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Alessio Giai Via,1 Antonio Frizziero,2 Paolo Finotti,2 Francesco Oliva,3 Filippo Randelli,1 Nicola Maffulli4,5 1Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy; 2Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy; 3Department of Orthopaedics and Traumatology, Tor Vergata Hospital, University of Rome “Tor Vergata”, Rome, Italy; 4Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy; 5Centre for Sport and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England Abstract: Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management. Different surgical options have been also described, but they should be reserved to recalcitrant cases. In this review, a critical analysis of the literature about athletic osteitis pubis is performed, especially focusing on its diagnostic and therapeutic management. Keywords: osteitis pubis, pubalgia, groin pain, rehabilitation, review

Abstract Background Congenital talipes equinovarus (CTEV) is a common developmental disorder of the foot, affecting between 1 and 4.5 per 1000 live births. The aetiology is not well elucidated. While both genetic and environmental factors are implicated, no specific genes have been identified and little is known about environmental risk factors. Methods We conducted a case-control study of idiopathic congenital talipes equinovarus (ICTEV) in the United Kingdom. 194 cases and 60 controls were recruited. Pedigrees were obtained for 167 cases. Results The rank of the index pregnancy, maternal education and caesarean delivery were significantly associated with ICTEV risk in a multivariate model. There were suggestions that maternal use of folic acid supplements in the three months before the pregnancy decreased ICTEV risk, and that parental smoking during the pregnancy increased risk, although the associations were not statistically significant. One quarter of pedigrees showed a family history of CTEV, and autosomal dominant inheritance was suggested in some of these. Conclusion Uterine restriction did not appear to have a strong influence on ICTEV development in our study. Large population-based studies are needed to clarify the aetiology of this common developmental disorder.

Objective: Knee osteoarthritis (OA) affects millions of people. The role of oral supplements among conservative treatments for knee OA is still debated. This prospective observational study evaluates the efficacy of oral supplements of hyaluronic acid and Boswellia serrata extract in reducing pain and improving joint range of motion in patients with mild-moderate knee OA. Patients and Methods: Forty patients (24 women and 16 men), with a mean age of 67.6 ± 7.9, took one tablet of oral supplement based on hyaluronic acid 300 mg + Boswellia serrata extract 100 mg per day for 60 consecutive days. The follow-up lasted six months. After 1 (T1), 3 (T2) and 6 (T3) months, each patient underwent clinical consultation with pain and knee function assessment using specific scores [(Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee (IKDC)]. Finally, during the last consultation, the degree of patient satisfaction was assessed (on a scale of 0 to 10). Results: Two of the 40 patients dropped out of the study (5% dropout rate). The VAS showed a statistically significant improvement (p < 0.001) between the first and subsequent visits, with a clear reduction in pain between T1 and T2. The KOOS improved at each visit, with statistically significant results (p < 0.001) between T0 and T1 and between T2 and T3. The WOMAC showed statistically significant improvements (p < 0.001) between the first and all subsequent consultations, while between T2 and T3, the results showed a non-statistically significant reduction in the score. The IKDC score showed statistically significant improvements (p < 0.001) between the first and all subsequent consultations, with non-statistically significant differences between T1 and T2, T1 and T3, T2 and T3. Finally, the degree of satisfaction was 8.1 ± 1.4. Conclusions: Oral administration of hyaluronic acid and Boswellia serrata extract decreases pain and improves knee function in patients with mild to moderate knee OA. [ABSTRACT FROM AUTHOR]