No Significant Differences between Bisphosphonates and Placebo for the Treatment of Bone Marrow Lesions of the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: The purpose of the present systematic review and meta-analysis is to summarize the current evidence on the role of bisphosphonates in the treatment of knee bone marrow lesions (BMLs), to understand whether they are truly effective in improving symptoms and restoring the subchondral bone status at imaging evaluation. Methods: A literature search was carried out on PubMed, Cochrane, and Google Scholar databases in accordance with the PRISMA guidelines. Potential risk of bias was evaluated using the Cochrane Risk of Bias 2 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies. Results: A total of 15 studies were included in the present systematic review and meta-analysis. Seven studies were RCTs, two were prospective cohort studies, three were retrospective, and three were case series. Our meta-analysis revealed that bisphosphonates did not significantly improve clinical scores or reduce BML size compared to placebo. Accordingly, the rate of adverse events was also non-significantly higher among bisphosphonate users versus placebo users. Conclusions: The main finding of the present meta-analysis and systematic review is that bisphosphonates show neither significant benefits nor significant adverse events when compared to placebo in the treatment of BMLs of the knee. Level of Evidence: Level IV systematic review of level II-III-IV studies. Level I meta-analysis of level I studies.

Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence.

The burden of osteoarthritis (OA) is around 300 million people affected worldwide, with the hip representing a commonly affected joint. Total hip arthroplasty (THA) has been used with notable success as a definitive treatment to improve pain and function in hip OA patients. The recent advent of new technologies, such as 3D printing, has pushed the application of these new concepts toward applications for the well-known THA. Currently, the evidence on the use of 3D printing to aid complex primary THA cases is still scarce. METHODS: An extensive literature review was conducted to retrieve all articles centered on the use of 3D printing in the setting of primary THA. RESULTS: A total of seven studies were included in the present systematic review. Four studies investigated the use of 3D-printed surgical guides to be used during surgery. The remaining three studies investigated the benefit of the use of 3D-printed templates of the pelvis to simulate the surgery. CONCLUSIONS: The use of 3D printing could be a promising aid to solve difficult primary total hip arthroplasty cases. However, the general enthusiasm in the field is not supported by high-quality studies, hence preventing us from currently recommending its application in everyday practice.

Anterior Cruciate Ligament Agenesia in a Patient with Ehlers-Danlos Syndrome and Open Physes.

Introduction: The agenesis of the anterior cruciate ligament (ACL) is a rare condition infrequently diagnosed as an isolated malformation. Still, it is linked to systemic disorders such as Ehlers-Danlos syndrome (EDS), an inheritable connective tissue disorder characterized by joint hyperlaxity and increased risk of dislocations and subluxations. The literature on ACL reconstruction in EDS patients is minimal, and ours is the second case report describing the surgical management of an ACL agenesis in a patient with this pathology. Case Presentation: The present case report describes the surgical management of an 11-year-old patient affected by EDS. The particularity of this case is that the young patient presented with complete agenesis of the ACL in the right knee resulting in severe joint instability needing surgical reconstruction. This case represented a challenge for the orthopedic surgeon due to the need to improve joint stability without compromising the bone growth of a young patient with open physes while also dealing with tissues that have reduced mechanical properties due to the patient's disease. The patient was therefore treated with an Achilles tendon allograft through a modified version of the typical ACL reconstructive surgery that excluded the classical tunnel drilling in the tibia and femur. Conclusion: At a 2-year follow-up, this technique proved to be an effective treatment for ACL agenesis in an EDS patient. It could provide a reference for surgeons facing similar cases. The proposed surgical technique, completely extra-epiphyseal, could also be applied to healthy young patients with open physes to avoid future growth disturbances.

The efficacy of intra-articular HYADD4-G injection in the treatment of femoroacetabular impingement: results at one year follow up.

OBJECTIVE: Femoroacetabular impingement (FAI) is a condition that has been increasingly recognized as a source of hip pain and a possible risk factor to early development of hip osteoarthritis (OA). To our knowledge, the use of HA in the treatment of femoroacetabular FAI has been investigated only by two studies, both using a high molecular weight HA. The aim of this study was to evaluate the efficacy of two weekly injections of an hexadecylamide derivative of HA (HYADD4-G, HYMOVIS, Fidia Farmaceutici) in FAI. METHODS: All patients received two weekly intra-articular injections of Hymovis at baseline and after 7 days. Clinical and functional assessments were performed at baseline and was repeated after 1, 3, 6 and 12 months. Functional measures included visual analogue scale (VAS) for pain, Harris Hip score (HHS), Lequesne Index (LI), Tegner activity level scale (TALS) and monthly consumption of nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS: Twenty-one hips (19 patients, 2 bilateral cases) were treated. The variables VAS, HHS as well as Lequesne improved significantly from T0 to T4 (at 12 months) with the best improvement between T0 and T1. At the same time, a reduction in NSAIDs monthly intake was registered. On the other hand, a significant improvement in Tegner scale was not observed. No adverse events were registered. CONCLUSION: This study states that one cycle of HYADD4-G could be a safe and effective treatment in patients with FAI, showing significative results in term of pain control as well as hip functionality and quality of life up to 1 year.

[Mixed cryoglobulinemia in HCV mono-infected and HCV/HIV co-infected patients]. / Crioglobulinemia mista in pazienti con infezione da HCV e con coinfezione HCV/HIV.

The aim of our study was to compare the prevalence of mixed cryoglobulinemia in a group of HCV positive/HIV- negative patients with respect to a group of HCV/HIV co-infected subjects. Between September 2002 and May 2003, 58 patients with proven HCV infection and 67 subjects with HIV/HCV co-infection were enrolled. Serum was assessed for detectable cryoglobulins, liver enzymes, HCV viral load and HCV genotypes. In HIV positive patients, plasma HIV RNA and CD4+ cell count were determined. A chi-square test was used to compare the prevalence of cryoglobulins in our two categories of patients. Cryoglobulinemia was detected in 14/58 HCV mono-infected patients (24.1%) and in 10/67 HCV/HIV co-infected patients (14.9%), without any significant statistical difference between the two groups (p=0.2). Only two HCV mono-infected patients complained of arthralgia. No significant correlation was found between the presence of cryoglobulinemia and ALT levels, HCV viremia and duration of HCV infection. In HIV patients circulating cryoglobulins were not correlated with plasma HIV viral load, CD4 cell count and with duration of HIV infection. In conclusion, mixed cryoglobulinemia may be detected in a similar rate in the two groups and HIV infection does not appear to play a significant role in cryoglobulin production.