Groin Pain Syndrome Italian Consensus Conference update 2023.

Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies. The GPS Italian Consensus Conference update 2023 is an update of the 2016 CC. The CC was based on a sequential, two-round online Delphi survey, followed by a final CC in the presence of all panelists. The panel was composed of 55 experts from different scientific and clinical backgrounds. Each expert discussed 6 different documents, one of which regarded the clinical and imaging definition of sports hernias, and the other 5 dealt with 5 new clinical situations thought to result in GPS. The panelists came to an agreement on the definition of a sports hernia. Furthermore, an agreement was reached, recognizing 4 of the 5 possible proposed pathologies as causes to GPS. On the contrary, the sixth pathology discussed did not find consensus given the insufficient evidence in the available scientific literature. The final document includes a new clinical and imaging definition of sports hernia. Furthermore, the etiology of GPS was updated compared to the previous CC of 2016. The new taxonomic classification includes 12 categories (versus 11 in the previous CC) and 67 pathologies (versus 63 in the previous CC).

Sports-related changes of the synovial membrane.

PURPOSE: the aim of this study is to differentiate the behavior of the synovial membrane in the presence of various stimuli in patients who practice sports. METHODS: fifty one patients (30 males and 21 females, mean age 48 years, range 31-59 years) who actively practiced non-competitive sports underwent a biopsy of the synovial membrane during arthroscopic surgery performed for joint effusion secondary to meniscal lesion (24 cases), anterior cruciate ligament injury (ACL) (17 cases), postoperative knee joint stiffness (2 cases), aseptic loosening or dislocation of the polyethylene component of uni-compartmental knee arthroplasty (5 cases), and anterior fibrous impingement of the ankle (3 cases). Synovial tissue samples were obtained during surgery from all the patients and processed for light microscopy, transmission electron microscopy and scanning electron microscopy observation. RESULTS: circulatory phenomena were observed in acute inflammatory processes, characterized by hyperemia and vasodilation. Exudative and infiltrative phenomena were observed in the presence of foreign bodies and were characterized by leukocytic exudation (presence of polynuclear neutrophils), accompanied by lymphomonocytic infiltration. Proliferative phenomena were observed in post-traumatic forms of synovitis (ACL and meniscal injuries), characterized by hypertrophy and proliferation of villous formations. Degenerative and regressive phenomena were observed in cases of fibrous reaction (ankle impingement and joint stiffness) and were characterized by formation of dense fibrous connective tissue with hyaline patches, evolving towards sclerosis. CONCLUSIONS: the activation of inflammatory processes in patients who expose their joints to excessive stress may lead to the formation of hyperplastic tissue. Ultramicroscopic debris is usually capable of transforming the structural organization of the synovial tissue. LEVEL OF EVIDENCE: Level IV, observational case series.

Meniscal injuries in basketball players.

Basketball is a highly competitive sport in which the knee joint is constantly subject to physical stresses. Basketball-related traumatic injuries are the result of specific technical movements. Even though basketball is not considered a contact sport, injuries in basketball players are due both to athletes' handling of the ball and to their intense physical interaction during games. Nowadays, traumatic meniscal injuries are constantly on the increase, especially in young athletes, and they are generally the result of compressive forces together with knee flexion rotation. Recognition of the great importance of meniscal biomechanics and of the functional role of the meniscus has resulted in the adoption of an increasingly preserving approach, also in the light of the effects, in terms of articular degeneration, of removing meniscal tissue. Even though recent decades have seen considerable developments in arthroscopic meniscectomy techniques, geared at preserving as much meniscal tissue as possible, basketball players undergoing this treatment often present, in the long run, clinical symptomatology severe enough to compromise their participation in competitive sport. Hence the treatment of meniscal injuries in athletes has become more and more preserving in recent years, through recourse to surgical techniques such as meniscal repair, biological replacement implantation and donor meniscus implantation, which allow pain relief, return to competitive activities and stable long-term results, slowing down arthritic progression. Therefore, considering the increasing number of meniscal injuries in basketball players, which can jeopardize their sporting careers, great importance is now attached to early diagnosis and to the correct choice of meniscal injury treatment in these athletes.

The treatment of chondral lesions of the knee with the microfracture technique and platelet-rich plasma.

PURPOSE: to assess the efficacy of associating the microfracture technique with platelet-rich plasma (PRP) injections in the treatment of chondral lesions to promote acceleration and optimization of the healing process compared with the traditional microfracture approach. METHODS: from September 2011 to August 2012, 20 patients (9 males and 11 females, aged 30-55 years) were treated. All presented with chondral lesions of the medial femoral condyle of the knee and a pain duration ranging from 8 to 12 months. The patients were randomized into two groups (A and B). Group A was treated with the microfracture technique and a total of three intra-articular injections of PRP. Group B was treated with microfractures alone. Clinical follow-up was performed at 3, 6 and 12 months after treatment. Clinical function was assessed on the basis of the International Knee Documentation Committee (IKDC) score. Pain was evaluated using a visual analogue scale (VAS). RESULTS: the patients in group A had a mean baseline IKDC score of 31.2, which rose to 84.2 at 12 months. The IKDC scores in group B were at 30.1 at baseline and 81 at 12 months. CONCLUSIONS: the results of our study suggest that functional recovery and resolution of pain are obtained more quickly in PRP-treated patients. We also observed a better functional outcome in the patients treated with the combination of PRP and microfractures, even at 12 months, although the difference was not statistically significant. LEVEL OF EVIDENCE: level II, randomized clinical study.