Institute of Sports Medicine and Science

Medial meniscal extrusion (MME) contributes to knee osteoarthritis and is often caused by a medial meniscal posterior root tear (MMPRT). Although early surgical repair of MMPRT improves outcomes, MME often persists. Centralization techniques aim to reduce meniscal extrusion by anchoring the capsule to the tibial plateau; however, their clinical effectiveness when combined with MMPRT repair remains uncertain. To evaluate the efficacy of centralization combined with MMPRT repair in reducing MME using intraoperative ultrasound. Case series; Level of evidence, 4. The study included 26 patients who underwent MMPRT repair with a pullout technique and centralization with three knotless anchors. Of these, 22 patients also underwent additional high tibial osteotomy. Initial tensions of 0 to 40 N were applied to the pullout repair sutures at 60° of knee flexion, and MME was measured by intraoperative ultrasound. MME was also measured at 0°, 30°, 60°, 90°, and 120° of knee flexion, as well as at internally and externally rotated positions (IR and ER) at 30° and 90° of knee flexion, before MMPRT repair, after repair, and after centralization. A total of 22 patients underwent additional high tibial osteotomy after MMPRT repair and centralization. When tension of 0 to 40 N was applied to the pullout repair sutures at 60°, the median MME decreased with increasing tension, with a significant reduction observed at 30 and 40 N compared with lower tension levels. Moreover, at tensions ≥30 N, the median MME remained <3 mm after centralization. MME was subsequently measured with 30 N tension applied to the pullout repair sutures. The median MME (mm) before MMPRT repair, after repair, and after centralization ranged from 7.6, 3.9, and 3 at 0° to 4.4, 3.5, and 2.6 at 120°, respectively. At 0°, MME was significantly smaller after centralization than before repair (P < .001) and also smaller than after repair (P < .006). At 120°, MME after centralization was significantly smaller than before repair (P < .001), and the difference among the 3 conditions was also significant (P = .03). Centralization resulted in the smallest MME at both flexion angles. The median MME before MMPRT repair, after repair, and after centralization at 30° were all smaller in the MME in the ER position. Conversely, the ER-IR differences were slight at 90°. Intraoperative ultrasound demonstrated that MMPRT repair reduced MME compared with the preoperative condition, and the addition of centralization further enhanced this reduction, yielding greater improvement than MMPRT repair alone.

BACKGROUND: Few tools assess motivation for nature-based physical activity (PA), with the PA and Leisure Motivation Scale (PALMS) and the Motivations for Nature-Connectedness Questionnaire (MNQ) addressing this gap. This study validated these tools in Italian and explored adolescents’ motivations for green exercise.METHODS: A cross-sectional validation study was conducted as part of the “IFormaMentis” project with Italian adolescents. The sample included students who engaged in vigorous/moderate PA twice a week. Motivational differences were analyzed between those practicing outdoor activities frequently (ASO) and those doing so less than twice a week (ASIO).RESULTS: PALMS-IT (α=0.980) and MNQ-IT (α=0.815) showed strong reliability. The study included 760 students, 88% of whom were active twice a week. A significant gender difference was found, with males being more active and more likely to participate in outdoor activities. The ASIO group showed greater motivation for appearance, physical condition, mastery, and enjoyment compared to ASO+ASIO. In contrast, ASO+ASIO participants showed higher motivation related to psychological condition.CONCLUSIONS: PALMS-IT and MNQ-IT effectively assess motivations for outdoor PA. Psychological condition, enjoyment, and mastery play key roles in sustaining PA, emphasizing the importance of emotional factors. The study also highlights a lasting impact of pandemic restrictions on adolescents’ PA choices. These findings offer policymakers and educators new avenues for promoting green activity among adolescents.

