Silvia Fiore

Background: Mild-to-moderate knee osteoarthritis (KOA) can be successfully treated using intra-articular hyaluronic acid (IA-HA). The medial infrapatellar (MIP) approach and lateral infrapatellar (LIP) approach are two of the most used techniques for performing IA-HA, but it is still not clear which one is preferable. Objectives: The study aims to find the best knee injection technique between MIP and LIP approaches. Methods: In total, 161 patients were enrolled, divided into two groups (MIP or LIP). Each technique was performed once a week for three weeks. Patients were evaluated using the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Roles and Maudsley Score (RMS) at T0 (before the first injection), T1 (one week after the third injection) and T2 (six months after). Results: NRS, KOOS and RMS showed a statistically significant improvement in both groups at all the detection times, without significant differences. No differences were detected between the groups in terms of systemic effect effusions, while the MIP group presented a mildly higher number of bruises in comparison with the LIP group (p = 0.034). Conclusions: Both the IA-HA techniques are equally effective in measured outcomes. The MIP approach seems to produce some local and transient side effects. So, the choice of the LIP or MIP approach depends on the operator’s skill and experience.

Wheelchair basketball (WB) is an increasingly popular sport that guarantees numerous health benefits for people with disabilities who regularly practice it, such as an improved quality of life and psychophysical well-being. However, WB is a contact and high-stress sport, which exposes players to frequent overloads and injuries, mainly affecting the upper limbs. Therefore, shoulder pain (SP) is the most common musculoskeletal disorder among WB players, forcing them to suspend or abandon this sport activity. This narrative review aims to summarize all the known literature on this topic and to be a starting point for further research. Firstly, it explores the biomechanical causes that lead to SP and the underlying diseases, among which the most recurrent are rotator cuff tendinopathies. Furthermore, this overview deepens the most effective and specific rehabilitation programs for SP in WB players and it emphasizes the need for further studies to trial new rehabilitative protocols using novel technologies to make them faster and more personalized. In this regard, the general recommendation still remains to perform a combination of exercises such as strengthening, endurance and stretching exercises of various durations and intensities. To conclude, the most important prevention strategies are described, underlining the need for constant sport-specific training led by qualified personnel and suggesting some insights on possible new research aimed at improving wheelchair ergonomics, stressing the importance of a multidisciplinary team fully dedicated to the individual athlete.