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BACKGROUND: Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. PURPOSE: To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL-Return to Sport After Injury scale, and the Forgotten Joint Score-12. RESULTS: The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P = .017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P = .041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P = .002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P = .044). CONCLUSION: In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old.

Asunto(s)

Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Volver al Deporte , Fútbol , Humanos , Fútbol/lesiones , Adulto , Estudios Retrospectivos , Lesiones del Ligamento Cruzado Anterior/cirugía , Adulto Joven , Adolescente , Masculino , Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Estudios de Seguimiento , Persona de Mediana Edad , Femenino

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Anterior cruciate ligament (ACL) injuries among young patients have increased in recent years. The purpose of this study was to present a physeal-sparing intra- and extra-articular reconstruction using semitendinosus and gracilis tendons autograft. In recent years, the management of these injuries in the pediatric population has become increasingly surgical to restore knee function and reduce the risk of meniscal and chondral injury due to persistent knee instability. However, this is a population at high risk for ACL graft rupture, but it can be lowered by an addition of lateral extra-articular tenodesis (LET). This study shows the pearls and pitfalls of an arthroscopic physeal-sparing ACL reconstruction combined with a concomitant LET using hamstrings autograft.

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Objectives: The aim of this retrospective study is to evaluate if Rush nail fixation still has a role in distal fibular fractures surgery compared with locking plate in terms of fixation quality, complications, functional results and patient satisfaction level. Methods: This study included 109 patients (average age 56.05), who had undergone operative treatment for bi- or trimalleolar fractures between 2009 and 2014. The patients were evaluated retrospectively, divided in group A (57 patients treated with Rush nail) and group B (52 patients treated with locking plate). The patients were evaluated at an average 4.9 years of follow-up (SD: 1.01) with Olerud-Molander Ankle Score (OMAS), American Orthopedic Foot and Ankle Society - Ankle-Hindfoot Scale (AOFAS) and Visual Analogue Scale (VAS) for clinical outcomes. X-rays were conducted to assess ankle osteoarthritis using the classification system by Takakura and joint space symmetry using measurements in comparison with contralateral ankles. Results: The groups were homogeneous regarding age and gender. Patients treated with Rush Nail fixation (Group A) showed statistically significant worse clinical results at functional scores (78.1 Group A versus 88.7 Group B at the OMAS (P<0.05); 83.1 Group A versus 90.1 Group B at the AOFAS (P<0.05); higher pain levels in the VAS (3.9 Group A versus 2.4 Group B) and lower satisfaction rates (52.6% Group A versus 73.1% Group B (P<0.05)) in comparison with patients treated with locking plate fixation (Group B). However, infections rate was significantly lower in Group A (1.8%) than in Group B (9.6%) (P<0.05). Radiographic evaluation showed more cases of post-traumatic osteoarthritis in Group A (35.1% Group A versus 15.4% Group B (P<0.05)) and worse results in regards to restoration of joint space symmetry (45.6% Group A versus 73.1% Group B (P<0.05)). Conclusion: Results of current study indicates that even though plating of lateral malleolus in bimalleolar and trimalleolar fractures is superior in fracture reduction quality, early functional recovery, reduced incidence of post-traumatic osteoarthritis and greater patient satisfaction, Rush nail fixation still provides acceptable clinical results with a lower infection rate. Therefore Rush nails could be considered as a valid choice in selected patients with high risk of soft tissue complications or low functional demand.

