Barriers to successful return to previous level of activity following Anterior Cruciate Ligament Recon-struction (ACLR) are multifactorial and recent research suggests that athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients. Thirty soccer athletes (26.9 ± 5.7 years old, male) with ACL injury were surgically treated with all-inside technique and semitendi-nosus tendon autograft. At 2 years from surgery, they were called back for clinical examination, self-reported psychological scores, and biomechanical outcomes (balance, strength, agility and velocity, and symmetry).

Nonparametric statistical tests have been adopted for group comparisons in terms of age, concomitant presence of meniscus tear, injury on dominant leg, presence of knee laxity, presence of varus/valgus, body sides, and return to different levels of sports. Athletes with lower psychological scores showed lesser values in terms of power, resistance and neuromuscular activity as compared to the ones with good psychological scores that showed, instead, better self-reported outcomes (TLKS, CRSQ) and low fear of reinjury (TSK). In the athletes who had a functional deficit in at least one subtest, a safe return to sports could not have been recommended. Our findings confirmed that demographics, physical function, and psychological factors were related to playing the preinjury level sport at mean 2 years after surgery, sup-porting the notion that returning to sport after surgery is multifactorial. A strict qualitative and quantitative assessment of athletes’ status should be performed at different follow-ups after surgery to guarantee a safe and controlled RTP.

The employment of biophysical therapy to accelerate the healing of tissues is by now a well-established practice in many orthopaedic situations, indicated mainly for osteogenesis and chondrogenesis. Assessments of the effects of biophysical stimuli on joint cartilage (CRES, Cartilage Repair & Elecromagnetic Stimulation) performed with pre-clinical studies and clinical studies (in operations to reconstruct LCA and microfractures) have shown how biophysical stimulation controls the microambience, and have suuplied the rationale for passing to an evaluation of the effects also in the case of joint replacement.

We launched a randomized prospective clinical study of 30 patients aged between 60 and 85 years, afflicted with gonarthrosis and undergoing operation for prosthesis. The randomization involved subdividing them into two homogeneous groups: the first with biophysical treatment with I-ONE therapy (Igea-Clinical Biophysics) (experimental group); the second not undergoing the biophysical treatment (control group). In the experimenal group, the I-ONE therapy was commenced at 3–7 days from the operation, administered for 4 hours per day and maintained for 60 days consecutively. The clinical evaluations were performed by compiling functional reports (swelling of the knee, Knee Score, SF-36 and VAS) in the pre-operative period and postoperatively at 1, 2, 6 and 12 months. The data processing was subjected to statistical evaluation by an independent observer using Student’s two-tail t test and the Generalized Linear Mixed Effects Model.

The preliminary results showed that at the baseline there are no differences between the groups either for the KNEE score, nor the VAS, or the SF-36. Already after 1 month the differences between the groups are statistically significant (p< 0.05 for KNEE score, p< 0.001 for swelling, p< 0.0001 for VAS and SF-36). At 2 months the differences between the groups are highly significant (p< 0.0001). The study entails a long-term evaluation with monitoring of the patients at one year from operation.

The results of this study supply the basis for clinical employment of biophysical treatment with I-ONE immediately following joint surgery, enabling inflammation to be controlled and increasing anabolic activity and protecting its microambience.

The purpose of this study was to investigate the effects of extra corporeal shock waves (ESW) therapy on the metabolism of healthy and osteoarthritic human chondrocytes, and particularly on the expression of IL-10, TNF-α and β1 integrin.

Human adult articular cartilage was obtained from 9 patients (6 male and 3 females), with primary knee osteoarthritis (OA), undergoing total joint replacement and from 3 young healthy donors (HD) (2 males, 1 female) with joint traumatic fracture. After isolation, chondrocytes underwent ESW treatment (Electromagnetic Generator System, Minilith SL1, Storz Medical) at different parameters of impulses, energy levels and energy fluxes. After that, chondrocytes were cultured in 24-well plate in DMEM supplemented with 10% FCS for 48 hours and then β1 integrin surface expression and intracellular IL-10 and TNF-α levels were evaluated by flow-cytometry.

At baseline, osteoarthritic chondrocytes expressed significantly lower levels of β1 integrin and higher levels and IL-10 and TNF-α levels. It has been recently reported that ESW may be useful to treat OA in dogs, and veterinarians have begun to use ESW also to treat OA in horses.

Following ESW application, while β1 integrin expression remain unchanged, a significant decrease of IL-10 and TNF-α intracellular levels was observed both in osteoarthritic and healthy chondrocytes. IL-10 levels decreased at any impulses and energy levels, while a significant reduction of TNF-α was mainly found at middle energies.

Our study confirmed that osteoarthritic chondrocytes express low β1 integrin and high TNF-α and IL-10 levels. Nonetheless, ESW treatment application down-regulate the intracellular levels of TNF-α and IL-10 by chondrocytes, suggesting that ESW might restore TNF-α and IL-10 production by osteoarthritic chondrocytes at normal levels thus potentially interfering with the pathologic mechanisms causing cartilage damage in OA and representing the theoretical rationale for using ESW as therapy of OA.

Reduction and fixation with a paracortical sliding screw or an intramedullary nail are the most used treatments for intertrochenteric fractures.

In cases of complications the attempt to perform further internal fixation may lead to failure because of the poor quality of bone and cartilage. Conversion to a hip replacement seems a better choice and the use of long stems with a distal, diaphyseal fit appears to be a good option, allowing to by-pass the intertrochanteric region. Authors report their experience in hip replacement for failed treatment of hip fractures that allow to restore immediately the function of the hip.