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OBJECTIVE: The clinical efficacy and tolerability of denosumab in severe osteoporosis are well-known. However, the evaluation on general health and quality of life over time and compared to population norms is still lacking. We aimed at evaluating denosumab effectiveness in a real-world clinical sample with a 6-years average follow-up. PATIENTS AND METHODS: In this retrospective-matched study with prospective data collection, a total of 101 patients affected by severe osteoporosis and treated with denosumab between 2014 and 2020 were evaluated. All patients completed the self-perceived quality of life (36-Item Short Form - SF-36) survey and visual analogue scale (VAS) before and after treatment. RESULTS: Overall, 13 patients died of causes unrelated to the procedure, 12 stopped therapy with denosumab, and 30 did not participate in the follow-up; thus, 46 patients completed the study. There were 44 (95.7%) women and 93.4% of patients reported history of osteoporotic fractures. The mean follow-up was 59±17.8 months and the mean age at follow-up was 73.9±10.6 years. We found a significant improvement in bodily pain (baseline 53.8±33.4, follow-up 62.7±26.6; p=0.002) and in general health (baseline 35±25.4, follow-up 41.7±24.2; p=0.002) over time. The bodily pain score at follow-up was similar to the mean of the age-matched healthy population (62.7±26.6 vs. 67.6±26, p=0.374). The MCS-36 scores were higher than the normative values before treatment and at follow-up (51.6±9.8 vs. 45.8±9, p=0.004 and 50.6±11.7 vs. 45.8±9, p=0.030, respectively). The PCS-36 score at follow-up was comparable to the normative values (39.4±10.4 vs. 42.7±9, p=0.107). CONCLUSIONS: Denosumab is effective to improve bone health and global mental and physical wellbeing, and quality of life over time. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Postoperative urine retention (POUR) is a well-known complication after total joint arthroplasty (TJA). POUR is most commonly managed with an indwelling catheter. However, indwelling catheters have been associated with a substantial risk of urinary tract infection (UTI). The purpose of this study was to (1) evaluate the incidence of UTI and POUR in patient with indwelling urinary catheter after TJA, (2) identify the microorganisms responsible for catheter colonization, and (3) assess preoperative risk factors (gender, body mass index, hypertension, diabetes mellitus, smoking) associated with catheter colonization. PATIENTS AND METHODS: Patients undergoing primary TJA with no preoperative bacteriuria were enrolled. Prior to the draping of the surgical site, each patient received an indwelling catheter that was inserted under sterile conditions and remained in place for 24 hours. Urine and tip catheter cultures were performed after catheter removal. RESULTS: 55 patients (38 females and 17 males) were recruited (26 total knee and 29 total hip arthroplasties). POUR was not reported in any patient, and only 1 patient (1.8%) had UTI. Cultures of catheter tips were positive in 16 patients (29.1%). Only 1 of these patients had a positive urine culture. Enterococcus faecalis was the most common pathogen isolated. None of the preoperative variables was associated with the risk of catheter colonization. CONCLUSIONS: Data from this study support early catheter removal after TJA. Predominant catheter-isolated bacteria are enteric species. The culture of a catheter tip specimen should be discouraged for the diagnosis of UTI within the firsts 24 hours after surgery. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The leading cause of pyogenic vertebral osteomyelitis is Staphylococcus aureus, and its incidence is rising, particularly in the elderly. We report an unusual case of cervical spondylodiscitis and epidural abscess mimicking Pott’s disease. CASE REPORT: A 67-year-old man was admitted to our institution with a 15-day history of neck pain radiating to the head, shoulders and left arm that was associated with weakness and paresthesia. Laboratory tests showed a mild leucocytosis and high levels of inflammatory markers. The MRI showed contrast enhancement of C6-C7 with an abscess infiltration extending to the intervertebral disc, the anterior epidural space, and the medullary cord. The patient had a medical history of a positive Mantoux tuberculin skin test 25 years prior, and the interferon-gamma release assay (IGRA) was positive for the identification of latent tuberculosis infection. All other examinations for diagnosis of spinal tuberculosis were inconclusive. Intravenous antibiotic therapy was initiated with teicoplanin 800 mg and levofloxacin 750 mg daily with a fast recovery of symptoms. CONCLUSIONS: Cervical spondylodiscitis can be an unusual cause of severe neck pain with a challenging differential diagnosis. Conservative treatment should always be considered for patients without neurological symptoms as long as close follow-up evaluations are performed. [ABSTRACT FROM AUTHOR]

