Translation, Cross-Cultural Adaptation, and Validation of the Italian Version of the Shoulder Instability-Return to Sport After Injury (SI-RSI) Scale.

OBJECTIVE: To culturally adapt and validate the Italian version of the Shoulder Instability-Return to Sport after Injury (SI-RSI-I) scale. METHODS: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament-Return to Sport Index-Italian version and replacing the term "knee" with "shoulder." Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test-retest reliability, measurement error, and construct validity. RESULTS: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α = .935), and excellent test-retest reliability (ICC = .926; 95% CI, .853-.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. CONCLUSION: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI.

Deep vein thrombosis and acute hepatitis after ChAdOx1 nCov-19 vaccination in a Charcot-Marie-Tooth patient: a case report.

Monitoring of side effects after coronavirus disease 2019 (COVID-19) vaccination has become an important issue for health systems worldwide to ensure its safety. Recently cases of deep vein thrombosis (DVT), vaccine-induced immune thrombotic thrombocytopenia, and autoimmune hepatitis have been described: the underlying pathophysiological mechanisms are still debated. We report on a patient who presented with DVT and acute hepatitis 8 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against COVID-19. The patient is a 56-year-old male who was already affected by a rare form of axonal Charcot-Marie-Tooth disease linked to MME (membrane metalloendopeptidase) gene variation and associated with mild symptoms. His blood exams did not have any evidence of thrombocytopenia but D-dimer, troponin T, alanine transaminase, and aspartate aminotransferase were abnormal, suggesting the presence of a blood clot and acute hepatitis. The patient was treated with subcutaneous enoxaparin for 15 days and with rivaroxaban for the following 8 months: his symptoms improved and his exams showed recanalization of the veins and a healed liver. The pathogenesis of thrombosis and hepatitis after vaccination is still unclear, especially in subjects affected by rare comorbidities and this may affect the safety of vaccination in this type of population. We highlight the importance of careful monitoring of side effects after vaccination: clinical suspicion must rise when patients complain of symptoms that differ from their usual presentation.

Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders.

BACKGROUND: The Kujala, Fulkerson, Larsen and Lysholm questionnaires have been demonstrated to be reliable and sensitive in assessing patients with patellofemoral pathology. The purpose of this study is to translate and cross-culturally adapt into Italian the English versions of the Kujala, Fulkerson, Larsen and Lysholm questionnaires, and undertake reliability and validity evaluations of the Italian versions of these scores in patients with patellofemoral pathology. MATERIALS AND METHODS: The cross-cultural adaptation process was carried out following the simplified Guillemin criteria. The questionnaires were administered to 63 patients with either patellar instability or painful patella syndrome. To assess the validity of the questionnaires, they were compared with the Oxford knee score. The questionnaires were administered to a subsample of 33 patients 5 days later to assess test-retest reliability. RESULTS: The interclass coefficient correlation was 0.96 for the Kujala score, 0.92 for the Larsen score, 0.96 for the Lysholm score, 0.94 for the Fulkerson score (P < 0.01), and 0.83 for the Oxford score. Pearson's correlation was0.96 between the Kujala and Oxford scores, 0.90 between the Larsen and Oxford scores, 0.94 between the Lysholm and Oxford score, and 0.93 between the Fulkerson and Oxford scores. Responsiveness, calculated by standardized response mean, was 1.2, and effect size was 1.4. CONCLUSIONS: The Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scoring systems were shown to be equivalent to their English versions and demonstrated good validity, reliability and responsiveness to surgical treatment of patellofemoral pathology. To the best of the authors' knowledge, this is the first attempt to adapt four of the most common patellofemoral-specific scoring scales to the Italian language. LEVEL OF EVIDENCE: Level II.

The Treatment of Distal Biceps Ruptures: An Overview.

