Comparison between intrarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis.

This study aimed to compare short-term clinical outcomes between intra-articular injection of hyaluronic acid (HA), oxygen ozone (O2O3), and the combination of both, in patients affected by osteoarthrosis (OA) of the knee. Seventy patients (age 45-75 years) with knee OA were randomized to intra-articular injections of HA (n=23), or O2O3 (n=23) or combined (n=24) one per week for 5 consecutive weeks. KOOS questionnaire and visual analog scale (VAS), before treatment (pre) at the end (post), and at 2 months after treatment ended (follow-up) were used as outcome measures. Analysis showed a significant effect (P < 0.05) of the conditions (pre, post and follow-up) in all parameters of the KOOS score and a significant effect (P < 0.05) of groups (HA, O2O3 and combined) for pain, symptoms, activities of daily living and quality of life. The combined group scores were higher compared to the HA and O2O3 groups, especially at follow-up. The combination of O2O3 and HA treatment led to a significantly better outcome especially at 2-month follow-up compared to HA and O2O3 given separately to patients affected by OA of the knee.

Effect of whole body vibration frequency on neuromuscular activity in ACL-deficient and healthy males.

Whole-body vibration (WBV) has been shown to enhance muscle activity via reflex pathways, thus having the potential to contrast muscle weakness in individuals with rupture of the anterior cruciate ligament (ACL). The present study aimed to compare the magnitude of neuromuscular activation during WBV over a frequency spectrum from 20 to 45 Hz between ACL-deficient and healthy individuals. Fifteen males aged 28±4 with ACL rupture and 15 age-matched healthy males were recruited. Root mean square (RMS) of the surface electromyogram from the vastus lateralis in both limbs was computed during WBV in a static half-squat position at 20, 25, 30, 35, 40 and 45 Hz, and normalized to the RMS while maintaining the half-squat position without vibration. The RMS of the vastus lateralis in the ACL-deficient limb was significantly greater than in the contralateral limb at 25, 30, 35 and 40 Hz (P<0.05) and in both limbs of the healthy participants (dominant limb at 25, 30, 35, 40 and 45 Hz, P<0.05; non dominant limb at 20, 25, 30, 35, 40 and 45 Hz, P<0.05). The greater neuromuscular activity in the injured limb compared to the uninjured limb of the ACL-deficient patients and to both limbs of the healthy participants during WBV might be due to either augmented excitatory or reduced inhibitory neural inflow to motoneurons of the vastus lateralis through the reflex pathways activated by vibratory stimuli. The study provides optimal WBV frequencies which might be used as reference values for ACL-deficient patients.

Physical fitness assessment in multiple sclerosis patients: a controlled study.

There is growing evidence to show the effectiveness of physical exercise for multiple sclerosis (MS) patients. Aim of this study was to evaluate aerobic capacity, strength, balance, and the rate of perceived exertion (RPE) after exercise, in ambulatory patients with mild MS and matched control healthy participants. Seventeen MS patients aged 48.09 ± 10.0 years, with mild MS disability (Expanded Disability Status Scale: EDSS 1.5 to 4.5) and 10 healthy sedentary age matched (41.9 ± 11.2 years) subjects volunteered for the study. MS patients underwent medical examination with resting electrocardiogram, arterial blood pressure, EDSS, and Modified Fatigue Impact Scale-MFIS. Both groups also underwent physical assessment with the Berg Balance Scale(,) test (Berg), Six Minutes Walking Test (6MWT), maximal isometric voluntary contraction (MIVC) of forearm, lower limb, shoulder strength test, and the Borg 10-point scale test. The one-way ANOVA showed significant differences for MFIS (F1.19=9.420; p<0.01), Berg (F1.19=13.125; p<0.01), handgrip MIVC (F1.19=4.567; p<0.05), lower limbs MIVC (F1.19=7.429; p<0.01), and 6MWT (F1.19=28.061; p<0.01) between groups. EDSS, Berg test and Borg scores explained 80% of 6MWT variation. Mild grade EDSS patients exhibited impaired balance, muscle strength, and low self pace-6MWT scores, whereas RPE response after the exercise was similar to that of sedentary individuals. Both groups showed similar global physiological adjustments to exercise.

Neck balance system in the treatment of chronic mechanical neck pain: a prospective randomized controlled study.

