Genome-Wide Association Screens for Anterior Cruciate Ligament Tears.

BACKGROUND: The etiopathogenesis of ACL rupture is not clarified. The aim of this study is to identify genomic regions and genetic variants relevant to anterior cruciate ligament injury susceptibility that could be involved in non-contact anterior cruciate ligament ruptures. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with a PRISMA checklist and algorithm. A search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases was conducted using combinations of the terms "anterior cruciate ligament", "ACL", "rupture", "genetics", "single nucleotide polymorphisms", and "SNP" since the inception of the databases until 2021. RESULTS: Twenty-three studies were included. A total of 7724 patients were analyzed. In total, 3477 patients had ACL ruptures and 4247 patients were controls. Genetic variants in genes encoding for collagens, elastin, fibrillin, matrix metalloproteinases, proteoglycans, angiogenesis-associated signaling cascade proteins, growth differentiation factors, tissue inhibitors of metalloproteases, interleukins, and fibrinogen were analyzed. CONCLUSION: Findings regarding the association between genes encoding for collagen (COL3A1, COL1A1, and COL12A1), aggrecan (ACAN), decorin (DCN), matrix metalloproteinase (MMP3), interleukin 6 (IL-6), vascular endothelial growth factor A (VEGFA), biglycan (BGN), fibrinogen (FGB), and ACL injuries were found to be inconclusive. Additional evidence is required in order to establish substantial conclusions regarding the association between genetic variants and ACL rupture.

Intra-articular temperature monitoring during radiofrequency ablation in ex-vivo bovine hip joints via Fiber Bragg grating sensors.

PURPOSE: Radiofrequency ablation is an increasingly used surgical option for ablation, resection and coagulation of soft tissues in joint arthroscopy. One of the major issues of thermal ablation is the temperature monitoring across the target areas, as cellular mortality is a direct consequence of thermal dosimetry. Temperatures from 45 °C to 50 °C are at risk of damage to chondrocytes. One of the most reliable tools for temperature monitoring is represented by fiber optic sensors, as they allow accurate and real-time temperature measurement via a minimally invasive approach. The aim of this study was to determine, by fiber Bragg grating sensors (FBGs), the safety of radiofrequency ablation in tissue heating applied to ex-vivo bovine hip joints. METHODS: Ex vivo bovine hips were subjected to radiofrequency ablation, specifically in the acetabular labrum, for a total of two experiments. The WEREWOLF System (Smith + Nephew, Watford, UK) was employed in high operating mode and in a controlled ablation way. One optical fiber embedding seven FBGs was used to record multipoint temperature variations. Each sensor was 1 mm in length with a distance from edge to edge with each other of 2 mm. RESULTS: The maximum variation was recorded in both the tests by the FBG1 (i.e., the closest one to the electrode tip) and was lower than to 2.8 °C. The other sensors (from FBG2 to FBG7) did not record a significant temperature change throughout the duration of the experiment (maximum up to 0.7 °C for FBG7). CONCLUSIONS: No significant increase in temperature was observed at any of the seven sites. The sensor nearest to the radiofrequency source exhibited the highest temperature rise, but the variation was only 3 °C. The minimal temperature increase registered at the measurement sites, according to existing literature, is not expected to be cytotoxic. FBGs demonstrate the potential to fulfil the strict requirements for temperature measurements during arthroscopic surgery.

Patients' Perceptions and Experiences during the Pre-Admission Phase for Total Hip Replacement Surgery: A Qualitative Phenomenological Study.

Osteoarthritis negatively impacts the patient's quality of life. Qualitative research is an effective tool in detecting the various emotions experienced by patients with osteoarthritis. Such studies play a crucial role in promoting comprehension of the patient's experiences of health and illness among healthcare professionals, including nurses. The purpose of this study is to examine patients' perceptions during the pre-admission process for total hip replacement (THR). The study utilized a qualitative descriptive methodology with a phenomenological approach. A sample of patients awaiting THR consented to participate in the study and were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: 1-Surgery generates mixed feelings; 2-Pain negatively impacts daily life activities; 3-Pain requires personal strategies to be alleviated. Patients awaiting THR demonstrate frustration and anxiety. They experience intense pain during daily activities, which persists even during night rest.

Colles' Fracture: An Epidemiological Nationwide Study in Italy from 2001 to 2016.

