Istituto Ortopedico Galeazzi

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potential complication following anterior cruciate ligament reconstruction (ACLR). The necessity and efficacy of routine thromboprophylaxis following ACL reconstruction remain controversial. To determine the efficacy and safety of thromboprophylaxis in preventing symptomatic venous thromboembolism (VTE) following ACLR. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Electronic searches of MEDLINE, EMBASE, PubMed, and the Cochrane Library were performed from inception to January 2026. Included studies compared any form of VTE prophylaxis (pharmacologic, mechanical, or combination approaches) to a control group (no prophylaxis) in patients undergoing isolated ACLR, reporting on symptomatic VTE as a primary outcome. Symptomatic VTE events were pooled and compared using a random-effects model, calculating the pooled odds ratio (OR) with 95% confidence intervals (CI). Thirteen studies, comprising 29,186 patients, were included (1 randomized controlled trial [RCT], 12 observational studies). The mean age of the overall patient cohort ranged from 26.5 to 34.2 years, with predominantly male patients (approximately 59.3%). The pooled incidence of symptomatic VTE across all studies was 0.41% (120/29,186 patients). Comparative analysis showed 51 symptomatic events in the prophylaxis group (n = 10,984, 0.46%), and 69 events in the no prophylaxis group (n = 18,202, 0.38%). Meta-analysis of eligible studies showed no statistically significant impact of thromboprophylaxis on the risk of symptomatic VTE occurrence (risk difference [RD], 0.00; 95% CI, -0.00 to 0.00; p = 0.795). The overall complication rate was notably higher among those who received prophylaxis (n = 122, 1.11%) compared to those who did not (n = 6, 0.03%), primarily due to minor bleeding events and hemarthrosis. Routine thromboprophylaxis following isolated ACLR does not yield a statistically significant reduction in the incidence of symptomatic VTE in the general patient population, which already has a very low intrinsic risk (0.41%). Given the very low baseline risk and potential for complications, routine prophylaxis is not recommended for all patients undergoing isolated ACLR. A risk-stratified approach using validated assessment tools should be employed to identify high-risk individuals who may benefit from prophylaxis. III.

Involvement of the bone marrow by metastases fromsolid tumors or multiple myeloma (MM) is a critical challenge in oncologic imaging. Lesion detection and staging, as well as accurate assessment of treatment response, disease recurrence, and complications, are key to optimal patient management. This article provides recommendations for performing and interpreting bone marrow MRI in cancer patients. MRI should be the primary imaging modality for patients suspected of having skeletal bone metastases or MM, and should replace radiography, bone scintigraphy, and CT for these indications. Protocols must be tailored to the clinical context and to each specific cancer. Whole-body MRI (WB-MRI) is preferred for a comprehensive assessment, while axial skeleton MRI (AS-MRI) is a fast and reliable alternative for targeted or follow-up evaluations. We recommend standardized protocols that incorporate anatomical sequences (preferably fast spin echo T2 Dixon) and diffusion-weighted imaging (DWI). Quantitative biomarkers, e.g., apparent diffusion coefficient (ADC) and fat fraction (FF), should be implemented to improve diagnostic accuracy and evaluate treatment response. Radiologists must be familiar with the typical patterns of bone marrow replacement by cancer cells, response assessment principles, and common imaging pitfalls. Every medical imaging facility should offer optimal bone marrow MRI and implement these recommendations using available MRI systems and existing disease-oriented guidelines. This ESR Essentials illustrates when, how, and why to perform bone marrow MRI to improve diagnostic precision and oncologic care across a broad range of indications. KEY POINTS: Prefer MRI of the bone marrow over radiographs, bone scintigraphy, or CT for suspected bone metastases of solid cancers and for myeloma staging. Use MRI for diagnosis of bone involvement, disease staging, assessment of lesion response to treatment, detection of recurrence, and assessment of osseous complications. Tailor MRI protocol to cancer type following existing guidelines, targeting either the axial skeleton or the "whole body," and using a panel of sequences with fat-sensitive, fast spin echo T2 Dixon and diffusion-weighted sequences as the fundamental components.

Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional deformation of the spine with a frontal plane curvature of 10° or more, measured using Cobb method. It typically gets more severe during pre-puberty and puberty, currently exhibiting unpredictable progression. Severe disease is more prevalent in females, and progression is associated with respiratory and neuromuscular dysfunction, pain, and psychological complications. Management strategies are guided by curve severity and include observation, therapeutic exercises, bracing, and surgery. Despite advances, the cellular and molecular mechanisms driving AIS remain poorly understood. Early detection and reliable progression biomarkers are increasingly recognized as critical to prevent clinical mismanagement. This mini-review summarizes current evidence on circulating biomarkers investigated in AIS, including growth-related hormones, bone metabolism proteins, and more recently non-coding RNAs (ncRNAs) such as microRNAs. In addition, we highlight key methodological limitations and risk-of-bias concerns across existing studies, especially the reliance on single-time-point sampling, underscoring the need for longitudinal prospective cohorts with repeated biomarker measurements. Such designs are critical for capturing dynamic biological changes, distinguishing stable from progressive cases, and validating biomarker trajectories for integration into clinically meaningful prediction models for AIS progression.

Athletes frequently experience sleep disturbances due to training intensity, competitive pressure, and travel. While sexual activity, particularly achieving orgasm, is linked with improved sleep through hormonal mechanisms in general populations, this relationship remains unexplored in athletes, whose sleep and recovery needs are unique. This cross-sectional study primarily aimed to examine competitive athletes' perceptions regarding how sexual activity (partnered intercourse and masturbation, with or without orgasm) influences sleep quality, latency, and sport performance and explore differences by sex and sport discipline (individual vs team). In this cross-sectional descriptive study, 164 competitive athletes (males = 115, females = 49; age 18-40y) from Italian sport federations completed a structured survey assessing sexual behavior, orgasm frequency, sleep parameters, and perceived athletic impact. Statistical analysis included chi-square, Fisher exact, and t tests with significance at P < .05. A majority reported that orgasmic sexual activity significantly improved sleep quality (partnered sex: 67.7%, masturbation: 49.1%) and latency (partnered sex: 58.4%, masturbation: 46.9%). Partnered sex appeared slightly more beneficial, but the difference was not statistically significant (quality: P = .810, latency: P = .996). Significant sex differences emerged in orgasm consistency during partnered sex (men: 77.8%, women: 30.0%; P < .001) and masturbation (men: 99.1%, women: 83.3%; P < .001). No sex or sport-discipline differences were identified regarding perceived sleep benefits or performance impact; most athletes (≥50%) perceived no negative effects on training or competition. Competitive athletes perceive sexual activity with orgasm as beneficial for sleep and neutral regarding athletic performance, challenging conventional abstinence recommendations. Practitioners should adopt individualized, evidence-based strategies when advising athletes on sexual behavior in relation to sleep and performance.

Osteoarthritis (OA) represents a significant challenge in both orthopedic research and clinical practice, necessitating the development of effective therapeutic strategies. Here, we describe an ex vivo model based on osteochondral (OCh) explants housed in a three‐dimensional printed device that enables the separation of bone and cartilage compartments. Our model demonstrates effective partitioning, as confirmed by significant differences in measurements of tissue‐specific markers. The markers included matrix metalloproteinase (MMP) activity and sulfated glycosaminoglycan (sGAG) release for cartilage and alkaline phosphatase (ALP) activity, tartrate‐resistant acid phosphatase (TRAP) activity, and osteocalcin (OC) levels for bone. The cartilage compartment of OCh explants was exposed to inflammatory stimuli, to mimic the OA‐related microenvironment, using 10 ng/mL TNFα and 1 ng/mL IL‐1β. Cytokine administration was coupled with secretome (or conditioned medium, CM) treatment obtained from 5 × 105 naïve or cytokine‐primed adipose‐derived mesenchymal cells (CM and pCM). After 3 days, inflammatory cytokines induced a significant upregulation of MMP activity, effectively countered by both CM and pCM, alongside a modest increase in sGAG release. No major changes were detected in the bone counterpart. This study holds dual significance: firstly, the development and preliminary assessment of a human‐based ex vivo model in accordance with 3Rs (Replacement, Reduction, Refinement) principles in preclinical research; secondarily, the evidence of an anti‐catabolic potential of the adipose‐derived mesenchymal cell secretome contributes, within a broader research context, to hypothesizing its potentiality in counteracting OA‐associated hallmarks, with possible applications at early onset to mitigate the degenerative processes of this pathology.Trial Registration: ClinicalTrials.gov identifier: NCT04223622

