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.

Introduction This review defines the recognized risk factors responsible for the development of knee osteoarthritis after surgical management of meniscal tears. Sources of data We performed a literature search using Medline, Ovid, Cochrane and Google Scholar using the keywords: ‘Meniscal tears’, ‘meniscectomy’, ‘osteoarthritis’, ‘complications’ and ‘risk factors’. Thirty-two published studies were identified. Areas of agreement In the long term, osteoarthritis develops in the knee of patients undergoing surgery for meniscal tears. The Coleman methodology score showed great heterogeneity in terms of patient characteristics and outcome assessment. Amount of meniscus removed, duration of pre-operative symptoms and lateral meniscectomy show strong statistical association to onset of knee osteoarthritis. Areas of controversy We did not find univocal findings defining the risk factors responsible for the development of post-operative knee osteoarthritis. Growing points There is a need for standardized clinical and imaging validated scale to improve definition of post-operative knee osteoarthritis to allow easier and more reliable comparison of outcomes in different studies. Areas timely for developing research Appropriately powered randomized controlled trials reporting clinical and imaging-related outcomes in patients undergoing arthroscopic minimally invasive procedures and meniscal suturing should be performed. Comparing imaging findings of patients undergoing arthroscopic partial and open meniscectomy, a lower incidence of knee osteoarthritic evolution was detected after arthroscopy. The amount of removed meniscus is the most important predictor factor for the development of osteoarthritis. Minimally invasive procedures seem to reduce the incidence of long-term osteoarthritic changes of the knee compared with more invasive open and or arthroscopic procedures.

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.

Purpose.In the last few years, evidence has emerged to support the possible association between increased BMI and susceptibility to some musculoskeletal diseases. We systematically review the literature to clarify whether obesity is a risk factor for the onset of tendinopathy.Methods.We searched PubMed, Cochrane Central, and Embase Biomedical databases using the keywords “obesity,” “overweight,” and “body mass index” linked in different combinations with the terms “tendinopathy,” “tendinitis,” “tendinosis,” “rotator cuff,” “epicondylitis,” “wrist,” “patellar,” “quadriceps,” “Achilles,” “Plantar Fascia,” and “tendon.”Results.Fifteen studies were included. No level I study on this subject was available, and the results provided are ambiguous. However, all the 5 level II studies report the association between obesity measured in terms of BMI and tendon conditions, with OR ranging between 1.9 (95% CI: 1.1–2.2) and 5.6 (1.9–16.6).Conclusions.The best evidence available to date indicates that obesity is a risk factor for tendinopathy. Nevertheless, further studies should be performed to establish the real strength of the association for each type of tendinopathy, especially because the design of the published studies does not allow identifying a precise cause-effect relationship and the specific role of obesity independently of other metabolic conditions.