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PURPOSE: The anterior cruciate ligament is probably one of the ligaments with the lowest healing potential. Many authors have reported cases of spontaneous healing but nowadays it is difficult to predict successful healing of an anterior cruciate ligament rupture and, even more, residual functionality and capability to return to sport. The aim of this study was to investigate cases of spontaneous healing in a population that received non-surgical treatment after anterior cruciate ligament rupture and to perform an updated review of contemporary literature. METHODS: The authors retrospectively reviewed patients who suffered from an acute complete anterior cruciate ligament rupture and underwent non-surgical treatment. No specific rehabilitation protocol was prescribed. A new magnetic resonance imaging study was conducted 6 months after the injury for all patients. A literature review was conducted regarding spontaneous healing of the anterior cruciate ligament. The papers included in the analysis were reports of any level of evidence, written in English, Italian, or French languages; articles were excluded if they reported non-human studies, histological studies, studies conducted without magnetic resonance imaging or arthroscopic second look, or partial anterior cruciate ligament tear. RESULTS: Case series: Six patients were enrolled in the study. All patients had a proximal anterior cruciate ligament lesion. The minimum follow-up was 13 months (range 6-20 months). At the last follow-up the mean score on the Lysholm scale was 97, the mean IKDC score was 94, and the mean KOOS score was 96. All patients returned to their own sport activities; no one reported significant differences. The magnetic resonance imaging study at 6 months revealed an end-to-end continuous anterior cruciate ligament with homogeneous signal. No one had any new knee injury at last follow-up. LITERATURE REVIEW: A search of comprehensive databases retrieved 1057 articles; 8 full-text articles met the eligibility criteria. The studies were heterogeneous regarding the populations analysed, sport activity level, treatment applied, healing definition, and follow-up. The failure rate of non-surgical management ranged among the papers from 0 to 73%. CONCLUSIONS: The study findings show that spontaneous anterior cruciate ligament healing is possible and there are chances of clinical recovery for patients not suitable for surgery. However, there is still a lack of evidence about predictors, clinical outcomes, and adequate rehabilitation protocols.

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Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.

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BACKGROUND: The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system.  Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation. MATERIALS AND METHODS: We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport. RESULT: The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p<0.0001). In particular, elderly patients (>=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively). CONCLUSION: Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.

Asunto(s)

COVID-19 , Pandemias , Adulto , Anciano , Control de Enfermedades Transmisibles , Refugio de Emergencia , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ciudad de Roma , SARS-CoV-2

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BACKGROUND: The osteoarthritis of the ankle, although less common than other joints, is associated with severe functional limitation. Surgical options are ankle arthroscopic debridement, osteotomies, ankle arthrodesis and ankle arthroplasty. Ankle arthroplasty is increasingly used thanks to the new implants design, but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure. AIM: To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis. METHODS: This study enrolled 23 patients, which underwent ankle arthrodesis. The patients were divided into 2 groups: group A (open procedure; n = 11) and group B (arthroscopic procedure, n = 12), the two groups were homogeneous with regard to age and body mass index (P = 0.347). The American Orthopaedic Foot and Ankle score (AOFAS), Freiburg Ankle score (FAS) and visual analogue scale for pain intensity were evaluated preoperatively, at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B (P = 0.364). RESULTS: Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS (group A, 62.2; group B, 78.5; P < 0.05) and the FAS (group A, 61.1; group B, 70.3; P = 0.015) scores. Pain relief was achieved in both groups at six-month follow-up (group A, 1.4; group B, 0.9; P = 0.162). Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up (P > 0.05). Hospital stay was shorter in group B than in group A (P = 0.001). More complications were reported in the open group than in the arthroscopic group (P = 0.459). CONCLUSION: The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up. Moreover, the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

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The COVID-19 outbreak strongly affected Italy, putting a strain on the National healthcare system. Hospitals quickly reorganized the activity to cope with the emergency. This retrospective comparative study aimed to analyze the impact of the lockdown imposed in Italy during the COVID-19 outbreak on acute orthopedic trauma, in order to identify critical issues for improvement and future planning. We collected data on all the trauma admissions to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during the COVID- 19 pandemic lockdown in Italy, comparing them with the corresponding period in 2019. We reported demographic data; the characteristics of the injury, including the anatomical location, fracture, sprain, dislocation, contusion, laceration, whether the injury site was exposed or closed, where the injury occurred, and polytrauma. We also recorded the waiting time in the emergency room and mode of transportation. The study sample was composed of 1199 patients, 636 (53.04%) males and 563 (46.96%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during COVID-19 outbreak in 2020. The average age of the 2020 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) (p<0.0001). In particular, elderly patients (≥65 years) were the most commonly involved in the COVID-19 group, while in the pre- COVID-19 period they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 65.7% of cases in the 2020 group, and in 32.3% of patients in the 2019 group. Concerning the injury type, in both groups, the most common injury was a fracture (45.1% in 2019; 62.7% in 2020) (p<0.0001). The most injured anatomical location during COVID-19 lockdown was the hand (14.2%), while in the pre-COVID- 19 group the most frequent injury type was polytrauma (22.8%). Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly individuals remained stable, indicating that not all trauma presentations would necessarily decrease during such times.