Federica Alviti

Italian version of ASES questionnaire for shoulder assessment: cross-cultural adaptation and validation.

The patient-oriented measures, represented by self-administered questionnaire, have become an important aspect of clinical outcome assessment. To be used with different language groups and in different countries, questionnaires must be translated and adapted to new cultural characteristics and then validated by a widely accepted process to evaluate reliability and validity, fundamental characteristic for each measure. The aim of the study is to perform the cross-cultural adaptation and to assess the Italian version instrument reliability and validity. The study design is a cross-cultural adaptation and cross-sectional study of a sample of patients affected by shoulder disorder with a subsample followed prospectively for retest reliability. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form was culturally adapted for Italian-speaking people, following the simplified Guillemin criteria. Reliability and validity were assessed in a cross-sectional study of 50 consecutive patients affected by shoulder disorder. A sub-sample of 20 patients was followed prospectively for retest reliability. The results were compared with other validated patient-oriented measures. The ASES scales showed a high correlation with other patient-oriented measures, as hypothesized, and it also showed good values with regard to reproducibility, consistency and validity, to the original versions published in English. These findings suggest that the evaluation capacities of the Italian version of ASES are equivalent to those of English language version.

Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction: Anteromedial Portal versus Transtibial Technique—A Randomized Clinical Trial

Purpose  The purpose of this study was to investigate, through three-dimensional computed tomography (3D-CT), the accuracy of femoral tunnel positioning in patients undergoing anterior cruciate ligament (ACL) reconstruction, comparing transtibial (TT) and anteromedial (AM) techniques. Methods  We evaluated postoperative 3D-CT scans of 26 patients treated with ACL reconstruction with hamstrings autograft using a low accessory AM portal technique and 26 treated with the TT technique. The position of the femoral tunnel center was measured with the quadrant method. Results  Using quadrant method on CT scans, femoral tunnels were measured at a mean of 32.2 and 28.1% from the proximal condylar surface (parallel to Blumensaat line) and at a mean of 31.2 and 15.1% from the notch roof (perpendicular to Blumensaat line) for the AM and TT techniques, respectively. Conclusion  The AM portal technique provides more anatomical graft placement than TT techniques. Level of Evidence  Level I, randomized clinical study.

Systematic review of shoulder function questionnaires: comment on the article by Roy et al.

1. Nikpour M, Urowitz MB, Ibanez D, Gladman DD. Frequency and determinants of flare and persistently active disease in systemic lupus erythematosus. Arthritis Rheum 2009;61: 1152–8. 2. Gladman DD, Ibanez D, Urowitz MB. Systemic Lupus Erythematosus Disease Activity Index 2000. J Rheumatol 2002;29:288– 91. 3. Mosca M, Bencivelli W, Vitali C, Carrai P, Neri R, Bombardieri S. The validity of the ECLAM index for the retrospective evaluation of disease activity in systemic lupus erythematosus. Lupus 2000;9:445–50. 4. Gladman DD, Urowitz MB, Goldsmith CH, Fortin P, Ginzler E, Gordon C, et al. The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum 1997;40:809–13.

Comment on “Early Efficacy of Intra-Articular HYADD® 4 (Hymovis®) Injections for Symptomatic Knee Osteoarthritis”

We read with great interest the study by Priano titled “Early efficacy of intra-articular HYADD® 4 (Hymovis®) injections for symptomatic knee osteoarthritis.”1 The author would like to explore the efficacy of intra-articular HYADD 4 (Hymovis) injections for symptomatic knee osteoarthritis. Results from this study are very interesting and promising from a clinical aspect; however, we believe that studying patient’s clinical status with visual analog scale and Western Ontario and McMaster Universities Arthritis Index scale should be supported by biomechanical information. From this point of view, to have more data that could influence the clinical practice, it is important to note the possible action that intraarticular injections of different kinds of hyaluronic acid could have on walking biomechanics using an objective measurement tool as gait analysis. In our opinion, thework by Priano1 is promising because it investigates the efficacy of a new formulation of hyaluronic acid. Nowadays, many hyaluronic acid formulations are approved for clinical use in Europe and the United States. Furthermore, hyaluronic acid injections’ efficacy has been demonstrated also in hip osteoarthritis.2 However, even if these formulations differ in their chemical– physical properties, joint space half-life, rheological properties, and clinical efficacy, there are few studies that investigate hyaluronic acid’s possible action from a biomechanical point of view.3,4 From this point of view, we believe that osteoarthritis management and rehabilitation should be prescribed after an objective analysis of functional walking alterations using gait analysis instrumentations. The use of gait analysis should be desirable during diagnosis and follow-up. In fact, it is capable to identify different walking patterns in patient with osteoarthritis of the lower limbs, whereas the radiology can evaluate the status of the joint’s structures. Moreover, gait analysis can find the exact altered phase of the walking cycle, guaranteeing a precise prescrip-

Comment on “Efficacy of a single intra-articular injection of ultra-high molecular weight hyaluronic acid for hip osteoarthritis: a randomized controlled study”

The original version of this article unfortunately contained a mistake. The first and last names of the authors were interchanged. The correct author names are given below.

