Hip and Groin Pain in Soccer Players

Purpose The aim of this article is to illustrate the recent framework necessary to standardize studies on groin pain and review the existing literature on groin pain in football. Methods The common pathological processes underlying groin pain such as muscle, tendon or ligament strain, bone injury or fracture, sport hernia, bursitis, osteitis pubis, and hip-related diseases have been reviewed and current management options have been considered. Results Groin pain is considered a pain in pubic or lower abdominal or adductors region which can be monolateral or bilateral. It is common in high-intensity team sports and can negatively affect an athlete's professional carrier, causing serious disruption in the performance. Despite a high prevalence of groin pain in athletes, diagnosis and management of the underlying pathological processes remain a challenge for surgeons, radiologists, and physiotherapists alike. Conclusion A multidisciplinary approach is essential for patients with groin pain allowing prompt diagnosis and initiation of treatment thus facilitating more rapid return to play and preventing potential long-term sequelae of chronic groin pathology.

Acute Groin Pain Syndrome Due to Internal Obturator Muscle Injury in a Professional Football Player

Traumatic groin pain syndrome is the result of an acute trauma, usually an indirect muscle injury (i.e., an overstretching of the muscle fibers). The most affected muscles in traumatic groin pain syndrome are rectus abdominis, adductors, and iliopsoas. The internal obturator muscle lesion is very rare. The internal obturator muscle externally rotates the thigh and contributes to the stabilization of the hip joint and its indirect injury may cause the onset of traumatic groin pain syndrome. This case report describes a rare indirect injury of internal obturator in a 29-year-old professional male soccer player.

Short-Term Outcomes of the Grammont Reverse Shoulder Arthroplasty: Comparison between First and Second Generation Delta Prosthesis

Purpose This article compares short-term outcomes of two series of patients, who underwent reverse total shoulder arthroplasty (RTSA) with two different implants, both based on Grammont's principles: the Delta III (D-3) and the Delta Xtend (D-XT) prostheses. Methods The D-3 group included a consecutive series of 26 patients (mean age 75 years), that were treated between 2000 and 2006; the D-XT group included a consecutive series of 31 patients (mean age 72.5 years), for a total of 33 implants performed between 2011 and 2015. In both groups the most common diagnoses were cuff tear arthropathy (18 and 22 shoulders, respectively) and malunion of proximal humerus fractures (3 and 5). All procedures were performed by the same surgeon. Constant–Murley score (CMS) was used to assess clinical and functional outcomes. Radiographic evaluation included the true anteroposterior and axillary views. Results Twenty-three patients of the D-3 group and 22 patients (24 shoulders) of the D-XT group were evaluated at a mean follow-up of 42 months (range 26–84) and 44 months (range 26–66), respectively. Four complications occurred in the D-3 group (1 partial deltoid detachment, 1 dislocation, and 2 glenoid component loosening), while one early postoperative infection occurred in the D-XT group. Increases in elevation and CMS between preoperative and postoperative period were observed in both groups; only the D-XT group showed a slight improvement in rotations. The incidence of scapular notching was significantly different between the two groups: 100% for D-3 and 22.2% for D-XT in patients with a minimum follow-up of 5 years. Conclusion Prosthetic design evolution and greater acquaintance with this surgery have undoubtedly led to an improvement in short-term outcomes with second generation implants of RTSA. Future studies will have to ascertain whether newer implants, relying on biomechanical solutions alternative to Grammont's original concept, might provide additional advantages and minimize drawbacks.

Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty

Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome scores and range of motion. It is unknown whether patients' preoperative expectations of surgery are lower in RTSA compared with aTSA. The purpose of this study was to assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA. Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively. Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE), and patient satisfaction were obtained. Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference in total preoperative expectations score between groups. On multivariate linear regression analysis, aTSA (p = 0.024) and younger age (p = 0.018) were associated with higher expectations for improved ability to exercise. Changes in preoperative to postoperative ASES (p = 0.004) and SANE (p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score was not correlated with postoperative functional outcomes or satisfaction in either group. In the aTSA group, expectations for participation in exercise were positively correlated with changes in preoperative to postoperative ASES score (p = 0.01) and SANE score (p = 0.01). Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional outcome than those undergoing primary RTSA, both groups reported similar aggregate preoperative expectations. Those undergoing aTSA had higher expectations for return to exercise which was positively correlated with postoperative functional outcomes. Level of Evidence Level II, prospective cohort study.

Treatment of Primary Shoulder Stiffness: Results of a Survey on Surgeon Practice Patterns in Italy

Objectives Shoulder stiffness is a condition of restricted glenohumeral range of motion (ROM), which can arise spontaneously or as consequence of a known cause. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. The aim of this study was to investigate surgeon practice patterns in Italy regarding treatment of primary shoulder stiffness. Methods A literature review was performed to identify randomized controlled trials reporting results of shoulder stiffness treatment. The following controversial or critical points in the treatment of primary shoulder stiffness were identified: modalities of physical therapy; indication for oral corticosteroid; indication and frequency for injective corticosteroid; technique and site of injection; and indication, timing, and technique for surgery. A survey composed by 14 questions was created and administrated to the members of a national association specialized in orthopaedics and sports traumatology (SIGASCOT at the time of survey completion, recently renamed SIAGASCOT after the fusion of the societies SIGASCOT and SIA). Results A total of 204 completed questionnaires were collected. Physical therapy was recommended by 98% of the interviewed. The use of oral corticosteroids was considered by 51%, and injections of corticosteroids by 72%. The posterior injection approach was the one preferred and a number of three was considered the upper limit for repeated injections. Injective therapy with local anesthetics and hyaluronic acid was considered by more than 20% of the interviewed. Thirty percent of the interviewed did not treat shoulder stiffness surgically. Conclusion Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. Several controversial points emerged both from a literature review and from this national survey. Treatment of shoulder stiffness should be tailored to the patient's clinical situation and the stage of its pathology and should aim at pain reduction, ROM restoration, functional regain, and shortening of symptoms duration, with conservative therapy remaining the mainstay of treatment.

