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The aims of the study were to evaluate long-term outcomes after autologous matrix-induced chondrogenesis (AMIC) in the treatment of focal chondral lesions and to assess the possible improvements given by the combination of this technique with bone marrow aspirate concentrate (BMAC). Twenty-four patients (age range 18–55 years) affected by focal knee chondral lesions were treated with standard AMIC or AMIC enhanced by BMAC (AMIC+). Pain (Visual Analogue Scale (VAS)) and functional scores (Lysholm, International Knee Documentation Committee (IKDC), Tegner, Knee injury and Osteoarthritis Outcome Score (KOOS)) were collected pre-operatively and then at 6, 12, 24, 60, and 100 months after treatment. Magnetic resonance imaging (MRI) evaluation was performed pre-operatively and at 6, 12, and 24 months follow-ups. Patients treated with AMIC+ showed higher Lysholm scores (p = 0.015) and lower VAS (p = 0.011) in comparison with patients in the standard AMIC group at the 12 months follow-up. Both treatments allowed for functional and pain improvements with respect to pre-operative levels lasting up to 100 months. MRI revealed consistent cartilage repair at 24 months in both groups. This study shows that AMIC and AMIC+ are effective treatments for focal chondral lesions with beneficial effect lasting up to 9 years. AMIC+ allows for faster recovery from injury, and is thus more indicated for patients requiring a prompt return to activity. Level of evidence: II, randomized controlled trial in an explorative cohort.

Purpose The aim of this study is to evaluate the return to sport after surgical treatment of shoulder injuries in professional goalkeepers in relationship with the mechanism of injury and the pattern of related shoulder lesions. Methods Twenty-six shoulders in nineteen elite male professional soccer goalkeepers were retrospectively analyzed considering multiple diseases (instability, rotator cuff, biceps or other tendon injuries). Data was collected for injury modality and context, pathological findings, surgical procedures, time, level of return to sport, and complications. Results The mechanism of injury was “mild trauma without contact” in 46% of the cases and 54% of injuries happened during training. 11 patients (42%) reported multiple pattern lesions and 9 patients (35%) classic anterior instability lesions. The mean time for return to differentiated training and unrestricted sport activity was 14 and 20.2 weeks, respectively. 15 athletes (62.5%) reported 100% return to sport, 4 (16.7%) to 90%, 1 (4.2%) to 85%, 3 (12.5%) to 80% and 1 athlete to 50%, stopping professional activity. 21% of the cases reported the persistence of some shoulder symptoms. 3 cases experienced a new injury. Patients with classic anterior instability had significantly lower age (30.7 vs 19.8 years, P =  0.001), experienced injury in different context and reported symptoms more frequently compared to multiple lesion patients (4/8 vs 0/10, P =  0.011). Conclusion Professional elite goalkeepers which required shoulder surgery for different causes demonstrated high-rate level of return to play despite the persistence of mild symptoms. The high frequency of multiple lesions, patients’ characteristics, injury context and mechanism, increase the concern for injuries in overstressed shoulder for this category of sport. Level of evidence IV.

The assessment of cardiac autonomic regulation (CAR) with non-invasive techniques, such as heart rate variability (HRV), might be of practical interest in elite sports, considering its importance in determining training. We studied 117 soccer players (74 male and 43 female) from three First Division European soccer teams. We used a ranked Autonomic Nervous System Index (ANSI, resulting from the combination of multivariate statistical methodologies applied to HRV-derived indices) to assess CAR. We hypothesized that ANSI might differentiate playing positions, considering goalkeepers, defenders, midfielders, and forwards. We also assessed the perception of somatic symptoms and stress. We observed in male athletes that ANSI was significantly greater in males as compared to females (p < 0.001), being higher in midfielders and defenders (p = 0.035), who usually sustain the greatest external load. Interestingly, this result was not observed in female athletes, who, instead, reported a significantly higher perception of somatic symptoms (p = 0.018) and stress (p = 0.049), the latter being particularly high in midfielders and forwards (p = 0.045). This approach might represent a convenient model to study the effects of long-term physical exercise on CAR in soccer, even to unveil possible differences due to sex, different playing positions characterized by distinct exercise routines, or stress perception.

Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy.

Background While extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship (“Primavera 1”). Results Conducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p  < 0.0001). Conclusions The study highlighted a peculiar distribution of non-contact muscle injuries among elite young football players. While hamstring injuries were confirmed as the most burdensome, incidence and burden of adductors and calf injuries were found to be similar. A significant incidence and burden of iliopsoas injuries were observed. These findings suggest potential implementations for targeted injury prevention strategies in the Italian male elite Under-19 football Championship. Key points • In the Italian male elite Under-19 football Championship, each Club can expect around 15 non-contact muscle injuries during the season (for a team of 25 players) distributed as follows: 6 hamstrings, 3 quadriceps, 2 adductors, 2 calf and 1 iliopsoas muscle injuries. • Hamstrings injury incidence and burden (both in training sessions and during matches), as well as the proportion of reinjuries, were found to be the highest among muscle sites. • Injuries to adductors and calf muscles exhibited comparable values of incidence and burden. • Iliopsoas emerged as a noteworthy site of injury in the current cohort, particularly during training sessions. • Aponeurosis or tendon damage was associated with longer return to football timing, particularly in hamstrings and adductors injuries.

