Intra-articular hyaluronic acid injections and oral collagen supplementation for knee OA: A case report of an elite female soccer player

Soccer players are susceptible to repeated trauma that could lead to a precocious development of knee osteoarthritis (OA). Intra-articular hyaluronic acid (IA-HA) injections have been proposed as a valid treatment for knee OA. Objectives: To describe the effects of IA-HA injections and oral collagen supplementation in a female soccer goalkeeper playing in Italian Women’s Serie A with secondary OA in her knee. Design: Case report. Setting: The athlete underwent three IA-HA injections (1 per week for 3 weeks in a row) together with oral collagen supplementation for one month. Treatment outcomes were evaluated using five scoring scales. Results: One week after the first IA-HA injection all the scores improved. One week after the second injection, compared with the first week, two scores improved, two remained the same, and one worsened. One week after the third injection, compared with the second week, all the scores worsened. At one month, compared with the third week, one score remained the same and all the others worsened. From baseline to one month, three scores improved, one remained the same, and one worsened. Conclusions: In our study, IA-HA injections and oral collagen supplementation showed short-term effects on pain and functional impairment for knee OA

Tendinopathies of the hip and pelvis in athletes: A narrative review

Tendon disorders represent some of the most frequent musculoskeletal complaints worldwide. In the athletic population, tendinopathy could affect different anatomical districts. Tendons surrounding hip and pelvis are frequently involved due to overuse and high functional demands in the athletes. These disorders negatively impact on sport performance, since they are a long-lasting clinical condition requiring a multimodal management. Great trochanter pain syndrome, proximal hamstring tendinopathy, insertional adductor tendinopathy and ileopsoas tendinopathy are the most common clinical conditions involving tendon structures of the hip and pelvis. Due to the anatomical complexity of the region, the relationship with pelvic organs, the demographic and anthropometric characteristics of the athletes, the differential diagnosis between these musculoskeletal disorders and other diseases is often difficult to conduct and some therapeutic options are challenging. Modification of risk factors, changes in training protocols, some specific therapeutic exercise programs and rehabilitation procedures have been proposed as an efficient conservative management strategy, guarantying a complete recovery of athletic function. Surgical approaches are required in a specific subset of patients. This narrative literature review aims to summarize current understanding and areas of ongoing research about the clinical features, diagnostic keys and therapeutic options of the main clinical tendinopathies surrounding hip and pelvis

Ultrasound-guided collagen injections for treatment of plantar fasciopathy in runners: A pilot study and case series

Background. Plantar fasciopathy is a frequent source of foot pain in athletes, and it is caused by the degeneration of the proximal insertion of the plantar fascia, usually triggered by repetitive microtrauma. Type I porcine collagen was shown to enhance tendon repair in vitro, and collagen injections are currently used to treat different tendinopathies. The aim of this study is to verify the effectiveness of collagen injections on pain and function in runners with plantar fasciopathy. Methods. Runners, who have been suffering from plantar fasciopathy for at least 6 months, were treated with a series of 4 ultrasound-guided type I porcine collagen injections, at weekly intervals. The Visual Analogue Scale, American Orthopedic Foot and Ankle Society-Ankle Hindfoot score and pressure algometry were used to verify the effects of collagen injections at 1-month and 3-month follow-up. Results. Compared to baseline, minor (p ≥ .05) and major (p ≤ .001) improvements on pain and function were registered at 1-month and 3-month follow-up, respectively. Conclusion. This is the first study that evaluates the effectiveness of collagen injections in the treatment of plantar fasciopathy in runners. Despite the limitations of this study, the positive findings could represent the starting point for further clinical trials

Effects of physical exercise on adiponectin, leptin, and inflammatory markers in childhood obesity: systematic review and meta-analysis

Background: New findings on adipose tissue physiology and obesity-Associated inflammation status suggest that modification of the adipokine level can be relevant for the long-Term prevention of obesity-Associated chronic disease. Objectives: The scope of the present study was to investigate the effectiveness of physical exercise in reducing the systemic inflammation related to obesity in children. Methods: We conducted a systematic review with meta-Analysis of controlled randomized trials, identified through electronic database search, which investigated the effect of physical exercise, without concomitant dietary intervention, on adiponectin, leptin, and/or other inflammatory markers in children up to age 18 years with a body mass index greater than the 95th percentile for age and sex. Results: Seven trials were included in the meta-Analysis, with a total of 250 participants. Compared with the control group without any lifestyle modification, the physical exercise resulted in a reduction in leptin [standardized mean difference (SMD)-1.13; 95% confidence interval (95%CI):-1.89 to-0.37; I2 = 79.9%] and interleukin-6 (SMD-0.84; 95%CI:-1.45 to-0.23, I2 = 0.9%) and an increase in adiponectin plasma concentration (SMD 0.69; 95%CI: 0.02-1.35; I2 = 74.3%). Conclusions: These results indicate that physical exercise improved the inflammatory state in children with obesity. It is unclear whether this effect can reduce the risk of cardiovascular and metabolic disease in adulthood. Clinical trials with a uniform intervention protocol and outcome measurements are required to put our knowledge on adipose tissue biology into a clinical perspective