Comment on “Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis”

We read with great interest the study by Lee et al. titled “Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis” [1]. The authors were able to evaluate and compare the effects and outcomes of the extracorporeal shock wave therapy and intraarticular injections of hyaluronic acid in patients with knee osteoarthritis. This research is considered relevant and interesting, especially because it is noted that the authors compare an invasive therapy, such the intraarticular injections, with the administration of an extracorporeal show wave therapy, which is notably a kind of therapy that does not involve the interruption of the integrity of the skin. It is noted that the results from the study are promising from a clinical aspect; however, we would like to underline how the studying and review of the patient’s clinical status with a visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-m fast-paced walk test, and stair-climb test should be supported by biomechanical information obtained from the precise study of walking pattern using a gait analysis. From this point of view, it is our determination that a gait analysis evaluation should be considered as an objective and useful instrumentation in order to have more data that could identify differences in the walking cycle’s sub-phases, before and after any kind of treatment for lower limb’s osteoarthritis. In our opinion, the work performed by Lee et al. [1] is relevant, important and useful, however, with would like to ask to the authors if they have the intention to provide results after a longer follow up time frame to be comprehensively reviewed in a further study. We recognize and agree that the subject of knee osteoarthritis is a theme currently representing an emerging topic for its increasing incidence, and it is well known that knee osteoarthritis is a chronic disease that could lead to important long-lasting disability. Therefore, knowing the Annals of Rehabilitation Medicine Ann Rehabil Med 2018;42(2):372-373 pISSN: 2234-0645 • eISSN: 2234-0653 https://doi.org/10.5535/arm.2018.42.2.372

Achilles Tendon Open Surgical Treatment With Platelet-Rich Fibrin Matrix Augmentation: Biomechanical Evaluation

ABSTRACT The relationship between surgical technique and ankle biomechanical properties after surgery for acute rupture of the Achilles tendon (ATR) has not yet been fully investigated. Platelet‐rich fibrin (PRF) matrices seem to play a central role in the complex processes of tendon healing. Our aim was to analyze the biomechanical characteristics, stiffness, and mechanical work of the ankle during walking in patients who had undergone surgery after ATR with and without PRF augmentation. We performed a retrospective review of all consecutive patients who had been treated with surgical repair after ATR. Of the 20 male subjects enrolled, 9 (45%) had undergone conventional open repair of the Achilles tendon using the Krackow technique (no‐PRF) and 11 (55%) had undergone surgery with PRF augmentation. An additional 8 healthy subjects were included as a control group. A gait analysis evaluation was performed at 6 months after surgery. The percentage of the stance time of the operated leg, double‐support time of the healthy leg, and net work of the ankle during the gait cycle showed statistically significant differences between the no‐PRF and the healthy group (p < .005). No differences were found between the PRF and healthy groups. Treatment with suture and PRF augmentation could result in significant functional improvements in term of efficiency of motion.

Aerobic Fitness protects from Atherosclerotic Cardiovascular Risk Paralympic Athletes with a Locomotor Impairment

Aim: This study, carried out on Paralympic athletes (PA) with a locomotor impairment (LI), was aimed at: 1. assessing the prevalence of atherosclerotic cardiovascular disease (ACVD) risk factors (RF) in PA with either a spinal cord injury (PA-SCI) or other (different from SCI) LI (PA-OLI); 2. evaluating the hypothesis that aerobic fitness (oxygen uptake peak - VO2peak) was inversely related to ACVD RF. Methods: A total of 135 male PA (72 PA-SCI, 28 PA with lower limb amputation, 12 PA with a cerebral palsy/brain injury, 7 PA with poliomyelitis, 9 PA with other neurological disorders and 7 PA with other orthopedic disorders) were screened through anthropometric and blood pressure (BP) measurements, laboratory blood tests and graded cardiopulmonary maximal exercise test, to estimate both an ACVD-RF score and VO2peak. The ACVD-RF score was assessed summing 1 point for each of the following RF: obesity –OB- (BMI≥30 or waist circumference ≥102 cm), hypertension –HT- (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg), dyslipidemia -DL- (total Cholesterol -C- ≥200 mg·dl-1 or LDL-C ≥130 mg·dl-1 or HDL-C <40mg·dl-1), impaired fasting glucose -IG- (fasting plasma glucose ≥100 mg·dl-1) and subtracting 1 point when serum HDL-C was higher than 60 mg·dl-1. Results: Prevalence of OB, HT, DL, IG and high HDL-C were equal to 5.9% and 3.2%, 13.9% and 14.3%, 58.3% and 49%, 29.2% and 34.9%, 27.8% and 17.4%, in PA-SCI and PA-OLI, respectively. Based on the ACVD RF, 3 groups were formed: group 1 (RF≤0, N=54), group 2 (RF=1, N=41), group 3 (RF≥2, N=40). VO2peak was equal to 37.9±14.71 ml·kg-1·min-1, 30.9±9.13 ml·kg-1·min-1 and 24.1±5.50 ml·kg-1·min-1 in the PA of groups 1, 2 and 3, respectively. Conclusions: Being VO2peak inversely related to groups of ACDR RF, high aerobic fitness provides a protective effect on ACVD morbidity in PA.

Meta‐analysis of hyaluronate injections for shoulder pain: Comment on the article by Saito et al

We read with great interest the article by Saito et al, published recently in Arthritis Care & Research, regarding hyaluronate injections (Saito S, Furuya T, Kotake S. Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: a meta-analysis of randomized controlled trials. Arthritis Care Res [Hoboken] 2010;62: 1009–18). Although we appreciate the effective study design and the clear exposure, we would like to comment on the variability of diagnosis of shoulder pain included in the meta-analysis. First, “periarthritis” is an old and imprecise diagnosis. Today we are able to precisely identify the pathologic tendon involved in the disease. Therefore, in a scientific article, this term should be substituted with the precise diagnosis that represents the different pathologic situations and the different structures involved in the disease. Second, the hyaluronate injections in the analyzed studies were performed in different locations (e.g., subacromial space, intraarticular joint, etc.). These facts, in our opinion, make the study by Saito et al less effective. In order to provide potentially useful information for therapeutic recommendations, the diagnosis and treatment must be more homogenous.