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A systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up.This systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting12 months follow-up were included.Data from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P 0.0001).Based on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.

INTRODUCTION The role of closed suction drainage during elective total joint arthroplasty is still unclear. The present study compared the use of closed suction drains to no drainage for elective total knee arthroplasty (TKA) and in total hip arthroplasty (THA) through a meta-analysis of randomized clinical trials (RCTs). METHODS Following the PRISMA guidelines, a meta-analysis of randomized controlled trials identified in December 2021. All randomized clinical trials comparing the use of closed suction drains to no drainage for elective THA or TKA were considered. RESULTS Twenty-five RCTs were included in the final analysis. 49% (1722 of 3505) of patients received no-drainage, and 51% (1783 of 3505) received closed suction drainage. There was no evidence of a statistically significant evidence between the two groups in occurrence of postoperative infections (P = 0.4), mean total postoperative hemoglobin (P = 0.2) or length of hospital stay (P = 0.1). The no-drainage group showed a lower rate of blood transfusion (P

Background Proximal avulsion injuries of the adductor longus have been managed both conservatively and operatively with good clinical outcomes, but there is no consensus on which option yields the best results. Thus, the present study aimed to review the available literature, comparing the outcomes and the time to return to sports with different management options. Material and methods This study was conducted according to the PRISMA statement. The literature search was conducted in September 2020. All the clinical trials investigating the management of traumatic proximal adductor longus avulsion injuries were considered for inclusion. Only studies reporting data from athletes were considered. The outcomes of interest were the time to return to sport and return to preinjury activity level. Results Data from 46 patients were retrieved. The mean follow-up was 24.6 ± 23.8 months. The study population was represented by male athletes with a mean age of 30.0 ± 4.8. Mean stump retraction was 3.3 ± 0.6 cm in the surgical and 1.7 ± 0.6 in the conservative cohort (P = 0.07). The rate of patients returning to prior activity level was similar in the two groups, but surgically treated patients required a longer time to return to sport (3.9 ± 1.5 months vs. 2.2 ± 1.0 months, P = 0.0001). Conclusion Conservative management for traumatic avulsion of the proximal adductor longus insertion may produce shorter time to return to sport. Both conservative and operative strategies allowed to achieve similar pre-injury activity level. Level of evidence IV, systematic review.

Aim of this study was to analyze the rate of tether breakages after lumbar vertebral body tethering (VBT) and to study the effects and possible benefits of the use of a 2-tether construct. Tether breakage is a known mechanical complication after VBT. However, the literature only refers to thoracic VBT, and no data on the breakage rate or 2-tether construct after lumbar VBT are available. Patients who underwent lumbar VBT with lowest instrumented vertebra at L3 or L4 and had a 1-year follow-up were included. Radiologic data were obtained preoperatively, at the 1st standing X-ray and at the 1-year follow-up to study breakage rate, loss of correction and lumbar lordosis in 1- and 2-tether constructs. Data from 30 patients (mean age 14.7 ± 1.8) were available, 12 with double tether. Double tether did not decrease lumbar lordosis. The breakage rate was 24% in segments instrumented with a single tether and 16% in segments instrumented with a double tether (OR 1.6, p = 0.4). Lumbar loss of correction was 10° ± 6.8° in the entire cohort and 12.1° ± 5.4° in patients with a breakage (p = 0.2). Revision rate was 10%, due to tether breakage and loss of correction. Breakage rate after lumbar VBT is high, but was improved with the use of a 2-tether construct. Despite tether breakage, loss of correction was limited and the revision rate low. The use of a double tether does not have a kyphotic effect on the lumbar spine.

INTRODUCTION To fulfill oncological criteria, extensive open anterior and posterior approaches are usually performed in the lumbar spine to obtain an appropriate en-bloc spondylectomy. It is commonly accepted that the price of a tumor-free margin includes such extensive incisions and soft-tissue damage, with consequent relevant blood loss and possible postoperative complications as delayed wound healing. In this article, a case of chordoma in L3 is presented, submitted to an oncologically appropriate en-bloc resection performed by an open posterior approach combined with a mini-retroperitoneal approach. The successful oncologic procedure was combined with a short and uneventful postoperative course. MATERIALS AND METHODS The authors present the surgical technique and the possible challenges of minimally invasive anterior oncologic surgery as a contribution to a limited literature. RESULTS Up to date, palliative care of single metastases has been the main setting in which anterior, minimally invasive surgery has been performed in the lumbar spine. The authors explained how, in selected cases, this approach can be performed in combination with an open posterior access for an oncologically appropriate treatment of a primary malignant tumor. CONCLUSION Anterior, minimally invasive surgery can have a role in selected patients with primary malignant tumors of the lumbar spine. The surgical team should have extensive training both in oncologic and minimally invasive surgery.

