Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This systematic review evaluated the comparative efficacy of transverse versus longitudinal skin incisions for open release of the first dorsal compartment in DQT. Materials and Methods: Four studies with 259 patients were included in the review. Data from 17 patients were unavailable due to loss to follow-up; therefore, 243 wrists (242 patients) were included in the quantitative analysis. The transverse incision group consisted of 114 cases, and the longitudinal incision group of 129 cases. The primary outcome of the review was the incision-related incidence of injuries to adjacent anatomical structures, including injuries to the superficial branch of the radial nerve (SBRN), tendon injuries, and vein injuries. Secondary outcomes included hypertrophic scar formation, wound infection, and postoperative changes in pain severity measured using a visual analog scale (VAS). Results: Although there was a lower rate of SBRN injury in the longitudinal group (5.4% vs. 7% in the transverse group), the difference did not meet statistical significance (OR = 2.17; 95% CI, 0.39–11.99; p = 0.37; I2 = 30%). Similarly, there was no significant difference in the risk of vein injury (RD = 0.06; 95% CI, −0.03 to 0.14; p = 0.21; I2 = 61%), hypertrophic scar formation (OR = 1.39; 95% CI, 0.32 to 6.04; p = 0.66; I2 = 35%), and wound infection (RD = 0.00; 95% CI, −0.03 to 0.03; p = 0.93; I2 = 0%). Although both approaches resulted in significant pain improvement, no statistically significant difference in postoperative pain was observed between incision types, as assessed by the VAS for pain (mean difference = 0.30; 95% CI, −0.70 to 1.30; p = 0.56; I2 = 43%). Conclusions: No significant differences were identified between incision techniques for DQT in terms of complication rates and postoperative pain outcomes. However, the available evidence is limited, and future high-quality trials are necessary to determine any clinically meaningful difference. Therefore, incision selection should be individualized based on surgeon preference, patient-specific anatomy, and procedural complexity. Despite the technique used, meticulous surgical technique is essential to prevent postoperative complications.

Background/objectives: Evidence on gait and postural recovery after robotically assisted total knee arthroplasty (raTKA), particularly with the ROSA system, remains limited. This study compared early gait, postural, functional, and patient-reported outcomes (PROMs) between ROSA raTKA and manual TKA (mTKA), with PROMs also assessed at final follow-up. Methods: This comparative cohort study included primary TKA patients treated by a single senior surgeon using the same implant and alignment strategy. Patients underwent either ROSA raTKA or mTKA. At three months, a senior physiotherapist assessed quadricep and tibialis anterior maximum voluntary isometric strength (MVIS), centre-of-mass (CoM) kinematics, lower-limb weight distribution, timed-up-and-go (TUG), range of motion (ROM), KOOS Pain, activities of daily living (ADL), and quality of life (QoL). The same KOOS domains were compared at final follow-up. Results: Seventy primary TKAs were included: 46 raTKAs and 24 mTKAs. No intraoperative complications occurred. Groups were comparable for age, BMI, sex, grip strength, and preoperative KOOS. At three months, no significant differences were found in quadricep MVIS (p = 0.257), tibialis anterior MVIS (p = 0.327), CoM kinematics (p = 0.066), weight distribution (p = 0.189), TUG (p = 0.599), ROM (p = 0.165), or KOOS domains. At final follow-up, KOOS-ADL (p = 0.041) and QoL (p = 0.032) were better in the raTKA group, but after Holm-Bonferroni correction, they were no longer significant (QoL, p = 0.384; ADL, p = 0.451). Conclusions: ROSA raTKA showed comparable early gait and postural recovery to mTKA. The marginal differences in KOOS domains are exploratory, as they were no longer significant after multiple-comparisons correction.