Traumatic lesions of the distal biceps brachii are uncommon. They often result from rapid elbow flexion against resistance. Conservative treatment is only indicated in low-demanding patient and in those who have severe comorbidities. Regarding the surgical approach, two options are available: the single- and the double-incision techniques. The former has been the first to be described and was associated with significant rate of neurologic complications. The second showed less frequent neurologic lesions, but considerable rate of heterotopic ossifications with reduced forearm movement. The choice of fixation device is another important issue. Cortical buttons, transosseous repair, suture anchors, and interference screws have shown satisfactory outcomes. However, cortical buttons have the best mechanical properties. Although a lack of high methodological quality studies emerges in the available literature, three recent systematic reviews and meta-analysis show interesting findings. Surgical reinsertion of the distal biceps brachii yields satisfactory clinical outcomes both with the single- and double-incision techniques. Higher prevalence of nerve injuries is associated with the single-incision techniques, whereas higher prevalence of heterotopic ossification is reported with double-incision techniques. Thus far, there is no sufficient evidence to support one option and the choice is mainly based on surgeon's experience.

The influence of critical shoulder angle on secondary rotator cuff insufficiency following shoulder arthroplasty.

INTRODUCTION: Secondary cuff failure after shoulder replacement is disabling and often requires additional surgery. Increased critical shoulder angle (CSA) has been found in patients with cuff tear compared to normal subjects. The interobserver reliability of the CSA and the relationship between CSA and symptomatic secondary cuff failure after shoulder replacement were investigated. MATERIALS AND METHODS: Nineteen patients with symptomatic cuff failure after anatomic shoulder replacement (mean FU 45 months) were compared to a control group of 29 patients showing no signs of symptomatic cuff failure (mean FU 105.7 months). The CSA was measured by two blinded surgeons at a mean follow-up of 45 and 105.7 months, respectively. Inter-observer reliability was calculated. RESULTS: The mean CSA in the study group in neutral, internal and external rotations were 33°, 34° and 34°, respectively. Corresponding values in the control group were 32°, 32° and 32°. The interclass correlation coefficient for the whole population between the two examiners were 0.956 (P < 0.01), 0.964 (P < 0.01) and 0.955 (P < 0.01), respectively. CONCLUSION: There were no significant differences of CSA values between patients who had undergone shoulder replacement and experienced late cuff failure and those in whom the same procedure had been successful. A good inter-observer reliability was found for the CSA method.

Lateral tibial plateau autograft in revision surgery for failed medial unicompartmental knee arthroplasty.

PURPOSE: Revision surgery for failed unicompartmental knee arthroplasty (UKA) with bone loss is challenging. Several options are available including cement augmentation, metal augmentation, and bone grafting. The aim of the present study was to describe a surgical technique for lateral tibial plateau autografting and report mid-term outcomes. METHODS: Eleven consecutive patients (median age 69.5 years) affected by posteromedial tibial plateau collapse after medial UKA were enrolled in the present study. The delay between UKA and revision surgery was 21 months (range 15-36 months). All patients were revised with a cemented posterior-stabilized implant, with a tibial stem. Medial tibial plateau bone loss was treated with an autologous lateral tibial plateau bone graft secured with two absorbable screws. All patients were evaluated with the Oxford Knee Score (OKS), visual analogue scale for pain (VAS), and complete radiographic evaluation. RESULTS: At a median follow-up of 60 months (range 36-84 months), the OKS improved from 21.5 (range 16-26) to 34.5 (range 30-40) (p < 0.01) and the median VAS score improved from 8.0 (range 5-9) to 5.5 (range 3-7) (p < 0.01). No intraoperative complications were recorded. Partial reabsorption of the graft was observed in two cases at final follow-up. CONCLUSION: Lateral tibial plateau bone autograft is an alternative to metal wedge or cement augments in the treatment of medial plateau collapse after UKA. Primary fixation of the tibial plateau autograft can be achieved with absorbable screws and a tibial-stemmed implant. Further comparative studies with a larger series may be helpful to draw definitive conclusions. LEVEL OF EVIDENCE: Case series, Level IV.

