Renato Andrade

Notch morphology is a risk factor for ACL injury: a systematic review and meta-analysis

Importance Several bone morphological parameters have been identified in the scientific literature as risk factors for sustaining an anterior cruciate ligament (ACL) injury; however, a clear consensus on which are the most predisposing factors is still missing. Aim This systematic review and meta-analysis aims to investigate the association between bone morphological parameters and the risk of sustaining an ACL injury. Evidence review We conducted a comprehensive search using PubMed, Cochrane Library, Scopus, CINAHL and SPORTDiscus databases from 2005 until 2015. Two authors independently searched for relevant studies that assessed the association between bone morphology and ACL injury. Other search sources were used for hand-searching additional potential studies and the reference list of recent studies was screened. The methodological quality of the included studies was assessed through an adapted scale for radiological studies. A fixed-effects or random-effects model was used accordingly to estimate the mean differences with 95% CIs regarding the association of ACL injury with intercondylar notch (ICN) width, notch width index (NWI) and tibial slopes. Findings 23 studies were included for analysis comprising a total of 3452 participants, 1681 with an ACL injury and 1763 with an intact ACL. The ACL-injured individuals had narrower ICN width (p<0.001), smaller NWI (p=0.005) and steeper tibial slope (p<0.001). Conclusions On the basis of the current scientific literature, narrower ICN widths, smaller NWI and increased tibial slopes put the individual at higher risk of injuring the ACL. Future research should focus on developing indexes for different parameters rather than absolute measurements.

Reverse shoulder arthroplasty for irreparable massive rotator cuff tears: a systematic review with meta-analysis and meta-regression

BACKGROUND Massive rotator cuff tears (MRCTs) are very large tears that are often associated with an uncertain prognosis. Indeed, some MRCTs even without osteoarthritis are considered irreparable, and nonanatomic solutions are needed to improve the patients symptoms. Reverse shoulder arthroplasty (RSA) is an option that can provide a more predictable pain relief and recovery of function. Nonetheless, outcomes after RSA for irreparable MRCTs have not been well defined. The aim of this study was to quantitatively aggregate the findings associated with the use of RSA in this subset of patients and analyze the effect on patient functional status and pain. METHODS A comprehensive search was performed until October 2015 using MEDLINE, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials databases. Studies that assessed the outcomes of RSA in patients with irreparable MRCT without osteoarthritis (with at least 2 years of follow-up) were included. If the results of MRCT without osteoarthritis were not possible to subgroup, the study was excluded. Methodologic quality was assessed using the Coleman Methodology Score. RESULTS Included were 6 studies (266 shoulders) with a follow-up ranging from 24 to 61.4 months. The mean Coleman Methodology Score was 58.2 ± 11.8 points. There was an overall improvement from preoperative to postoperative assessments of the clinical score (Cohen d = 1.35, P < .001), forward flexion (d = 0.50, P = .009), external rotation (d = 0.40, P < .001), function (d = 1.04, P < .001), and pain (d = -0.89, P < .001). CONCLUSION Patients with irreparable MRCT without presence of osteoarthritis have a high likelihood of achieving a painless shoulder and functional improvements after RSA.

Aging hallmarks: the benefits of physical exercise

World population has been continuously increasing and progressively aging. Aging is characterized by a complex and intraindividual process associated with nine major cellular and molecular hallmarks, namely, genomic instability, telomere attrition, epigenetic alterations, a loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. This review exposes the positive antiaging impact of physical exercise at the cellular level, highlighting its specific role in attenuating the aging effects of each hallmark. Exercise should be seen as a polypill, which improves the health-related quality of life and functional capabilities while mitigating physiological changes and comorbidities associated with aging. To achieve a framework of effective physical exercise interventions on aging, further research on its benefits and the most effective strategies is encouraged.

MRI-Based Laxity Measurement for Return to Play

The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligament (ACL) lesion has an essential role in the knee stability assessment. These measurements can further be evaluated through magnetic resonance imaging (MRI), which in combination with instrumented assessment and physical examination can correlate both the “anatomy” and “function” of the ligament. The Porto-Knee Testing Device (PKTD) is a knee laxity testing device compatible with MRI that is capable of measuring the posterior-anterior tibial translation and tibial internal and external rotation. In this sense, the PKTD is a useful tool for the assessment of knee sagittal and rotatory laxity in the follow-up of football players that underwent ACL reconstruction. Hence, this tool may allow to identify individuals presenting residual knee laxity with increased risk of sustaining secondary ACL injuries and assist in the planning of secondary prevention programs.