The American journal of sports medicine (2021). doi:10.1177/03635465211037349, Published by Sage, London [u.a.]

The American journal of sports medicine 50(10), 2853-2859 (2022). doi:10.1177/03635465211029642, Published by Sage, London [u.a.]

To investigate the correlation between spine flexibility and age, skeletal maturity, coronal and sagittal parameters for adolescent idiopathic scoliosis (AIS). All AIS patients evaluated for surgery were included. Following parameters were obtained: age, gender, skeletal maturity (Risser and Sanders), Cobb angle at high thoracic (HT), mean thoracic (MT) and thoracolumbar/lumbar (TL/L) level, flexibility of HT, MT and TL/L curves, coronal and sagittal parameters. A multivariate diagnostic through the Pearson Product–Moment Correlation Coefficient ( $$r$$ ) was performed. Data from 200 patients were obtained (30 males, age 15 ± 1.9 years). No significant correlation was found between curve flexibility and age or gender. A negative correlation was observed between flexibility of MT curves and magnitude of HT ( $$r$$ = − 0.4) and MT curves ( $$r$$ = − 0.4). A weak correlation among curve flexibility at different levels was observed: the flexibility of HT curves correlated with the flexibility of MT and TL/L curves, and the flexibility of MT curves correlated with flexibility TL/L curves. A negative correlation between flexibility of MT curves and AVT-T (thoracic apical vertebral translation) ( $$r$$ = − 0.2) was evidenced. No correlations between flexibility and sagittal parameters were observed. No strong correlation were observed between curve flexibility and age or skeletal maturity. A negative correlation between curve magnitude and flexibility at thoracic level was demonstrated. Furthermore, a weak positive correlation between flexibility of PT, MT and TL/L curves was observed.

The American journal of sports medicine 50(4), 1146-1156 (2022). doi:10.1177/03635465211011744, Published by Sage, London [u.a.]

Introduction Osteonecrosis of the femoral head (ONFH) often leads to secondary osteoarthritis and total hip arthroplasty. Source of data Recent published literatures. Areas of agreement There has been increasing focus on the early intervention in ONFH patients to preserve the native hip articulation, reduce pain and improve function. Areas of controversy Efficacy of surgical strategies for ONFH is debated. Several clinical studies showed controversial results, and the best treatment has not yet been clarified. Growing points To provide an overview over current treatment options for ONFH compares their failure rates and conversion to total hip arthroplasty (THA) rates. Areas timely for developing research Core decompression (CD) augmented with autologous bone grafting plus the implantation of bone marrow concentrate can decrease the rate of failure and progression to THA rates compared to CD alone.

Vertebral body tethering (VBT), otherwise known as fusion-less anterior scoliosis correction (ASC), is a new and increasingly interesting therapeutic option for selected scoliosis patients. The available data on this surgical technique are still limited and guidelines on patient selection or surgical timing are not available. The aim of this study was to conduct a systematic review of the available literature on VBT. The analysis was performed in accordance with the PRISMA Statement. Nine studies with data from 175 patients were available. On average, 7.3 vertebrae were instrumented. Surgical time was 230 min and the estimated blood loss 153 ml. The mean correction on the coronal plane was 52%, and there was no significant change in sagittal parameters. The revision rate was 18.9%. The methodological quality assessment with the Coleman score gave unsatisfactory results, so that available data are not sufficient to propose general indications or guidelines to perform VBT.Das Vertebral Body Tethering (VBT) bzw. die dynamische Skoliosekorrektur (DSK) repräsentiert eine neue und zunehmend diskutierte Therapieoption für ausgewählte Skoliosepatienten. Die Datenlage zu dieser Technik ist jedoch noch sehr begrenzt und von Fachgesellschaften unterstützte Behandlungsempfehlungen sind nicht vorhanden. Ziel dieser Studie war die systemische Analyse der aktuellen Literatur mit Bezug zum VBT. Die Analyse erfolgte nach dem „PRISMA Statement“. Neun Studien mit Daten von 175 Patienten wurden eingeschlossen. Durchschnittlich wurden 7,3 Wirbelkörper instrumentiert. Die Operationsdauer betrug 230 min, der Blutverlust betrug 153 ml. Die durchschnittliche koronale Skoliosekorrektur betrug 52%. Einen signifikanten Einfluss auf die sagittalen Parameter gab es nicht. Die Revisionsrate betrug 18,9%. Eine Bewertung der analysierten Studien mithilfe des Coleman Methodology Scores ergab eine unzureichende Aussagekraft. Somit kann basierend auf dieser Analyse noch keine allgemeine Behandlungsempfehlung für oder gegen das VBT definiert werden.

