Rugby and shoulder trauma: a systematic review

Rugby is a popular contact sport worldwide. Collisions and tackles during matches and practices often lead to traumatic injuries of the shoulder. This review reports on the epidemiology of injuries, type of lesions and treatment of shoulder injuries, risk factors, such as player position, and return to sport activities. Electronic searches through PubMed (Medline), EMBASE, and Cochrane Library retrieved studies concerning shoulder injuries in rugby players. Data regarding incidence, type and mechanisms of lesion, risk factors and return to sport were extracted and analyzed. The main reported data were incidence, mechanism of injury and type of lesion. Most of the studies report tackle as the main event responsible for shoulder trauma (between 50% and 85%), while the main lesions reported were Bankart lesions, Superior Labral tear from Anterior to Posterior (SLAP tears), anterior dislocation and rotator cuff tears. Open or arthroscopic repair improve clinical outcomes. Shoulder lesions are common injuries in rugby players. Surgical treatment seems to be effective in for rotator cuff tears and shoulder instability. More and better designed studies are needed for a higher Level of Evidence analysis of this topic

Is the femoral intramedullary alignment already actual in total knee arthroplasty?

Abstract Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient‐specific instrumentation (PSI) and robotic and computer‐assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion

Successful endovascular embolization of an intralobar pulmonary sequestration

Pulmonary sequestration is a congenital malformation characterized by dysplastic pulmonary tissue which receives blood supply by arterial systemic system, not in communication with tracheobronchial tree. Although it could be asymptomatic, it can also cause recurrent infections and hemoptysis, rarely massive and fatal. The conventional treatment consists in surgical resection of the pulmonary sequestration, but in the last few years endovascular embolization has been proposed as a valid therapeutic alternative. In this paper, we report the case of a 43–year-old woman affected by recurrent hemoptysis. Computed tomography angiography of the chest, abdomen, and pelvis was performed in emergency setting. Intralobar pulmonary sequestration in the lower lobe of the right lung was found. A bulky aberrant artery originating from the thoracic aorta supplied the pulmonary sequestration. The interventional radiologist performed an endovascular embolization with coils of the vascular malformation. The technical success of the procedure was confirmed by computed tomography angiography of the chest performed on the fourth day after procedure. Further examination performed 6 months later showed no complications. The patient was completely asymptomatic during follow-up. This procedure can demonstrate that arterial embolization is a valid and effective therapeutic alternative to surgical resection in the treatment of pulmonary sequestration

Italian consensus statement for the use of allografts in ACL reconstructive surgery

Graft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the "Allografts for Anterior Cruciate Ligament Reconstruction" consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making