Use of an Elastomeric Knee Brace in Patellofemoral Pain Syndrome: Short-Term Results

Purpose This article verifies the effectiveness of a new brace on patellofemoral pain syndrome (PFPS) in adjunct to a specifically developed rehabilitation program. Methods Two groups of 30 patients with PFPS were prospectively and randomly allocated to a rehabilitation protocol, with (group A) or without (group B) the use of a specific brace. All the patients were assessed at 3, 6, and 12 months using the disease specific Kujala scale and a visual analog scale (VAS) for pain; time to return to sport and patient satisfaction with the brace were also recorded. Results Kujala scale’s values showed constant and progressive improvement. The mean score at 6 months was 79.8 � 6.8 points in group A and 76.8 � 8.6 in group B, rising at 12 months to 80.9 � 7.5 in group A and 78.4 � 8.3 in group B. VAS scores significantly differed (p < 0.05) between the two groups at both 6 and 12 months; the score recorded at 12months was 0.9 � 1.3 in the brace-treated group and 1.8 � 1.6 in the controls. The patients who used a brace showed a quicker return to sports and 75% of the patients in this group were satisfied. Conclusion All the scores improved progressively in both groups. The most significant improvement concerned pain, showing that the brace used in this study may allow a better subjective outcome and a quicker return to sport. Level of Evidence Level 2, prospective randomized controlled trial

Controversies in ACL revision surgery: Italian expert group consensus and state of the art

Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction. Methods A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience. Conclusions The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case

Patellofemoral instability: classification and imaging

Patellofemoral disorders must be approached through an appropriate process of diagnostic framing, performed using language that is, as far as possible, unequivocal and a validated and organic classification system. At present, the classification proposed by the Lyonnaise school, which fulfills these requirements, is the most complete. This classification divides patellofemoral disorders into three groups: objective patellar instability, potential patellar instability and painful patella syndrome. It also identifies three principal factors of instability: trochlear dysplasia, abnormal patellar height and pathological tibial tubercle-trochlear groove (TT-TG) distance. Imaging is crucial for correct classification and for identifying and measuring the principal factors of instability. Up to now, the emphasis has been placed on the contribution made by traditional diagnostic radiology and computed to - mography. In recent years, however, growing attention has been paid to the use of magnetic resonance imaging in the assessment of the patellofemoral joint and in the study of factors of instability, even though there is still a need for validation of this approach before it can be routinely used in preoperative plannin