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Background: This observational study investigates the efficacy of combining local muscle vibration (LMV) therapy and kinesiotaping using the McConnell method (KMcCM) in patients with patellofemoral pain syndrome (PFPS). PFPS is a prevalent knee condition characterized by anterior or medial knee pain exacerbated by activities that overload the patellofemoral joint., Objective: The primary aim of this study was to evaluate the effectiveness of LMV combined with KMcCM in reducing pain and improving function in PFPS patients., Methods: A total of 52 participants, aged 25-85, with PFPS were included. Participants underwent LMV and KMcCM treatments three times weekly for three weeks. Pain and function were assessed using the Visual Analog Scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline (T0) and six months post-treatment (T1). Radiological assessments of patellar alignment and biomechanics were also conducted through dynamic MRI., Results: Significant pain reduction and functional improvements were observed across all age groups. Notably, younger participants showed greater improvement compared to older participants. Among women, those in the younger age group experienced more substantial reductions in VAS scores compared to their older counterparts. KOOS scores improved significantly, indicating enhanced knee function overall. A significant decrease in VAS scores from T0 to T1 was observed across all patellar alignment groups, signifying a reduction in pain levels. However, Group 2 (Laxation and Subluxation) experienced the most substantial reduction in VAS scores at T1 compared to the other groups. These results suggest that the combination of LMV and KMcCM may be particularly effective in addressing biomechanical abnormalities associated with patellar maltracking and enhancing VMO muscle contraction, leading to more substantial improvements in these patients., Conclusions: The combination of LMV and KMcCM demonstrates promising efficacy in reducing pain and improving knee function in PFPS patients, with age and gender influencing treatment outcomes. The most significant improvements were observed in younger individuals and those with specific patellar alignment issues, highlighting the potential of this combined approach for the targeted treatment of PFPS.

Introduction: The plantar plate, also called the plantar ligament, is a fibrocartilaginous structure found in the metatarsophalangeal (MTP) and interphalangeal (IP) joints. Our study aimed to evaluate the role of magnetic resonance imaging (MRI) performed with the patient in the standard position or with joint hyperextension (the "stress test", ST) in the study of plantar plate (PP) disease that involves metatarsophalangeal joints., Materials and Methods: All patients underwent forefoot MRI (Atroscan C, Esaote, Genoa, Italy), operating at 0.2 T. All patients first underwent a standard MRI examination (coronal T1 and T2 weighted image (WI) with fat suppression and axial and sagittal T2 WI); the examination was completed by performing a stress test (hyperextension of toes). The ST is an easy task to perform and is not time-consuming (requiring only one additional sagittal fast spin echo (FSE) T2-weighted MRI sequence; repetition time/ echo time (TR/TE): 3200/90 ms) for patients and operators. A 45°-dorsiflexion ST was performed for approximately 2.30 min, the time required to complete the sequence. No further diagnostic investigations were necessary; no patients underwent arthrography or arthro-MRI. The examinations were performed in a double-blind mode by two operators with proven experience in musculoskeletal radiology; no cases of intra-operator discordance were found., Results: Twenty-five patients were recruited into our study over a 2-year period; 15 were positive for metatarsal pain and 10 were controls. Before treatment (surgery), all patients displaying symptoms underwent evaluation. As a result, the imaging features accurately represented the natural and actual conditions of the lesions. Among the symptomatic patients, 11 out of the 15 exhibited a PP tear or dysfunction in both the standard position and the ST. Additionally, two out of the 15 individuals displayed a tear in the ST alone, with no indication of it in the standard position. In contrast, two out of 15 patients showed no evidence of a PP tear in either the standard position or the ST. However, these two patients demonstrated dorsal subluxation during the ST, likely due to micro-instability resulting from PP failure. In the asymptomatic patients, nine out of the 10 individuals were found to be negative for PP dysfunction. Only one out of the 10 patients exhibited dorsal subluxation solely in the ST, indicative of plantar plate dysfunction, but no evidence of a tear in the PP. In the asymptomatic patients, standard MRI provided a specificity of 100% and a high negative predictive value (NPV) (90%), while the latter increased with the ST (specificity and NPV equal to 100%). In symptomatic patients, standard MRI gave a sensitivity of 75% when assessing a PP tear, which increased to 100% with the ST; the sensitivity of standard MRI the evaluation of MF subluxation was 60%, but it reached 100% with the ST., Conclusions: In our study, by introducing the ST, the sensitivity in both the diagnosis of a PP tear and the evaluation of MTP subluxation reached 100% (a surgical assessment was performed on all positive patients for confirmation). Ultrasound has the advantage of being a non-invasive method. However, comparing the results of our study with the data available in the literature, ultrasound has a lower sensitivity and a negative predictive value. Also, ultrasound does not allow for the assessment of possible bone marrow oedema or the degree of concomitant arthritis. If other studies in the literature confirm these results, it will be possible to consider incorporating the ST into diagnostic practice in the future., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

