Background: Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing.Methods: A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ². The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used.Results: Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures).Conclusions: Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

Cancer patients are likely to undergo osteoporosis as consequence of hormone manipulation and/or chemotherapy. Little is known about possible increased risk of fracture in this population. The aim of this study was to describe the biomechanical effect of a metastatic lesion in an osteoporotic lumbar spine model. A finite element model of two spinal motion segments (L3-L5) was extracted from a previously developed L3-Sacrum model and used to analyze the effect of metastasis size and bone mineral density (BMD) on Vertebral bulge (VB) and Vertebral height (VH). VB and VH represent respectively radial and axial displacement and they have been correlated to burst fracture. A total of 6 scenarios were evaluated combining three metastasis sizes (no metastasis, 15% and 30% of the vertebral body) and two BMD conditions (normal BMD and osteoporosis). 15% metastasis increased VB and VH by 178% and 248%, respectively in normal BMD model; while VB and VH increased by 134% and 174% in osteoporotic model. 30% metastasis increased VB and VH by 88% and 109%, respectively, when compared to 15% metastasis in normal BMD model; while VB and VH increased by 59% and 74% in osteoporotic model. A metastasis in the osteoporotic lumbar spine always leads to a higher risk of vertebral fracture. This risk increases with the size of the metastasis. Unexpectedly, an increment in metastasis size in the normal BMD spine produces a greater impact on vertebral stability compared to the osteoporotic spine.

Background: The purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up.Methods: According to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured.Results: The search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P < 0.05) at 3-month follow-up; in terms of forward elevation, external rotation, abduction (P < 0.05), but not in terms of Constant-Murley score at 6-month follow-up; in terms of forward elevation (P < 0.05) at 12-month follow-up. No significant differences between the two group were highlighted at 24-month follow-up.Conclusions: No statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.

Rotator cuff disease is a widespread musculoskeletal pathology and a major cause of shoulder pain. Studies on familial predisposition suggest that genetic plays a role in the pathogenesis of rotator cuff disease. Several genes are responsible for rotator cuff disease. The aim of this study was to perform a systematic review on genetic association between rotator cuff disease and genes variations. A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases were searched comprehensively using the keywords: “Rotator cuff”, “Gene”, “Genetic”, “Predisposition”, “Single-nucleotide polymorphism” and “Genome-wide association”. 8 studies investigating genes variations associated with rotator cuff tears were included in this review. 6 studies were case-control studies on candidate genes and 2 studies were GWASs. A significant association between SNPs and rotator cuff disease was found for DEFB1, FGFR1, FGFR3, ESRRB, FGF10, MMP-1, TNC, FCRL3, SASH1, SAP30BP, rs71404070 located next to cadherin8. Contradictory results were reported for MMP-3. Further investigations are warranted to identify complete genetic profiles of rotator cuff disease and to clarify the complex interaction between genes, encoded proteins and environment. This may lead to individualized strategies for prevention and treatment of rotator cuff disease. Level IV, Systematic Review.

The rehabilitation of those who have undergone anterior cruciate ligament reconstruction (ACL-R) is a complex process that involves many factors. Physical ability recovery is not the only factor in the return to sport; psychosocial factors such as anxiety, pain response, self-esteem, locus of control, and fear of re-injury also play an important role. A systematic search was conducted on the PubMed, Medline, Cochrane, CINAHL and Embase databases using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). No randomized controlled trials (RCTs) were identified. The Methodological Index for Non-Randomized Studies (MINOR) was used to assess the quality of the identified non-RCT studies. A total of 308 studies were identified, of which 32 met the eligibility criteria. The results of these studies were obtained using the KOOS (ADL, Sport, QoL), ACL, TSK-11, K-SES, questionnaires/interviews, and other scales as instrumental approaches. This systematic review and meta-analysis revealed that psychological factors have a significant influence on the post-anterior cruciate ligament reconstruction outcomes of athletes. Fear of re-injury and pain were the primary factors that limited return to sport, whereas self-efficacy, psychological will, and age were associated with better functional outcomes and were essential for male and young patients. Clinicians should focus on both physical and psychological components to optimize rehabilitation.

Background and Objectives: Soccer is the most popular sport in the world. To describe athletic performance, match statistics, and their relationships with the probability of achieving the first positions of the final ranking in the Italian football league “Serie A”, season 2016/2017. Materials and Methods: Analyses comprised all the matches played by the 20 teams of the “Serie A” championship during the season 2016–2017. Indicators of athletic performance (total distance covered in km, jogging, running and sprint activities, and average speed) and match statistics (total shots, shots on target, goal attempts, assists, turnovers, and steals) were obtained from the Italian football league. Results: Analyses of performance activities according to the final ranking showed no significant differences for the total distance covered and speed, while a statistically significant difference (p < 0.05) among teams was observed for jogging, running and sprint activities. In regard to match statistics, all the parameters investigated were significantly different among the teams. By grouping teams into four subgroups (those who qualified for the Champions League, those who qualified for the Europe League, those who ranked intermediate positions and those who relegated from the “Serie A” league), the percentage of jogging, running and sprint activities, as well as match statistics were significantly different among groups, with a downward trend for total shots, shots on target, goal attempts, assists, and turnovers. The logistic regression analysis revealed that sprint activities as well as total shots, shots on target, goal attempts, and assists higher than the 3rd tertile of their distribution were associated with a higher probability of reaching the first three positions of the final ranking. Conclusions: An increased probability to achieve the first positions of the final ranking in the Italian football league “Serie A” seemed to be mainly related to sprint activity, goal attempts, total shots, shots on target and assists.