BACKGROUND: Chronic mechanical neck pain (MNP) is a very common condition, that may occur in general population. There is a lack of evidence for most therapies except for exercise therapy with combining methods, whose effectiveness is still moderate. AIM: The aim of this study was to determine the effect of a novel neck balance system-Dal Monte 2(NBS-DM2) incorporated into a special cap on pain in sufferers of MNP after treatment and at three months follow-up. DESIGN: Prospective randomized controlled trial. SETTING: Outpatient clinic of the University of Rome "Foro Italico". POPULATION: Forty-five volunteers of both sexes affected by grade II MNP were enrolled. METHODS: NBS-DM2/RW (regular weight), NBS-DM2/NW (negligible weight) and Pulsed Electromagnetic Fields (PEMF) have been used for 8 weeks. Neck Disability Index (NDI), Neck Pain and Disability Scale (NDPS) questionnaires and Visual Analogic Scale (VAS) score were evaluated before, after the treatment period and 3 months after the end of treatment. RESULTS: NBS-DM2/RW compared with NBS-DM2/NW and PEMF group performed better in the reduction of the three measures at the end and at short term run (p ≤ 0.05). CONCLUSION AND CLINICAL REHABILITATION IMPACT: When applied to grade II MNP patients, NBS-DM2/RW leads to pain relief and reduction of disability. These effects persist over a short term follow-up period. PEMF therapy was found to have no significant effect on reduction of pain and disability in this study.

Psychological well-being and social participation assessment in visually impaired subjects playing Torball: a controlled study.

The aim of this study was to evaluate the differences in psychological well-being, symptomatic psychological disorders and social participation, between blind Torball players and non-players. Thirty blind male participants were recruited, 17 Torball players (aged 36.27±3.46) and 13 non-players (aged 34.80±2.53), and evaluated for social participation level, psychological well-being and symptomatic psychological disorders, using three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale (PWBS) and Symptom Checklist 90 R (SCL-90-R) respectively. ANOVA showed significant overall differences between the two groups. The social restriction score in the non-player group was significantly higher (p<0.01) than the player group. The Torball player group showed significant better scores than non-player group in 5 of the 6 dimensions of the PWB Scale (p<0.01) and in 8 of the 10 dimensions of the SCL-90-R (7 dimensions p<0.01; 1 dimension p<0.05) and in the three global scores of the SCL-90-R (p<0.01). The results of this study showed a relationship between psychological well-being and social skills of visually impaired people and their Torball practice.

Asymptomatic Achilles, patellar, and quadriceps tendinopathy: a longitudinal clinical and ultrasonographic study in elite fencers.

Lower limb tendon changes detected at imaging are common among asymptomatic athletes. We aimed to prospectively assess the clinical status, tendon structure, and vascularity of lower limb tendons of elite fencers, and predict the risk of developing symptoms over time. Clinical examination, changes at ultrasonography (US), and Power Doppler (PD) flow of both the Achilles, patellar, and quadriceps tendon were assessed in 37 elite fencers in January 2007 and 3 years after. Two hundred and twenty-two tendons were examined. At the last appointment, patellar tendons diagnosed as abnormal at baseline were more likely to develop symptoms than those normal at baseline (P < 0.05, Fisher's exact test), while US and PD abnormalities on Achilles and quadriceps tendons were no predictive for development of symptoms over years. A very low percentage of tendons diagnosed as normal at baseline (1.45%) showed US abnormalities at 3-year follow-up. In asymptomatic elite fencers, structural changes are relatively common at US and PD assessment of Achilles, quadriceps, and patellar tendons. It seems unlikely that additional PD investigations provide further information or change prognosis in patients with US diagnosis of tendinopathy.

Is menstrual delay a serious problem for elite rhythmic gymnasts?

AIM: The aim of this study was to identify the influence of training workloads and dietary habits on the menstrual status of elite rhythmic gymnasts. In many sports disciplines, it has long been assumed that menstrual disorders among elite female athletes are related to intense physical effort and insufficient energy intake. Potential consequences of this condition include reduced fertility and decreased bone density. METHODS: Eighty-one female gymnasts (age 15.9±3.1) completed two self-administered questionnaires: the Menstrual History Questionnaire (MHQ), and the Semiquantitative Food Frequency Questionnaire (FFQ). Eighty female athletes (age 16.3±3.7), who participated in basketball, volleyball, tae kwon do and fitness activity served as a control group. Physical characteristics, menstrual cycles, training workloads and dietary habits were compared and the relationship between physical training and menstrual cycle characteristics was assessed for the two groups. RESULTS: Fifty percent of the gymnasts declared themselves amenorrheic. Age was significantly and positively correlated (P<0.01) with menarche and menstrual irregularities, and negatively correlated with amenorrhea. The percentage of variance for age at menarche, explained by training hours/week and body mass, was 43%, (P<0.01). CONCLUSION: The present study, which examined and compared different age groups of gymnasts, showed that young rhythmic gymnasts who trained intensively, had a delayed onset of menarche of more than two years, thus favouring secondary amenorrhea. Nonetheless, almost all athletes, even though with significant delay, reached cycle regularity, thus minimizing the effect of menstrual disorders on fertility and bone density.

