The aims of this systematic review and meta-analysis were to evaluate the effects of physical exercise on static and dynamic balance in the elderly population, and to analyze the number of falls and fallers. A systematic literature search was conducted using PubMed–Medline, Cochrane Central, and Google Scholar to select randomized clinical trials that analyzed the role of exercise on balance and fall rate in patients aged 65 or older. Sixteen articles were included in this review. Applying the Cochrane risk-of-bias tool, three studies were determined to be at low risk of bias, nine at unclear risk of bias, and four at high risk of bias. The meta-analysis showed improvements in dynamic balance (p = 0.008), static balance (p = 0.01), participants’ fear of falling (p = 0.10), balance confidence (p = 0.04), quality of life (p = 0.08), and physical performance (p = 0.30) in patients who underwent physical exercise compared to controls. The analysis of the total numbers of falls showed a decreased likelihood of falls in patients who participated in exercise programs (p = 0.0008). Finally, the number of patients who fell at least once was significantly reduced in the intervention group (p = 0.02). Physical exercise is an effective treatment to improve balance and reduce fall rates in the elderly.

Background: Mosaicplasty has been associated with good short‐ to long‐term results. Nevertheless, the osteochondral harvesting is restricted to the donor‐site area available and it may lead to significant donor‐site morbidity.Purpose: Provide an overview of donor‐site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure.Methods: Comprehensive search using Pubmed, Cochrane Library, SPORTDiscus and CINAHL databases was carried out through 10^th October of 2016. As inclusion criteria, all English‐language studies that assessed the knee donor‐site morbidity after mosaicplasty were accepted. The outcomes were the description and rate of knee donor‐site morbidity, sample’s and cartilage defect’s characterization and mosaicplasty‐related features. Correlation between mosaicplasty features and rate of morbidity was performed. The methodological and reporting quality were assessed according to Coleman’s methodology score.Results: Twenty‐one studies were included, comprising a total of 1726 patients, with 1473 and 268 knee and ankle cartilage defects were included. The defect size ranged from 0.85 cm² to 4.9 cm² and most commonly 3 or less plugs (averaging 2.9 to 9.4 mm) were used. Donor‐site for osteochondral harvesting included margins of the femoral trochlea (condyles), intercondylar notch, patellofemoral joint and upper tibio‐fibular joint. Mean donor‐site morbidity was 5.9 % and 19.6 % for knee and ankle mosaicplasty procedures, respectively. Concerning knee‐to‐knee mosaicplasty procedures, the most common donor‐site morbidity complaints were patellofemoral disturbances (22 %) and crepitation (31 %), and in knee‐to‐ankle procedures there was a clear tendency for pain or instability during daily living or sports activities (44 %), followed by patellofemoral disturbances, knee stiffness and persistent pain (13 % each). There was no significant correlation between rate of donor‐site morbidity and size of the defect, number and size of the plugs (p > 0.05).Conclusions: Osteochondral harvesting in mosaicplasty often results in considerable donor‐site morbidity. The donor‐site morbidity for knee‐to‐ankle (16.9 %) was greater than knee‐to‐knee (5.9 %) mosaicplasty procedures, without any significant correlation between rate of donor‐site morbidity and size of the defect, number and size of the plugs. Lack or imcomplete of donor‐site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies.Level of evidence: Level IV, systematic review of Level I‐IV studies.

In meniscal root tears (MRTs), the disruption of collagen fibers that provide hoop strength results in extrusion of the menisci, altering their biomechanical properties. Clinical diagnosis is difficult, but magnetic resonance imaging usually allows to identify the lesion. Located into the vascularized zone of the meniscus, management is preferentially arthroscopic, aimed at repairing the lesions with arthroscopic transosseous sutures or suture anchors. PubMed, Cochrane Library, Google Scholar and Ovid Medline were searched in July 2012 to find literature on MRT tears. We reviewed the literature on biomechanics, imaging features and current treatments of these tears. Twenty-seven appropriate articles were identified and included in the study: 6 biomechanical studies, 11 imaging-based investigations for diagnosis, 1 study on clinical diagnosis and 9 studies about treatment. MRTs are infrequent, accounting for 10.1% of all arthroscopic meniscectomies. When the damage occurs to the roots, the transmission of the circumferential hoop tension is impaired and, consequently, the menisci tend to be displaced anteriorly and posteriorly, altering the biomechanics and possibly the kinematics of the knee. Although the importance of the integrity of the meniscal roots is well established, their diagnosis and treatment are still controversial. Biomechanical and clinical studies demonstrate that surgical repair of acute, traumatic meniscal root injuries fully restores the biomechanical features of the menisci, leading to pain relief and functional improvement. The current available surgical techniques for the meniscal root repair (suture anchors and pullout repair) are comparable. IV.

The aim of this systematic review and meta-analysis is to determine the role of physical activity as a conservative treatment for older people with knee or hip osteoarthritis. The effect on pain, physical function, stiffness, quality of life, and dynamic balance of Aquatic Exercise, Land-based Exercise, and Sports were compared in a specific population composed of osteoarthritic patients aged 65 or over. A systematic search using Pubmed-Medline, Google Scholar, and the Cochrane Library was carried out to select randomized clinical trials, observational studies, or case series that evaluated outcome measures after physical activity. Twenty randomized controlled trials (RCTs) and two case series were included in this review. Four trials were at low risk of bias (A), 12 at unclear risk of bias (B), and four at high risk of bias (C). Compared to controls, Aquatic Exercise, Land-based Exercise, Tai Chi, and Yoga showed a small to high effect for improving pain, physical function, quality of life, and stiffness. Active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis. Nevertheless, further studies are required to validate the use of land-based exercise, aquatic exercise, or sport to treat the symptoms of older adults that suffer from knee and hip osteoarthritis.

Sport participation and exercise practice are considered to be beneficial for mental status, yielding an improved mood and better quality of life. On the other hand, good mental fitness is thought to lead to better physical status and sport performance. The key aim of this narrative review is to provide an unstructured overview on the topic with special considerations on the role of mental and physical health to summarize the evidence on their reciprocal influence. While very few papers describe the role of mental health measures in affecting physical performance, more evidence is available concerning the effect of exercise and sport in improving mental health outcomes. Furthermore, there is a consistent role of depressive and anxiety symptoms in influencing the risk of sport injury in either recreational or elite athletes. Moreover, the importance of investigating mental health issues in elite and retired athletes is highlighted. On the basis of the available literature, several biases were found to affect the provided evidence mainly because of the complexity of a proper study design in this field.

Background: Few data on shoulder arthropathy in patients undergoing arthroscopic repair for glenohumeral instability are available.