BMC musculoskeletal disorders 22, 250 (2021). doi:10.1186/s12891-021-04112-z, Published by BioMed Central, London

Purpose Vertebral body tethering (VBT) is an alternative to fusion for selected scoliosis patients. As VBT does not limit spine mobility, it has been propagated that this technique allows a quicker return to physical activity than fusion. However, no data are available to support this statement. Aim of this study was to quantify how much time patients required to resume preoperative activity level and to seek possible associations between return to physical activity and demographic, radiographic and surgical data. Methods One year postoperatively, the validated sport activity questionnaire (SAQ) was administered to all skeletally immature patients who underwent VBT at our institution. SAQ data were analyzed and a multivariate analysis was conducted to investigate associations between SAQ and demographic, radiographic and surgical data. Results Thirty-one patients aged 14.5 years completed the SAQ. Within 3 months from VBT, 97% returned to school, 61% resumed physical education, 97% carried a backpack, 68% run, and 82% rode a bike; 70% bent within a month from VBT. Ninety-four percent of patients returned to their preoperative athletic level. Within 3 months, 63% of responders resumed noncontact, 61% contact and 53% collision sports. No relevant associations were observed between the SAQ and demographic, radiographic and surgical data. In particular, number of instrumented vertebrae, level of the lowest instrumented vertebra and postoperative Cobb angle did not influence patients’ return to preoperative activities. Conclusion VBT allows patients to quickly return to their preoperative activity level, irrespectively of the postoperative Cobb angle or type of instrumentation.

Retrospective study. Vertebral body tethering (VBT) is raising interest for the treatment of adolescent idiopathic scoliosis (AIS), but many scoliosis surgeons have not been trained in anterior surgical approaches. We analyzed data of our first patients to define the learning curve for VBT. VBT has shown encouraging results in the treatment of growing AIS patients, but there is a paucity of data and long-term results are not yet available. To our best knowledge, there is no published data regarding the learning curve for VBT. A retrospective analysis was performed, of all consecutive patients who underwent VBT at our Institution. Outcomes of interest were intubation time, surgical duration and estimated blood loss per screw and hospitalization length. For the statistical analysis, we referred to a linear model regression diagnostic and we used the Pearson product-moment correlation (r) for pairwise correlation. The final effect ranked between + 1 and − 1. Data of 90 patients were analyzed, age 14.6 ± 1.8 years. On average, 9.4 ± 2.6 levels were instrumented. Per screw, mean intubation time was 33.1 ± 7.6 min (r = − 0.57; p > 0.0001), mean surgical duration 21.3 ± 5.7 min (r = − 0.55; p > 0.0001), mean estimated blood loss 21.3 ± 18.2 ml (r = − 0.66; p > 0.0001). Mean hospitalization length was 8.3 ± 3.1 days (r = − 0.32; p = 0.002). No intraoperative complications were reported. VBT has a rapid learning curve: the estimated blood loss per screw is expected to decrease by 60%, intubation time and surgical duration by over 50%, and hospitalization length by 32% for each treated patient. III.

Journal of sport and health science 11(1), 123-129 (2022). doi:10.1016/j.jshs.2020.11.011, Published by Elsevier, Amsterdam [u.a.]

Background The present systematic review analysed the available literature to assess reliability of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score in the evaluation of knee and ankle osteochondral lesions. Methods All the studies using the MOCART score for knee and/or talus chondral defects were accessed in March 2021. A multivariate analysis was performed to assess associations between the MOCART score at last follow-up and data of patients at baseline, clinical scores and complications. A multiple linear model regression analysis was used. Results The MOCART score evidenced no association with patient age (P = 0.6), sex (P = 0.1), body mass index (P = 0.06), defect size (P = 0.9), prior length of symptoms (P = 0.9) or visual analogue scale (P = 0.07). For chondral defects of the knee, no statistically significant association was found between the MOCART score and the International Knee Documentation Committee (P = 0.9) and with the Lysholm Knee Scoring Scales (P = 0.2), Tegner Activity Scale (P = 0.2), visual analogue scale P = 0.07), rate of failure (P = 0.2) and revision (P = 0.9). For chondral defect of the talus, no statistically significant associations were found between the MOCART score and the American Orthopedic Foot and Ankle Score (P = 0.3), Tegner Activity Scale (P = 0.4), visual analogue scale (P = 0.1), rate of failure (P = 0.1) and revision (P = 0.7). Conclusion The MOCART score demonstrated no association with patient characteristics and with the surgical outcome in patients who underwent surgical management for knee and talus chondral defects. Level of evidence Level IV.