Preliminary shape analysis of the outline of the baropodometric foot: patterns of covariation, allometry, sex and age differences, and loading variations.

AIM: Baropodometrical digital techniques map the pressures exerted on the foot plant during both static and dynamic loadings. The study of the distribution of such pressures makes it possible to evaluate the postural and locomotory biomechanics together with its pathological variations. This paper is aimed at evaluating the integration between baropodometric analysis (pressure distribution) and geometrical models (shape of the footprints), investigating the pattern of variation associated with normal plantar morphology. METHODS: The sample includes 91 individuals (47 males, 44 females), ranging from 5 to 85 years of age (mean and standard deviation = 40 + or - 24).The first component of variation is largely associated with the breadth of the isthmus, along a continuous gradient of increasing/decreasing flattening of the foot plant. This character being dominant upon the whole set of morphological components even in a non-pathological sample, such multivariate computation may represent a good diagnostic tool to quantify its degree of expression in individual subject or group samples. RESULTS: Sexual differences are not significant, and allometric variations associated with increasing plantar surface or stature are not quantitatively relevant. There are some differences between adult and young individuals, associated in the latter with a widening of the medial and posterior areas. CONCLUSIONS: These results provide a geometrical framework of baropodometrical analysis, suggesting possible future applications in diagnosis and basic research.

Osteoid osteoma mimicking overuse syndromes in athletes.

This article reports the clinical features, findings at imaging, management and outcome of five athletes who presented with osteoid osteoma. The diagnosis was missed initially in all the athletes, who were managed for an overuse syndrome for many months before receiving a correct diagnosis. Osteoid osteoma can cause atypical pain, and therefore lead to delay in diagnosis and inappropriate management. Each injured athlete must be fully evaluated by history, physical examination and appropriate imaging investigations to minimize the rate of misdiagnosis and underestimation, unnecessary procedures, and delayed management.

Bone mineral density and sport: effect of physical activity.

Osteoporosis is a multifactorial progressive skeletal disorder characterized by compromised bone mass which predisposes to increased fracture risk. Fractures are often associated with increased morbidity, mortality, loss of function, deformity and functional limitations. The major public health impact of osteoporosis calls for organized strategies for both primary and secondary prevention. Even if pharmacological therapeutic interventions provide substantial reduction in fracture risk, prevention of osteoporosis should begin early in life. Primary prevention during growth and adolescence aims to obtain a high peak bone mass, adequate calcium intake, exercise and early diagnosis and treatment of potential skeletal deformities. Secondary prevention, during middle age, aims to identify the subjects with low bone mass and more than one risk factor for an osteoporotic fracture, in order to plan multifactorial interventions with a special emphasis on nutritional aspects and individualized sport therapy.

Spinal curvature: comparison of frontal measurements with the Spinal Mouse and radiographic assessment.

AIM: The Spinal Mouse is an external non-invasive device which measures the spinal shape and mobility of the spine in several planes. The aim of the present study was to evaluate the reliability and the validity of the Spinal Mouse to assess frontal standing measurements of the spine in a sample of young healthy volunteers. METHODS: Twenty-six young volunteers of both sex took part in the study. Angle data of vertebral inclination of each subject in frontal view were measured by Spinal Mouse and standard radiography for vertebral segments from T1-T2 down to L5-S1. RESULTS: Repetition of the measurements by Spinal Mouse performed by two examiners in different days resulted in no significant difference for the parameter examined, as well as measurements performed by the two examiners in the same day (P<0.05). The ICC values showed no correlation between the two devices in the following pairs of vertebrae: T2-T3, T4-T5, T5-T6, T7-T8, T8-T9, T9-T10, T11-T12, T12-L1, L1-L2, L3-L4, L4-L5. CONCLUSION: The Spinal Mouse results, concerning the standing frontal curvature of the spine, even if reliable, were poor when compared with the standard radiography.