Abstract Background The superiority of tenotomy vs. tenodesis for surgery on lesions of the long head of the biceps brachii tendon is still under debate. Indeed, high-quality evidence is lacking, mainly because of methodological problems, such as retrospective design, population sample size or lack of patient randomization. Methods/Design The study will be a two-center, double-blind, randomized, controlled trial to compare patients treated with biceps tenotomy or tenodesis for lesions of the long head of the biceps brachii tendon over a 2-year follow-up period. The study participants will be 128 adults with biceps brachii tendinopathy and supraspinatus tendon tears. The primary end point will be the postoperative difference in the Constant-Murley score (CMS) between the 2 groups at the two-year follow-up. A comparison of the mean improvement with standard age- and gender-related CMS will be performed. The secondary end point will be evaluation of the postoperative general health of patients, as evaluated with Short Form 36 (SF-36) scores. The number and severity of complications associated with use of the different surgical techniques will be assessed. Discussion This study will be the first randomized and appropriately powered clinical trial to directly compare tenotomy and biceps tenodesis. The results of this study will help to establish clinical practice guidelines for patients suffering from lesions of the long head of the biceps brachii tendon, providing important information to patients and health care providers about the possible complications, outcome predictors and effectiveness of the targeted interventions. Trial Registration Current Controlled Trials ISRCTN38839558

Abstract Background There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in calcific tendinopathy of the rotator cuff, but the best current evidence does not support its use in non-calcifying tendinopathy. We conducted a randomized placebo-controlled trial to investigate the efficacy and safety of low energy ESWT for non-calcifying tendinopathy of the rotator cuff. Methods 20 patients with non-calcifying supraspinatus tendinopathy (NCST) were randomized to an active or a sham treatment group. Physical, blood, roentgenographic, and MRI examinations of the shoulder were conducted to verify that patients met the inclusion and exclusion criteria. These examinations were repeated six and twelve weeks after treatments. Effectiveness was determined by comparison of the mean improvement in the Constant and Murley score (CMS) between the treatment and the placebo groups at three months. Safety was assessed by analyzing the number and severity of adverse events. Results All the patients completed the investigation protocol. At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values. Significantly higher total CMS, and significantly higher scores for CMS pain and ROM were observed in the ESWT group when compared to the placebo. No serious adverse events were noted after ESWT. Conclusions Patients suffering from NCST may benefit from low energy ESWT, at least in short-term. The application protocol of ESWT is likely to play a key-role in a successful treatment. Future investigations should be undertaken on the long-term effects of this technique for the treatment of NCST. Trial registration Current Controlled Trials ISRCTN41236511

Abstract Background There is a lack of data on the long-term outcome of total hip arthroplasty procedures, as assessed by validated tools. Methods We conducted a follow-up study to evaluate the quality of life and functionality of 250 patients an average of 16 years (range: 11-23 years) after total hip arthroplasty using a validated assessment set including the SF-36 questionnaire, Harris Hip Score, WOMAC score, Functional Comorbidity Index, and a study specific questionnaire. Models of multiple stepwise linear and logistic regression analysis were constructed to evaluate the relationships between several explanatory variables and these functional outcomes. Results The SF-36 physical indexes of these patients compared negatively with the normative values but positively with the results obtained in untreated subjects with severe hip osteoarthritis. Similar results were detected for the Harris Hip Score and WOMAC score. There was a 96% rate of post-surgical satisfaction. Hip functionality and comorbidities were the most important determinants of physical measures on the SF-36. Conclusions Patients who had undergone total hip arthroplasty have impaired long-term self-reported physical quality of life and hip functionality but they still perform physically better than untreated patients with advanced hip osteoarthritis. However, the level of post-surgical satisfaction is high.