Sudden cardiac death and coronary artery anomalies in the athletes: A narrative review

Sudden cardiac death (SCD) in the athletes is an unexpected dramatic event. The mechanism underneath SCD is often represented by a ventricular tachyarrhythmia arising as complication of a broad spectrum of cardiovascular diseases, with a silent clinical course. Therefore, SCD often represents the onset manifestation of an underlying heart disease. To prevent SCD in the athletes, several international guidelines proposed pre-participation screening protocols to identify high-risk subjects. Behind atherosclerotic diseases, other structural or functional conditions have been related to SCD, such as hypertrophic cardiomyopathy, QT-long syndrome, arrhythmogenic right ventricular dysplasia, and others. Among these, the coronary artery anomalies represent almost the 20% of all cases. The coronary artery anomalies can be classified into anomalies of origin, course and termination and can be isolated or associated with other congenital cardiac defects. Some of them are rarely symptomatic. Others could impair heart function and determine SCD. Some others determine secondary cardiovascular diseases such as increased risk of endocarditis, secondary aortic valve diseases, myocardial ischemia, and others. Innovative diagnostic and therapeutic options allowed to recognize the different coronary artery anomalies, preventing SCD in athletes. The aim of this review was to analyse coronary artery anomalies to understand their implications in SCD in athletes

Achilles tendon pathologies: How to choose the best treatment

The Achilles tendon is the thickest and strongest tendon of the human body and it gets frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over the last decades, especially in the last few years, as a result of the increased sports participation among general population and for the diffusion of competitive sports at a high level. Although the increased interest and number of studies about Achilles tendon pathologies, at the moment there is not a consensual point of view on which is the best treatment for Achilles tendon injuries, and its management is still controversial. Treatment options mainly include conservative treatment and surgical repair. The decision for treatment in patients with an Achilles tendon pathology should be tailored on patient’s needs and level of activity, since patients with high activity levels may accept the risk of a higher complication rate to rapidly return to previous activity, while less active patients or those who cannot undergo surgery due to comorbidities may choose the non-operative option to decrease the risk of infection and other complications. The aim of this article is to give an insight about the most used and recent treatment options for Achilles tendon pathologies

The effects of COVID-19 pandemic countermeasures on patients receiving botulinum toxin therapy and on their caregivers: a study from an Italian cohort

COVID-19 outbreak had a huge worldwide impact, and several countermeasures to contain its spread have been adopted, such as the interruption of nonurgent outpatient clinics. We wanted to describe the effects of the national lockdown on the well-being of a cohort of Italian patients with cerebral palsy (CP) receiving botulinum toxin (BT) therapy and of their caregivers. Twenty-five patients receiving BT therapy were surveyed using the structuralized questionnaire by Dressler and Adib Saberi, while the caregivers were assessed using the Caregiver Burden Scale. The lockdown delayed BT therapy by 9 ± 2.8 months. Around 44% of the selected patients noticed increased muscle cramps, 24% increased muscle pain, and 32% both of them. Due to the lockdown, the patient's quality of life was reduced by 68.4 ± 21.1%. After the lockdown, 100% of patients perceived BT therapy as more important than before. Around 76% of the patients perceived the lockdown as inadequate and felt that their rights were not respected. The overall score of the Caregiver Burden Scale, as regarded before the lockdown, was 29.12 ± 11.63, while the overall score as regarded after the lockdown was 37.44 ± 14.85. The overall score increased, from before the lockdown to after the lockdown, for 92% of caregivers. The BT outpatient clinic's interruption was seen to significantly worsen the psychophysical condition of subjects with CP and the care burden of their caregivers, exposing them to greater stress than before. Therefore, any kind of BT treatment suspension or delay should be avoided

Achilles tendon pathologies: How to choose the best treatment

The Achilles tendon is the thickest and strongest tendon of the human body and it gets frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over the last decades, especially in the last few years, as a result of the increased sports participation among general population and for the diffusion of competitive sports at a high level. Although the increased interest and number of studies about Achilles tendon pathologies, at the moment there is not a consensual point of view on which is the best treatment for Achilles tendon injuries, and its management is still controversial. Treatment options mainly include conservative treatment and surgical repair. The decision for treatment in patients with an Achilles tendon pathology should be tailored on patient’s needs and level of activity, since patients with high activity levels may accept the risk of a higher complication rate to rapidly return to previous activity, while less active patients or those who cannot undergo surgery due to comorbidities may choose the non-operative option to decrease the risk of infection and other complications. The aim of this article is to give an insight about the most used and recent treatment options for Achilles tendon pathologies