The present study aimed to evaluate the yearly number of Colles' fractures in Italy from 2001 to 2016, based on official information found in hospitalization records. A secondary aim was to estimate the average length of hospitalization for patients with a Colles' fracture. A tertiary aim was to investigate the distribution of the procedures generally performed for Colles' fractures' treatment in Italy. An analysis of the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health, concerning the 15 years of our study (from 2001 to 2016) was performed. Data are anonymous and include the patient's age, sex, domicile, length of hospital stays (days), primary diagnoses and primary procedures. From 2001 to 2016, 120,932 procedures for Colles' fracture were performed in Italy, which represented an incidence of 14.8 procedures for every 100,000 adult Italian inhabitants. The main number of surgeries was found in the 65-69- and 70-74-year age groups. In the present study, we review the epidemiology of Colles' fractures in the Italian population, the burden of the disease on the national health care system (in terms of length of hospitalization) and the distribution of the main surgical procedures performed for the treatment of the disease.

Total Hip Replacement: Psychometric Validation of the Italian Version of Forgotten Joint Score (FJS-12).

BACKGROUND: One million Total Hip Replacements (THA) are thought to be performed annually. To measure prosthesis awareness throughout daily activities, the FJS-12 patient-reported outcome scale was developed. This article's goal is to undertake a psychometric validation of the Italian FJS-12 among a sample of related THA patients. METHODS: Between January and July 2019, data from 44 patients were retrieved. The participants were required to complete the Italian version of FJS-12 and of the WOMAC at preoperative follow-up, after two weeks, 1, 3, and 6 months postoperatively. RESULTS: The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.287 (p = 0.002) at preoperative follow-up, r = 0.702 (p < 0.001) at 1 month, r = 0.516 (p < 0.001) at 3 months and r = 0.585 (p < 0.001) at 6 months. The ceiling effect surpassed the acceptable range (15%) for FJS-12 in 1 month (25.5%) and WOMAC in 6 months follow-up (27.3%). CONCLUSIONS: The psychometric validation of the Italian version of this score for THA was executed with acceptable results. FJS-12 and WOMAC reported no ceiling and floor effects. Therefore, to distinguish between patients who had good or exceptional results following UKA, the FJS-12 could be a reliable score. Under the first four months, FJS-12 had a smaller ceiling effect than WOMAC. It is recommended to use this score in clinical research concerning the outcomes of THA.

Combined MPFL reconstruction and tibial tuberosity transfer avoid focal patella overload in the setting of elevated TT-TG distances.

PURPOSE: Objectives are (1) to evaluate the biomechanical effect of isolated medial patellofemoral ligament (MPFL) reconstruction in the setting of increased tibial tuberosity-trochlear groove distance (TTTG), in terms of patella contact pressures, contact area and lateral displacement; (2) to describe the threshold of TTTG up to which MPFL reconstruction should be performed alone or in combination with tibial tuberosity transfer. METHODS: A finite element model of the knee was developed and validated. The model was modified to simulate isolated MPFL reconstruction, tibial tuberosity transfer and MPFL reconstruction combined with tibial tuberosity transfer for patella malalignment. Two TT-TG distances (17 mm and 22 mm) were simulated. Patella contact pressure, contact area and lateral displacement were analysed. RESULTS: Isolated MPFL reconstruction, at early degrees of flexion, restored normal patella contact pressure when TTTG was 17 mm, but not when TTTG was 22 mm. After 60° of flexion, the TTTG distance was the main factor influencing contact pressure. Isolated MPFL reconstruction for both TTTG 17 mm and 22 mm showed higher contact area and lower lateral displacement than normal throughout knee flexion. Tibial tuberosity transfer, at early degrees of flexion, reduced the contact pressure, but did not restore the normal contact pressure. After 60° of flexion, the TTTG distance was the main factor influencing contact pressure. Tibial tuberosity transfer maintained lower contact area than normal throughout knee flexion. The lateral displacement was higher than normal between 0° and 30° of flexion (< 0.5 mm). MPFL reconstruction combined with tibial tuberosity transfer produced the same contact mechanics and kinematics of the normal condition. CONCLUSION: This study highlights the importance of considering to correct alignment in lateral tracking patella to avoid focal patella overload. Our results showed that isolated MPFL reconstruction corrects patella kinematics regardless of TTTG distance. However, isolated MPFL reconstruction would not restore normal patella contact pressure when TTTG is 22 mm. For TTTG 22 mm, the combined procedure of MPFL reconstruction and tibial tuberosity transfer provided an adequate patellofemoral contact mechanics and kinematics, restoring normal biomechanics. This data supports the use of MPFL reconstruction when the patient has normal alignment and the use of combined MPFL reconstruction and tibial tuberosity transfer in patients with elevated TT-TG distances to avoid focal overload.