Subchondroplasty in the Treatment of Bone Marrow Lesions of the Knee: Preliminary Experience on First 15 Patients

Purpose The aim of this prospective study was to assess the effectiveness in terms of pain relief and functional improvement of the Subchondroplasty procedure in the treatment of osteoarthritis-related bone marrow lesions (BMLs) of the knee. Methods The study included first 15 consecutive patients undergone to Subchondroplasty procedure for the treatment of chronic degenerative BMLs in which previous conservative treatment have failed. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), and visual analog scale (VAS) pain scores were obtained preoperatively and at 1, 6, and 12 months of follow-up. Results WOMAC scores significantly improved from 39.7 ± 20.2 before surgery to 26.8 ± 16.1 at the 1-month follow-up (p = 0.045). A further significant improvement to 15.5 ± 12.7 (p = 0.02) and to 8.6 ± 3.1 (p < 0.01) was obtained both at 6-month and at 1-year follow-up. KOOS scores improved significantly from 47.5 ± 16.6 before surgery to 65.4 ± 14.9 at 1 month (p = 0.013) and to 80.4 ± 15.1 at 6-month follow-up (p = 0.01). A further improvement to 85.6 ± 15.1 was recorded 1 year postoperatively, although nonsignificant. VAS score showed a significant improvement from 55.8 ± 20.5 preoperatively to 36.2 ± 16.9 at 1 month (p = 0.008) and to 18.2 ± 17.3 at 6-month follow-up (p = 0.005). This further improved to 12.8 ± 17.9 at 1-year follow-up, although not significantly. Conclusion Subchondroplasty procedure represents a safe and valid surgical option in the treatment of osteoarthritis-related BMLs of the knee, providing an improvement in terms of pain relief and functional recovery. Longer studies are required to evaluate how long these improvements may last. Level of Evidence Therapeutic case-series, Level IV study.

Histological Study of Discoid Lateral Meniscus in Children and Adolescents: Morphogenetic Considerations

Background Discoid lateral meniscus is the most frequent variant of the meniscus. Few studies have focused on the histology of discoid menisci. The aim of the present study was to report the histological findings of discoid lateral meniscus in children and adolescents, after arthroscopic partial resection, to give a possible explanation of its developmental etiology. Methods Five patients aged 9, 10, 13, 15, and 17 years were operated on for a 1-piece excision of a discoid lateral meniscus, and the specimens were histologically examined. Results The extracellular matrix showed a different distribution and characteristics depending on the different side of the meniscus. Irregularly oriented collagen fibers in discoid lateral meniscus were found. Cells of different shapes were observed depending on the surficial or deep location in the tissue. There were no blood vessels in the inner part of discoid lateral meniscus. Conclusion The findings of the current study seem to confirm that discoid lateral meniscus arises from variant morphogenesis. Furthermore, the altered distribution and shape of the cells and disorganization of collagen fibers (irrespectively of the age of the patients) may predispose discoid lateral meniscus to degeneration, damage, and tear in young patients also. Level of Evidence Level of evidence 4 (case series).

A New Treatment for the Reconstruction of the Medial Compartment of the Ankle: The Combined Use of Biological Materials

Fractures, especially if articular and periarticular, are frequently associated to functional and clinical disabling outcomes and chronic pain. In particular, the injuries with loss of bone, ligament, and/or tendon tissue in which the full recovery of the wound area is not obtained are the worst anatomical/pathological conditions to heal. In this study, three different biological materials were used as regenerative approaches to rebuild the medial malleolus fracture of the ankle in which loss of bone, ligament, and tendon tissue occur. In particular, the morselized human bone tissue was combined with the human dermis decellularized, both augmented with homologous platelet-rich plasma. The magnetic resonance imaging study with contrast at the follow-up showed a signal compatible with vascularization of the tissue without sign of degeneration. Our new regenerative approach in which different biological materials were combined together showed a good choice of treatment for the reconstruction of not repairable outcome of a fracture.

The Relationship between Kinesiophobia and Return to Sport after Shoulder Surgery for Recurrent Anterior Instability

Purpose To evaluate the relationship between kinesiophobia and patient's return to sport after shoulder stabilization surgery. The hypothesis was that kinesiophobia represents an independent factor correlated to the difference between preinjury and postoperative level of sport. Methods This study retrospectively evaluated 66 patients (mean age: 35.5, standard deviation [SD] = 9.9 years) and at a mean follow-up of 61.1 (SD = 37.5) months after arthroscopic Bankart's repair or open Bristow–Latarjet procedure. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); return to the preinjury sport was assessed by the difference between baseline and postoperative degree of shoulder involvement in sport (D-DOSIS) scale. The Western Ontario Shoulder Instability index (WOSI) was used to evaluate participants' perceptions of shoulder function. Results TSK showed correlation with D-DOSIS (ρ = 0.505, p < 0.001) and the WOSI score (ρ = 0.589, p < 0.001). There was significant difference in TSK and WOSI scores between participants who had and had not returned to their previous level of sport participation (p = 0.006, and 0.0001, respectively). Conclusion This study demonstrated that kinesiophobia is correlated to the return to sport after shoulder stabilization surgery. Level of Evidence Level IV, retrospective case series.

Metallosis in Sequelae of Prosthetic Revision for Ceramic Components Fracture: A Case Report with Clinical Presentation Mimicking Periprosthetic Hip Infection

Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.