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Introduction: The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients has acutely increased over the last 20 years, yet there is no consensus on a single "best treatment". Selection of an optimal treatment is critical and based on individual circumstances; consequently, we propose a treatment-selection algorithm based on (i) skeletal development, (ii) ACL tear location, type, and quality, as well as (iii) parental perspective in order to facilitate the decision-making process. Evidence acquisition: We combined our surgical group's extensive case histories of ACL tear management in Tanner Stage 1 and 2 patients with those in the literature to form a consolidated data base. For each case (i) the diagnostic phase, (ii) communication with patient and parents, (iii) treatment choice(s), (iv) selected surgical techniques and (v) rehabilitation schedule were critically analyzed and compared for patient outcomes. Evidence synthesis: MRI-imaging and intraoperative tissue quality assessment were preeminent in importance for selection of the optimal treatment strategy. Considerations for selecting an optimal treatment included: (i) associated lesions, (ii) the child/patient and parent(s)' well-informed and counseled consent, (iii) biological potential, and (iv) the potential for successful ACL preservative surgery. Complete ACL tears were evaluated according to tear-location. In Type I and II ACL tears with remaining good tissue quality, we propose primary ACL repair. In Type III and IV ACL tears we propose physeal-sparing reconstruction with an iliotibial band graft. Finally, in the case of a Type V ACL tear, we propose that the best treatment be based on the Meyers-McKeever classification. Conclusions: We present a facile decision-making algorithm for ACL management in pediatric patients based on specific elements of tissue damage and status.

Purpose: To investigate whether soccer affects the young players’ one leg stance balance ability and to understand if balance ability in young soccer players is influenced by age, morphometric parameters or motor coordination capabilities. Methods: Ninety-two male healthy pediatric soccer players aged between 5 and 10 years were enrolled in this study. Sway path, sway area, and sway velocity of center of pressure (CoP) were recorded by means of a strain gauge platform with automatic weight correction. Athletes stood barefoot on firm surface with open eyes alternatively on bipedal condition, dominant or non-dominant foot and with closed eyes on bipedal condition. Morphometric parameters were collected. Gross motor coordination was tested with the Koerperkoordinations Test fuer Kinder (KTK). Results: Better balance outcomes were observed in open eyes and closed eyes bipedal conditions with respect to unipedal ones. Our study shows no differences in dominant and non-dominant single leg stance control. We observed a significant positive correlation of the age with the KTK score. One leg stance on dominant foot demonstrated to be well predicted by age, BMI, and motor coordination capabilities. Non-dominant one leg stance was predicted by BMI and coordinative parameters. Conclusions: Young footballers developed the ability to control in the same way one leg stance on dominant and non-dominant leg. Their postural control is directly influenced by their gross motor coordination for dominant and non-dominant leg, but age influences only dominant leg balance parameters. This supports the hypothesis that balance training should also be introduced in childhood sports training sessions to improve postural control.

Background: Intertrochanteric fractures are among the most common fracture in elderly and are correlated with an average 1-year mortality of 25 %. Increased mortality after hip fracture could be related to blood loss and comorbidities. Aims: We compared two groups of patients treated with percutaneous compression plating (PCCP) and dynamic hip screw (DHS) with the hypothesis that treatment with PCCP can reduce blood loss and 1-year mortality. We furthermore investigated the role of several surgical-related and patient-related factors on mortality of all the enrolled patients. Methods: We performed a comparative retrospective study of 280 patients with type 31A1 or 31A2 hip fractures treated in our department from January 2004 to May 2008. Exclusion criteria were age <60 years, multiple injuries and pathological fractures. A total of 194 patients were treated with DHS, and 86 patients were treated with PCCP. Results: No statistical differences were found in term of blood loss, blood transfusion and 1-year mortality between the two groups, whereas we found a significant incidence of gender, age, American Society of Anaesthesiologists score and preoperative haemoglobin on mortality. Discussion: Both plates seem to be comparable in terms of blood loss and blood transfusion rate, and mortality was rather correlated with some patient-related factors reflecting the global health status. Conclusion: Emerging mortality in this kind of patient should encourage us to improve preventative orthogeriatric health care.

Mesenchymal stromal cells (MSCs), seeded onto a scaffold and associated with platelet-gel, may represent an innovative treatment to improve bone repair. The preparation of MSCs for clinical use requires the fulfillment of Good Manufacturing Practice indications. The aim of this study was to validate a Good Manufacturing Practice–grade protocol of tissue engineering for bone regeneration, seeding platelet lysate (PL)–cultured MSCs onto an hydroxyapatite clinical-grade scaffold. Six large-scale experiments were performed. MSC expansions were performed comparing fetal bovine serum 10% and PL 5%. We demonstrated that PL lots contain high levels of growth factors possibly responsible of accelerated growth rate, since the number of colony-forming unit–fibroblast and population doublings were always significantly higher in PL cultures. MSCs were characterized for their phenotype and multilineage differentiation capacity, demonstrating appropriate features for both conditions. Gene expression analysis revealed higher expression of typical osteogenic genes of PL-cultured MSCs, when compared to fetal bovine serum MSCs. Cell transformation was excluded by analysis of karyotype, absence of growth without anchorage, and p53/c-myc gene expression. Scaffolds were precoated with retronectin before MSC seeding. MSC adhesion, distribution, and proliferation were demonstrated through the whole surface of the scaffold by scanning electron microscopy analysis or by immunofluorescence and MSC osteogenic differentiation through quantitative reverse transcriptase–polymerase chain reaction of typical osteogenic genes. The present report offers a model of an MSC-based bioengineered device, using an hydroxyapatite clinical-grade scaffold, and supports its potential use in tissue engineering to repair bone defects