Universita degli Studi di Roma "Foro Italico"

Knee osteonecrosis (ON), often subclassified as spontaneous ON of the knee, secondary ON, and post-arthroscopic ON of the knee, is a common disorder often associated with suboptimal outcomes. Magnetic resonance imaging is the current gold standard for diagnosis, revealing bone marrow edema and subchondral fracture lines. Therapeutic methods range from conservative treatments, such as partial weight-bearing, pharmaceutical interventions, and physical therapy, to surgical procedures in cases of advanced joint collapse. Available evidence from histological studies consistently shows the absence of bone necrosis, highlighting microfractures and bone remodeling as central features of these lesions. Therefore, the appropriateness of this terminology has recently been questioned, with knee ON being more accurately reinterpreted as subchondral insufficiency fracture of the knee (SIFK). This clinical dilemma stems from longstanding misclassification that has led to diagnostic confusion and inconsistent treatment approaches. Despite this progress, several unresolved issues persist. The precise biomechanical and biological factors that initiate SIFK remain unclear, and the optimal timing for intervention is still debated. In addition, long-term outcomes of both nonoperative and operative treatments have yet to be definitively established. Addressing these gaps requires comprehensive clinical trials and advanced imaging studies that correlate histological findings with patient outcomes. This evolving understanding calls for a reclassification of knee ON lesions, aiming to enhance diagnostic accuracy and inform more effective, targeted treatment strategies.

To investigate the effect of digital exercise interventions on muscle mechanical function in community-dwelling older adults aged 60 and above.

Systematic review of randomised controlled trials (RCTs) retrieved from PubMed, EMBASE (Ovid), the Cochrane Central Register of Controlled Trials, and Web of Science until end of March 2024. The Cochrane RoB2.0 tool and GRADE were employed for quality assessment. We performed meta-analysis using random-effects model and sub-group and meta-regression analyses to investigate the robustness of the findings. GRADE was used to assess the overall certainty of the evidence.

Thirty RCTs, comprising 1697 participants with a mean age of 71.27 years, were included in the data analysis. The meta-analysis revealed a significant overall effect of technology-based physical activity intervention on muscle mechanical function (Hedge’s g = 0.27, p = < 0.001). In the sub-analysis, 18 studies focused on interactive interventions on handgrip strength (SMD 0.10, 95% CI -0.17 to 0.38) and leg strength (SMD 0.56, 95% CI 0.19 to 0.93). The overall certainty of the evidence was deemed low.

Digital interventions focusing on physical activity interventions have generally shown small but significant improvements in older adults. Interactive and semi-interactive interventions were effective, while passive ones were not.

Background: Despite outstanding clinical outcomes are routinely achieved after ACL reconstruction (ACLR), the major current issue is the failure rate (re-rupture or objective clinical instability). Reinjury rates have been reported to be about 6% for ipsilateral graft rupture and 8% for contralateral ACL rupture, with a cumulative reinjury rate of about 20%. Methods: A comprehensive review of the literature was performed to summarize the latest evidence on biological, surgical and rehabilitation aspects of ACLR. Results: It has been demonstrated that young age is a risk factor for ACL graft rupture and so is not passing return-to-play (RTP) testing following ACLR (those who pass the RTP test battery have a one-third reduction in the ACL re-rupture rate). Furthermore, up to 30% of reinjury occurs within two years from ACLR. These data can be explained by numerous pieces of evidence showing that the recovery of proprioception, proper neuromuscular activation and strength, as well as proper biomechanics, remains affected for a long time after surgery (up to two or three years in some cases) despite adequate rehabilitation programs. Conclusions: Clinical evidence, together with biological data on the ligamentization process and the remodeling phase, suggest that return to strenuous sports, especially in younger athletes, should be delayed by at least 18 months or 2 years after ACLR.