Introduction Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. Methods A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. Results Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A 2A and A 3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. Discussion The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. Conclusion The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.

Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.

Low-back pain is very frequent, especially in active adult population. There are several different orthopaedic condition that can cause low-back pain, and the pain worsen the quality of life significantly. The treatments vary from drugs, physical therapies, kinesiology, local infiltrations, and so on. Laser therapy has an important role in the treatment of the inflammatory causes of pain, with several studies that demonstrate the efficacy of low and high energy laser therapy in the treatment of low-back pain. Sixty-six consecutive patients with low-back pain with or without leg pain were treated using a combination of Tri-length laser I-Triax® (Mectronic Medicale, Bergamo, Italy) and Pharon® tecar therapy (Mectronic Medicale, Bergamo, Italy). The patients were treated three times a week, every other day, for a total of 10 sessions. Clinical results were evaluated using visual analogic scale for individual pain (0 to 10) and the Oswestry disability scale (ODS). Tests started before the beginning of therapies and 8 weeks after the end of the therapies. Visual analogic scale (VAS) score significantly improved from an average value of 8.1 ± 1.58 pre-treatment to an average value 8-weeks post-treatment of 2.63 ± 2.74 (P < .01). ODS values start from a pre-treatment average value of 53.0 ± 13.0 to a post-treatment average value of 23.5 ± 19.8 (P < .01). A higher improvement both in VAS and in ODS was denoted in the group of patient with low-back pain and leg pain (respectively, VAS from 8.66 ± 1.58 to 2.86 ± 2.94 and ODS from 57.8 ± 15.5 to 23.7 ± 19.5). Low-back pain, associated or not with leg pain, is a very common clinical situation. The treatments of this condition are different, and an important role can be given to the laser therapy. The conclusion of this study is that the association between laser therapy iLux-Triax® and tecar therapy Pharon® in the treatment of low-back pain, with or without leg pain, can significantly reduce pain and improve the quality of life in patients with degenerative and inflammatory problems.

VAS and functional score in all trials that we have analyzed. Conclusion: intra-articular injection with HA is effective in reducing pain and improving function in shoulder with rotator cuff tears and without severe adverse reaction. Level of evidence: Level I.KEY WORDS: cuff tears, glenohumeral, hyaluronic acid, hyaluronate, shoulder, viscosupplementation. IntroductionRotator cuff pathology is the main cause of shoulder pain and disability. The causes arises from a multivariate etiology, often due to age-related chronic degeneration in which play a role the decrease in collagen synthesis, increase in free radicals expression and metabolism imbalance in favor of catabolic activity 1 . Classically, the diagnosis is clinical, characterized by pain, mostly during the night, severe disability and functional impairment 2,3 . MRI and US may usefully this diagnosis 4,5 . The first management is conservative, including oral anti-inflammatory drugs, topic agents, cortisone injections, physical therapies, and joint rehabilitation exercises [6][7][8] . In the past, much has been published on the use of steroid and local anesthetic injections, administered alone or in combination to other therapies. On the other hand, many evidences have corroborated their potential effects as negative on the collagen matrix of tendons and ligaments [9][10][11][12][13][14] . In the substance, compared to other treatments, effective in the mid and long term, the benefits after these injections could be valid only in the short-term 15 . Clinical trials have confirmed that HA may be effective for management of tendons disorders. Specifically, in Achilles tendinopathy, the tendon healing process is improved and the formation of adhesions in reduces by the regulation of the expression of vascular endothelial growth factor (VEGF) and type IV collagen 16 . After hand surgery, it improves the motion of fingers lubricating the tendon surface and reducing friction and adhesions 17,18 . Few papers have investigated the effects of HA in rotator cuff disorders, and no systematic review have been performed on this matter. The aim of the present review is to summarize all papers published inherently to the injection of HA for management of cuff tendinopathy, in terms of feasibility, safety, and efficacy. © C I C E d i z i o n i I n t e r n a z i o n a l i Material and methods Criteria for considerationWe included randomized clinical trials, prospective and retrospective studies reporting on clinical and functional outcomes in patients who had undergone sub-acromial or intra-articular injections of HA for management of rotator cuff pathology. Given the linguistic capabilities of the research team, we considered only papers published in English language. We performed a broad search for relevant studies published up to August 2014 in Medline (http://www.ncbi.nlm.nih.gov/sites/entrez/); Ovid (http://www.ovid.com); Cochrane Reviews (http://www.cochrane.org/reviews/), Google Scholar, Enbase database. Combined key words for the search were "cuff tears", "gl...

Further studies are needed to produce clear guidelines to determine how to balance the apoptosis process to reduce the failed healing response found in non-traumatic RC tears.