Aging frailty is a multifactorial geriatric syndrome characterized by reduced physiological reserve across multiple interrelated systems, leading to increased vulnerability to adverse health outcomes. Mesenchymal stem cells (MSCs) have emerged as a potential therapeutic intervention due to their immunomodulatory and regenerative properties. This systematic review aimed to evaluate the available clinical evidence regarding the safety and efficacy of MSC administration in individuals with aging frailty. A systematic literature search was conducted in PubMed, Scopus, and the Cochrane Library from database inception to 15 April 2026. Only randomized controlled trials (RCTs) were eligible. Data were extracted according to study design, participants’ characteristics, MSC source and dosing, safety outcomes, functional performance measures, quality of life (QoL) indices, and inflammatory, immune, and vascular biomarkers. Three RCTs met the inclusion criteria, comprising a total of approximately 208 participants. MSC administration was well-tolerated, with no treatment-related serious adverse events reported. Signals of improvement were reported in mobility-related and physical performance outcomes, although the magnitude and consistency of the response varied across studies. A dose-dependent increase in 6 min walk distance was observed at nine months in one trial, while improvements in SPPB, TUG, and grip strength were reported in the other studies. Additionally, MSC therapy was associated with QoL improvement and reduction in circulating pro-inflammatory cytokine concentrations. MSC administration was also associated with changes in immune-cell activation and a dose-dependent reduction in circulating sTIE2. Because of substantial clinical and methodological heterogeneity among the included trials, a quantitative meta-analysis was not performed. Current randomized evidence remains limited but suggests that intravenous MSC therapy is generally well tolerated in older adults with aging frailty and may produce clinically relevant signals of improvement in mobility-related functional outcomes, quality of life, and selected inflammatory, immune, and vascular biomarkers. However, the small number of trials, heterogeneity in MSC source, dose, endpoints, and follow-up duration, and the exploratory nature of much of the evidence preclude definitive conclusions regarding efficacy. Larger, adequately powered trials with standardized frailty endpoints are required, while future trials specifically targeting sarcopenia should apply consensus diagnostic criteria and direct measures of muscle quantity, strength, and physical performance.

Background. Few studies assess gait in robotically assisted total knee arthroplasty (raTKA); none in ROSA raTKA patients. Methods Maximum voluntary isometric strength (MVIS), body centre-of-mass (COM) walking kinematics, body-weight distribution, time-up-and-go (TUG) test, quality of life, and range of motion (ROM) were evaluated in three postoperative months between manually TKA (mTKA) and raTKAs. A surgeon performed all procedures using the same technique. Results Forty-six uncomplicated primary raTKAs and 24 mTKAs were included, showing similar demographics, grip strength, and preoperative KOOS scores. At three months, there were no significant differences in quadriceps (p = 0.869), tibialis MVIS (p = 0.327), COM kinematics (p = 0.801), body-weight distribution (p = 0.189), TUG (p = 0.59), and ROM (p = 0.165). Patient satisfaction was significantly higher in the raTKA group (p = 0,048) and furthermore numerical differences favoring the raTKA group were observed in tibialis anterior MVIS, weight distribution, TUG, and ROM, even though there were no statistically significant differences. Conclusions At three months post-operation, ROSA raTKA resulted in significantly higher patient satisfaction but did not yield statistically differences in gait, posture, or strength outcomes compared to mTKA. The observed non-significant numerical differences in favor of the raTKA grpoup, should be explored in larger, long-term, randomized controlled trials.

BACKGROUND Massive rotator cuff tears (RCTs) result in impaired shoulder function and quality of life. These tears lead to structural changes in the rotator cuff muscles, which compromise recovery after repair and increase re-tear rates. AIM To investigate the potential inhibitory effects of alpha-tocopherol (vitamin E) and OTR-4131 on muscle atrophy, fatty infiltration, and fibrosis in rotator cuff muscles following a massive RCT using a Wistar rat model, and establish a standardized methodology for evaluating potential therapeutic agents. METHODS This protocol outlines a controlled animal study using 40 male Wistar rats, randomized into five groups. The experimental groups will receive either systemic administration of alpha-tocopherol or local administration of OTR-4131 via intramuscular injection into the supraspinatus and infraspinatus muscles. Two sham groups will receive systemic and local saline injections respectively, while a control group will undergo no intervention. The interventions will be administered after surgical transection of the supraspinatus and infraspinatus tendons. Outcomes will be assessed via wet muscle weight measurements, muscle fiber diameter, fatty infiltration percentage, and fibrosis evaluation using histological methods. RESULTS The study anticipates that alpha-tocopherol and OTR-4131 will reduce muscle atrophy, fatty infiltration, and fibrosis compared to control and sham groups, supporting their potential protective role in rotator cuff muscle degeneration. CONCLUSION The results are expected to improve the understanding on the role of alpha-tocopherol and OTR-4131 in rotator cuff muscle protection after massive RCT and may serve as a foundation for further preclinical and clinical research aimed at improving rotator cuff repair outcomes.

