The grade of preoperative subscapularis muscle atrophy as a prognostic factor for postoperative retears: A double-center retrospective series.

The aim of the study was to investigate whether subscapularis muscle atrophy is a negative prognostic factor leading to increased risk of retears in patients treated with an arthroscopic subscapularis tendon repair. We hypothesized that fatty infiltration of the subscapularis muscle deteriorates the clinical and sonographic outcome of the arthroscopic repair and inhibits reparability of the ruptured tendons. A double- center, multinational, retrospective, blind (in the follow-up) clinical study regarding 32 patients who underwent an arthroscopic subscapularis repair was conducted. Patients were divided into two groups according to the preoparative fatty infiltration grade of subscapularis muscle (group A: grade

Italian consensus conference on guidelines for conservative treatment on lower limb muscle injuries in athlete.

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV.

Posterior cruciate ligament reconstruction with "all-inside" technique: a technical note.

INTRODUCTION: posterior cruciate ligament (PCL) injuries are an increasingly recognized cause of knee instability in the practice of orthopaedic surgery and sports medicine. Clinical interest in these injuries has been increasing over the last several decades as knowledge and understanding of the biomechanical consequences and surgical reconstruction options have progressed. These injuries can be extremely challenging for the treating physician as substantial controversy exists regarding the optimal management of this problem. There has also been increasing interest and recognition of the importance of secondary stabilizing structures, including the posterolateral and posteromedial corner injuries as well as the issues with malalignment that must also be addressed at the time of PCL surgery to optimize results. Thanks to the continuous research for a correct anatomical placement and new systems of fixation, we can now perform the tibial and femoral bone tunnel more easily and safely by retrograde out-in approach with a special "drill-pin". CONCLUSION: this technique provides a graduated precise execution of the tunnels. New methods were also developed to determine the so-called "second-generation cortical suspensory fixations" that have the feature of being "Adjustable": shortens implant by pulling on strands to allow cinching graft passing and tensioning button to regulate their length after fixation and then to create tension in the new graft, once introduced into the joint.

Ibandronate and periprosthetic bone mass: new therapeutic approach in periprosthetic loosening prevention.

A prosthetic implant modifies the physiological transmission of loads to the bone, initiating a remodeling process.Studies of the mechanisms responsible for periprosthetic bone loss contributed to the definition of new pharmacological strategies that may prevent aseptic implant loosening. Bisphosphonates are a class of drugs useful to this purpose, and have been shown to be effective in reducing periprosthetic resorption during the first year after the implant. We aimed to assess the inhibitory effect on periprosthetic osteolysis of ibandronate, a highly potent aminobisphosphonate, administered orally and IV with an extended interval between doses and optimal treatment adherence. In view of the fact that periprosthetic remodeling takes place during the first 6-12 months after surgery and is ultimately responsible for prosthesis longevity, we may conclude that the administration of high dosage ibandronate postsurgery by IV bolus and subsequently as cyclic oral treatment reduced cortical osteopenia in the metaphyseal region, and in the calcar region of the proximal femur. This therapy might therefore be used as preventive measure against postsurgical osteopenia and probably also against aseptic loosening.