Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV.
In conclusion, other than observing the better results in meniscal tears with ACL-deficient knee, we observed that among all cases the best healing occurred in patients affected by meniscal longitudinal vertical tears located in Red-Red zone of external meniscus with an extension of 10 mm in ACL-deficient knee, treated with Fast-Fix suture and ACL reconstruction associated.
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness.Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term.In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle.The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications.ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues.Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time.The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs. Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
Transphyseal ACL reconstruction is a viable option for skeletally immature patients, with high reproducibility, a high rate of return to sport, and a low incidence of growth disturbance. Early surgery can prevent the onset of meniscal lesions and early osteoarthritis.
Background. The purpose of the study is to compare clinical outcomes and return to sport between transtibial and anteromedial portal techniques for Anterior Cruciate Ligament (ACL) reconstruction by using single bundle hamstrings grafts secured with variable suspensory fixation device. Methods. Patients undergoing ACL reconstruction were chosen randomly in the period between January 2016 and July 2016. A total of 20 patients met the criteria required to be included in the case study and ultimately grouped by different surgery approaches: 10 transtibial cohort (TT), 10 anteromedial portal cohort (AM). Outcomes were assessed with KT-1000, KSS, KOOS, Tegner-Lysholm scores and Tegner Activity Level scale. Criteria developed by Illingworth et al. were used in the radiological evaluation of bone tunnel placement as a reference to assure quality standards. Results. There was no significant difference in postoperative KT-1000 measurements between the 2 cohorts. A significant improvement in all scores was observed in both cohort. There was a significant difference between the AM group and the TT group in terms of anatomical placement of the femoral tunnels and grafts (p < 0.001). Conclusion. In terms of clinical and functional outcomes, there was no difference between the two groups in the long-term period, except for the time to return sports, which was 6.8 and 7.9 months in the AM and TT groups, respectively.
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