Engagement in physical and cognitive activities is associated with a decreased risk of mild cognitive impairment (MCI) and dementia, but the association with Alzheimer disease (AD) neuroimaging biomarkers is less clear. We thus examined associations of physical and cognitive activities with longitudinal trajectories of AD neuroimaging biomarkers among older adults free of dementia. We conducted a longitudinal study within the population-based Mayo Clinic Study of Aging (mean follow-up durations 1.3-3.4 years). Participants were aged 50 years or older and were cognitively unimpaired or had MCI at baseline. Engagement in physical and cognitive activities during 12 months before baseline was assessed through questionnaires. Participants underwent AD neuroimaging biomarker assessments at 1 or more time points. We ran linear mixed-effect models to examine associations between physical and cognitive activity composite scores and trajectories of individual yearly change in amyloid deposition (Pittsburgh compound B [PiB]-PET centiloid), tau burden (tau-PET standardized uptake value ratio [SUVR]), and regional glucose hypometabolism (fluorodeoxyglucose [FDG]-PET SUVR), adjusted for age, sex, APOE ɛ4 carrier status, and medical comorbidity. We included 1,176 participants (47% female; mean [SD] age, 68.7 [9.6] years) for PiB-PET trajectories, 399 participants (49% female; mean [SD] age, 71.9 [11.0] years) for tau-PET trajectories, and 983 participants (46% female; mean [SD] age, 67.9 [9.2] years) for FDG-PET trajectories. PiB-PET and tau-PET measures increased during follow-up (3.4 [SD 4.0] and 1.3 [SD 2.1] years, respectively), whereas FDG-PET values decreased over 2.9 (SD 3.5) years of follow-up. Participants with higher total physical activity (interaction estimate 0.0017; 95% CI 0.0003-0.0031; p = 0.021) and higher moderate-to-vigorous physical activity (interaction estimate 0.0015; 95% CI 0.0001-0.0029; p = 0.040) had a less pronounced decrease in FDG-PET over time. Participants with higher cognitive activity experienced a less pronounced increase in PiB-PET (interaction estimate -0.2253; 95% CI -0.4437 to -0.0070; p = 0.043) and a smaller decrease in FDG-PET (interaction estimate 0.0015; 95% CI 0.0001-0.0028; p = 0.038) over time. Physical activity was associated with less synaptic dysfunction and cognitive activity with less synaptic dysfunction and lower amyloid burden over time, albeit effect sizes were small. Further research is needed to validate findings and clarify causal inference between physical and cognitive activities and AD neuroimaging biomarkers.

Winter sports exert significant anthropogenic pressures on the snow microbiome, affecting the entire alpine ecosystem. The massive usage of artificial snow, human occupation, and the release of xenobiotics like microplastics or ski wax components on ski tracks can profoundly alter snow microbial ecology. Here, we reconstructed the temporal dynamics of the snow microbiome at three sites in the Italian Alps: inside and outside a ski track at the impacted site of Santa Caterina Valfurva and near Cancano lake as an unimpacted control. Using epifluorescence microscopy, 16S rRNA amplicon sequencing, and inferred metagenomics, we found that the snow microbiome inside the track presented a higher load of prokaryotes and viruses. Notably, N2-fixing microorganisms from cryospheric environments and host-associated taxa, like Terrisporobacter, Clostridium sensu stricto, Enterococcus, and Muribaculaceae, and the opportunistic pathogen Citrobacter characterised the impacted site. These microorganisms could originate from the river water used to produce artificial snow during winter. Our findings highlight the complexity and multifunctionality of the snow microbiome, where microorganisms with different ecological propensities can coexist, and the detectable impact of ski tourism, which enriches host-associated and xenobiotic-degrading microorganisms. This underscores the need for systematic monitoring and protection of the snow microbiome in the Alpine environment from anthropogenic threats.

PurposeChronic ankle instability (CAI) is a common condition characterized by recurrent episodes of lateral instability, often due to a lesion of the ankle collateral lateral ligament complex. If untreated, CAI can lead to persistent symptoms and long‐term degenerative changes. Arthroscopic ‘all‐inside’ repair has gained traction as a minimally invasive technique offering functional and clinical benefits.MethodsThis retrospective study analyzed 43 patients undergoing arthroscopic ligament repair using the all‐inside technique between 2021 and 2024. Functional outcomes were evaluated preoperatively (T0), post‐rehabilitation (T1), and at the final follow‐up (T2) using the Foot and Ankle Ability Measure (FAAM) score, VAS, and satisfaction ratings. Complications occurred were recorded during the follow up. Subgroup analyses investigated the influence of BMI, anchor use, and preoperative functional scores on outcomes.ResultsPatients demonstrated significant improvement in FAAM scores (T0: 71%, T2: 95%) and pain reduction (VAS: T0: 7.67, T2: 1.00). Two‐anchor repairs yielded superior outcomes compared to single‐anchor procedures (p = 0.01). While higher BMI was associated with poorer outcomes (p = 0.04), internal bracing improved functional scores in this subgroup. Preoperative FAAM scores did not predict postoperative outcomes (p = 0.21).ConclusionAll‐inside arthroscopic ligament repair is a safe and effective option for CAI, providing rapid recovery, low complication rates, and excellent patient satisfaction.Level of EvidenceLevel IV.