Clinical Management in Early OA

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

Management of Cartilage Injuries in Handball

Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the handball player competitive career. Returning to competition at the pre-injury sports activity level as early and as safe as possible is the ultimate goal to be achieved. There is no consensus on the best surgical technique, and clinical algorithms have been proposed to manage the different articular cartilage defects. The chapter will also overview and summarize the available conservative and surgical management options and stepwise criteria-based rehabilitation strategy and return to play considerations in handball players with focal cartilage defects and osteochondral lesions.

Return to Play Following Cartilage Injuries

Articular cartilage lesions are serious injuries, particularly in the football player, once these may endanger the athlete’s competitive career. Returning to competition at the preinjury sports activity level as fast and as safe as possible is the ultimate goal to be achieved. Although there is no consensus on the best surgical technique, clinical algorithms have been proposed to manage the different articular cartilage defects. Herein, we summarize the available clinical treatment possibilities for addressing focal cartilage defects and osteochondral lesions. We also overview the three rehabilitation phases and the progression of the patient within these plans shall follow objective criteria. The considerations to return to play are also briefly discussed herein.

Percutaneous Instrumentation and Reduction Technique for the Treatment of Thoracolumbar Fractures: A Case Report

Minimally invasive spine surgery suffered a sustained development in the last 15 years. One of its main goals is to achieve the same results as conventional surgery with less blood loss, muscle damage, infection rate, and hospital stay. Surgical management of thoracolumbar fractures aims to correct sagittal deformities and provide a stable and durable fixation. This article describes a new percutaneous method of thoracolumbar fracture reduction based on the 6-screw construct, which promotes an indirect reduction of the fractured vertebrae with lordotic rods connected with 4 long monoaxial percutaneous pedicle screws in the fractured and upper adjacent vertebrae. The vertebra below the fractured one is instrumented with polyaxial screws to facilitate the introduction of the lordotic rods. The postoperative radiography and computed tomography imaging results show that this technique is able to correct posttraumatic kyphosis and provide a solid and durable construct.

Injury of Ankle Ligaments

Injury of the ankle ligaments is very common during sports participation. These injuries may result in mechanical and/or functional ankle instability, which if not treated properly might develop into chronic instability. Diagnosis is made through comprehensive medical history taking and manual testing, which may be complemented with imaging studies. Both conservative and surgical treatments have shown good results; however, when considering elite athletes, the surgical management is preferred. Several preventive strategies have emerged providing a cost-effective approach to reduce the risk of ankle ligament injury. Tibiofibular syndesmotic injuries should be treated conservatively when stable and surgically when unstable. Similarly, isolated superficial deltoid ligament injuries may be treated through a conservative approached, and, in case of insufficiency, the approach should be surgical. A rapid return to sports participation should be expected with a reasonable return to the pre-injury levels.

Arthroscopic and open repair of massive rotator cuff tears have similar results: a systematic review

Importance The surgical outcomes of massive rotator cuff tears (MRCTs) repair are poorly reported in the scientific literature. Objective This study aimed to evaluate the reported outcomes of open or arthroscopic repair of MRCTs. Evidence review We comprehensively searched the Medline, Scopus, Cochrane Database of Systematic Reviews and CENTRAL databases up to January 2017. We included studies with a prospective design assessing the outcomes of open or arthroscopic repair of MRCTs, with a minimum of 1 year of follow-up. We excluded studies in which subgrouping of massive tears was not possible. We assessed the methodological quality of the studies using the Coleman methodology score. Findings We included 12 studies (comprising 990 patients, 511 of whom had an MRCT): eight reported the arthroscopic rotator cuff repair outcomes, two reported open repair and the other two reported the outcomes of both techniques. The mean follow-up time was 57 months (range 12–108). A quantitative synthesis of the arthroscopic rotator cuff repair results showed clinical improvements in the Constant and American Shoulder and Elbow Surgeons scores from preoperatively to postoperatively. Comparing the arthroscopic and open repair procedures, we observed similar pooled weighted means for the Constant, University of California, Los Angeles and American Shoulder and Elbow Surgeons scores at 26–56 months of follow-up. Conclusions and relevance Both arthroscopic and open repair produced similar and improved postoperative outcomes to those preoperatively. MRCT repair requires further research and better reporting to obtain stronger conclusions. Level of evidence Level II, systematic review and meta-analysis.