Background: Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) has been used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR) in recent years. However, there are still concerns that these procedures may lead to complications such as overconstraint of the lateral compartment, stiffness, infections, tunnel convergence, and other intra- and postoperative complications because of increased surgical time and the need for additional procedures., Hypothesis/purpose: The lateral extra-articular procedure will reduce the failure rate of reconstructed ACLs without increasing the number of complications. The purpose was to compare the complication and graft reinjury rates of 2 main anterolateral complex procedure categories described in the literature-LET and ALLR with isolated ACLR., Study Design: Systematic review and meta-analysis of randomized controlled trials (RTCs); Level of evidence, 2., Methods: The methodology followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched on March 15, 2024, to identify RTCs comparing isolated ACLR with ACLR + LET or ALLR. The methodological index for nonrandomized studies was employed for the quality evaluation. Complications and graft reinjury rates were recorded and meta-analyzed from all included studies., Results: The initial search yielded 1411 articles. Seventeen studies that included the complication rates (5 in the ALLR group and 12 in the LET group) were included in the review. No significant differences were found in the incidence of complications between the ACLR and ACLR + ALLR groups (Mantel-Haenszel [M-H], 1.20 [95% CI, 0.05-29.30]; P = .91) or between the ACLR and ACLR + LET groups (M-H, 0.39 [95% CI, 0.05-2.98]; P = .36). Significant differences were observed in the failure rate between the ACLR + ALLR group (M-H, 6.78 [95% CI, 1.98-23.22]; P = .002) and the ACLR + LET group (M-H, 3.14 [95% CI, 1.96- 5.04]; P < .00001)., Conclusion: Adding a lateral extra-articular procedure, regardless of the surgical technique, can reduce the failure rate without increasing the number of complications at the mid-term follow-up., Study Registration: PROSPERO (CRD42023458354)., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Failure, persistent knee instability, and reinjury rates after anterior cruciate ligament (ACL) reconstruction are still concerns. Biomechanical investigations have highlighted the role of the anterolateral ligament (ALL) as a crucial knee stabilizer, and clinical outcomes after combined ACL and ALL reconstruction appear to indicate the success of the procedure., Purpose: To compare the functional outcomes, return-to-sport (RTS) rate, and complications between combined ACL and ALL reconstruction and isolated ACL reconstruction., Study Design: Meta-analysis; Level of evidence, 4., Methods: The PubMed/MEDLINE, Scopus, and Cochrane Central databases were used to search keywords, and a total of 16 studies were included. The data extracted for quantitative analysis included the Tegner activity scale score, Lysholm knee score, International Knee Documentation Committee (IKDC) score, laxity measured using the KT-1000 knee arthrometer, number and types of complications, RTS rate, and survival rate. Random- and fixed-effects models were used for the meta-analysis of pooled mean differences and odds ratios., Results: A total of 2329 patients were identified, 1116 of whom underwent combined ACL and ALL reconstruction and 1213 of whom underwent isolated ACL reconstruction. The mean ages were 25.4 ± 7.2 years and 26.5 ± 7.8 years for the combined ACL and ALL reconstruction and isolated ACL reconstruction groups, respectively. The mean follow-ups were 40.3 ± 21.4 months and 42.5 ± 21.6 months, respectively. Comparable Tegner activity scale ( P = .16), Lysholm knee ( P = .13), and IKDC ( P = .83) scores were found between groups. Significantly greater postoperative knee laxity was found in the isolated ACL reconstruction group (mean difference, -0.44; 95% CI, -0.85 to -0.04; P = .03). The combined ACL and ALL reconstruction group showed a significantly lower rate of graft failure (odds ratio [OR], 0.37; 95% CI, 0.18-0.77; P = .008), a higher RTS rate (OR, 1.41; 95% CI, 1.11-1.80; P = .005), and a higher survival rate (OR, 2.94; 95% CI, 1.97-4.37; P < .001)., Conclusion: Compared with isolated ACL reconstruction, combined ACL and ALL reconstruction yielded comparable functional outcomes but significantly less residual knee laxity and a lower graft failure rate. Patients who underwent combined ACL and ALL reconstruction also had higher RTS and survival