Background Focal chondral defects of the knee are common. Several surgical techniques have been proposed for the management of chondral defects: microfractures (MFX), osteochondral autograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC) and autologous chondrocyte implantation (ACI)—first generation (pACI), second generation (cACI) and third generation (mACI). A Bayesian network meta-analysis was conducted to compare these surgical strategies for chondral defects in knee at midterm follow-up. Methods This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Google Scholar, Embase and Scopus databases were accessed in July 2021. All the prospective comparative clinical trials investigating two or more surgical interventions for chondral defects of the knee were accessed. The network meta-analyses were performed through a Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measures were used for dichotomic variables, while the standardized mean difference (SMD) for the continuous variables. Results Data from 2220 procedures (36 articles) were retrieved. The median follow-up was 36 (24 to 60) months. The ANOVA test found good baseline comparability between symptoms duration, age, sex and body mass index. AMIC resulted in higher Lysholm score (SMD 3.97) and Tegner score (SMD 2.10). AMIC demonstrated the lowest rate of failures (LOR −0.22) and the lowest rate of revisions (LOR 0.89). As expected, MFX reported the lower rate of hypertrophy (LOR −0.17) followed by AMIC (LOR 0.21). No statistically significant inconsistency was found in the comparisons. Conclusion AMIC procedure for focal chondral defects of the knee performed better overall at approximately 3 years’ follow-up.

Anterior dynamic scoliosis correction is an innovative non-fusion option in the treatment of patients with severe adolescent scoliosis. Growth modulation and sometimes intraoperative curve correction is achieved by convex insertion of segmental screws and a flexible polyethylene cord. The present review analyses and discusses the current literature and proposes a new treatment algorithm that is based on our own experience. Short term results are published for approximately 100 patients from different institutions. Fusion could be prevented in the vast majority of patients. Perioperative complication rate is very low but a few cases of cord rupture and overcorrection are reported. Anterior dynamic scoliosis correction has promising short term results but there is a paucity of literature and optimal criteria for the best candidate has yet to be defined.Die dynamische Skoliosekorrektur ist ein innovatives Verfahren zur nicht versteifenden Behandlung der schweren adoleszenten Skoliose. Mittels konvexseitig eingebrachten segmentalen Schrauben und einem flexiblen Polyethylenseil erfolgt eine Wachstumsmodellierung sowie in manchen Fällen bereits eine intraoperative Skoliosekorrektur. Das vorliegende Review analysiert und bewertet die aktuelle Studienlage und stellt einen Behandlungsalgorithmus vor, der auf den eigenen Erfahrungen basiert. Kurzzeitergebnisse von knapp 100 Patienten aus unterschiedlichen Institutionen sind aktuell publiziert. In der überwiegenden Mehrheit konnte eine klare Indikation zur Spondylodese abgewendet werden. Die perioperative Komplikationsrate ist äußerst gering. In einigen Fällen kam es im Verlauf zu Implantatrupturen oder zu Überkorrekturen. Die dynamische Skoliosekorrektur zeigt bisher vielversprechende Ergebnisse, jedoch ist die Datenlage noch äußerst limitiert und die optimale OP-Indikation noch nicht definiert.

The purpose of this systematic review is to analyse and summarize current literature, to obtain an extensive overview, and improve the evidences concerning injury patterns in volleyball players. A comprehensive review of the literature was conducted. The main databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar. Articles in English, French, Spanish, Italian, and German were considered for inclusion. We focused on the following outcomes of interest: injury place, type of injury, circumstance, injury severity. Missing data pertinent to these parameters warranted exclusion from this systematic review. We referred to the Newcastle–Ottawa Scale for the methodological quality assessment. A total of 28,889 patients were enrolled. The mean age was 22 years and the mean follow-up 24.9 months. There were seven retrospective cohort studies and 16 prospective cohort studies. The mean injury rate was 4.21/1000 playing hours. The methodological quality assessment resulted moderate. The lower limb was the most affected area, followed by the upper limb, trunk, and the head. Regarding lower limb, the most commonly injured area was the ankle, followed by the knee. Joint injuries were the most frequent, mostly represented by sprains and ligament damages. Spiking and blocking represented the most frequent circumstances correlated with these injuries. Acute onset lesions were more frequent than those caused by overuse. About a third of the injuries entailed a short-term absence from the field. Though volleyball is commonly considered to be a safe sport, the overall probability of sustaining an injury is comparable with previous reports from other high-contact team sports.