ObjectiveEthnicity is associated with varying reporting of pain, coping mechanisms, and disease severity in patients with knee osteoarthritis (KOA). However, few studies have evaluated its importance in ethnicity, particularly the Hispanic population. This study compares pain intensity (VAS), function (WOMAC), and pain catastrophizing (PCS) between Hispanic (HP) and non-Hispanic White patients (NHWP) stratified by socio-economic status (SES) and osteoarthritis radiographic K-L grade.MethodsA cross-sectional study of patients from a tertiary care clinic between July 2021 and December 2022 was performed. Patients with knee pain, radiographs, and doctor-diagnosis of KOA completed questionnaires in English or Spanish. Descriptive statistics characterized demographic differences between NHWP and HP in VAS, WOMAC, and PCS. Two one-way analyses of variance evaluated the effect of both ethnicity and sex, with subgroup analyses stratifying by K-L grade. Multivariate general linear models assessed primary outcomes while controlling for confounders.ResultsA total of 195 subjects (HP = 145, NHWP = 50) were included. HP exhibited higher VAS, PCS, and WOMAC scores compared to NHWP. PCS was higher in HP (p = 0.004, mean = 8.89) than NHWP (mean = 4.58), as was VAS (p < 0.001, mean = 4.28 vs. 2.74) and WOMAC (p = 0.029, mean = 27.86 vs. 21.58). These differences remained when controlled for NSES and K-L grade. Stratifying by sex and comparing primary outcomes between HP and NHWP, male HP had greater VAS (p = .021, mean = 3.83 vs. 2.42) and PCS (p = .008, mean = 8.83 vs. 3.35), while female HP had greater VAS (p = .019, mean = 4.62 vs. 3.08) and nonsignificantly greater PCS (p = .164, mean = 8.94 vs. 5.92).ConclusionHP with KOA reported greater pain severity, functional limitation, and PCS.compared with NHWP, even after adjusting for NSES and K-L grade. Our findings expand on previous reports by including a larger number of HP and analyzing the role of sex, impact of socioeconomic status, and influence of radiographic severity on patient symptoms.

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Anterior cruciate ligament reconstruction induces deleterious neuromuscular alterations. Musculoskeletal ultrasonography provides an accessible method to quantify muscle size and quality in patients with anterior cruciate ligament reconstruction who suffer from persistent skeletal muscle atrophy. This study compares rectus femoris and vastus intermedius muscle thicknesses and echo intensities using extended field-of-view ultrasonography in individuals with a history of anterior cruciate ligament reconstruction versus non-injured controls. Twenty-six individuals with previous anterior cruciate ligament reconstruction and 20 controls were participated in this study. Extended field-of-view ultrasonography was used to analyze the muscle thickness in the proximal, middle, and distal regions of the thigh, while the echo intensity was measured to assess the muscle quality. Findings indicate significant asymmetries in the muscle thickness (p<0.01 and η p 2=0.312) and echo intensity (p=0.024 and η p 2=0.111) for the anterior cruciate ligament reconstruction group, favoring the uninvolved leg, with no site-specific differences between groups. Results show muscle-specific size differences, with greater vastus intermedius muscle thickness than rectus femoris muscle thickness in controls (p<0.01 and d=0.609), but no difference between muscles in either leg of the anterior cruciate ligament reconstruction group (p>0.05 and d=0.094). Overall, these results highlight unique skeletal muscle changes between the biarticular rectus femoris and the monoarticular vastus intermedius following anterior cruciate ligament reconstruction, likely reflecting postoperative deficiencies in knee extensor function.