rates., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background : Improper neuromuscular control with excessive dynamic valgus loading of the knee has been identified as one of the main anterior cruciate ligament injury risk factors. This study aimed to analyze the impact of the FIFA 11+ training program on the valgus loading of the knee in academy soccer players over a competitive season. Methods : A prospective study was conducted on 85 players. The drop vertical jump test was carried out before the match and at the end of the same match at the beginning and at the end of the season over a period of 11 months. Results : An increase of the varus angle on the right limb was noted between the start and the end of the season at the beginning of the match (-4.7 ± 8.9 versus -6.9 ± 6, p = 0.003) and between the start and the end of the match in values measured at the beginning of the season (-4.7 ± 8.9 versus -7.7 ± 9, p < 0.001). An increase of the flexion angle of both limbs was noted between the start and the end of the season in values measured at the start of the match (left limb 76.8 ± 32.8 versus 98.6 ± 17.2, p < 0.001; right limb 76.4 ± 32.8 versus 96.1 ± 16.1, p < 0.001) and between the start and the end of the season in values measured at the end of the match (left limb 92.8 ± 19.1 versus 98.5 ± 16.3, p = 0.002; right limb 92.6 ± 19.2 versus 96.7 ± 14.5, p = 0.013). Conclusions : A decrease in dynamic valgus angle and an increase in knee flexion angle measured with the DVJ test were noted between the start and the end of the season, suggesting a protective role of the FIFA 11+ training program.

We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Quadriceps tendon rupture (QTR) is an uncommon injury. In chronic QTR there may be a large defect and direct repair is not possible with sutures or transosseous anchors. There is no gold standard surgical procedure for the treatment of chronic QTR. We propose a novel technique in which the quadriceps tendon (QT) is reconstructed using a transfer of ipsilateral sartorius tendon., Methods: Between January 2002 and April 2020, 19 patients undergoing sartorius muscle transfer for chronic QTR were prospectively recruited. The Knee Society Score (KSS), range of motion (ROM), and Medical Research Council (MRC) Scale for QT muscle strength were collected preoperatively and at a minimum of 2 years follow up., Results: The mean age of our cohort was 53.4 ± 9.8 years with a female patient count of 12 (54%). The mean body mass index recorded was 28.5 ± 3.2 kg/m 2 (range 23-30). At the mean follow up of 53.4 ± 28.1 months the mean KSS was 90.9 ± 6.3 (range 80-100) (P < 0.05), the mean ROM was 119.5 ± 9.9° for flexion (range 100-130) (P < 0.05) and the mean extension lag was 3.8 ± 5.1° (range 0-15) (P < 0.05). The mean MRC scale was 4.5 ± 0.7 (range 3-5) (P < 0.05). The most frequent complication was QT hypotrophy; it was noted in 14 patients., Conclusion: Satisfactory clinical outcomes of ipsilateral sartorius muscle transfer for chronic QTR can be expected a mean of 4.4 years after surgery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility., Methods: A review of the published literature was conducted and reported through PubMed/Scopus/Cochrane libraries. We included studies using any antipsychotic treatment where the bone metabolism, osteoporosis, and/or risk of fractures has been assessed., Results: After screening 1707 items, we finally included 15 papers. A total of 3245 initial patients were identified, of whom 1357 patients with a mean age of 43.8 years underwent antipsychotic treatment and were analyzed. The mean antipsychotic treatment duration of the treated group was 15.8 ± 13.9 years. Among the included studies, two reported a statistically significant difference in lumbar BMD reduction between the antipsychotic exposed group and the control group. Femoral neck BMD levels had been reported in four of the case-control studies; two reported a statistically significant difference in femoral neck BMD reduction between the antipsychotic exposed group and the control group., Conclusions: Prolonged use of antipsychotic treatment seems to be associated with an increased risk of reduced BMD, and, consequentially, with an augmented risk of bone fragility and fractures. This effect is not limited to vulnerable groups, such as those with significant medical comorbidities, the elderly, and postmenopausal women, but may also apply to anyone using antipsychotics in the long-term. Clinicians' awareness of antipsychotic prescriptions should optimize their potential while reducing this risk.