Introduction: Secondary spinal cord injury (SCI) sets on immediately after trauma and, despite prompt treatment, may become chronic. SCI is a complex condition and presents numerous challenges to patients and physicians alike, also considering the lack of an approved pharmacological therapy.Areas covered: This review describes the pathophysiological mechanisms leading to secondary SCI to highlight possible targets for pharmacological therapy. Furthermore, an extensive search of the literature on different databases (PubMed, Google scholar, Embase, and Scopus) and of the current clinical trials (clinicaltrials.gov) was performed to investigate the current outlook for the pharmacological management of SCI. Only drugs with performed or ongoing clinical trials were considered.Expert opinion: Pharmacological therapy aims to improve motor and sensory function in patients. Overall, drugs are divided into neuroprotective compounds, which aim to limit the damage induced by the pro-inflammatory and pro-apoptotic milieu of SCI, and neuroregenerative drugs, which induce neuronal and axonal regrowth. While many compounds have been trialed with promising results, none has yet completed a stage III trial and has been approved for the pharmacological management of SCI.

Chronic low back pain (LBP) is common, and some patients require opiates therapy. This Bayesian network meta-analysis (NMA) analysed available randomized clinical trials (RCTs) on the use of opioid...

Introduction Chondral defects of the talus are common and their treatment is challenging. Source of data Recent published literatures. Areas of agreement Membrane-induced Autologous Chondrocyte Implantation (mACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) have been proposed as management for chondral defects of the talus. Areas of controversy It is debated whether AMIC provides greater outcomes compared to mACI for chondral regeneration. Several clinical studies showed controversial results, and the best treatment has not yet been clarified. Growing points To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up. Areas timely for developing research AMIC exhibits similar clinical results to mACI. However, AMIC involves one single surgical procedure, no articular cartilage harvest and hence no morbidity from it, no need for chondrocyte expansion in a separate laboratory setting. For these reasons, AMIC may be preferred to mACI.

Life : open access journal 11(3), 183 (2021). doi:10.3390/life11030183 special issue: "Special issue "Focal chondral defects" / special issue editors: Filippo Migliorini, guest editor; Nicola Maffulli, guest editor", Published by MDPI, Basel

Knee surgery, sports traumatology, arthroscopy 29(11), 3608-3620 (2021). doi:10.1007/s00167-020-06306-9, Published by Springer, Berlin ; Heidelberg

Introduction The role of tourniquet during knee arthroplasty is controversial. The present study compares various tourniquet protocols using a Bayesian network meta-analysis of peri-operative data. Material and methods The present study was conducted in accordance with the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health interventions. The literature search was conducted in September 2020. All clinical trials investigating the role of tourniquet in knee arthroplasty were considered for inclusion. Methodological quality was assessed using Review Manager 5.3. A Bayesian hierarchical random-effects model analysis was used in all comparisons. Results Ultimately, pooled data from 68 studies (7413 procedures) were analysed. Significant inconsistency was found in the data relating to total estimated blood lost; no assumption could be made on this outcome. Full-time tourniquet resulted in the shortest surgical duration and lowest intra-operative blood lost, in both cases followed by incision-to-suture. The incision-to-suture protocol achieved the smallest drop in haemoglobin during the first 72 h post-operatively and the lowest rate of blood transfusion, both followed by full-time tourniquet. Hospitalisation was shortest in the absence (no-tourniquet) group, followed by the cementation-to-end group. Conclusion For knee arthroplasty, longer tourniquet use is associated with the shorter duration of surgery, lower intra-operative blood lost, lower drops in haemoglobin and fewer transfusion units. The shortest average hospitalisation was associated with no tourniquet use.

Background The present systematic review investigated return to sport, patient reported outcome measures (PROMs), complications and subsequent progression to total hip arthroplasty (THA) in patients undergoing arthroscopic labral repair for FAI. Material and methods Following the PRISMA statement, the literature search was performed in February 2021. The outcomes of interest were: rate of return to sport, modified Harris Hip Score (mHHS), the subscales Activities of Daily Living and Sport-Specific Subscale of the Hip Outcome Score (HOS-ADL and HOS-SSS, respectively). Complications, revision surgeries and progression to total hip arthroplasty were recorded. Results Data from 210 procedures were retrieved. The mean follow-up was 34.0 (24.0–42.5) months. The mean age of the patients was 32.0 (20.0–47.0) years, while the mean BMI was 20.9 (20.1–21.7) kg/m2. 52.8% (111 of 210 patients) were women. At 24-month follow-up, 100% of the patients had returned to sport. At a mean of 34 months follow-up, the mean mHHS increased by 25.5% (P = 0.02), the mean HOS-ADL by 23.0% (P = 0.03), the mean HOS-SSS by 32.8% (P = 0.001). No complications were observed. The rate of revision was 4.3% (9 of 210 procedures). At a mean of 37.9 ± 7.5 months, 1.9% of patients (4/210) underwent THA. Conclusion Arthroscopic labral refixation for FAI yields reliably positive clinical outcomes, with a low rate of revision and conversion to THA.

Objectives: Postmenopausal osteoporosis carries a high risk of fractures, which decrease quality of life and are associated with high morbidity, mortality, and economic burden. The best pharmacolog...

