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Background: The study aimed to validate a revised Italian version of the Anterior Knee Pain Scale (AKPS) by addressing shortcomings in previous adaptations and following the COSMIN guidelines to ensure robust psychometric evaluation., Methods: One hundred thirty patients with anterior knee pain symptoms were recruited, with 65 undergoing a retest after 7 days to assess the scale's reliability. Structural validity was assessed through confirmatory factor analysis (CFA) to evaluate the scale's dimensionality. Internal consistency was measured using Cronbach's alpha, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Measurement error was evaluated using the standard error of measurement (SEM) and the smallest detectable change (SDC). Construct validity was examined by correlating the AKPS with other established scales, including the Knee Injury and Osteoarthritis Outcome Score, Internal Knee Documentation Committee, Victorian Institute of Sport Assessment - Patella, Short-Form 36 Health Survey, and the Visual Analogue Scale., Results: The CFA supported a three-factor model encompassing pain intensity and interference, functional limitations in daily activities, and knee structural and functional issues. The scale demonstrated good internal consistency (Cronbach's α=0.79) and excellent test-retest reliability (ICC=0.91), with low measurement error (SEM<5%). Construct validity was confirmed through moderate-to-strong correlations with related scales, particularly in domains related to pain intensity, symptoms, and daily functioning., Conclusions: The newly validated scale, demonstrating strong psychometric properties, meets international standards for clinical assessment tools, making it a reliable and effective instrument for assessing anterior knee pain in the Italian context.

Purpose: To investigate the incidence of popliteomeniscal fascicles (PMF) tears in anterior cruciate ligament (ACL) rupture in professional soccer players, to describe arthroscopic and magnetic resonance imaging (MRI) findings and treatment of these lesions with clinical outcomes, and to evaluate the incidence of subsequent lateral meniscus tears and ACL reinjury., Methods: ACL reconstructions on soccer players were retrospectively analyzed, and among them, a cohort of patients with PMFs tears was reviewed. The cohort was assessed with MRI examination, arthrometric testing, Lysholm score, and International Knee Documentation Committee score. The occurrence of subsequent lateral meniscus tears and ACL reinjury were evaluated., Results: A total of 208 ACL reconstructions were identified. From these, 43 male and 3 female subjects with a mean age of 24 ± 4.2 years were included. Median time from injury to surgery was 5 days. Preoperative MRI showed a tear of posterior PMFs in 24 of 47 knees (51.1%). The mean preoperative arthrometric measured laxity was 4.3 ± 1.65 mm, and postoperatively 0.1 ± 1.1 mm. Preoperative Lysholm score and International Knee Documentation Committee score were, respectively, 50.4 ± 25.4 and 39.6 ± 5, and postoperatively 98 ± 2.4 and 73.6 ± 1.2. Mean time to return to play, at the same preoperative level for all patients, was 184 ± 41.7 days. One patient underwent ACL revision due to a reinjury 9 months after surgery, whereas no lateral meniscus tears occurred in the follow-up period., Conclusions: PMF tears are found in approximately 20% of professional soccer players with acute ACL injuries. After ACL reconstruction and PMFs repair, outcomes including return to play are good, ACL retear is low, and recurrent lateral meniscus tears were not observed., Level of Evidence: Level IV, therapeutic case series., Competing Interests: All authors (P.P.M., G.T., M.J.B., R.C., R.P.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Context: In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking., Objective: The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program., Methods: From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism., Results: The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 μg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%., Conclusion: Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)

Newborn screening (NBS) for inborn errors of metabolism is one of the most advanced tools for secondary prevention in medicine, as it allows early diagnosis and prompt treatment initiation. The expanded newborn screening was introduced in Italy between 2016 and 2017 (Law 167/2016; DM 13 October 2016; DPCM 12-1-2017). A total of 1,586,578 infants born in Italy were screened between January 2017 and December 2020. For this survey, we collected data from 15 Italian screening laboratories, focusing on the metabolic disorders identified by tandem mass spectrometry (MS/MS) based analysis between January 2019 and December 2020. Aminoacidemias were the most common inborn errors in Italy, and an equal percentage was observed in detecting organic acidemias and mitochondrial fatty acids beta-oxidation defects. Second-tier tests are widely used in most laboratories to reduce false positives. For example, second-tier tests for methylmalonic acid and homocysteine considerably improved the screening of CblC without increasing unnecessary recalls. Finally, the newborn screening allowed us to identify conditions that are mainly secondary to a maternal deficiency. We describe the goals reached since the introduction of the screening in Italy by exchanging knowledge and experiences among the laboratories.