Gender related results in total knee arthroplasty: a 15-year evaluation of the Italian population.

INTRODUCTION: This study aimed to estimate separately in women and men the number of Total knee arthroplasty (TKA) procedures performed in Italy from 2001 to 2016, exploring specific gender-related characteristics and trends. MATERIALS AND METHODS: Data of this study were collected from the National Hospital Discharge Reports (NHDR) reported at the Italian Ministry of Health in the years between 2001 and 2016. The information included in this archive are the patient's sex, age, the year when the surgical procedure was performed and the length of the hospitalization. RESULTS: Between the years 2001 and 2016, a total of 848,863 TKAs have been performed in Italy. TKAs in women passed from 20,719 in 2001 to 49,320 in 2016 showing an increase of 138%, while TKAs in men passed from 6631 in 2001 to 23,601 in 2016 showing an increase of 256%. From the age of 50 onwards, there was a prevalence of procedures in women, from 63.2% in the 50-54 group to 85.7% in the 100 + group. Conversely, under the age of 50, there was a higher percentage of surgeries performed in males, 57.1% on a total of 16,434 TKA surgeries carried out in this age group. CONCLUSIONS: This study showed that TKA is growing and heavily affecting the female population (70.6% of all TKAs) between 2001 and 2016. However, under 50 years old there was a higher percentage of surgeries performed in males (57.1%). The average number of days of hospitalization in females was higher than in males.

Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry.

This study aims to determine the annual incidence of proximal femoral fractures in Italy in the period between 2001 and 2016 among older adults, and to describe the trends in the clinical management of these cases. Data were retrieved from the National Hospital Discharge records issued by the Italian Ministry of Health and from the Italian Institute for Statistics. The number of hospitalizations increased between 2001 and 2016, while the age-adjusted yearly incidence decreased from 832.2 per 100,000 individuals to 706.2. The median age was 83 years (IQR 78-88) with a large majority of females (76.6%). The type of fracture varied with age in female subjects, with older women more frequently reporting pertrochanteric fractures. Therapeutic strategies for the different types of fracture depended on patients' age. During the study years, improvements in fracture classification and management strategies were observed, with a clear decreasing trend for non-operative solutions. In conclusion, the number of proximal femur fractures in older adults is growing, even if at a lower rate compared to population aging. The Italian surgical practice changed during the study period towards the implementation of the most recent guidelines.

Lateral retinacular release in concordance with medial patellofemoral ligament reconstruction in patients with recurrent patellar instability: A computational model.

BACKGROUND: The aim of this study was to develop and validate a finite element (FE) model of the patellofemoral joint to analyze the biomechanics of lateral retinacular release after medial patellofemoral ligament (MPFL) reconstruction in patellar malalignment (increased tibial tubercle-trochlear groove distance (TT-TG)). We hypothesized that lateral retinacular release is not appropriate in patellar instability addressed by MPFL reconstruction due to decreased lateral stability and inappropriate adjustment in patellofemoral contact pressures. METHODS: A FE in-silico model of the patellofemoral joint was developed and validated. The model was used analyze the effect of lateral retinacular release in association with MPFL reconstruction on patellofemoral contact pressures, contact area, and lateral patellar displacement during knee flexion. RESULTS: MPFL reconstruction alone results in restoration of patellofemoral contact pressures throughout the entire range of motion (0-90°), mimicking the results from healthy condition. The addition of the lateral retinacular release to the MPFL reconstruction resulted in significant reductions in both patellofemoral contact pressure and contact area. Lateral retinacular release resulted in more lateral patellar displacement during the mid-flexion knee range of motion. CONCLUSIONS: Combination of lateral retinacular release with MPFL reconstruction in patients with increased TT-TG is not recommended as MPFL reconstruction alone for first-line management of recurrent patellar instability offers a greater biomechanical advantage and restoration of contact forces to resemble that of the healthy knee. The presented biomechanical data outlines the effect of concomitant MPFL reconstruction and lateral retinacular release to help guide surgical planning for patients with recurrent patellar instability due to malalignment.

Epidemiology of revision hip replacement in Italy: a 15-year study.