Diabetes mellitus (DM) is associated with an increased risk of fractures, mainly due to impaired bone architecture and microvascular complications. Whether DM is also associated with increased risk of sarcopenia is not yet known, with studies yielding inconclusive results. The aim of this study was to systematically review and synthesize the best available evidence regarding the association between DM and sarcopenia risk. A comprehensive search was conducted in PubMed, CENTRAL and Scopus databases. Data are expressed as odds ratio (OR) with 95% confidence intervals (CI). The I 2 index was employed for heterogeneity. Only studies which had implemented at least two of the three criteria for sarcopenia diagnosis (low muscle mass, muscle strength and/or muscle performance), as defined by the international studying groups, were included. Fifteen studies fulfilled eligibility criteria, yielding a total of 1832 patients with type 2 DM (T2DM) and 1159 cases of sarcopenia. Patients with T2DM demonstrated a higher risk of sarcopenia compared with euglycemic subjects (OR 1.55, 95% CI 1.25–1.91, p < 0.001; I 2 34.6%). This risk remained significant when analysis was restricted to studies matched for age and sex. Sarcopenia risk was independent of disease definition or study design. Notably, T2DM patients presented lower muscle performance and strength compared with euglycemic subjects, whereas no difference in muscle mass was observed between groups. Patients with T2DM have an increased risk of sarcopenia compared with euglycemic subjects.

Scoliosis is curvature of the spine, often found in adolescents, which can impact on their quality of life. In recent years, smartphone applications (apps) and web-based applications may help the parents with the doctors' supervision in scoliosis screening and monitoring, thereby reducing the number of in-person visits. This paper suggests the usage of the SCOLIOSIS system to detect the onset of scoliosis. This tool is being developed for simple use on mobile devices and as a web-based monitoring system for doctors, which will be an interactive tool for the patients and doctors that will provide data, information, and knowledge. The study conducts a usability assessment of the mobile application by doctors and non-clinician users. User test application developed for the android platform and the results show that this has the potential to be applied in medical practice.

Background:Serotonin Reuptake Inhibitors (SRIs) are commonly utilised antidepressants among populations in Western countries; however, their use has been linked to adverse effects and postoperative complications. This systematic review assessed the risk of both early and late perioperative complications in SRIs users undergoing elective total hip arthroplasty (THA) and knee arthroplasty (TKA) compared to non-users. Methods:This study adhered to the 2020 PRISMA guidelines. A comprehensive search of PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews was conducted from inception until January 2025. Comparative studies examining SRI users and non-users undergoing elective THA or TKA that addressed at least one postoperative outcome (blood loss, postoperative haemoglobin reduction, transfusion rate, length of stay, readmission and revision rate) were included. The Newcastle-Ottawa Scale was employed to evaluate the quality of the included studies. A meta-analysis was performed to assess the risk of transfusion, utilising a random-effects model. Results:Ten comparative cohort studies, including two prospective and eight retrospective studies, were included in this analysis, involving 2,098,833 patients who underwent either elective THA or TKA. Among these patients, 418,527 were using SRIs during the perioperative period, with a mean age of 65.2 years. Our meta-analysis revealed an odds ratio of 1.78 (95 % CI, 1.11, 2.83; p = 0.02) concerning the blood transfusion rate in patients utilising SRIs, although it was characterised by considerable heterogeneity (I2 = 97 %). The findings regarding length of stay, readmission rate, and revision rate were inconclusive. Conclusion:The use of SRIs in patients undergoing elective THA and TKA may be linked to a slightly increased risk of bleeding and need for blood transfusion. However, considering the potential benefits of these medications for this patient group, it remains uncertain whether discontinuing them during the perioperative period is advisable. More high-quality studies are required to establish an etiological relationship.

