Professional football training strategies during home confinement in the COVID-19 pandemic.

BACKGROUND: SARS-CoV-2 emergency forced athletes to train at home on their own and mostly unsupervised, making it difficult to provide training solutions. The aims of the study were 1) to collect data and experiences from a Serie A male football team, a top-level female football team and a male young elite football team; 2) to compare data from lockdown and pre-lockdown period; 3) to report changes in training strategies adopted to overcome logistical constraints and 4) to evaluate their congruence to cardio, strength and stretching recommendation mentioned above; 5) to report compliance through player daily feedback. METHODS: Three different professional football teams were enrolled. From March 16, 2020 to April 13, 2020, data for each team were recorded weekly and compared to a standard training period (October 15th to November 15th, 2019) from the same groups. The rate of perceived exertion (RPE), Visual Analogue Scale (VAS) and Total Quality of Recovery Scale (TQR) values were used to compare the two periods using The Student t-Test and Pearson Test. RESULTS: Each group chose a different training approach. Between the pre-lockdown and the lockdown period, there was no significant difference in the VAS, TQR and RPE indexes. Other else players' compliance differed between the groups during the lockdown period. CONCLUSIONS: Most athletes maintained a high level of training during the COVID-19 forced isolation, thanks to the help of team athletic trainers who provide functional tools and indications customized for each differ. Athletes' feedback and compliance differed according to their gender and age. Monitoring with live video sessions and social group sharing among younger players improved compliance and aggregation.

ACL Reconstruction Combined With the Arnold-Coker Modification of the MacIntosh Lateral Extra-articular Tenodesis: Long-term Clinical and Radiological Outcomes.

BACKGROUND: Interest in the role of lateral extra-articular tenodesis (LET) in preventing rotatory instability and the pivot-shift phenomenon after anterior cruciate ligament reconstruction (ACLR) has been recently renewed. Nevertheless, there is still concern about overconstraint of the lateral compartment of the knee and the risk of subsequent osteoarthritis (OA). PURPOSE: The purpose of this retrospective study was to compare long-term subjective and objective outcomes and the rate of OA development between patients undergoing isolated ACLR (iACLR) with a hamstring tendon autograft and those with a combined Arnold-Coker modification of the McIntosh extra-articular procedure. Risk factors for long-term OA were evaluated. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study included 165 consecutive patients treated at a single center by ACLR. A total of 86 patients underwent iACLR (iACLR group) and 79 received combined intra- and extra-articular reconstruction (ACLR+LET). The International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores were administered. Knee stability was tested through the Lachman test, the pivot-shift test, and the KT-1000 knee arthrometer test. A positive pivot-shift test (++/+++), laxity on the KT-1000, and referred giving-way episodes or revision ACLR were considered failures. Radiographic results were assessed according to the Fairbank, IKDC, and Kellgren-Lawrence scales. Radiographic evaluation included both the overall tibiofemoral joint and the medial and lateral compartment separately. A univariate and a multivariate logistic regression with penalized maximum likelihood was used to identify risks factors associated with long-term OA. RESULTS: The mean follow-up was 15.7 years. There were no statistically significant differences in subjective scores between the 2 groups. A side-to-side difference >5 mm on the KT-1000 arthrometer evaluation was found in 8 patients in the iACLR group and in 1 patient in the ACLR+LET group (P = .01). Nine cases of failure were found in the iACLR group and only 1 case was found in the ACLR+LET group (P = .0093). Patients in the iACLR group had a significantly higher OA grades than those in the ACLR+LET group for the overall tibiofemoral joint and the lateral compartment of the knee. No differences were found in the medial compartment. A higher level of lateral compartment OA was found in patients who received partial lateral meniscectomy in the iACLR group compared with those in the ACLR+LET group. Univariate and multivariate analysis results demonstrated that meniscectomy was the most significant factor for long-term OA development. CONCLUSION: A significantly higher risk of long-term OA was found with iACLR than with ACLR combined with the Arnold-Coker modification of the McIntosh extra-articular procedure. Knees with combined ACLR also had a significantly lower OA grade after partial lateral meniscectomy. Additionally, those undergoing combined ACLR had better knee stability and lower graft rupture rates at the long-term follow-up. Partial meniscectomy was the main risk factor negatively associated with OA changes.

