Anterior Cruciate Ligament Reconstruction with Quadrupled Semitendinosus Graft or Synthetic Ligament: Knee Stability and Clinical Outcomes at Three Years Follow-Up.

The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and graft choice is important for a rapid return to activity, especially in patients older than 30 years. The aim of this study is to compare in term of quality of life and knee stability of patients who undergone ACLR using quadrupled semitendinosus (ST4) graft against patients who undergone ACLR with synthetic ligaments. Thirty-nine patients undergoing ACLR were enrolled in the study and were divided into two groups: ACLR with synthetic ligaments-LARS (group A) and ACLR with quadrupled semitendinosus graft ST4 (group B). They underwent surgery at Policlinico di Bari Orthopedic Unit between January 2017 and January 2020. Group A was composed by nineteen patients (36.16 ± 4.41 mean age-years, 22.47 ± 2.63 mean BMI-kg/m2, 39.37 ± 10.05 mean time evaluation after surgery-months) and group B was composed by twenty patients (34.95 ± 3.59 mean age-years, 21.1 ± 2.88 mean BMI-kg/m2, 36.75 ± 8.69 mean time evaluation after surgery-months). For each patient, the following data were recorded: age; side of injury, BMI, date of surgery, anterior knee laxity with the arthrometer, and Lysholm knee scoring scale. Mean value of anterior tibial translation (ATT) in group A was 3.09 mm ± 0.65 and in group B was 2.66 mm ± 1.61 (pvalue of 0.1139). Mann--Whitney U test used to compare the Lysholm means values between groups showed a pvalue of 0.9307. LARS has comparable clinical and functional outcomes compared with hamstring autografts at short-term of 3 years follow-up. Level of Evidence: IV.

Platelet Rich Plasma Injections for Knee Osteoarthritis Treatment: A Prospective Clinical Study.

Background: The aim of this prospective study was to evaluate the efficacy and safety of Platelet Rich Plasma (PRP) injections in patients affected by knee osteoarthritis (KOA). An autologous blood product containing a high percentage of various growth factors (GFs), cytokines and modulating factors as PRP has shown promising results in achieving this goal. Methods: One hundred and fifty-three patients (72 males, mean age 59.06 ± 8.78, range 40−81 years old) from January 2018 to January 2020 received three consecutive PRP injections and completed the follow ups. Western Ontario and McMaster University Osteoarthritis index (WOMAC), Knee society score (KSS) and Visual Analogic Scale (VAS) were evaluated before PRP injection (T0), one month (T1), three months (T2) and six months (T3) after the treatment. All patients underwent baseline and at 6 months MRI and X-ray evaluation. Results: A statistically significant VAS, KSS and WOMAC reduction emerged in the comparison between evaluations (p < 0.05), MRI demonstrated non-statistically significant improvement in cartilage thickness for both tibial plate and femoral plate (p = 0.46 and p = 0.33 respectively), and no radiographic changes could be seen in any patients. Conclusions: PRP injection represents a valid conservative treatment to reduce pain, improve quality of life and functional scores even at midterm of 6 months follow-up.

Thermal versus cooled radiofrequency in patients with sacroiliac joint pain: a systematic review of the literature and pooled analysis of clinical outcomes.

INTRODUCTION: Chronic low back pain (LBP) can be caused by sacroiliac joint (SIJ) disease. Many conditions could cause SIJ dysfunction. The lateral branches of the L4-S3 dorsal rami are responsible for the primary innervation of the posterior SI joint. Radiofrequency (RF) denervation represent an emerging promising treatment for refractory sacroiliac joint pain. There are different types of RF denervation such as thermal or cooled. Use of irrigation cooled electrodes allows targeted tissues to reach the neuroablative temperatures slowly, preventing collateral damage of adjacent tissue. EVIDENCE ACQUISITION: We conducted electronic database (PubMed, Medline, Cochrane and Google Scholar) research (time frame: January 1st, 2010 to May 31st, 2021) for clinical studies that had tested conventional radiofrequency (RFT) and cooled radiofrequency (RFC) to treat sacroiliac joint pain. These studies were evaluated according to Level of Evidence. Quantitative assessment of qualifying studies was done using the random effects model. We calculated the pooled size effect using standardized mean difference (SMD) as the main effect measure. EVIDENCE SYNTHESIS: We identified nine studies, with a total of 276 patients affected by sacroiliac joint pain and treated with radiofrequency. The analysis revealed a small and non-significant difference in pain reduction and an improvement in quality of life in RFT subgroup (Pain measured in Visual Analogic Scale: RFT subgroups SMD=-3.643 (95% CI -4.478, -2.807), RFC subgroup SMD=-3.285 (95% CI -4.428, -2.141), P=0.587; Quality of Life measured in Oswestry Disability Index: RFT subgroup SMD=-35.969 (95% CI -53.993%, -17.945%), RFC subgroup SMD=-20.589% (95% CI -33.424%. -7.754%), P=0.123). Publication bias was found in quality-of-life assessment due to the low number and high heterogeneity of studies. Two techniques showed no major complications. CONCLUSIONS: Current evidence indicates no statistical difference between two techniques examined. The literature is currently lacking, and well-constructed randomized clinical trials are necessary to evaluate this deficient aspect.