Background: To arthroscopically evaluate the incidence of lateral meniscal root avulsion (LMRA) and associated intra-articular injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction., Materials and Methods: From April 2014 to March 2017, 532 consecutive patients were diagnosed as having an ACL injury and underwent arthroscopic ACL reconstruction. The diagnosis of LMRA was made arthroscopically. The effects of gender, activity, grade of laxity, time from injury, and concomitant meniscal lesions were analyzed., Results: Among 532 patients, 497 (93.4%) underwent primary ACL reconstruction and 35 (6.5%) underwent revision procedures. 383 were acute or subacute injuries (less than 6 months from injury to surgery) and 149 chronic (more than 6 months). Average age was 30.4 years (DS: ± 11.04); there were 422 (79.3%) males and 110 (20.6%) females. A LMRA associated with the ACL injury was detected in 72 cases (13.5%), with a significant prevalence observed in males ([Formula: see text] = 4.65; P = 0.031, statistically significant). In the 149 patients with a chronic injury, 27 patients had LMRA (18.1%), while 45 of the 383 patients with an acute or subacute injury had LMRA (11.7%). There was a tendency, albeit not significant ([Formula: see text] = 3.721; P = 0.054), for the prevalence to increase with time since the initial ACL injury. LMRA was significantly associated ([Formula: see text] = 7.81; P = 0.006) with a meniscocapsular tear of the posterior horn of the medial meniscus (ramp lesion). No other significant associations, such as with severity of A-P translation (as measured by KT-2000) or activity level, were detected., Conclusion: LMRA is a relatively common injury associated with both acute and chronic ACL tears. A relatively high incidence in cases of chronic ACL insufficiency suggests that LMRAs do not heal spontaneously or that they may appear with time, even when absent at the time of the initial injury., Level of Evidence: Level III, cross-sectional study., (© 2021. The Author(s).)

This study describes a modified AMIC technique consisting of perforations according to Pridie, rather than microfractures, and the covering of the focus of the lesion with a biological collagen patch enriched with bone marrow blood drawn through the knee itself. This technique allows advantages of both the Pridie technique and the in situ proliferation of mesenchymal cells beneath a biological collagen membrane, 'augmented', with bone marrow blood. The collagen membrane forms the roof of a 'biological chamber', and serves to protect and contains the stem cells as they differentiate into chondrocytes, which will form a healthy regenerative cartilage.

We report a very rare case of fibroma of the tendon sheath arising from the anteromedial ankle joint capsule, with no apparent connection to any tendon in the area, found in a 58-year-old patient complaining of progressive local swelling. This uncommon tumor has its usual localization in tendon sheaths, is extremely rare in joint capsules, and has never been described in this location previously. MRI showed nonuniform low signal intensity in T1- and T2-weighted images and high intensity in STIR images. The mass was completely excised by open surgery. Histopathological analysis later confirmed the diagnosis of a fibroma of the tendon sheath.

Aim: The aim of this study was to determine the role of combined mechanical and pharmacological prophylaxis in the prevention of deep venous thrombosis (DVT) after total knee replacement (TKR)., Design: prospective case series study., Methods: Between October 2002 and June 2003, 38 total knee procedures were carried out on 34 patients (4 patients had bilateral TKR). To exclude the presence of a concomitant DVT echo-color-flow of the legs was performed between 2 and 1 week prior to surgery, in the postoperative period (before discharging) and 30 days after surgery. Patients received one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight). An intermittent foot sole pump (IFSP) was applied in the recovery room postoperatively, in both feet for about 5 h a day and all night long, and continued at home until the 15(th) day., Results: No major perioperative or rehabilitation phase-related complications were observed (2 patients required manual drainage of blood clots from the wound). The incidence of DVT was 7.9% (3 cases). In one of these cases we observed a previous DVT so it was classified as rethrombosis. All were successfully treated with therapeutic introduced low molecular weight heparin (LMWH) therapy. No pulmonary embolism or deaths associated with the use of LMWH or IFSP were observed., Conclusions: In our experience the combined prophylaxis with nadroparin calcium and IFSP significantly reduced the incidence of DVT.