Facet joint injections (FJI) and medial branch blocks (MBB) can be employed for chronic low back pain (LBP) using different drugs such as corticosteroids, hyaluronic acid, sarapin and local anaesthetics. This systematic review compares the results of injections obtained with different compounds in the management LBP originating from facet joints.The present systematic review was conducted according to the PRISMA statement. The literature search was performed in October 2020. All the randomized clinical trials concerning injection treatments for chronic LBP. Drugs rather than steroids, hyaluronic acid, anaesthetics and sarapin were not considered, as well as those reporting outcomes from combined treatments. The Oswestry Disability Index (ODI) and the numeric rating scale (NRS) were retrieved.Data from 587 patients were retrieved. The mean follow-up was 12.4 ± 10.5 months. The mean age was 51.3 ± 9.6 years old. 57% (335/587) of patients were women. Steroids promoted a reduction of NRS by 28% (P 0.0001) and an improvement of the ODI by 13.2% (P = 0.005), and local anaesthetics produced an improvement of the ODI by 9.8% (P 0.0001). Sarapin resulted in a reduction of NRS by 44% (P = 0.04) and an improvement the ODI by 14.9% (P = 0.004); sarapin combined with steroids promoted a reduction of NRS by 47% (P = 0.04) and an improvement of the ODI by 11.7% (P = 0.001).Injections for chronic LBP deriving from facet joints osteoarthritis are encouraging, especially when considering MBB.I, systematic review of RCTs.

Study Design: Retrospective analysis. Objectives: The objective of this study was to analyze the feasibility of correcting double-curve scoliosis using dynamic scoliosis correction (DSC, also known as vertebral body tethering), which requires a bilateral anterior approach with deflation of both lungs. Typically, this approach falls under the exclusionary criteria for the eligibility for anterior scoliosis surgery. No data exists on the feasibility of single-staged bilateral DSC. Methods: A retrospective analysis was performed utilizing the data from 25 patients who underwent a bilateral anterior thoracic approach and instrumentation. Thirty-day postoperative complication rates were analyzed. A learning curve subanalysis was also performed to compare the first 12 patients to the remainder of the 13 patients, with a T-test ( P ≤ .05). Results: Of the 25 patients treated, there was 1 intraoperative event: After performing lumbar DSC, the contralateral DSC was abandoned due to unexpected pleural scarring and staged selective thoracic fusion was performed. We observed 4 postoperative complications: 2 patients had recurrent pleural effusions, 1 patient was diagnosed with pneumonia, and 1 patient had a minor pulmonary embolism without cardiopulmonary consequences (after an international 24 hour flight). All patients recovered well. We observed a significant influence of learning curve on surgical time (328 vs 280 min, P = .03) and blood loss (480 vs 197 mL, P = .03). Conclusion: Data suggests that bilateral, single-stage surgery for DSC is feasible albeit with an elevated complication rate that may partially attributable to the learning curve. Future research should focus on the cause of pulmonary complications and include a matched comparative analysis with traditional posterior fusion.

Introduction Several pharmacological therapies have been proposed for the management of chronic low back pain (LBP), but no consensus has been reached yet. Source of data Recent published literatures identified accessing PubMed, Google scholar, Embase and Scopus. Areas of agreement Exploring effective conservative alternatives to the surgical intervention is of especial interest. Areas of controversy The efficacy and safety of non-steroidal anti-inflammatory drugs and gabapentinoids for chronic LBP are debated. Several clinical studies showed controversial results, and the most effective and safe class of drugs has not yet been clarified. Growing points The effects of selective and non-selective NSAIDs and gabapentinoids in chronic LBP are probably over-estimated. Areas timely for developing research The effect of behavioural changes, including exercise, should be explored, alone or in combination with drugs.

Background and Purpose Patient-Reported Measured Outcomes (PROMs) are essential to gain a full understanding of a patient’s condition, and in spine surgery, these questionnaires are of help when tailoring a surgical strategy. Electronic registries allow for a systematic collection and storage of PROMs, making them readily available for clinical and research purposes. This study aimed to investigate the reliability between the electronic and paper form of ODI (Oswestry Disability Index), SF-36 (Short Form Health Survey 36) and COMI-back (Core Outcome Measures Index for the back) questionnaires. Methods A prospective analysis was performed of ODI, SF-36 and COMI-back questionnaires collected in paper and electronic format in two patients’ groups: Pre-Operatively (PO) or at follow-up (FU). All patients, in both groups, completed the three questionnaires in paper and electronic form. The correlation between both methods was assessed with the Intraclass Correlation Coefficients (ICC). Results The data from 100 non-consecutive, volunteer patients with a mean age of 55.6 ± 15.0 years were analysed. For all of the three PROMs, the reliability between paper and electronic questionnaires results was excellent (ICC: ODI = 0.96; COMI = 0.98; SF36-MCS = 0.98; SF36-PCS = 0.98. For all p Conclusions This study proved an excellent reliability between the electronic and paper versions of ODI, SF-36 and COMI-back questionnaires collected using a spine registry. This validation paves the way for stronger widespread use of electronic PROMs. They offer numerous advantages in terms of accessibility, storage, and data analysis compared to paper questionnaires.