Contrary from what was thought at the beginning, young people are also affected by the disease and can develop the severe respiratory conditions mentioned above. Since 8 March 2020, the Italian Serie A has been stopped until at least 3 April 2020, but, in the meanwhile, some clubs are requesting to resume the training activities not to lose physical fitness. According to a 1995’s Italian law, team doctors are in charge of his team footballers’ health, therefore, with this letter, the whole category wanted to take a strong position about this issue. [...]a significant number of insiders participate in daily training, greatly increasing the chances of infections as well.

In 90% of the cases, muscle strains affect hamstrings, rectus femoris, adductors, soleus and gastrocnemius.2 3 In particular, into the group of the so-called minor muscle injuries, a subgroup defined ‘non-structural muscle injuries’ (NSI) has been identified.2 The NSIs do not present any visible muscle fibre lesion at MRI and ultrasound examination and are classified as grade 1a, 1b2 or zero3 according to the latest classifications.2 3 Moreover, they are fare from being rare as they account for 30% – 40% of all muscle lesions recorded by professional football clubs.1 Despite the fact that NSIs are not detected by imaging, they can have functional sequelae.2 3 The challenge of diagnosing subtle muscle strains The player affected by NSI generally loses between 1 and 7 days of training/match exposure, and the diagnosis of this type of injury can be challenging. [...]mechanical damage incurred by the muscle ultrastructure could be further divided into two phases: an initial phase which takes place during physical activity and a later phase associated with a secondary, inflammatory response resulting in a painful condition approximately 24 hours after the triggering event.4 The biological repercussions of the mechanical damage inflicted on the muscle ultrastructure involve: sarcomere damage, perturbation of the excitation-contraction coupling mechanism and a situation of calcium overload caused by Ca2+ spilling out from the damaged sarcoplasmic reticulum into the cytosol.4 From a practical point of view, because most clinics will not have MRI scanners handy, the medical staff are in a difficult position when a player or a member of the player’s entourage challenges the working diagnosis and suggests shortening the recovery time. Currently, the most promising plasma biomarkers seem to be: calpain (n-calpain and μ-calpain), circulating miRNAs (miR208a-3p, miR208b-3p, miR206-3p, miR-133b-3p and miR-434–3 p), skeletal muscle troponin I (type I and type II skeletal troponin), fatty acid-binding protein 3 (cytoplasmic form), plasma myosin heavy chain fragment, interleukins (IL-1, IL-1β, IL-6), tumour necrosis factor and carbonic anhydrase isoenzyme III. [...]interesting and promising biomarkers for muscular lesions can be obtained from a simple urinalysis, specifically: urinary myoglobin, 1/3-methylhistidine and metalloproteinase (MMP2, MMP-3, MMP-7, MMP-9, MMP-14) and titin fragment excretion rate.7 8 Unfortunately, to date, only a few saliva constituents are associated with musculoskeletal tissue injuries.8 It is likely that a single marker is not sufficient, and a combination of markers could be necessary.

Purpose The purpose of this study is to analyse the effect of BMI on clinical outcomes of cemented fixed-bearing lateral unicompartmental knee arthroplasty (UKA) on a 2- to 12-year follow-up. Methods Between January 2010 and January 2020, a total of 103 lateral UKAs were implanted. The Oxford Knee Score (OKS) and the Western Ontario and McMaster University Osteoarthritis Index for pain, stiffness, function, and total score were administered to estimate patients’ overall health status pre- and post-operatively. Results were considered good or excellent for WOMAC values > 85 points and OKS > 40 points. Survivorship, described with Kaplan–Meier method, was defined as the lack of revision at the latest follow-up. Complications or further operations were recorded. p values of < 0.05 were considered significant. Results One hundred one lateral UKAs were assessed at a mean follow-up of 77.8 months. No patients underwent revision, but 2 patients (2, 0%) developed aseptic loosening of the implant 2 and 5 years after surgery but for clinical reasons neither undergo revision (5-year survivor 97.2%). Overall satisfaction was generally high, with excellent scores in all WOMAC subscales and OKS for all BMI groups. Considering the pain subscale (WOMAC pain), patients with normal weight and overweight achieve excellent results more frequently [10 (25.64%) vs 10 (23.81%) p  = 0.026] than obese patients ( n  = 0); on the other hand, considering the quality of life (WOMAC QoL), obese patients most frequently reach excellent values, even statistically significant [ n  = 15 (75.00%) p  = 0.040]. Conclusion Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. Therefore, the classic contraindication of UKAs in patients with BMI > 30 kg/m 2 may not be justified. According to the present study, lateral UKA patients with BMI > 30 kg/m 2 had satisfactory patient-reported outcome measures compared to non-obese patients on a long term with survival rates comparable to medial UKA. Obese patients should not be excluded from the benefit of lateral UKA surgery.

Lateral unicompartmental knee arthroplasty (UKA) is a valid alternative treatment in the event of arthritis confined to the lateral compartment. This paper examines its indications, technique and short to medium‐term results. A total of 159 Miller–Galante cemented UKA prostheses (Zimmer, Warsaw, Indiana) were implanted consecutively (131 medial and 28 lateral) by the same surgeon. This study investigates 28 lateral UKAs in 27 patients. Twenty‐five implants in 24 patients (including a subject operated bilaterally) were followed up for 12–60 months. Three patients were discarded on account of to short a follow‐up period. The Hospital for Special Surgery (HSS) knee score was used to compare the pre‐ and post‐operative results of the lateral UKA patients. The HSS score improved from a pre‐op mean of 59.92 (range 48–68) to 88.04 (range 71–95) at the last follow‐up. There was a positive increase in the pain, function and ROM components of the score. The lateral UKA prosthesis can be regarded as a sound alternative to total knee replacement. Correct patient selection on the basis of optimum surgical indications, however, is essential.