The knee is an essential part of our body, and identifying its injuries is crucial since it can significantly affect quality of life. To date, the preferred way of evaluating knee injuries is through magnetic resonance imaging (MRI), which is an effective imaging technique that accurately identifies injuries. The issue with this method is that the high amount of detail that comes with MRIs is challenging to interpret and time consuming for radiologists to analyze. The issue becomes even more concerning when radiologists are required to analyze a significant number of MRIs in a short period. For this purpose, automated tools may become helpful to radiologists assisting them in the evaluation of these images. Machine learning methods, in being able to extract meaningful information from data, such as images or any other type of data, are promising for modeling the complex patterns of knee MRI and relating it to its interpretation. In this study, using a real-life imaging protocol, a machine-learning model based on convolutional neural networks used for detecting medial meniscus tears, bone marrow edema, and general abnormalities on knee MRI exams is presented. Furthermore, the model's effectiveness in terms of accuracy, sensitivity, and specificity is evaluated. Based on this evaluation protocol, the explored models reach a maximum accuracy of 83.7%, a maximum sensitivity of 82.2%, and a maximum specificity of 87.99% for meniscus tears. For bone marrow edema, a maximum accuracy of 81.3%, a maximum sensitivity of 93.3%, and a maximum specificity of 78.6% is reached. Finally, for general abnormalities, the explored models reach 83.7%, 90.0% and 84.2% of maximum accuracy, sensitivity and specificity, respectively.

Background: Magnetic Resonance Imaging (MRI) and Ultrasound (US) in combination with clinical data could contribute to the diagnosis, staging and follow-up of Patello-Femoral Syndrome (PFS), which often overlaps with other pathologies of the knee., Purpose of the Study: To evaluate the diagnostic role of MRI and US findings associated with PFS and define the range values of instrumental measurements obtained in pathological cases and healthy controls, the performance of the two methods in comparison, and the correlation with clinical data., Materials and Methods: 100 subjects were examined: 60 patients with a high suspicion of PFS at the clinical evaluation and 40 healthy controls. All measurements obtained by MRI and US examination were correlated with clinical data. A descriptive analysis of all measurements was stratified for pathological cases and healthy controls. A Student's t -test for continuous variables was used to compare patients to controls and US to MRI. Logistic regression analysis was applied to test the correlation between MRI and US measurements with clinical data., Results: Statistical descriptive analysis determined the MRI and US range values of medial patello-femoral distance and the thickness of retinacles and cartilages in pathological cases and healthy controls. In pathological cases, the retinacle results of both increased; the medial appeared to be slightly more increased than the lateral. Furthermore, in some cases, the thickness of the cartilage decreased in both techniques; the medial cartilage was more thinned than the lateral. According to logistic regression analyses, the best diagnostic parameter was the medial patello-femoral distance due to the overlapping results of the US and MRI. Furthermore, all clinical data obtained by different tests showed a good correlation with patello-femoral distance. In particular, the correlation between medial patello-femoral distance and the VAS score is direct and equal to 97-99%, which is statistically significant ( p < 0.001), and the correlation with the KOOS score is inverse and equal to 96-98%, which is statistically significant., Conclusions: MRI and Ultrasound examination in combination with clinical data demonstrated high-value results in the diagnosis of PFS.