Treating chronic low back pain (LBP) can be challenging, and the most effective pharmacological therapy is controversial. The present systematic review investigated the efficacy of various pharmacological compounds to achieve pain relief and improve disability in chronic LBP patients. The present study focused on acetaminophen, amoxicillin, flupirtine, baclofen, tryciclic antidepressants (TCAs), duloxetine, topiramate, gabapentinoids, non-steroid anti-inflammatory drugs (NSAIDs) and opioids.All randomized clinical trials comparing two or more drug treatments for chronic low back pain were accessed. Studies reporting outcomes concerning patients with neurologic or mechanic, specific or aspecific low back pain with or without radiculopathy were included. LBP was considered chronic if pain had lasted more than 6 weeks. Data from 47 articles (9007 patients: mean age: 52.62 ± 7.0 years; mean BMI: 28.26 ± 2.8; mean follow-up: 3.23 ± 3.2 months) were obtained.According to published level I evidence, only baclofen, duloxetine, NSAIDs, and opiates showed to improve pain and disability levels in patients with LBP. However, the patients' demographics are heterogeneous, and the results must be interpreted with caution and in the light of possible adverse events connected to the use of these drugs.

Objectives: The regenerative capabilities of bone marrow-derived cell therapies (BMCTs) have been employed in combination with core decompression (CD) in the management of osteonecrosis of the femo...

The role of tourniquet during knee arthroplasty is controversial. The present study compares various tourniquet protocols using a Bayesian network meta-analysis of peri-operative data.The present study was conducted in accordance with the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health interventions. The literature search was conducted in September 2020. All clinical trials investigating the role of tourniquet in knee arthroplasty were considered for inclusion. Methodological quality was assessed using Review Manager 5.3. A Bayesian hierarchical random-effects model analysis was used in all comparisons.Ultimately, pooled data from 68 studies (7413 procedures) were analysed. Significant inconsistency was found in the data relating to total estimated blood lost; no assumption could be made on this outcome. Full-time tourniquet resulted in the shortest surgical duration and lowest intra-operative blood lost, in both cases followed by incision-to-suture. The incision-to-suture protocol achieved the smallest drop in haemoglobin during the first 72 h post-operatively and the lowest rate of blood transfusion, both followed by full-time tourniquet. Hospitalisation was shortest in the absence (no-tourniquet) group, followed by the cementation-to-end group.For knee arthroplasty, longer tourniquet use is associated with the shorter duration of surgery, lower intra-operative blood lost, lower drops in haemoglobin and fewer transfusion units. The shortest average hospitalisation was associated with no tourniquet use.

Purpose: Both anatomic total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (SHA) are used for the management of end-stage glenohumeral osteoarthritis (GHOA). The present study compared TSA and SHA in terms of clinical outcome and complication rate. Methods: This meta-analysis followed the PRISMA guidelines. In October 2021, the following databases were accessed: Web of Science, Google Scholar, Pubmed, Scopus. All clinical trials comparing anatomical TSA versus SHA for GHOA were considered. Results: Data from 11,027 procedures were retrieved. The mean length of the follow-up was 81.8 (16 to 223.20) months. The mean age of the patients was 61.4 ± 8.6 years, and 56.0% (5731 of 10,228 patients) were women. At last follow-up, the age-adjusted constant score was greater following TSA (p < 0.0001), as were active elevation (p < 0.0001), flexion (p < 0.0001), abduction (p < 0.0001), and American Shoulder and Elbow Surgeons Shoulder Score (p < 0.0001). Postoperative pain (p < 0.0001) and revision rate (p = 0.02) were lower in the TSA group. Conclusions: Anatomic TSA performed better than SHA in patients with GHOA.

