Abstract Early-onset knee osteoarthritis (OA) is no longer a condition of ageing joints; it is now an emerging threat to the careers of athletes in their prime. High-impact sports, repetitive microtrauma, and incomplete recovery after injury contribute to a biologically active and mechanically unstable joint environment, often years before radiographic changes appear. In this narrative review, we explore how modern sports medicine is shifting from reactive to proactive strategies, focusing on joint preservation, functional optimisation, and long-term performance sustainability. From precision diagnosis using advanced imaging and biomarkers to tailored exercise programmes, biologic injections, and targeted surgical options, the management of early-onset knee OA demands an integrated, sport-specific approach. The athlete’s return to sport is not merely a clinical milestone but a biomechanical, psychological, and strategic decision. Despite growing awareness, current guidelines fail to address the complexity of early-onset OA in high-performing individuals, and robust long-term data are lacking. This review provides an evidence-based framework to delay degeneration, empower athletes, and keep performance at the centre of care.
Abstract Background Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. Methods Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword ‘orthopaedic’. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. Results Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103–0.114, p < 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p < 0.001), whereas title length in words showed a negative association (β = −0.183 per word, p < 0.001). The presence of a colon (+0.314 citations/year, p < 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (−0.476, p < 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p < 0.0001). Conclusions In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.
Abstract Background Shoulder preservation surgery encompasses various joint-sparing procedures aimed at delaying arthroplasty in patients with glenohumeral osteoarthritis (OA). This systematic review synthesises and discusses the evidence on shoulder joint-preservation surgeries for the management of glenohumeral arthritis in adults. Methods This systematic review was conducted following the PRISMA 2020 guidelines and the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search of PubMed, Web of Science, and Embase was conducted in June 2025 to identify clinical studies evaluating shoulder joint-preservation surgeries for the management of glenohumeral arthritis in adults. Only studies reporting a minimum follow-up of six months were considered. Results Data from nine studies (333 patients, 335 shoulders) were analysed. The mean age ranged from 41.7 to 57.5 years, and 28.8% (96 of 333 patients) were women. The length of the follow-up ranged from 6.0 to 123.7 months. The reported surgical interventions primarily involved arthroscopic debridement procedures, often combined with capsular release or subacromial decompression, as well as microfracture with or without biological augmentation and glenoid resurfacing using dermal allografts. The complication rate was 2% (6 of 246 patients), and the infection rate was 0.5% (1 of 199 patients). 22.4% (71 of 317) of patients underwent surgical revision. 19.6% (62 of 317) of patients progressed to total shoulder arthroplasty (TSA), with a reported mean time to conversion of 8.0 to 56.4 months. Conclusion Shoulder joint preservation surgeries may alleviate symptoms of glenohumeral OA in adults. Nonetheless, available evidence is constrained by heterogeneity in study design, limited patient numbers, and the absence of comparative data. High-quality prospective studies are needed to refine patient selection criteria and establish evidence-based treatment recommendations.
Abstract Background Orthopaedics, as a surgical speciality with a structurally narrower citing audience and lower citation density than general medicine, is systematically disadvantaged in any cross-disciplinary comparison relying on absolute citation counts. Whether this disadvantage is stable or has changed over time has not been previously quantified. Methods The 100 most-cited articles indexed in the Web of Science Core Collection were identified for medicine and orthopaedics in 2014 and 2024. Citation data were extracted from a single snapshot taken on 19 January 2026. Total citations and citation velocity, defined as citations per year since publication, were compared between fields and across time points using Mann-Whitney U tests. Ratio-based analyses and distributional characteristics were also assessed. Results Median citation counts were substantially higher in medicine than in orthopaedics in both years, reaching 5055 versus 288 in 2014 and 720.5 versus 34.0 in 2024, corresponding to 17.6- and 21.2-fold differences, respectively. Citation velocity followed the same pattern, with medicine maintaining an approximately 17- to 21-fold advantage at both time points. Within-field temporal analysis showed that citation velocity remained broadly stable in medicine between cohorts, whilst orthopaedics demonstrated reduced early citation accrual in the more recent cohort. Citation distributions were more right-skewed in medicine, with a small number of articles accounting for a disproportionate share of total citations, whereas orthopaedic citations were more evenly distributed across the top 100. Conclusions Orthopaedics demonstrated substantially lower citation performance than general medicine articles, and this gap appeared to persist over time.
BACKGROUND:Catheter-related thrombosis (CRT) and the fibroblastic sleeve (FS) are common complications of venous catheters. The FS has got a higher incidence compared to CRT, both in central and peripheral venous catheters. However, no study evaluated the incidence and the risk of these two non-infectious complications in midline catheters placed in patients admitted to intensive respiratory care units. OBJECTIVE:The purpose of this prospective study is to describe the incidence of CRT and FS in midline catheters in intensive care setting and to investigate the association between these events and the clinical characteristics of patients. MATERIALS AND METHODS:The study carried out at "San Filippo Neri" Hospital in Rome since May 2023 to April 2024 evaluated the outcomes of midline catheter placement in adult patients admitted to the respiratory intensive care unit. Catheters were placed using the "GAVeCeLT SIP protocol," with ultrasounds performed 7-10 days post-insertion (T1) and before removal (T2) in order to monitor complications like CRT and FS. Data were analyzed using Jamovi 2.0, focusing on catheter safety and related issues in critically ill patients. RESULTS:In total, 33 patients were recruited in the study. The incidence of symptomatic CRT was 15.2% (5 cases), while asymptomatic cases accounted for 12.1% (4 cases). The incidence of the FS was 24.2% (8 cases). Statistical analysis showed that patients with CRT had significantly lower Barthel Index scores, compared to those without thrombosis. CONCLUSION:Midline catheters are safe even in intensive care settings. However, special attention should be reserved to patients with severe functional limitations of the upper limbs.
