Purpose  The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods  Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results  Postoperatively, the IKDC objective total score significantly improved ( p  = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up ( p  = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up. Conclusion  The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence  Level IV, therapeutic case series.

Neuromuscular electrical stimulation allows a slightly better functional recovery after total knee arthroplasty, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.

This review focuses on the various techniques of conservative treatment of plantar fasciitis and posterior heel pain. Being the optimal therapy controversial, the intent is to drive surgeons and rehabilitation specialists in the choice of the strategies. The Data sources were MEDLINE, PubMed, CINAHL, EMBASE, and Psych INFO databases using the selected key words. Studies have been selected for review using as criteria English, adults, clinical population and intervention. Among several published studies about rehabilitation and fasciitis, only a few showed bases on scientific evidence. Moreover, many studies were heterogeneous and included different outcomes and evaluations. There is consensus that a specific rehabilitation program is necessary to avoid chronicity. However, the real efficacy of every specific treatment (orthoses, stretching, radiotherapy, botulin toxin, shock waves, corticosteroid therapy, and platelet rich plasma) is still questionable, and often related to the experience of the authors. In conclusion, patients undergoing physiotherapy obtain a better and faster outcome achievement than non-treated patients; however, evidence-based treatments, protocols and clinical trials are recommended.

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

Background The incidence of Achilles tendon (AT) rupture increased, but there is no gold standard treatment. The aim of this study is to compare clinical and functional results of standard and fast rehabilitation program (immobilization and no weight bearing for 4 weeks vs early joint mobility and weight bearing). Methods 33 patients underwent to open achilles tenorraphy between January and July 2018 using Krackow suture.15 patients were enrolled and underwent fast rehabilitation program. A control group of 18 patients underwent surgery and standard protocol. The degree of sural triceps hypotrophy compared with the controlateral leg (calf circumference 4 cm below the anterior tibial tuberosity and the tibial length), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score [8], the Victorian Institute of Sports Assesement - Achilles Questionnaire (VISA-A) [9] and The Achilles tendon Total Rupture Score (ATRS) [10] were recorded at 12 months follow up. Ultrasonography and elastosonography were used to calculate different parameters both on the operated tendon and on the contralateral. Discussion Using ultrasonography, the only significant difference was recorded in the distal depth in both groups. We detected an increase of all measures in both groups comparing surgical side to the contralateral one. Using the elastosonography, the stiffness on healthy side was increased at the proximal and medial third in standard group, even if the distal third was major in fast group. On the operated side, stiffness was more on the proximal third in fast group (not statistically significant). There was an increase of tendon size on the surgical side compared to the “basal” one using US. The only statistically significant result was at distal third, and it could be due to the fact that giving an accelerated mobilization stimulates more collagen deposition, which could be a protective factor. Furthermore, at distal third of tendon we observed a greater reduction of stiffness in the fast group compared of the standard one. The results of the post-operative assessment scales are overlapping in the two groups. Clinical and functional evidence suggest that fast rehabilitation after AT surgical repair may be a first choice of treat, especially in young and active patients, because of minor local complications and higher level of satisfaction.