Study design:Retrospective study BACKGROUND: Indirect decompression with ALIF allows the restoration of the disk and foraminal height with limited soft tissue damage. However, it does not offer a direct view of the neural structure and a direct intraoperative assessment of the results of the decompression is not possible. For this reason, ALIF is often accompanied by posterior, direct decompression. So far, there is no consensus on the effects of indirect decompression alone for L5-S1 foraminal stenosis. Objective:Evaluation of the clinical and mechanical performance of indirect decompression with anterior lumbar interbody fusion (ALIF) in L5-S1 foraminal stenosis. Methods:All patients who underwent ALIF at our institution and had a minimum follow-up of six months were assessed for inclusion. Radiographic parameters (anterior and posterior disc height, foraminal height and surface, L5-S1 angle, pelvic incidence, pelvic tilt and lumbar lordosis) and clinical data (Oswestry Disability Index - ODI and Numeric Rating Scale - NRS) before ALIF and at the last follow-up were compared. A regression analysis was performed to investigate the correlation between radiographic and clinical outcomes. Results:Thirty-four patients were available for the study (55.9% female, mean age 53.4±11.5 years), mean follow-up was 26.4±11.1 months. At the last follow-up, a significant increase in foraminal height (14.6±4.0 vs. 17.9±3.9 mm, p Conclusion:ALIF provided significant indirect foraminal decompression and improvement of radicular pain. The increase of foraminal height, surface, and posterior disc height is directly associated with radicular pain improvement. Level of evidence:IV AVAILABILITY OF DATA AND MATERIAL: The datasets used and/or analyzed in the present study are available from the corresponding author on reasonable request.

IntroductionWork-related musculoskeletal (MSK) pain is a highly prevalent condition and one of the main contributors to disability and loss of work capacity. Current approaches to the management and prevention of work-related MSK pain do not consistently integrate current evidence-based knowledge and seem to be outdated. The Prevent4Work (P4W) Project aims to collect and spread evidence-based information to improve the management and prevention of work-related MSK pain. P4W will longitudinally investigate (1) risk factors associated with the prevalence of work-related MSK pain, (2) predictive factors for new events of work-related MSK pain in the short term and (3) the modification of pain beliefs after participating in evidence-based e-learning courses.Methods and analysisThis project employs a mixed-methods design with international cohorts of workers from Spain, Italy and Denmark. All participants will be assessed using self-reported variables at baseline (ie, cross-sectional design) with follow-up after 3 and 6 months (ie, prospective–predictive design). Throughout the first phase (0–3 months), all participants will be offered to self-enrol in e-learning courses on work-related MSK pain. Changes in pain beliefs (if any) will be assessed. The dataset will include sociodemographic characteristics, physical and psychological job demands, lifestyle-related factors, MSK pain history and pain beliefs. At baseline, all participants will additionally complete the P4W questionnaire developed to detect populations at high risk of suffering work-related MSK pain.Descriptive statistics, binary logistic regression, and analysis of variance will be used to identify the significant factors that influence the history of work-related MSK pain, evaluate the short-term prediction capacity of the P4W questionnaire, and investigate whether workers’ participation in e-learning courses will modify their pain beliefs.Ethics and disseminationThe study received ethical approval from the Ethical Committee of San Jorge University (USJ011-19/20). The results will be made available via peer-reviewed publications, international conferences and P4W official channels.

Applied Sciences 11(17), 7966 (2021). doi:10.3390/app11177966 special issue: "Special Issue "Osteoarthritis and Cartilage Regeneration: From Pathophysiology to Novel Therapeutic Approaches" / Special Issue Editors: Dr. Paolo Alberton, Guest Editor; Dr. Emeline Perrier-Groult, Co-Guest Editor", Published by MDPI, Basel

Life : open access journal 11(4), 295 (2021). doi:10.3390/life11040295 special issue: "Special issue "Focal chondral defects" / special issue editors: Filippo Migliorini, guest editor; Nicola Maffulli, guest editor", Published by MDPI, Basel

A systematic review of the literature was conducted to clarify the outcomes of autologous mesenchymal stem cells (MSC) injections for the regeneration of the intervertebral disc (IVD). The following databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar bibliographic databases. Articles including previous or planned surgical interventions were excluded. Only articles reporting percutaneous autologous MSC injection to regenerate IVD in humans were included. We referred to the Coleman Methodology Score for the methodological quality assessment. The statistical analysis was performed using Review Manager Software 5.3. After the databases search and cross-references of the bibliographies, seven studies were included in the present work. The funnel plot detected low risk of publication bias. The Coleman Methodology Score reported a good result, scoring 61.07 points. A total of 98 patients were enrolled, with 122 treated levels. All the patients underwent conservative therapies prior to injection. A remarkable improvement in the quality of life were reported after the treatment. The average Oswestry Disability Index (ODI) improved from “severe disability” to “minimal disability” at one year follow-up. The visual analogue scale (VAS) showed an improvement of ca. 30% at one year follow-up. Only one case of herniated nucleus pulposus was reported. No other adverse events at the aspiration or injection site were observed. This systematic review of the literature proved MSC injection to be a safe and feasible option for intervertebral disc regeneration in the early-degeneration stage patients. Irrespective of the source of the MSCs, an overall clinical and radiological improvement of the patients has been evidenced, as indeed a very low complication rate during the follow-up.