The present work defines a modified critical size rabbit ulna defect model for bone regeneration in which a non-resorbable barrier membrane was used to separate the radius from the ulna to create a valid model for evaluation of tissue-engineered periosteal substitutes. Eight rabbits divided into two groups were used. Critical defects (15 mm) were made in the ulna completely eliminating periosteum. For group I, defects were filled with a nanohydroxyapatite poly(ester urethane) scaffold soaked in PBS and left as such (group Ia) or wrapped with a tissue-engineered periosteal substitute (group Ib). For group II, an expanded-polytetrafluoroethylene (e-PTFE) (GORE-TEX(®)) membrane was inserted around the radius then the defects received either scaffold alone (group IIa) or scaffold wrapped with periosteal substitute (group IIb). Animals were euthanized after 12-16 weeks, and bone regeneration was evaluated by radiography, computed microtomography (μCT), and histology. In the first group, we observed formation of radio-ulnar synostosis irrespective of the treatment. This was completely eliminated upon placement of the e-PTFE (GORE-TEX(®)) membrane in the second group of animals. In conclusion, modification of the model using a non-resorbable e-PTFE membrane to isolate the ulna from the radius was a valuable addition allowing for objective evaluation of the tissue-engineered periosteal substitute.

Background/aim: The aim of the present study was to evaluate the safety and the clinical outcome of platelet-rich plasma for the treatment of teno-desmic injures in competition horses., Patients and Methods: From January 2009 to December 2011, 150 sport horses suffering from teno-desmic injuries were treated with no-gelled platelet-concentrate., Results: No horse showed any major adverse reaction as a result of the procedure. Full healing was obtained for 81% of the horses. Twelve percent had clinical improvement and only 7% a failure. Eight percent of cases of relapse were observed. No statistically significant correlation existed between clinical outcome and the area of the lesion. A statistically significant correlation existed between the clinical outcome and the age of the horse., Conclusion: Treatment with platelet-derived growth factors leads to the formation of a tendon with normal morphology and functionality, which translate in the resumption of the agonistic activity for the horses we treated., (Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Serum of animal origin and in particular fetal bovine serum is the most commonly utilized cell culture medium additive for in vitro cell growth and differentiation. However, several major concerns have been raised by the scientific community regarding the use of animal sera for human cell-based culture applications. Among the possible alternatives to the animal serum, platelet-derived compounds have been proposed since more than 10 years. Nevertheless, the high degree of variability between the different platelet preparations, and the lack of standardized manufacturing and quality control procedures, made difficult to reach a consensus on the applicability of this novel cell culture medium supplement. In this study, we describe the preparation of a standardized platelet-rich plasma (PRP) derivative obtained starting from human-certified buffy coat samples with a defined platelet concentration and following protocols including also freeze-drying, gamma irradiation and biological activity testing prior the product release as cell culture medium additive. Biological activity testing of the different preparations was done by determining the capability of the different PRP preparations to sustain human bone marrow mesenchymal stem cell (MSC) clone formation and proliferation. Taking advantage of a developed MSC in vitro clonogenicity test, we also determined biological activity and stability of the freeze-dried gamma-sterilized PRP preparations after their storage for different times and at different temperatures. The PRP effects on cell proliferation were determined both on primary cell cultures established from different tissues and on a cell line. Results were compared with those obtained in "traditional" parallel control cultures performed in the presence of bovine serum [10% fetal calf serum (FCS)]. Compared to FCS, the PRP addition to the culture medium increased the MSC colony number and average size. In primary cell cultures and in cell line cultures, the PRP promoted cell proliferation also in conditions where the FCS had not a proliferation stimulating effect due to either the nature of the cells and the tissue of origin (such as human articular chondrocytes from elderly patients) or to the critical low density cell seeding (such as for HeLa cells). In summary, the standardized PRP formulation would provide an "off-the-shelf" product to be used for the selection and expansion of several cell types also in critical cell culture conditions.

