Bone marrow edema of the knee: a narrative review.

Bone marrow edema (BME) is a frequent MRI finding in patients with knee pain. According to the etiology, BME of the knee can be classified into three main categories: ischemic, mechanic, and reactive. The diagnosis may be difficult, because of the specificity of symptoms and the poor radiographic findings. MRI is the gold standard, showing an area of altered signal of the bone with an high signal intensity on fat-suppressed, T2 weighted images, usually in combination with an intermediate or low signal intensity on T1 weighted images. Bone marrow edema tends to be self-limiting and, in most cases, resolves without any consequences in a varying amount of time. However, since it may evolve to complete joint destruction, early diagnosis and correct treatment are crucial to prevent the articular degeneration. Conservative therapy is the first step, with no weight-bearing for 3 to 6 weeks on the affected side, in combination with the administration of anti-inflammatory drugs or painkillers to manage symptoms. In non-responding forms and more advanced stages, minimally invasive preservative surgery can provide significant results, with subchondroplasty and core decompression being the two main procedures available. Knee arthroplasty, both total (TKA) or unicompartmental (UKA), is the only effective option when the degradation of cartilage is diffuse and in patients with subchondral bone collapse.

Targeting the Inflammatory Hallmarks of Obesity-Associated Osteoarthritis: Towards Nutraceutical-Oriented Preventive and Complementary Therapeutic Strategies Based on n-3 Polyunsaturated Fatty Acids.

Obesity (Ob), which has dramatically increased in the last decade, is one of the main risk factors that contribute to the incidence and progression of osteoarthritis (OA). Targeting the characteristics of obesity-associated osteoarthritis (ObOA) may offer new chances for precision medicine strategies in this patient cohort. First, this review outlines how the medical perspective of ObOA has shifted from a focus on biomechanics to the significant contribution of inflammation, mainly mediated by changes in the adipose tissue metabolism through the release of adipokines and the modification of fatty acid (FA) compositions in joint tissues. Preclinical and clinical studies on n-3 polyunsaturated FAs (PUFAs) are critically reviewed to outline the strengths and weaknesses of n-3 PUFAs' role in alleviating inflammatory, catabolic and painful processes. Emphasis is placed on potential preventive and therapeutic nutritional strategies based on n-3 PUFAs, with a focus on ObOA patients who could specifically benefit from reformulating the dietary composition of FAs towards a protective phenotype. Finally, tissue engineering approaches that involve the delivery of n-3 PUFAs directly into the joint are explored to address the perspectives and current limitations, such as safety and stability issues, for implementing preventive and therapeutic strategies based on dietary compounds in ObOA patients.

Surgical management of clubfoot overcorrection: a case series.

INTRODUCTION: Overcorrection is a possible complication of clubfoot treatment, whose prevalence varies from 5 to 67%. Overcorrected clubfoot usually presented as a complex flatfoot with different degrees of hindfoot valgus, flat top talus, dorsal bunion, and dorsal navicular subluxation. The management of clubfoot overcorrection is challenging, and both conservative and surgical treatments are available. This study aims to present our experience in the surgical management of overcorrected clubfoot and to provide an overview of actual treatment options for each specific sub-deformity. MATERIALS AND METHODS: A retrospective cohort study of patients surgically treated for an overcorrected clubfoot from 2000 to 2015 at our Institution was conducted. Surgical procedures were tailored to the type and symptomatology of the deformity. A medializing calcaneal osteotomy or subtalar arthrodesis was performed for hindfoot valgus. Subtalar and/or midtarsal arthrodesis were considered in cases of dorsal navicular subluxation. The first metatarsus elevatus was addressed through a proximal plantarflexing osteotomy, sometimes associated with a tibialis anterior tendon transfer. Clinical scores and radiographic parameters were obtained pre-operatively and at the last follow-up. RESULTS: Fifteen consecutive patients were enrolled. The series included 4 females and 11 males, with a mean age at surgery of 33,1 (18-56) years, and a mean follow-up of 4,46 (2-10) years. Seven medializing calcaneal osteotomies, 5 subtalar arthrodesis, 11 first metatarsal plantarflexing osteotomies, and 7 anterior tibialis tendon transfers were performed. A statistically significant improvement in both clinical and radiographic scores was observed. CONCLUSIONS: Management of overcorrected clubfoot involves many surgical techniques because of the high interpersonal variability of the deformities. The surgical approach showed positive results, as long as the indication is based on clinical symptoms and functional impairment rather than morphological alterations and radiographic findings.