Background: Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR., Purpose: To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR., Study Design: Cohort study; Level of evidence, 3., Methods: A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL-Return to Sport after Injury scale., Results: After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score ( P = .013), IKDC ( P = .003), total KOOS ( P < .001), KOOS Symptoms ( P = .004), KOOS Pain ( P = .029), KOOS Activities of Daily Living (ADL) ( P = .044), KOOS Sport and Recreation (Sport/Rec) ( P = .001), KOOS Quality of Life (QoL) ( P < .001), and Lysholm score ( P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores ( P = .003), total KOOS ( P = .001), and KOOS Sport/Rec ( P = .011). Playing only on artificial turf was associated with lower Lysholm score ( P = .018) and total KOOS ( P = .014). The contact mechanism was associated with higher IKDC ( P = .044) and KOOS QoL ( P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores ( P = .012). Playing at a nonprofessional level was associated with lower total KOOS ( P = .028), KOOS Symptoms ( P = .002), KOOS ADL ( P = .033), and KOOS Sport/Rec ( P = .016)., Conclusion: Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Background: The rationale for the Latarjet procedure was described as the "triple blocking" effect. Satisfactory surgical outcomes have been reported after surgery. However, it has been reported that the "triple blocking" effect increases joint stability, but it does not fully restore it. Moreover, the procedure is nonanatomic and concerns remain regarding the effects. The study of scapulohumeral rhythm, which is a clinical parameter used for the functional evaluation of shoulder kinematics, can offer new perspectives on the rationale for the procedure. This study aimed to compare the shoulder kinematics of patients after the Latarjet procedure to the shoulders of a healthy population using magnetic and inertial measurement units with a motion analysis system., Methods: A retrospective study with prospective data collection was conducted on 28 patients who underwent the open Latarjet procedure for recurrent shoulder instability. At a minimum 12-month follow-up, each patient was evaluated by assessing the range of motion, the Rowe score, and the Constant-Murley score. Patients were examined using the ShowMotion 3D kinematic tracking system (NCS Lab, Modena, Italy), which uses wireless wearable noninvasive magnetic and inertial measurement units sensors to assess the three-dimensional kinematics of the shoulder. For each plane of elevation (ie, flexion and abduction), the scapulohumeral rhythm was described by three scapulothoracic rotations (ie, protraction-retraction, mediolateral rotation and posterior-anterior tilting) as a function of humeral anteflexion or humeral abduction., Results: The mean time from first shoulder dislocation to surgery was 6.6 ± 3 years (range, 1-12 years). No intraoperative complications occurred, and computed tomography (CT) performed 3 months after surgery showed graft union in all patients. After a mean follow-up time of 32.4 ± 20 months (range, 12-96), the mean Constant-Murley score and Rowe scores were 94.5 ± 4.8 (range, 84-100) and 96.7 ± 3.5 (range, 90-100), respectively. All patients showed no signs of glenohumeral arthritis on X-ray examination. Scapular posterior tilt and scapular internal rotation were significantly greater in the patient group than in the healthy population for the flexion-extension and abduction-adduction movements along the whole shoulder range of motion (all P < .05); no differences were found in upward/downward scapular rotation., Conclusion: A greater scapular posterior tilt and scapular internal rotation were observed after the Latarjet procedure. The modified position of the scapula was maintained during the entire range of motion, suggesting a shoulder-stabilizing kinematic effect in addition to the bony, sling and bumper effects., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)