Background: Hyperthermia has been introduced as a physical therapy modality for soft tissue injuries., Hypothesis: The authors tested the null hypothesis that there are no short-term differences after the use of hyperthermia, ultrasound, and exercises for tendinopathy of the supraspinatus tendon., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: The authors studied 37 athletes (29 men, 8 women; mean age, 26.7 +/- 5.8 years; range, 19-43 years) with supraspinatus tendinopathy who had had symptoms between 3 and 6 months. Subjects were randomly assigned to 3 groups. Group A (n = 14) received hyperthermia at 434 MHz. Group B (n = 12) received continuous ultrasound at 1 MHz at an intensity of 2.0 w/cm(2) 3 times a week. Group C (n = 11) undertook exercises, consisting of pendular swinging and stretching exercises 5 minutes twice a day every day. All interventions were undertaken for 4 weeks. Subjects were evaluated at baseline, immediately on completion of treatment, and at 6 weeks after the end of the intervention using mean pain score for pain at night, during movement, and at rest on a visual analog scale; pain on resisted movement and painful arc on active abduction between 40 degrees and 120 degrees on a 4-point scale; and Constant score., Results: Patients who received hyperthermia experienced significantly better pain relief than did patients receiving ultrasound or exercises: group A, 5.96 to 1.2 (P = .03); group B, 6.3 to 5.15 (P = .10); group C, 6.1 to 4.9 (P = .09)., Conclusion: Hyperthermia at 434 MHz appears safe and effective in the short term for the management of supraspinatus tendinopathy.

It is the purpose of this study to review current trends and guidelines in the treatment of periprosthetic hip fractures, and to report three cases of patients operated on and treated by different types of instrumentation: Modified Mennen plate by De Puy, Dall-Miles trochanteric grip, Zimmer cable-ready plate.

We report a case of a rare neurological tumour arising in the knee joint with no apparent connection to the major nerve trunks in the area. After the patient failed to improve through rehabilitation, surgery was performed, revealing a concomitant tear of the medial meniscus as well as a mass which was excised through an external supero-medial incision into the knee. Histopathological analysis later confirmed the diagnosis of a neurilemoma.

An unusual case of myositis ossificans secondary to a muscle tendon junction (MTJ) strain of long head of biceps in a young athlete is reported. Plain radiographs, ultrasonography and MRI in association with clinical assessment showed the appearance and the evolution of this pathological entity. This case had a resolution of pain and function after 3 months of conservative treatment. At 6 months follow-up, the athlete became asymptomatic and he gradually returned back to his sports activity.

Background: To verify statistically the hypothesis that birthdate represents a risk factor for Congenital Hypothyroidism, as proposed by some European Authors. Moreover, to verify the existence of seasonal cyclic trends in TSH levels., Methods: For the verification of birthdate as a risk factor, we considered retrospectively a data set of all consecutives newborns of Marche Region (Italy) affected by Congenital Hypothyroidism, in the period 1981-1996 (n = 92). For the evaluation of seasonal cyclic trends in TSH, we considered the level of the hormone in all newborns of Marche Region screened in the period 1989-1996. Data were collected from Neonatal Screening Register of Marche Region. All the statistical analyses are based on circular statistics techniques (Rayleigh test, Roger test, estimation of density by kernel method, Mardia test for circular-linear correlation, Maximization of Mean Vector Length)., Results: No cyclic trend was pointed out with regard to Congenital Hypothyroidism; neither seasonal rhythms nor other cyclic patterns of TSH levels were evidenced., Conclusions: Neither the hypothesis of birthdate as a risk factor for Congenital Hypothyroi-dism, nor the existence of seasonal variations in TSH hormone releasing were confirmed.