The unhappy triad of the knee re-revisited.

AIM OF THE STUDY: To describe the surgical findings of the anterolateral complex in patients with the "unhappy triad" lesion of the knee. METHOD: One hundred and twenty-five consecutive patients presenting with acute anterior cruciate ligament (ACL) tears were selected for this study. Only cases, evaluated with a valgus stress test under fluoroscopy, with a medial opening more than 5 mm of the medial collateral ligament (MCL) were included in the study (11 patients). For the included cases, open MCL surgical repair was performed only in cases with a valgus stress test more than 10 mm as revealed by fluoroscopy (3 patients). All included cases (11 patients) underwent ACL reconstruction and exploration of the anterolateral complex that was then assessed, photographed, classified, and eventually repaired. RESULTS: At clinical evaluation under anaesthesia, all patients presented a positive Lachman test and a pivot shift test graded as ++ in four cases and +++ in five cases, not valuable in two cases. At surgical exploration, the anterolateral complex was involved in all cases (11 patients): one case demonstrated a type I injury, eight cases a type II injury, two cases a type III injury, and no patient with a type IV injury (Segond's fracture). All anterolateral complex lesions were repaired by direct suture and re-tensioning. DISCUSSION: On the basis of a recent analysis performed by other authors, we could speculate that injuries of ACL and anterolateral compartment occur in the very early phase of the injury when the knee is forced into internal rotation. The MRI evidence of bone bruising in the lateral compartment in most cases of the present series support the hypothesis of an internal rotation torque. CONCLUSIONS: The unhappy triad of injuries to the knee is actually a tetrad involving not just the ACL, MCL, and medial/lateral meniscus but also involved the anterolateral complex.

Latarjet procedure versus open capsuloplasty in traumatic anterior shoulder dislocation: long-term clinical and functional results.

PURPOSE: To compare the results of two different open surgical techniques (open capsuloplasty and Bristow-Latarjet procedure) at a mid- to long-term follow-up (6 years) in patients with recurrent traumatic anterior shoulder dislocations. METHODS: Seventy-three patients (73 shoulders, 48 males; 25 females) fulfilled inclusion and exclusion criteria. Patients were classified as group A if operated on with a Bristow-Latarjet procedure (40 patients, 24 males; 16 females) or group B if operated on with an open capsuloplasty (33 patients, 24 males; 9 females). All patients were followed up with physical examination and functional evaluation scores (UCLA, ROWE and WOSI). RESULTS: In group A, no further episodes of dislocation or subluxation were reported; in group B, one patient (3.3%) reported a new episode of anterior dislocation as a result of a new trauma. No statistical difference in regard of new episodes of shoulder dislocation was found between the two groups (p > 0.05). At physical examination, two patients (5%) of group A and four patients of group B (13.3%) showed a positive apprehension test (p > 0.05); anterior drawer test was positive in six patients (15%) of group A and in nine patients (30%) of group B (p > 0.05). Statistical analysis showed better external rotation in group A (Latarjet group) than in group B. (p = 0.0176). No statistical differences were detected in regard to the scale scores (UCLA, WOSI, Rowe) (p > 0.05). Regarding the return to sport, 29 patients (72.5%) of group A and 18 patients (60%) of group B reported they resumed the same sports activity at the same pre-operative level (p > 0.05). CONCLUSION: Open capsuloplasty and Bristow-Latarjet procedure are both validated surgical techniques for the treatment of recurrent shoulder anterior instability. We found no statistical difference in terms of recurrent dislocation rates, clinical shoulder stability tests, and scoring scales. The rate of patients returning to sport was similar after both techniques. However, patients with open capsuloplasty reported a significantly lower recovery of external rotation than patients operated via the Latarjet procedure.

Anterior cruciate ligament reconstruction in patients older than fifty years: a comparison with a younger age group.

