areas of anterior temporalis and masseter in the control group showed a significantly lower sEMG activity compared with subjects in the study group, both in the right and the left sides (p<0.05). The same was found for the sEMG activity of the areas of SCM and lower trapezius. At MVC, the right areas of anterior temporalis and masseter in the study subjects showed a significantly lower sEMG activity compared with the control group. The same was observed for the lower trapezius area, both in the right and the left sides. In general, ACL injury appears to provide a change in the sEMG activity of head, neck and trunk muscles.

It has been proposed that intraoral devices can influence cervical posture. Cervical posture might also be influenced by stimuli from the lower limbs, such as injury of the knee. The hypothesis to be tested is that intraoral devices are useful during the rehabilitation of orthopedic patients to accelerate the restoration of postural control. This study evaluates cervical posture on lateral skull radiographs in subjects who suffered anterior cruciate ligament (ACL) injury of the left knee. Twenty adult Caucasian males (mean age 30.6+/-9.2 yrs.) with ACL injury of the left knee were compared with 40 control subjects (mean age 27.9+/-7.2) who did not show any ACL injury. Lateral skull radiographs, made in natural head position (mirror position), were obtained for all subiects. Various postural and morphological variables were individualized on each radiograph. To assess errors due to landmark identification, duplicate measurements were made of 15 radiographs and compared using the Dahlberg formula. The method error from both sources was less than 0.5 degrees for all angular measurements and less than 0.5 mm for all linear measurements. No difference was observed between the two groups in any of the morphological variables of face or in the cervical lordosis angle (CVT/EVT). However, subjects in the study group showed significantly higher craniocervical angulations (SN/OPT, SN/CVT, SN/EVT, pns-ans/OPT, pns-ans/CVT, pns-ans/EVT, GoGn/OPT, GoGn/CVT, GoGn/EVT) compared with the control subjects (p<0.001). The subjects with ACL injury had significant head extension compared with the control subjects.

The authors compared postural changes produced in 20 Caucasian female children treated with the Frankel Functional Regulator appliance (FR-2) (Frankel Industries, Morangis Cedex, France) using cephalometric tracings and comparing the tracings to 20 untreated Class II controls from the University of Chieti. Each patient in the study group was treated for exactly two years by the same operator using the FR-2 appliance and a standardized design and clinical technique, including prefunctional orthodontics where indicated. The average starting age was 8.4 yrs. (SD+/-2.1). At the end of the therapy, the average age was 10.3 yrs. (SD+/-2.4). Two teleradiographs were made of each patient: the first one at the beginning of treatment and the second one after six months. The radiographs were taken with the subjects standing in the ortho-position with no ear rods in the cephalostat; mirror position was carried out. In order to detect errors due to landmark identification, duplicate measurements were made using ten radiographs, and the error variance was calculated using Dahlberg's formula. Thirty-seven variables were studied. The cervical lordosis angle (CVT/EVT) was significantly higher in the study group as compared to the control group (p<0.05) at the end of treatment, probably due to a significant backward inclination of the upper segment of the cervical column (OPTNer and CVTNer) in the treated group (p<0.001 and p<0.01) from pre- to posttreatment. There was no significant change in the lower segment of the cervical column inclination (EVT/Ver). The changes resulted in a weak association in the multiple regression model to an increasing of maxillary base length and mandibular protrusion (R2=0.272; p<0.05). Other variables in the multiple regression were not significant.

Pain and joint noises associated with temporomandibular joint (TMJ) internal derangement are often treated by using an intra-oral splint. This study evaluated whether an anterior repositioning splint (AR splint) could be more effective in the treatment of these symptoms than a full-arch maxillary stabilization splint (FAMS splint), because of its capability to re-establish immediately the normal condyle/disk relationship. The authors treated 40 patients (average age 16.8; range 8.0-24.0) with confirmed internal derangement, joint pain, and joint noises in at least one TMJ for at least two months, with AR splint (20 subjects) or FAMS splint (20 subjects); 10 untreated patients comprised the control group. Joint noise, joint pain, and the intensity of pain were assessed using a visual analogic scale (VAS), and the pain was characterized (i.e., constant or chewing/biting pain) and evaluated monthly for eight months. Significantly fewer AR splint patients experienced pain after four months of treatment. A significantly lower intensity of pain was experienced by the AR splint patients after two months of treatment. Significantly fewer AR splint patients experienced chewing/biting pain after eight months of treatment. The frequency of joint noises decreased over time, with no significant differences between the groups. In conclusion, the AR splint seems to be more effective in decreasing pain, but it seems to make no difference in the treatment of joint noises.

The literature reports evidence of various types of correlations between cervical alterations and cervical pain, and the existence of cervical pain in subjects with temporomandibular joint internal derangement (TMD). The hypothesis of this study is that cervical lordosis angle (CVT/EVT angle) alteration on cephalometrics could be correlated to the presence of TMD. The cephalometric records of 50 females with documented TMD were compared with those of a control group of 50 females. The subjects in the sample were 25-35 years of age, average 28.9 years (SD, 3.2). Radiographs were taken in mirror position, and seventeen variables, including the CVT/EVT angle, were traced. Double measurements were made to evaluate method error using Dahlberg's formula. Pearson's correlation coefficient and Mann-Whitney's t-test were used to evaluate the data. Intra-group analysis showed significant correlations between the CVT/EVT angle and mandibular length (p<0.01), mandibular position (p<0.05), mandibular divergence (p<0.01), and overjet (p<0.01) in both groups. Between groups, the analysis showed significant differences in CVT/EVT angle (p<0.05), maxillary protrusion (p<0.01), mandibular protrusion (p<0.01), mandibular length (p<0.01), mandibular divergence (p<0.05), and overbite (p<0.05).