Background: Cardiac complications secondary to iron overload remain a significant matter in patients with transfusion dependent anemias., Patients and Methods: To evaluate cardiac siderosis, Magnetic resonance imaging T2* (MRI T2*) was performed in 3 cohorts of transfusion dependent patients: 99 with thalassemia major (TM), 20 with thalassemia intermedia (TI), and 10 with acquired anemias (AA). Serum ferritin was measured and all patients underwent echocardiographic evaluation., Results: In TM patients cardiac T2* pathologic values (below 20 ms) were found in 37 patients. Serum ferritin was negatively associated with age (r=-0.32, p=0.001) and weakly with T2* values (r=-0.19, p=0.057). A positive correlation was found between T2* and LVEF (r=0.27, p=0.006). Out of 37 patients with T2*<20 ms, 18 (48%) had serum ferritin values<1000 ng/ml. In TI cohort, 3 patients had cardiac T2* pathologic values. In AA cohort, pathologic T2* values were found in 2 patients, who received 234 and 199 PRBC units, respectively, and were both on chelation therapy (in one patient ferritin value was 399 ng/ml). T2* values were negatively associated, but not significantly, with the number of PRBC transfused (r=-0.53, p=0.07)., Conclusion: In our experience, 37% of TM patients had a myocardial iron overload assessed by MRI T2*; this value is higher than in TI patients. Serum ferritin measurement was a poor predictor of myocardial siderosis. In patients with AA, more than 200 PRBC units transfused were required to induce cardiac hemosiderosis, in spite of chelation therapy and, in one patient, of normal ferritin values., (Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

The aim of our study was to define cardiac morphological and functional abnormalities of right ventricular dysplasia by magnetic resonance imaging. Twenty-two healthy volunteers (age, 37.7 +/- 14.2 years) free of cardiac or respiratory diseases (group I) and 12 patients (age, 41.9 +/- 15.8 years) with clinical, electrophysiological and cineangiographic diagnosis of right ventricular dysplasia (group II) underwent magnetic resonance imaging at 0.2 Tesla. End-diastolic diameter, trabecular disarray and segmental wall motion abnormalities were evaluated for the right ventricle as were adipose replacement and fractional shortening for both ventricles. The right ventricular end-diastolic diameter was significantly enlarged in group II (P = 0.0023). Right ventricular trabecular disarray was mild in two group I subjects, and moderate in seven and massive in five group II patients. Right ventricular systolic bulges were found in seven group II patients, aneurysms in five. Excellent agreement was found between magnetic resonance imaging and cineangiography for bulges, aneurysms and tricuspid regurgitation (P < 0.0001). On spin-echo images, signal hyperintensities, due to adipose replacement, were found in 44 cardiac regions in group II: right ventricular outflow tract (12), sub-tricuspid posterobasal region (8), right ventricular apex (9), right ventricular anterior wall (6), interventricular septum (4), left ventricular lateral wall (4), left ventricular apex (1). Significant signal-to-noise ratio differences were found between group II abnormal areas and group I myocardial tissue for the right (P < 0.0001) and left ventricles (P = 0.0006). Fractional shortening in the right and left ventricles were significantly reduced in group II (P = 0.0002 and P = 0.00016, respectively). Magnetic resonance imaging can be considered a very useful diagnostic tool for the detection of features typical of right ventricular dysplesia, such as adipose replacement, trabecular disarray, bulges and aneurysms and provides useful information about cardiac function and regional wall motion. It indicates that left ventricular involvement occurs in a significant fraction of patients, and suggests that right ventricular dysplasia may be a generalized cardiomyopathy.