Background:Soccer is a contact sport during which participants risk injury, including due to concussion. Interestingly, the task most frequently associated with concussions is the act of heading the ball. This study seeks to answer the following research question: Does an acute playing of purposeful soccer heading in female football players lead to changes in BESS normative outcomes and balance? Additionally, we aim to explore the relationship between a gold-standard BESS Test and a Balance Test performed on a force plate. Methods:This project involved twenty-eight female soccer players (age = 19.6 + 2.96 years, mass = 60.4+ 5.3 kg, and height = 163.6 + 6.4 cm). pre and post the heading condition and the results of the Wilcoxon Signed Ranks Test. The participants were healthy and underwent BESS monitoring on a force plate before and after heading and footing training. Standard 450 g soccer balls were utilized. Participants performed ten headers for the header condition and ten footers for the footer condition. Resultant sway velocity and BESS error outcomes were calculated before and after heading and footing training. I need a brief description of the statistical approach here. Results:Statistically significant increases after the heading condition were found for Single Leg Stance (COP PATH) score (Z = -3.986, p = 0.000), BESS score on foam surface (Z = -2.511, p = 0.012), BESS score on firm surface (Z = -2.353, p = 0.019). A statistically significant increase after the footer condition was found for the Tandem Stance (mm2) score (Z = -2.900, p = 0.004). A statistically significant difference between the group conditions was found in the post-BESS score foam difference (U = 268.500, p = 0.042). BESS score foam mean increase was 1.93 after the heading condition and 0.21 after the footer condition. Conclusion:This pilot study not only tests the feasibility of using force plates to measure BESS outcomes after heading in female soccer but also underscores the effectiveness of using BESS parameters to evaluate changes in balance function following heading compared to a control footer condition. The findings of this study provide valuable insights into the potential effects of soccer on balance in female players, contributing to the body of knowledge in sports medicine and physical education. Level of evidence:3.

Introduction The prevalence of periprosthetic femoral fractures (PFFs) in Greece has not been previously documented. This study aims to determine the prevalence of PFFs in a Greek population over the past 20 years, using data from a referral centre. Methods A retrospective analysis of PFFs was conducted at a Greek academic orthopaedic department, covering the period from 2004 to 2023. Demographic data, PFF types, treatment methods, time from admission to surgery, length of hospital stay (LOS), and operative times were recorded and compared between the two decades. Results The study included 244 patients with PFFs, with a mean age of 78.2 years. Most patients were female (86.5%, p < 0.001). The incidence of PFFs significantly increased between the first and second decades (mean: 9.8 vs. 14.6 cases per year, p = 0.01). This increase was particularly evident in fractures around total knee arthroplasties (TKAs) (p = 0.0027). Treatment choices between internal fixation and revision arthroplasty remained consistent over time for PFFs around total hip arthroplasties (THAs) and TKAs (p > 0.05). However, the LOS and the time from admission to surgery significantly decreased from the first to the second decade (p = 0.001 and p = 0.02), respectively. Conclusion This study is the first to document PFFs in a Greek population, showing a notable increase in incidence, higher prevalence among females, consistent treatment methods, and a reduction in the time from admission to surgery and LOS over the past decade.

Introduction: This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. Methods: Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. Results: Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, −1.77, −0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). Conclusion: The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.

The purpose of this study was to determine if women footballers have an increased lack of neuromuscular control of the knee joint after a concussion compared to a healthy cohort tested with tensiomyography (TMG). Forty-one female collegiate footballers were enrolled in this study from which there were 20 with a history of sports-related concussions (SRCs) and 21 control subjects. Results from the SRC group had significantly higher Tc (ms) (z = −5.478, p = 0.000) and significantly lower Dm (mm) (z = −3.835, p = 0.000) than the control group in the case of the rectus femoris muscle. The SRC group had significantly higher Tc (ms) (z = −2.348, p = 0.016) and significantly lower Dm (mm) (z = −4.776, p = 0.000) than the control group in the case of the vastus medialis muscle. The SRC group had significantly higher Tc (ms) (z = −5.400, p = 0.000) and significantly lower Dm (mm) (z = −4.971, p = 0.000) than the control group in the case of the vastus lateralis muscle. The SRC group had significantly higher Tc (ms) (z = −5.349, p = 0.000) than the control group in the case of the biceps femoris muscle response, whereas no significant difference was found in Dm (mm) (z = −0.198, p = 0.853) between the groups. The results of the current study may have implications for current practice standards regarding the evaluation and management of concussions and can add valuable information for knee prevention programs as well.