Functional anatomy of trunk flexion-extension in isokinetic exercise: muscle activity in standing and seated positions.

AIM: This study examined the functional differences existing in the trunk flexion-extension movement in standing and seated positions during isokinetic exercises, as well as the influence of position on overload of the lumbar column. METHODS: Nine females underwent an isokinetic test at 60 and 180 degrees /s in standing and seated positions. Muscle electrical activity was assessed by means of surface electromyography (EMG). Motion angles related to the different body segments were extrapolated from video images. RESULTS: The range of motion for hip movements was statistically significantly higher in the standing position, whereas it was similar for all the other segments studied in both positions. During the first phases of the movement, the lumbar tract showed a more marked lordosis in standing position. Peak torque values were significantly higher for flexion in standing position. Surface EMG showed significant differences in both positions only for the gluteal and biceps femoris muscles. CONCLUSION: The seated position allowed made it possible to limit the involvement of the hip muscles, particularly the iliopsoas during flexion, whereas there was little contribution to the trunk extension from hip extensor muscles. In addition, trunk extensors/flexors ratio showed values variable with velocity in standing position. Therefore, if the participation of accessory muscles is avoided, the seated position allows us to more accurately assess these two groups of antagonist muscles, whose balanced ratio is essential in the prevention of spine pathologies. The seated position has also been found to be more suitable in order to limit functional overload of the lumbar column.

A synovial ganglion of the knee: two cases in athletes.

The objective of the study is to describe two cases of proximal tibiofibular ganglion cysts in high level athletes. In May 2003 and March 2005 two athletes (one tennis player in the top eighty of the Italian national ranking and a gymnast belonging to the Italian rhythmic gymnastics national team) were referred to our institution complaining of postero-lateral knee discomfort and the presence of localized swelling over the fibular head and the antero-lateral aspect of the leg, with a clinically suspected diagnosis of ganglion cyst of the proximal tibiofibular joint. Ultrasonography clearly detected the fluid-filled structures while magnetic resonance imaging confirmed the diagnosis, also showing precisely the anatomic relationship between the ganglions and the surrounding structures. Both athletes underwent surgical excision and the histological examination was compatible with a proximal tibiofibular joint ganglion cyst; as yet they have had no recurrence.

Hyperthermia induced by microwave diathermy in the management of muscle and tendon injuries.

INTRODUCTION: Hyperthermia induced by microwave diathermy raises the temperature of deep tissues from 41 degrees C to 45 degrees C using electromagnetic power. Microwave diathermy is used in the management of superficial tumours with conventional radiotherapy and chemotherapy and, recently, its use has been successfully extended to physical medicine and sports traumatology in Central and Southern Europe. METHODS: We searched the literature for relevant studies. Most of the published studies in these fields have used 434 and 915 microwave diathermy, as these wavelengths are most effective. RESULTS: Hyperthermia induced by microwave diathermy into tissue can stimulate repair processes, increase drug activity, allow more efficient relief from pain, help in the removal of toxic wastes, increase tendon extensibility and reduce muscle and joint stiffness. Moreover, hyperthermia induces hyperaemia, improves local tissue drainage, increases metabolic rate and induces alterations in the cell membrane. CONCLUSIONS: The biological mechanism that regulates the relationship between the thermal dose and the healing process of soft tissues with low or high water content or with low or high blood perfusion is still under study. Microwave diathermy treatment at 434 and 915 MHz can be effective in the short-term management of musculo-skeletal injuries.

Stress fractures of the ribs in elite competitive rowers: a report of nine cases.

OBJECTIVE: The objective was to report the clinical and imaging patterns of nine cases of stress fractures of the rib diagnosed in Italian Olympic rowers. PATIENTS AND METHODS: Nine patients with stress fractures of the rib detected from 103 (8.7%) Italian team rowers competing between May 2000 and May 2006 were identified based on the database of a sports medicine institute. All athletes were male. They were aged between 17 and 31 years (mean: 24.4). Patient weight, fracture location, rowing side and imaging methods employed were noted. RESULTS: The diagnosis was made based on history, clinical examination and Tc-99m MDP bone scintigraphy. Eight of the 9 fractures were located anterolaterally between the fourth and ninth rib. In 1 of the 5 athletes with standard radiographs, a fracture line was visible and in 4 there was callus formation. In 2 athletes sonography was performed, which detected discontinuity of the rib surface and callus formation (1 case each). CONCLUSION: Stress fractures of the ribs are relatively common in competitive rowers. They are characterized by increasing lateral chest pain and typical scintigraphic, radiographic and sonographic findings.

