Valentina Casale

Emerging Orthobiologic Approaches to Tendon Injuries

With the increasing popularity of sport activities, the frequency of sport-related lesions, such as tendon injuries, is rapidly rising [1]. Orthobiology is a new exciting area of medical research aimed to enhance tendon tissue healing. New therapies are emerging with promising results, but further investigation is warranted to better define indications, techniques, modalities, safety, and cost-effectiveness.

Pain management in total knee arthroplasty: efficacy of a multimodal opiate-free protocol.

PURPOSE this study was conducted to identify the most effective method of postoperative pain management, comparing the intravenous opiate infusion protocol with the use of a single periarticular local anesthetic infiltration (LAI) in patients undergoing total knee arthroplasty (TKA) surgery. METHODS 50 patients submitted to TKA surgery between 2013 and 2015 were divided into two groups. Buprenorphine was administered intravenously to the patients in Group A, while the Group B patients received a single periarticular LAI (ropivacaine and ketorolac) during surgery. Pain was assessed using a visual analog scale (VAS) and the knee injury and osteoarthritis outcome score. Hemoglobin and hematocrit were measured in the early postoperative period and at 40 days post-surgery. Range of motion and inflammatory markers were also assessed. Statistical analysis was performed using Students t-test. RESULTS students t-test showed no significant difference between the groups in functional outcomes or blood values, but a difference in VAS score on the day of surgery was found (p < 0.0001), in favor of Group B. CONCLUSIONS LAI considerably reduces postoperative pain, allowing rapid mobilization and accelerating functional recovery. LEVEL OF EVIDENCE Level I, prospective single-blind randomized trial.

Surgical Treatment of Patellar Tendinopathy

Patellar tendinopathy is a common musculoskeletal disorder among recreational and professional athletes. It has an important impact on the athletes’ careers, because of its high prevalence, the resulting impairment of knee function, and its chronic clinical course Surgery is recommended in the presence of patellar tendinopathy only when the conservative treatment has failed. Both open and arthroscopic procedures are widely used, even if arthroscopy is preferred due to its shorter recovery times. The surgical rationale consists in the debridement of the damaged tissue, and performing apicectomy could be an option in case of bony protrusion. The mean time to return to sports activities is 3–6 months.The healing process requires time to avoid postoperative complications, thus the rehabilitation program should not be too aggressive.

Adductor and Upright Abdominal Tendinopathy

Insertional tendinopathy of the adductors and the rectus abdominis is common in male athletes, especially in soccer players. Dysfunction of the adductor muscles represents the most common single cause of groin pain in athletes. If preventive measures and conservative treatment fail, an open or percutaneous approach may be effective and allows return to sport activities.

Arthroscopic debridement and bone marrow stimulation for talar osteochondral lesions: current concepts

Symptomatic osteochondral lesions of the talus are a common cause of ankle pain and frequently occur among recreational and professional athletes. These lesions are being increasingly diagnosed and a great variety of treatment approaches exist. Since the talar cartilage has poor repair capacity, the aim of treatment paradigms is to restore the joint surface with a repair tissue as similar as possible to the original cartilage to provide good long-term results. Multiple surgical approaches have been described over the past years in order to identify the ideal treatment option. Arthroscopic debridement and bone marrow stimulation techniques have increasingly gained consensus. We aimed to review the available evidence on these arthroscopic minimally invasive approaches for osteochondral talar lesions.

Return to Sport After Muscle Tendon Lesions

Muscle and tendon injuries are extremely common in athletes. Appropriate diagnosis and management, including exact medical history and detailed clinical investigation, can optimize recovery and time to return to play. It is extremely important to maintain good physical conditions while the lesion heals. In addition, a positive attitude can hasten the recovery.

Arthroscopic Debridement of Osteochondral Lesions of the Talus

Osteochondral ankle defects are mostly caused by a traumatic event but can occur even spontaneously. Conservative treatment is the first choice of management, but in case of persistence of symptoms, surgical treatment is required.