Introduction Primary knee osteoarthritis (OA) is a multifactorial degenerative joint disorder characterized by articular cartilage degradation. Matrix metalloproteinases (MMPs) have been reported to play a vital role in OA pathogenesis, significantly contributing to extracellular matrix (ECM) catabolism. The purpose of this study is to investigate the association of MMP-2 -1575G/A (rs243866), MMP-9 836A/G (rs17576), and MMP-13 -77A/G (rs2252070) gene polymorphisms with knee OA in the Greek population. Methods One hundred patients (24% males, mean age: 68.3 years) with primary knee OA were included in the study along with 100 controls (47% males, mean age: 65.2 years). Genotypes were identified through polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) technique. Allelic and genotypic frequencies were compared between patients and controls. Results The MMP-13 -77A/G polymorphism was significantly associated with knee OA in the crude analysis (P = 0.008). After binary logistic regression analysis, the dominant model of the MMP-13-77A/G (AG + GG versus AA) was found to be associated with increased risk for knee OA (odds ratio (OR) = 2.290, 95% confidence interval (95%CI) = 1.059-4.949, P= 0.035). Compared to the A allele, the G allele in the MMP-13rs2252070 locus was a predictive factor for knee OA (OR = 2.351, 95%CI = 1.134-4.874, P= 0.022). No significant associations were detected for the MMP-2 -1575G/A and MMP-9 836A/G polymorphisms (P > 0.05). Conclusions The present study shows that the MMP-2 -1575G/A and MMP-9 836A/G polymorphisms are not significantly associated with primary knee OA in the Greek population. The MMP-13 -77A/G was found to be a significant risk factor for knee OA in the Greek population. Additional research is needed to verify this association in larger and different populations, in different joints, to elucidate the role of this single nucleotide polymorphism (SNP) in OA pathogenesis.

The first Fragility Hip Fracture Registry has been established in Greece. The in-hospital length of stay was 10.8 days and was significantly influenced by the delayed surgical fixation. The increased age, the higher ASA grade, and the male gender influenced negatively the 30-day mortality, which reached 7.5

Background: The direct superior hip approach (DSA) has been less researched than other approaches in the literature. We retrospectively compared the early postoperative and functional outcomes of patients with hip osteoarthritis undergoing total hip arthroplasty (THA) via DSA with a matched control group using a standard posterior approach (SPA). Methods: The DSA group comprised 100 THAs performed via DSA by a senior surgeon between January 2018 and May 2019. Patients with primary osteoarthritis and ASA score ⩽3 who were eligible for surgery were included. The DSA group was compared to a matched cohort of 100 patients operated on with a SPA in the same period by another chief surgeon. Patients were matched for age, sex, and ASA score. All patients received the same postoperative chemoprophylaxis, pain management and physiotherapy. 2 independent attending arthroplasty surgeons assessed the incision length, operative time, blood loss, hospital stay, and complications. VAS, HHS, and HOOS scores were also evaluated for a year postoperatively. Results: Mean incision length and hospital stay were significantly lower in the DSA group. DSA patients had non-significantly lower intraoperative blood loss, transfusion needs, and postoperative pain than SPA patients. Mean operation time and complication rate did not differ between groups. The DSA group demonstrated significantly greater functional scores than the SPA group at the first postoperative month. No differences in scores were recorded following the third month. Conclusions: The DSA approach may provide earlier functional recovery and hospital discharge for THA patients compared with SPA. DSA was equivalent to SPA concerning pain and blood loss, showing minimal complication rates.

Background: Spontaneous non-specific pyogenic spondylodiscitis (SNPS) is a rare medical condition, whose optimal treatment remains controversial. We evaluated the multidisciplinary protocol implemented at our department for the conservative treatment of patients with SNPS. Methods: Patients with lumbar or thoracic SNPS, whose treatment was initiated conservatively and had at least six months of follow-up, were enrolled in this retrospective audit study. Patients with specific, postoperative, or iatrogenic spondylodiscitis or necessitating immediate operative treatment were excluded. The location of the infection, initial symptoms, co-morbidities, pathogens, duration of antibiotic treatment, hospitalization and follow-up, and outcome were retrieved. The visual analogue scale (VAS) score was used to register pain improvement after treatment. Results: Between January 2011 and December 2021, forty-seven patients (male: 26, mean age: 68.5 years) with SNPS (lumbar: 29, thoracic: 18) were hospitalized. The main co-morbidity was diabetes mellitus (23 patients). Pain was the predominant (46 patients), and fever was the second most common (19 patients) symptom. The most frequent causative microorganism was staphylococcus aureus (29 patients); no pathogen was identified in ten patients. The mean hospitalization duration for patients completing their conservative treatment (43/47) was 27 (range: 22-41) days. They received antibiotics for a mean period of 23 days intravenously (range: 21-29), 23.8 days per os (range: 21-35), and 46.8 days in total (range: 42-63). Conservative treatment was discontinued in two females. Two male patients died due to septic shock. The mean follow-up was 11.5 months (range: 6-15). During follow-up, no one developed any neurologic deficit and/or recurrence. There was a significant improvement in the mean VAS, from 8.3 +/- 0.8 pre-treatment to 1.6 +/- 0.5 at the latest follow-up (p <0.001). Conclusions: Although treatment is gradually shifting towards surgical intervention, conservative therapeutic management of SNPS patients with antibiotic administration, bed rest, and careful mobilization remains a viable and efficacious option. HIPPOKRATIA 2023, 27 (2):106-111.