PURPOSE: To evaluate functional and radiological results in patients older than 50 years who underwent an anatomic anterior cruciate ligament (ACL) reconstruction with semitendinosus and gracilis tendons and to compare these results with those of patients younger than 40 years. METHODS: Thirty-six patients over the age of 50 years with a diagnosis of ACL complete lesion and 36 consecutive patients under 40 years were included in this prospective study. Follow-up included clinical evaluation using Lysholm, IKDC, and Tegner scores and a KT-1000 arthrometric evaluation. Bilateral weight-bearing radiographs were obtained before surgery and at final follow-up of five years to evaluate the degree of osteoarthritis. All patients were evaluated at a one year follow-up (T1) (range 13-17 months) and at final follow-up (T2) (range 60-72 months). RESULTS: No statistically significant difference was found between the two groups at the subjective and objective evaluations. At a KT-1000 arthrometric evaluation, the mean side to side maximum manual difference was 1.6 mm in the over 50 (group I) and 2.7 mm in the under 40 (group II) (p = 0.009). At 30 lb, the mean side to side difference was 1.7 mm in the over 50 group and 2.6 mm in the under 40 group (p = 0.040). No statistically significant increase in the degree of osteoarthritis was found at follow-up in the over 50 group. CONCLUSIONS: The results of this study seems to confirm that ACL reconstruction in patients older than 50 years is a safe procedure with good to excellent subjective, objective, and radiological outcomes that are comparable to those for younger patients.

Long-Term Results of Anterior Cruciate Ligament Reconstruction Using Hamstring Grafts and the Outside-In Technique: A Comparison Between 5- and 15-Year Follow-up.

BACKGROUND: Increased femoral tunnel widening and weakness of the hamstring muscles postoperatively have been described as potential adverse events after anterior cruciate ligament (ACL) reconstruction (ACLR) with a hamstring graft. Meniscectomy and cartilage lesions are important factors for the development of degenerative osteoarthritis. PURPOSE: To compare 15-year follow-up data with 5-year follow-up data from the same cohort of patients after ACLR with a hamstring autograft using an outside-in technique. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 72 patients who underwent anatomic ACLR with a quadruple hamstring graft and an outside-in technique were selected for this prospective study. Patients were reviewed at a minimum follow-up of 15 years. Results were compared with the same series of patients previously reviewed at 5 years after surgery. Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores as well as KT-1000 arthrometer measurements were obtained at final follow-up. Comparative weightbearing radiographs were obtained and analyzed according to the Fairbank, Kellgren-Lawrence, and IKDC classifications and used for the tunnel evaluation. RESULTS: No significant difference was detected on the subjective evaluation. Objectively, patients categorized as A or B according to the IKDC score were not significantly different at 5 and 15 years (P < .01). A KT-1000 arthrometer side-to-side manual maximum difference >5 mm, a pivot shift >2+, any giving-way episode, and ACL revision surgery were considered as failures, and these were noted in 6 patients at 5 years and 6 patients at 15 years. The radiological evaluation at 15 years showed a higher rate of osteoarthritis in 2 of 3 radiological scales used in the study compared with results at 5-year follow-up (P < .01). At 15-year follow-up, there was a statistically significant reduction in the mean tibial tunnel diameter (P < .01). CONCLUSION: Endoscopic single-bundle ACLR using hamstring grafts and an outside-in technique demonstrated good results at 15-year follow-up in terms of subjective, objective, and radiographic evaluations. As compared with 5-year follow-up, clinical results remained stable both subjectively and objectively. However, a progression of osteoarthritis changes was observed, especially in patients in whom meniscectomy had been performed.

The role of diabetes mellitus and BMI in the surgical treatment of ankle fractures.

BACKGROUND: Open reduction and internal fixation is the standard treatment for displaced ankle fractures. However, the presence of comorbidities such as diabetes mellitus and body mass index (BMI) are associated with poor bone quality, and these factors may predict the development of postoperative complications. The study aim was to assess the role of diabetes mellitus and BMI in wound healing in patients younger than 65 years who were surgically treated for malleoli fractures. METHODS: Ninety patients, aged from 18 to 65 years old, with surgically treated ankle fracture, were retrospectively enrolled. Patients were classified in two groups: patient with diabetes and patients without diabetes (insulin-dependent and noninsulin dependent). All patients were assessed for wound complications, Visual Analogue Scale and Foot and Ankle Disability Index (FADI) were assessed for all patients. Logistic regression was used to identify the risk of wound complications after surgery using the following factors as explanatory variables: age, gender, duration of surgery, BMI, hypercholesterolemia, smoking history, diabetes mellitus, and high blood pressure. RESULTS: In total, 38.9% of patients showed wound complications. Of them, 17.1% were nondiabetics and 82.9% were diabetics. We observed a significant association between DM and wound complications after surgery (P = .005). Logistic regression analysis revealed that DM (P < .001) and BMI (P = .03) were associated with wound complications. The odds of having a postoperative wound complication were increased 0.16 times in the presence of diabetes and 1.14 times for increasing BMI. CONCLUSION: This study showed that diabetes mellitus and higher BMI delay the wound healing and increase the complication rate in young adult patients with surgically treated bimalleolar fractures.