BACKGROUND: Over the past two decades, there has been an increase in the amount of primary total hip arthroscopies (THA) which in turn has increased the need for THA revision surgeries. The purpose of this study was to quantify the increase in THA revision in Italy, evaluate the causes and types of THA procedures performed. METHODS: The data regarding revision hip prosthetic replacements performed both in public and private structures between 2001 and 2015 was collected by the National Hospital Discharge reports (SDO) carried out by the Italian Ministry of Health. RESULTS: Overall, 109,746 Revision Hip Replacements (RHR) were performed in Italy from 2001 to 2015 in the adult population. The study shows a greater number of female patients underwent surgery between 2001 and 2015 and the 75- to 79-year age group had the highest incidence of THA revision. The main causes for THA revision were found to be "Mechanical complication of internal orthopedic device implant and graft" (31.5%), "Infection and inflammatory reaction due to internal joint prosthesis" (10.5%) and "Mechanical loosening of prosthetic joint" (8.3%). CONCLUSIONS: Revision hip replacement is growing and heavily affecting the population between 65 and 89 years and the main causes of THA revision have been quantified. The average length of hospitalization (LOS) was found to have decreased over the 14-year study period. Understanding the causes and risk factors for revision is essential in identifying avoidable complications and improving preventative care for patients undergoing primary implantation to decrease the revision burden.

Trends in hospitalization for pediatric hip arthroplasty: an epidemiological Nationwide study in Italy from 2001 to 2015.

BACKGROUND: The epidemiology of Pediatric Hip Arthroplasty (PHA) is unclear. Prevalence of PHA in Europe was reported in Scandinavian registries, but data on this procedure are not described in other countries. Therefore, it is challenging to redact a complete and valid epidemiological report on PHA in Europe. Nevertheless, national health statistics for PHA are helpful for an international audience, as different treatments are reported between countries. Moreover, sharing national statistics and correlating those to other countries' protocols could be helpful to compare outcomes for different procedures internationally. The principal purpose is to evaluate the yearly hospital admission for PHA in Italy. METHODS: Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health. RESULTS: From 2001 to 2015, 770 PHA hospitalizations were performed in Italy, with an incidence of 0.5 procedures for every 100,000 pediatric Italian inhabitants. The average age of patients was 15.2 ± 4.6 years. The mean length of days of hospitalization was 10.9 ± 8.6 days. The majority of patients were male of 15-19 years old age group. A progressive decrease in days of hospitalizations was found during the years of the study. CONCLUSIONS: In Europe, the incidence of hospital admission for PHA is not fully described. There is a lack of consensus on the best type of surgery to perform on young patients. Epidemiological studies are helpful to understand the national variation of a specific surgical procedure and compare them with other countries.

Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation.

OBJECTIVE: Medial patellofemoral ligament (MPFL) injury occurs in the majority of the cases of acute patellar dislocation. The role of concomitant lateral retinaculum release with MPFL reconstruction is not clearly understood. Even though the lateral retinaculum plays a role in both medial and lateral patellofemoral joint stability in MPFL intact knees, studies have shown mixed clinical outcomes following its release during MPFL reconstruction surgery. Better understanding of the biomechanical effects of the release of the lateral retinaculum during MPFL reconstruction is warranted. We hypothesize that performing a lateral release concurrent with MPFL reconstruction will disrupt the patellofemoral joint biomechanics and result in lateral patellar instability. METHODS: A previously developed and validated finite element (FE) model of the patellofemoral joint was used to understand the effect of lateral retinaculum release following MPFL reconstruction. Contact pressure (CP), contact area (CA) and lateral patellar displacement were recorded. abstract. RESULTS: FE modeling and analysis demonstrated that lateral retinacular release following MPFL reconstruction with tibial tuberosity-tibial groove distance (TT-TG) of 12 mm resulted in a 39% decrease in CP, 44% decrease in CA and a 20% increase in lateral patellar displacement when compared to a knee with an intact MPFL. In addition, there was a 45% decrease in CP, 44% decrease in CA and a 21% increase in lateral displacement when compared to a knee that only had an MPFL reconstruction. CONCLUSION: This FE-based analysis exhibits that concomitant lateral retinaculum release with MPFL reconstruction results in decreased PF CA, CP and increased lateral patellar displacement with increased knee flexion, which may increase the risk of patellar instability.

Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability.