Clinical applications of vibration therapy in orthopaedic practice.

BACKGROUND: Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes. METHODS: a literature review using the key words "vibration therapy" and "whole-body vibration" and "orthopaedics" was performed. After checking the available abstracts 71 full text articles were evaluated. RESULTS: fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials. CONCLUSIONS: VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement.

Cross-cultural adaptation and validation of the Italian version of the Western Ontario Osteoarthritis of the Shoulder index (WOOS).

BACKGROUND: The Western Ontario Osteoarthritis of the Shoulder index (WOOS) has been introduced as a disease-specific quality of life measurement in patients with glenohumeral arthritis. The aim of the present study was to perform a cross-cultural adaptation of the English version of the WOOS to Italian and to assess its validity, reliability and responsiveness in patients with glenohumeral joint osteoarthritis treated conservatively. MATERIAL AND METHODS: The adaptation process was carried out following the simplified Guillemin criteria. The English version was translated into Italian by two bilingual orthopaedic surgeons and then translated back into English by two different bilingual orthopaedic surgeons. The original version was compared with the back-translation. The questionnaire was prospectively administered to 30 patients with glenohumeral osteoarthritis at baseline and again after 5 days for retest reliability. After 6 months of conservative treatment, the responsiveness of the questionnaire was assessed in a subsample of 20 patients. The level of statistical significance was set at 0.05. RESULTS: The interclass correlation coefficient between test and retest of the WOOS was 0.99 (P < 0.001). Pearson's correlation coefficient between the WOOS and disability of the arm, shoulder and hand (DASH) preoperatively was 0.73 (P < 0.01) and the correlation between the changes of score for the WOOS and DASH was 0.75 (P < 0.01). There were no floor or ceiling effects. Responsiveness, calculated by standardized response mean, was 1.1 and effect size was 1.3. CONCLUSIONS: The Italian version of the WOOS questionnaire has shown to be equivalent to its English version and demonstrated good validity, reliability and responsiveness to conservative treatment of glenohumeral osteoarthritis. LEVEL OF EVIDENCE: Level II.

The role of wound closure in total knee arthroplasty: a systematic review on knee position.

PURPOSE: Post-operative range of motion (ROM) is one of the most important parameters to assess, following total knee arthroplasty (TKA). The aims of the present systematic review were to analyse the available literature and determine if closing the knee in flexion or extension influences post-operative ROM, clinical outcomes, and complications following TKA. METHODS: A systematic review was performed using the keywords "total knee arthroplasty", "total knee replacement", and "wound closure" or "joint closure" or "extension" or "flexion" with no limit regarding the year of publication. The review was limited to the English-language articles, and each article was evaluated with a modified Coleman Methodology Score (mCMS). RESULTS: Six articles met inclusion criteria. The initial cohort included 202 TKAs in the flexion group and 201 in the extension group. Three hundred and ninety-seven TKAs were evaluated with an average follow-up of 8 months. There was no statistical difference (n.s.) between the two groups in terms of the average post-operative flexion. There were no statistical differences between the two groups regarding post-operative functional scores and VAS scores (n.s.). The average mCMS was 70.9, indicating good methodological quality in the included studies. CONCLUSIONS: The findings of the present review did not show any statistically significant differences in terms of post-operative flexion ROM, functional scores, or complications related to the position of the knee at the time of joint and wound closure during TKA. There is no clear advantage to either closure method based on the currently available evidence, and therefore, this choice should be based on surgeon preference.

Bone block procedures in posterior shoulder instability.