The role of posterior condylar offset ratio on clinical and functional outcome of posterior stabilized total knee arthroplasty: a retrospective cohort study.

BACKGROUND: Postoperative Range of Motion (ROM) is an important measurement of the success of a Total Knee Arthroplasty (TKA). Much enthusiasm has been recently directed toward the posterior femoral condylar offset (PFCO), with some authors reporting increasing postoperative knee flexion when increasing PFCO. The aim of this study is to retrospectively determine the effect of the PFCO on the clinical and functional outcome of a cohort of patients who underwent a Posterior Stabilized (PS) TKA. METHODS: Clinical and radiological data of all patients who underwent TKA with PS implant for primary osteoarthritis were retrospectively reviewed. Knee Society Score (KSS), knee ROM, PFCO ratio (PFCOR), and tibial slope (TS) were measured pre and postoperatively. RESULTS: One hundred and twenty-one patients (141 knees) met the inclusion criteria. The mean knee flexion increased from 98 ± 20.2° (range 30-130) to 123 ± 12.1° (range 70-140) and the mean KSS increased from 74.0 ± 3.3 (range 27-130) to 203.9 ± 8.1 (range 26-249). Postoperative PFCOR and TS were 0.492 ± 0.005 (range 0.40-0.57) and 2.36 ± 0.56° (range - 10.9-12.15°), respectively. Neither maximal flexion angle nor KSS showed a significant correlation with postoperative PFCOR (Pearsons'r = - 0.057, p = 0.5 for flexion angle and Pearsons'r = - 0.073, p = 0.5 for KSS) or with postoperative TS (Pearsons'r = 0.042, p = 0.62 for flexion angle and Pearsons'r = 0.002, p = 0.98 for KSS). CONCLUSION: Posterior femoral condylar offset remains an important parameter and, especially when using anterior femoral referencing TKA, care must be taken to prevent excessive resection of the posterior femoral condyles.

Overview of Anti-Inflammatory and Anti-Nociceptive Effects of Polyphenols to Halt Osteoarthritis: From Preclinical Studies to New Clinical Insights.

Knee osteoarthritis (OA) is one of the most multifactorial joint disorders in adults. It is characterized by degenerative and inflammatory processes that are responsible for joint destruction, pain and stiffness. Despite therapeutic advances, the search for alternative strategies to target inflammation and pain is still very challenging. In this regard, there is a growing body of evidence for the role of several bioactive dietary molecules (BDMs) in targeting inflammation and pain, with promising clinical results. BDMs may be valuable non-pharmaceutical solutions to treat and prevent the evolution of early OA to more severe phenotypes, overcoming the side effects of anti-inflammatory drugs. Among BDMs, polyphenols (PPs) are widely studied due to their abundance in several plants, together with their benefits in halting inflammation and pain. Despite their biological relevance, there are still many questionable aspects (biosafety, bioavailability, etc.) that hinder their clinical application. This review highlights the mechanisms of action and biological targets modulated by PPs, summarizes the data on their anti-inflammatory and anti-nociceptive effects in different preclinical in vitro and in vivo models of OA and underlines the gaps in the knowledge. Furthermore, this work reports the preliminary promising results of clinical studies on OA patients treated with PPs and discusses new perspectives to accelerate the translation of PPs treatment into the clinics.

Proximal femoral replacement for non-neoplastic conditions: a systematic review on current outcomes.

Proximal femoral replacement (PFR) is a well-established treatment for neoplasia of the proximal femur. The use of this surgical technique for non-neoplastic conditions has increased over the years. We carried out a systematic review of the literature to study the indications, complications, and functional results when PFR is used for non-neoplastic conditions. Twenty-seven studies were included in the review with a total of 828 PFRs with a mean follow-up of 50 months (range 1-225 months). The main indications were infection (28%), periprosthetic fracture (27%), aseptic loosening (22%), and fracture (16%). The rate of reoperation was 20.3% overall. The overall revision rate was 15.4%. The main complications were dislocation (10.2%) and infection (7.3%). After 2010, the rates of reoperation (25.5% versus 18.2%), loosening (9.4% versus 3.2%), and dislocation (15.7% versus 7.9%) were lower than before 2010. The 30-day mortality ranged from 0% to 9%. The hip function scores improved post-surgery. In conclusion, the use of PFR in non-neoplastic conditions remains a marginal tool, associated with low direct mortality and high complication rates, but we expect its use to increase in the near future.

Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: a review of the current literature.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a frequent disorder. Since patients with AIS are typically as active as age-matched controls and post-operative reduction in physical activity has detrimental effects on their well-being, return to sport (RTS) is an important perioperative concern. Aim of the present study is to review the literature concerning return to sport after spinal fusion for AIS. METHODS: This work was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out in December 2020. Only peer-reviewed randomized controlled trials (RCTs), retrospective studies (RS), retrospective case series (RCS) and perspective cohort studies (PCS) were considered for inclusion. RESULTS: Six studies were included; only one of them was prospective. All the authors reported a time to RTS ranging between 6 and 18 months. Between 28 and 36.6% of all patients changed sport, choosing lower impact activities, mostly due to loss of flexibility of the spine. No complications due to return to play were noted. CONCLUSION: According to current evidence, patients who received spinal arthrodesis for AIS can safely return to any sport, even those that require extreme levels of spinal and pelvic movements such as gymnastics and golf. As there is little evidence, however, of the spinal loading that occurs during such movements, there is a lack of scientific evidence-based recommendations or guidelines surgeons and other health care providers can follow. Prospective comparative studies are needed to investigate these biomechanical and clinical issues. LEVEL OF EVIDENCE: Level III.

Long-term results of subtalar arthroereisis for the treatment of symptomatic flexible flatfoot in children: an average fifteen year follow-up study.

AIM OF THE STUDY: The aim of this study is to report the long-term outcomes of a homogenous series of patients who underwent subtalar arthroereisis (STA) for the treatment of symptomatic flexible flatfoot (FFF). METHODS: Thirty-four pediatric patients who underwent STA with a bioabsorbable implant were enrolled and radiographic measurements, clinical outcomes, and patients' satisfaction were evaluated. RESULTS: At a mean 180 months follow-up, radiographic measurements showed significant improvement. A physiological footprint and a proper hindfoot alignment were shown in more than 70% of patients. Mean AOFAS score was 90.4 ± 9.2 (72-100), mean SF-12 was 44.7 with 30 out of 34 patients (88.2%) satisfied with the procedure. CONCLUSION: STA with a bioabsorbable implant showed satisfactory long-term results. Based on the data subgroup analysis, nine to 11.5 years for female and nine to 13.5 years for male appeared to be the most appropriate age for surgery.

Acute Presentation of Lumbar Spinal Stenosis Due to Ossified Ligamentum Flavum: The Possible Role of Spondylolisthesis: A Case Report.

CASE: A 64-year-old woman with a history of low back pain, presented with acute gait impairment and lower limbs numbness without any history of trauma. Imaging studies revealed ossification of the ligamentum flavum (OLF) at L4-L5 and concomitant spondylolisthesis. Decompression surgery with en-bloc removal including the laminae, the ossified ligamentum flavum, and the medial facet and posterior stabilization was performed resulting in complete immediate recovery. CONCLUSIONS: This report is the first to describe a case of an acute nontraumatic presentation of OLF associated with spondylolisthesis. OLF pathogenesis in still unknown, although several factors have been considered. According to the literature, operative treatment has demonstrated to be effective.

Correction to: Surgical correction of double major adolescent idiopathic scoliosis.

Unfortunately, the affiliation of the author group has been incorrectly published in original version. The complete correct affiliation of all authors should read as follows.

Patient-perceived outcomes after subtalar arthroereisis with bioabsorbable implants for flexible flatfoot in growing age: a 4-year follow-up study.

PURPOSE: Results of subtalar arthroereisis in flexible flatfoot have been mainly reported in the literature using clinical or radiographical findings. However, the aim of this study is to evaluate the patient-perceived quality of life using self-reported questionnaires after subtalar arthroereisis using a bioabsorbable implant. METHODS: Italian modified FFI and the SEFAS scores were submitted to a consecutive series of 173 patients who underwent surgical treatment for flatfoot deformity using a bioabsorbable endo-orthotic implant. Postoperative complication rates were assessed. Time needed to resume normal sports activities was recorded. RESULTS: Mean population age was 11.2 years with slight variability between males and females. At a mean follow-up of 4 years, arthroereisis with bioabsorbable implants showed excellent results for the perception of the quality of life with an average result for FFI score of 4.5 and an average SEFAS score of 47.19. Time needed to resume sport activities was 4.7 months ± 0.2 with almost no difference between the groups. Four patients needed a second procedure for implant removal. CONCLUSION: Arthroereisis using a bioabsorbable implant offers good results in terms of satisfaction and quality of life with a negligible rate of failures and patient complaints based on self-reported questionnaires. The patient reported high degrees of satisfaction, and their quality of life was not compromised at all by the procedure.