PURPOSE: The purpose of this study was to develop and validate a finite element (FE) model of the patellofemoral (PF) joint to characterize patellofemoral instability, and to highlight the effect of lateral retinacular release in combination with tibial tuberosity transfer with respect to contact pressures (CP), contact area (CA), and kinematics during knee flexion. METHODS: A comprehensive, dynamic FE model of the knee joint was developed and validated through parametric comparison of PF kinematics, CP, and CA between FE simulations and in vitro, cadaveric experiments. Using this FE model, we characterized the effect of patellar instability, lateral retinacular release (LR), and tibial tuberosity transfer (TTT) in the setting of medial patellofemoral ligament injury during knee flexion. RESULTS: There was a high level of agreement in CP, CA, lateral patellar displacement, anterior patellar displacement, and superior patellar displacement between the FE model and the in vitro data (P values 0.19, 0.16, 0.81, 0.10, and 0.36, respectively). Instability conditions demonstrated the greatest CP compared to all of the other conditions. During all degrees of flexion, TTT and concomitant lateral release (TTT + LR) decreased CP significantly. TTT alone shows a consistently lower CA compared to nonrelease conditions with subsequent lateral release further decreasing CA. CONCLUSIONS: The results of this study demonstrate that the FE model described reliably simulates PF kinematics and CP within 1 SD in uncomplicated cadaveric specimens. The FE model is able to show that tibial tubercle transfer in combination with lateral retinacular release markedly decreases patellofemoral CP and CA and increases lateral patellar displacement that may decrease bony stabilization of the patella within the trochlear groove and promote lateral patellar instability. CLINICAL RELEVANCE: The goal of surgical correction for patellar instability focuses on reestablishing normal PF kinematics. By developing an FE model that can demonstrate patient PF kinematics and the results of different surgical approaches, surgeons may tailor their treatment to the best possible outcome. Of the surgical approaches that have been described, the biomechanical effects of the combination of TTT with lateral retinacular release have not been studied. Thus, the FE analysis will help shed light on the effect of the combination of TTT with lateral retinacular release on PF kinematics.

Epidemiology of Posterior Cruciate Ligament Reconstructions in Italy: A 15-Year Study.

BACKGROUND: The posterior cruciate ligament (PCL) is an essential element in knee stability. PCL reconstructions represent an under-investigated topic in the literature due to the rarity of this type of knee injury. This study aims to investigate the incidence of PCL reconstructive surgeries in Italy, following their trend during a 15-year period. METHODS: The National Hospital Discharge records (SDO) collected by the Italian Ministry of Health between January 2001 and October 2015 were analyzed. The database reports anonymous data comprising patients' ages, genders, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for diagnosis and intervention, census regions, regions of hospitalization, lengths of hospitalization and types of reimbursement. RESULTS: The overall incidence of PCL reconstructions in the Italian population during the study period was 0.46 surgeries per 100,000 inhabitants/year, ranging from 0.32 to 0.54. The median patient's age was 30 years old, and the male:female ratio was 5.3. PCL lesions were isolated in 39.7% of patients, while anterior cruciate ligament injuries were the most frequently associated lesions (31.1%). CONCLUSIONS: The incidence of PCL reconstruction in Italy was low and stable during the study period. Young men are the category at the highest risk for these procedures. Given the paucity of epidemiological data on PCL reconstructions, this data may represent a reference for the current and foreseeable needs in PCL surgeries for countries sharing similar cultural context.

Epidemiology of Anterior Cruciate Ligament Reconstruction Surgery in Italy: A 15-Year Nationwide Registry Study.

There remains little information on the epidemiology of anterior cruciate ligament reconstruction (ACL-R), therefore, we performed an epidemiological evaluation on the ACL-R procedures performed in Italy from 2001 to 2015 to highlight potential disparities in access to healthcare. The National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health were analyzed from 2001 to 2015; 248,234 ACL-Rs were performed in Italy over the 15-year study period in the adult population (starting from 15 years old), and the incidence rate per year in 100,000 persons ranged from 21.70 to 33.60 over the study period. The overall male/female ratio was 4.54. The length of hospitalization ranged from four days in 2001 to two days in 2015. Italy is historically divided into north, center, and south regions, and more than half of ACL-R surgery was performed in the north (67.2%); 95.2% of ACL-Rs were underwent in public institutions. The predicted model projected a slight growth in the number of ACL-Rs in the next 10 years (2016-2025). The number of ACL-R procedures increased in the adult population from 2001 to 2015. The ACL-R procedures were concentrated in the north of Italy, suggesting that efforts on regionalization of ACL-Rs should turn toward improving quality in hospitals in the south of Italy.

Role of α-Tocopherol Acetate on Nasal Respiratory Functions: Mucociliary Clearance and Rhinomanometric Evaluations in Primary Atrophic Rhinitis.