Combined Intra-articular and Extra-articular Reconstruction in Anterior Cruciate Ligament-Deficient Knee: 25 Years Later.

PURPOSE: To determine whether an anterior cruciate ligament (ACL)-reconstructed knee with hamstring autograft has a greater incidence of degenerative changes when an extra-articular reconstruction is added and to determine the effect of the combined reconstruction on knee stability and function at long-term follow-up. METHODS: For this retrospective study, patients who underwent ACL reconstruction between January 2002 and December 2003 were selected and classified into 2 groups, I and II. Group I consisted of patients operated by a standard ACL reconstruction, and group II consisted of patients in whom, owing to the presence of risk factors (severe pivot shift graded +++ or high-risk sports), an extra-articular reconstruction performed with ileo-tibial tract according to McIntosh as modified by Cocker Arnold technique, was used in conjunction with intra-articular ACL reconstruction. At final follow-up, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores were used. An arthrometric KT-1000 evaluation was done. Comparative weight-bearing radiographs were taken, including a skyline view for the patellofemoral joint and analyzed according to Fairbank, Kellgren, and IKDC classification. RESULTS: Seventy-two of the 75 (96%) patients in group I and 68 of the 75 patients in group II were available at the final follow-up (minimum 10 years). Subjective scores improved significantly in both groups, with no significant difference. Objectively, the number of patients receiving C and D IKDC objective activity scores in group I (7/56; 12.5%) was significantly higher than in group II (0/60) (P = .01). Considering as a failure a side-to-side arthrometric difference more than 5 mm or a pivot shift test graded as ++ or +++, or any giving way episode occurring postoperatively, we found 8 cases in group I and no cases in group II (P = .01) despite the presence of risk factors that group I did not include. Radiologic evaluation showed less arthritic changes in group II in both tibiofemoral and patellofemoral joints. CONCLUSIONS: On the basis of the results of this study, adding an extra-articular reconstruction to an anatomically placed intra-articular ACL reconstruction, followed by a modern rehabilitation protocol, does not increase the risk of osteoarthritis and may be able to reduce the rate of failure. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Knee stability after anterior cruciate ligament reconstruction in patients older than forty years: comparison between different age groups.

PURPOSE: The aim of this study was to compare clinical and arthrometrical results of a series of patients older than 40 years with those of younger patients following anterior cruciate ligament (ACL) reconstruction. The hypothesis of this study was that certain biological and biomechanical factors related to middle-aged patients, ACL reconstruction would provide different results compared with younger patients. METHODS: Thirty-six patients >40 years operated for ACL reconstruction between 2002 and 2010 were selected for this retrospective study, and results were compared with patients in two other age groups (<30 years and 30-40 years). At a minimum follow-up of two years, patients were reviewed and clinically examined subjectively and objectively according to Tegner, International Knee Documentation Committee (IKDC) classification and Lysholm evaluation scales. An arthrometric evaluation with KT-1000 was also performed. RESULTS: No statistically significant difference was found among the three different age groups at the subjective and objective evaluations. However, the KT-1000 arthrometric study showed a statistically significant mean side-to-side difference at 30 lb with 1.8 mm [standard deviation (SD) 2.4] for patients >40 years, 2.7 mm (SD 1.8) for patients aged 30-40 years and 2.6 mm (SD 1.8) for patients <30 years. CONCLUSIONS: Our results seem to show that ACL reconstruction is a safe and valid option for patients of all age groups, even for those >40 years. Moreover, in that group, greater knee stability was found when compared with the younger patient groups.