Partial rupture of the distal biceps brachii tendon in elite waterpolo goalkeeper: a case report of conservative treatment.

The aim of this study was to describe a case of a 27-year-old male elite waterpolo goalkeeper, who had a partial rupture of the distal biceps tendon of his dominant arm while he was trying to save a strong outside shot. Pain on the antecubital fossa was the chief complaint. Ultrasound and magnetic resonance imaging completed the instrumental set-up. This case had the resolution of the pain and impairment after 3 months of conservative treatment. At 1-year follow-up, the athlete is asymptomatic and the isokinetic test provided almost complete recovery of the strength for elbow flexors and supinators muscles.

Arthroscopic treatment of shoulder ochronotic arthropathy: a case report and review of literature.

Alcaptonuria is an inherited hereditary metabolic disorder, which is associated with various systemic abnormalities and related to the accumulation of homogentisic acid and a derived melanine-like pigment in the connective tissues; the latter is termed ochronosis. We present the arthroscopic findings in the shoulder of a 58-year-old female with ochronotic arthropathy and discuss the role of arthroscopy in the diagnosis and management of this rare metabolic disorder.

Heterotopic ossification of the ulnar collateral ligament: a description of a case in a top level weightlifting athlete.

The purpose of this paper is to describe a case of heterotopic ossification of the ulnar collateral ligament in a 29-year-old top level weightlifter. Plain radiography of the elbow determined the extent and location of heterotopic ossification. Ultrasound and MR imaging completed the instrumental set-up. This symptomatic case had the resolution of pain after 2 months of a supervised rehabilitation program. At one year follow-up the athlete is asymptomatic referring occasional minor pain only in the periods of vigorous training.

Low-intensity pulsed ultrasound in the conservative treatment of pseudoarthrosis.

AIM: The management of pseudarthrosis remains a challenge. Several in vivo animal and controlled clinical studies have demonstrated that low-intensity pulsed ultrasound can influence fracture healing. METHODS: A prospective longitudinal design was used. Fifteen patients (12 males and 3 females; mean age 35.5+/-12.9, range 18 to 60), all amateur athletes, under treatment for pseudarthrosis at different sites (average fracture age: of 336.6+/-60.1 days) were treated with a single 20 min daily application of low-intensity pulsed ultrasound (frequency 1.5 MHz and intensity 30 mW/cm2). All patients underwent clinical examination and plain radiography at the beginning of treatment and were followed up clinically and radiographically at 4, 8, 12, 16, 20 and 24 weeks until the fracture healed. RESULTS: All fractures healed with a mean healing time of 94.7+/-43.8 days. CONCLUSION: Low-intensity pulsed ultrasound is effective in the management of long standing fracture non-unions. Prospective randomized studies are needed to confirm the value of this modality of treatment.

Isokinetic evaluation of anterior cruciate ligament reconstruction: quadriceps tendon versus patellar tendon.

AIM: The goal of this prospective randomized study was to compare the isokinetic recovery of thigh strength after anterior cruciate ligament (ACL) reconstruction by using patellar or quadriceps tendon as graft at the 6th month follow-up. METHODS: The authors evaluated 48 patients who underwent arthroscopic ACL reconstruction using patellar tendon (PT group) or quadriceps tendon (QT group) as autograft after a 6 months follow-up undergoing the following tests: the Ergojump Bosco System springboard and Universal's FITNET computerized isokinetic system. RESULTS: The counter movement jump (CMJ) test showed a 24% (p<0.01) strength deficit in patients operated with patellar tendon and 11% in the quadriceps tendon group. Also in the leg press test the greater differences in strength (p<0.05) were verified in the patellar tendon group, above all the peak torque (PT) test carried out at 3 repetitions (15%). CONCLUSIONS: The strength deficit found in the subjects operated with quadriceps tendon were statistically lower in comparison to that verified in the patellar tendon group. A good recovery in thigh strength after 6 months in patients operated with quadriceps tendon could encourage the use of this kind of graft in order to achieve an easier rehabilitation and a faster release of the patient to daily and sports activity.