PURPOSE: Posterior shoulder dislocation is often associated with bone defects. Surgical treatment is often necessary to address these lesions. The aim of the present systematic review was to analyse the available literature concerning bone block procedures in the treatment of bone deficiencies following posterior dislocation. In addition, the methodology of the articles has been evaluated through the Coleman methodology score. METHODS: A systematic review of the literature was performed using the keywords "posterior shoulder instability", "posterior shoulder dislocation", "bone loss", "bone defect", "bone block", and "bone graft" with no limit regarding the year of publication. All English-language articles were evaluated using the Coleman methodology score. RESULTS: Fifty-four articles were identified, and 13 articles met inclusion criteria. The initial cohort included 208 shoulders, and 182 were reviewed at an average follow-up of 72.7 months (±55.2). The average Coleman score was 57.2 (±8.0). The most lacking domains were the size of study population, the type of study, and the procedure for assessing outcomes. All the articles showed an increase in the outcome scores. Radiographic evaluation revealed degenerative changes such as osteoarthritis and graft lysis in most of the series. CONCLUSIONS: This review confirms the lack of studies with good methodological quality. However, bone grafting is a reliable option since significant improvement in all scores is reported. Although a low incidence of recurrence is generally described, there are concerns that the results may deteriorate over time as evidenced by graft lysis and glenohumeral osteoarthritis in up to one-third of patients. LEVEL OF EVIDENCE: Systematic review, Level IV.

The "comma sign": an anatomical investigation (dissection of the rotator interval in 14 cadaveric shoulders).

PURPOSE: The aim of the present study was to describe the precise anatomy of the so-called "Comma Sign" which has been observed during arthroscopy in retracted subscapularis (SSC) tears. METHODS: Fourteen fresh cadaveric shoulders were prepared to obtain an articular view comparable to arthroscopic posterior portal view. A step-by-step dissection was carried out to verify the presence of any anatomic structure inserting directly on the lateral margin of the SSC tendon. A sequential detachment of the superior gleno-humeral ligament (SGHL), the coraco-humeral ligament (CHL), and the SSC tendon from their bony humeral insertions was performed. Under intra-articular and extra-articular view, the SSC and its connections with the supraspinatus (SS), the SGHL and the CHL were evaluated. RESULTS: The detachment of the CHL and the SGHL from the humerus did not reveal any structure directly inserted on the superior-lateral margin of the SSC tendon. However, when the SSC tendon was excised from the lesser tuberosity and pulled medially, a bundle of fibers, which inserted directly onto its superior-lateral edge, was constantly observed. CONCLUSIONS: We constantly found an effective link between the superior-lateral corner of the SSC tendon and a bundle of fibers coming from SS and CHL. It became visible only after medial traction of the detached SSC. This structure yields the "Comma Sign" in subscapularis tendon tears.

Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up.

BACKGROUND: Anterior instability in rugby players is characterized by the common finding of a bony lesion, which has been identified as a potential cause of recurrence after soft-tissue reconstruction. The Latarjet-Patte procedure is effective in the treatment of recurrent anterior instability in collision sports such as rugby union. METHODS: We retrospectively assessed 34 rugby players (37 shoulders) stabilized with the Latarjet-Patte procedure. The mean follow-up was 12 years. All patients underwent clinical and radiographic assessment preoperatively and at final follow-up. Functional evaluation was performed with the Walch-Duplay and Rowe scores. A visual analog scale score for the evaluation of pain and the subjective shoulder value were recorded. In addition, all patients completed a questionnaire regarding the return to playing rugby. RESULTS: No recurrence of either dislocation or subluxation occurred. Persistent apprehension on clinical examination was present in 5 patients (14%). A bony lesion of the glenoid was present in 73% and a Hill-Sachs lesion in 68%. Sixty-five percent of the patients returned to playing rugby; only 1 patient did not return to playing rugby because of his shoulder. The mean Walch-Duplay and Rowe scores were 86 and 93 points, respectively. The mean subjective shoulder value was 90%. Radiographic healing of the bone block was observed in 89% of cases. At final follow-up, 11 patients (30%) had minor arthritic changes, with no cases of moderate or severe arthritis. CONCLUSION: The Latarjet-Patte procedure provides a reliable method for stabilizing the shoulder, resulting in a return to playing rugby in a high number of cases without increasing the risk of long-term arthritic degradation.