BACKGROUND:Muscle fatty degeneration following rotator cuff tears has been unequivocally associated with poorer functional outcomes and increased risk for retear following rotator cuff repair. Promising results have emerged from animal studies, with the implementation of various interventions for biologic inhibition of this fatty muscle degeneration. The lack of high quality randomized human evidence on this topic, increases the impact of pooled results from animal literature. The aim of the present study was to systematically review the available published literature for animal studies evaluating the ability of several interventions used to mitigate muscle fatty degeneration following the repair of massive rotator cuff tears. PATIENTS AND METHODS:A comprehensive search was conducted on Pubmed, Scopus and Google Scholar, covering the period from conception until 16th April 2022. Datasets were stratified based on the type of intervention performed. SYRCLE risk of bias instrument was implemented for quality assessment of the included studies. RESULTS:Rotator cuff repair augmentation with Adipose derived stem cells (ADSC's), Mesenchymal stem cells (MSC's) and Nandrolone was effective against fatty infiltration, but less effective against muscle atrophy. More beneficial effect was shown by the utilization of Beige adipose tissue - Fibroadipogenic progenitors (BAT-FAP) stimulation, using either Amibregon or BAT-FAPs transplantation. Both provided good results in mitigating muscle atrophy, fatty infiltration and fibrosis. DISCUSSION:ADSC's, MSC's, Nandrolone and BAT-FAP stimulation may have a role in mitigating muscle fatty degeneration following rotator cuff tears. Large scale human studies are required to further elucidate their role in the clinical setting. LEVEL OF EVIDENCE:V; systematic review of pre-clinical studies.

Background:Soccer is unique among sports because it is the only sport that involves purposeful use of the head to control, pass, or shoot the ball. Over the previous five years, a relationship between lower extremity (LE) injury and sports related concussion (SRC) has been established in various sporting populations. Athletes at the high school, collegiate, and professional levels have demonstrated a greater risk for sustaining a LE injury post SRC. The purpose of this systematic review was to examine the relationship of the SRC with the incidence of LE injuries. Methods:Ten databases were searched with the following keywords: Lower limb, ball heading, neuromuscular control, concussion, MEDLINE, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), EMBASE, and Scopus. The search was limited to English-language and peer-reviewed publications, until 15/12/2022. The PEDro scale was used for the assessment of the risk of bias among the included studies. All included papers were qualitatively analyzed. Results:A total of 834 studies were identified and 10 articles (four concussion-MSK biomechanics, six concussion-MSK injury) were included in the qualitative analyses. Included papers ranged from low to high quality. Due to the heterogeneous nature of the included study designs, quantitative meta-analysis was unable to be performed. All four of the included concussion-MSK biomechanics studies demonstrated, to some degree, that worse cognitive performance was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. Among the six injury related studies, two investigations failed to determine group differences in cognitive performance between subsequently injured and non-injured athletes. Conclusion:More research is needed to better understand the relationship of SRC and lower extremity injuries and the extent to which they are related to concussions and/or repetitive neurotrauma after ball heading sustained in soccer. Level of Evidence:2.

PURPOSE:Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS:Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS:One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS:This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients' scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient's age was 68.5 (+/- 14.5) years, and the mean follow-up 3.81 (+/- 1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1-84.5) and 80.5 months for dislocation (95% CI, 75.8-85.2). The mean postoperative functional scores were significantly improved (p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs' offset relative to stem-neck impingement are necessary to maximise outcomes.