Implant-based reconstruction is the most frequent procedure after mastectomy. Effective preoperative counseling and a thorough informed consent process are crucial for informing patients about oncologic surgery, reconstruction options, and expected cosmetic outcomes. Recent studies indicate that a multimedia video-assisted informed consent procedure may enhance patient information retention compared to traditional methods. This study aims to compare the conventional informed consent process, supplemented with a written informational brochure, to a multimedia video-assisted approach. From January to June 2024, 265 consecutive breast cancer patients scheduled for mastectomy and implant-based reconstruction at the European Institute of Oncology in Milan, Italy, were enrolled in this controlled randomized prospective study. Of these, 200 patients completed evaluation questionnaires assessing information retention and anxiety. A six-minute video featuring simple schematic illustrations and automated text-to-speech narration in Italian was developed to enhance understanding of the risks, benefits, and alternatives of the surgical treatment. Patients were randomly assigned to two groups: Group A received the video presentation along with evaluation questionnaires via email, while Group B received only the questionnaires. Patients in the multimedia video-assisted group demonstrated significantly higher overall comprehension compared to those in the control group. Although scores from the Spielberger State/Trait Anxiety Inventory (STAI) and the Decisional Conflict Scale (DCS) indicated greater anxiety and decisional conflict in the standard group, these differences were not statistically significant. The multimedia video-assisted informed consent process is an effective tool for enhancing patient knowledge and awareness regarding implant-based breast reconstruction. This method improves information uptake and retention, suggesting its superiority over traditional communication techniques in preoperative counseling. These findings support the integration of multimedia resources in patient education to facilitate better-informed decision-making. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

We performed a systematic review and meta-analysis to evaluate the outcomes of end-to-side (ETS) anastomosis to the internal jugular vein (IJV) in head and neck free flap reconstruction. Postoperative outcomes of ETS were compared to the conventional end-to-end (ETE) technique. A comprehensive electronic search was performed on PubMed/MEDLINE, Scopus, and Google Scholar databases. Odds ratios (ORs) were calculated with their 95% confidence intervals (CIs) for each study comparing the two groups (ETS vs. ETE). A total of 9645 patients undergoing 9663 head and neck free flap reconstructions (ETS, N = 2618; ETE, N = 7045) were included from 45 studies. The ETS technique showed an overall free flap failure rate of 2.5% (95% CI: 1.9-3.2). The pooled venous thrombosis rate was 3.8% (95% CI: 2.5-5.8), while the reoperation rate was 5.6% (95% CI: 2.7-11.5). No significant difference was found for the free flap failure rate (OR = 1.35, 95% CI: 0.77-2.36), venous thrombosis rate (OR = 0.93, 95% CI: 0.48-1.82) and reoperation rate (OR = 0.83, 95% CI: 0.42-1.63) when comparing the two groups. This study demonstrates that ETS venous anastomoses offer excellent outcomes, with safety and efficacy comparable to ETE anastomoses. Both techniques can be successfully employed depending on individual patient anatomy and surgeon experience.

AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, version 2) and ROBIS are tools used to assess the methodological quality and the risk of bias in a systematic review (SR). We applied AMSTAR-2 and ROBIS to a sample of 200 published SRs. We investigated the overlap in their methodological constructs, responses by item, and overall, percentage agreement, direction of effect, and timing of assessments. AMSTAR-2 contains 16 items and ROBIS 24 items. Three items in AMSTAR-2 and nine in ROBIS did not overlap in construct. Of the 200 SRs, 73% were low or critically low quality using AMSTAR-2, and 81% had a high risk of bias using ROBIS. The median time to complete AMSTAR-2 and ROBIS was 51 and 64 minutes, respectively. When assessment times were calibrated to the number of items in each tool, each item took an average of 3.2 minutes per item for AMSTAR-2 compared to 2.7 minutes for ROBIS. Nine percent of SRs had opposing ratings (i.e., AMSTAR-2 was high quality while ROBIS was high risk). In both tools, three-quarters of items showed more than 70% agreement between raters after extensive training and piloting. AMSTAR-2 and ROBIS provide complementary rather than interchangeable assessments of systematic reviews. AMSTAR-2 may be preferable when efficiency is prioritized and methodological rigour is the focus, whereas ROBIS offers a deeper examination of potential biases and external validity. Given the widespread reliance on systematic reviews for policy and practice, selecting the appropriate appraisal tool remains crucial. Future research should explore strategies to integrate the strengths of both instruments while minimizing the burden on assessors.