Primary atrophic rhinitis is a disease of the nose and of paranasalsinuses characterized by a progressive loss of function of nasal and paranasal mucosa caused by a gradual destruction of ciliary mucosalepithelium with atrophy of serous-mucous glands and loss of bonestructures.The aim of this study was to evaluate the therapeutic effects of topic α-tochopherol acetate (vitamin E) in patients with primary atrophicrhinitis based on subjective and objective data.We analyzed 44 patients with dry nose sensation and endoscopic evidence of atrophic nasal mucosa. We analyzed endoscopic mucosascore, anterior rhinomanometry, and nasal mucociliary clearance before and after 6 months of topic treatment with α-tochopherol acetate. For statistical analysis, we used paired samples t test (95% confidence interval [CI], P < .05) for rhinomanometric and muciliary transit time evaluations and analysis of variance 1-way test (95% CI, P < .05) for endoscopic evaluation. All patients showed an improvement in "dry nose" sensation and inperception of nasal airflow. Rhinomanometric examination showed increase of nasal airflow at follow-up (P < .05); nasal mucociliaryclearance showed a reduction in mean transit time (P < .05); and endoscopic evaluation showed significative improvement of hydration of nasalmucosa and significative decreasing nasal crusts and mucusaccumulation (P < .05). Medical treatment for primary atrophic rhinitis is not clearly documented in the literature; in this research, it was demonstrated that α-ochopherol acetate could be a possible treatment for atrophic rhinitis.

Trends of anterior cruciate ligament reconstruction in children and young adolescents in Italy show a constant increase in the last 15 years.

PURPOSE: The aim of this 15-year nationwide study was to investigate the trend in ACL reconstructive surgeries in patients younger than 15 years old in Italy, as well as their social and economic impact. MATERIALS AND METHODS: The National Hospital Discharge records (SDO) collected by the Italian Ministry of Health in the 15-year period between 2001 and 2015 were analyzed. This contains anonymous data including patients' age, gender, ICD-9-CM codes for diagnosis and intervention, census region, region of hospitalization, length of the hospitalization, and public or private reimbursement. RESULTS: 1,350 ACL reconstructions were performed in Italy in the population younger than 15 years old, with an incidence rate ranging from 0.16 to 2.04 procedures per 100,000 age-matched individuals. Similarly, the percentage of surgeries in 0-14 year old patients increased with respect to the total number of ACL reconstruction from 0.13% in 2001 to 0.95% in 2015. The age range 10-14 years is the most involved, accounting for 97.3% of surgeries recorded in the study period. The male:female ratio was 1.05 and most of these procedures were performed in the North of Italy (78.3%). CONCLUSION: ACL reconstructions in patients aged 10-14 years are increasing constantly since 2001, and thus, specific actions aimed to define the best management strategy as well as national educational programs to prepare the future surgeons to this new reality are mandatory in the interest of the public health. LEVEL OF EVIDENCE: Level III.

Correction to: Epidemiology of Achilles tendon surgery in Italy: a nationwide registry study, from 2001 through 2015.

An amendment to this paper has been published and can be accessed via the original article.

Epidemiology of Achilles tendon surgery in Italy: a nationwide registry study, from 2001 through 2015.

BACKGROUND: This study aims (1) to estimate the yearly number of Achilles tendon (AT) surgeries in Italy from 2001 to 2015 based on official hospitalization records; (2) to investigate the eventual presence of geographical variation in equity in access to AT surgery between three macroregions of Italy (North, Center and South); (3) to perform statistical projections of the number of AT procedure volumes and rates based on these data. METHODS: We analysed the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health for a 15-year period, from 2001 through 2015. These data are anonymous and include the patient's age (evaluated in the class of age), sex, census region, the region of hospitalization, length of the hospitalization, public or private reimbursement and diagnosis. RESULTS: During the 15-year study period, 118,652 AT repair were performed in Italy, whose peak of incidence was in 2010. More than half of AT repairs was performed in the North of Italy (52.1%), while 27.2% was performed in the South of Italy and 20.6% Center of Italy. The projection model predicted a slight growth of 2.65% in 2025 in comparison with 2015. CONCLUSION: The current study provides detailed information about the national population-weighted incidence of AT surgery, distribution and projection. The peak of average age was 35-45 year. The majority of AT procedures was performed in the North of Italy. The projection model predicts a slight growth of AT surgery by 2025. Furthermore, this 15-year nationwide registry study shows that the age of incidence of AT injuries shifted from 30 to 40 to 35-45 years compared to the available literature. The higher prevalence of AT surgery was found in men during the working age. Moreover, a low rate of procedures in pediatric and elder age classes was observed.