PurposeThe timing of psychological and physical recovery after anterior cruciate ligament reconstruction represents an open issue in current orthopedic practice. Several tools have been developed to evaluate these factors, with the most recent being represented by the anterior cruciate ligament (ACL) return to sport injury scale (ACL‐RSI). The aims of this study were to provide a validated Italian translation of the ACL‐RSI in a population of sport patients, and to identify a possible correlation of the ACL‐RSI score with the return to sport (RTS) time and the level of sport participation in comparison to the pre‐injury one. MethodsThe Italian translation and cultural adaptation of the scale were completed using a using the “translation–back translation” method. A total of 130 patients were enrolled and completed the study questionnaires 6 months after ACL reconstruction. Randomly, 65 of them were re‐tested for the ACL‐RSI within 2 weeks. The internal consistency, reliability, feasibility, and construct validity of the Italian version of ACL‐RSI were assessed and compared to Italian version of the KOOS, the Lysholm Score, the AKPS and the IKDC subjective score. Responsiveness was tested comparing patients returning to sport at 6 and 12 months. The Tegner activity scale was collected at baseline, 6 and 12 months to identify the level of activity after return to sport, in relation to the ACL‐RSI score. ResultsThe Italian adaptation of the ACL‐RSI demonstrated excellent internal consistency (Cronbach’s alpha = 0.953), reliability (test–retest ICC = 0.916) and feasibility, with no ceiling or floor effect. Construct validity was confirmed by the moderate to strong correlation with all the other scales (p < 0.0001). Slight and non‐significant higher ACL‐RSI score was shown by patients returned to sport at 6 or 12 months after surgery. Nevertheless, the ACL‐RSI score at 6 months was significantly different between patients who returned and those who did not returned to the same level of sport activity 12 months after the procedure. ConclusionsThis study demonstrated that the Italian ACL‐RSI is a reliable tool for evaluating the psychological readiness for return to sports of athletes who underwent ACL reconstruction, especially when collected at the end of the rehabilitation process. Since the IT ACL‐RSI used in this study is a faithful translation of the original English version, this finding can be generalized to other cultural contexts and languages too. Level of evidenceLevel II.

Objectives: To report, through a systematic review of the literature, the clinical and radiographic outcomes of unicompartmental knee replacement (UKR) combined to anterior cruciate ligament (ACL) reconstruction. It was hypothesized that this combined technique is a safe and effective procedure providing satisfactory post-operative functional outcomes. Methods: A systematic review was performed by searching Pubmed/MEDLINE, CINAHL, SCOPUS, Embase and Ovid. Only studies in English pertaining all levels of evidence reporting on subjects with medial osteoarthritis and ACL deficiency undergoing UKR combined to ACL reconstruction were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications, clinical assessment including activity level, associated procedures, rate of complications such as revision surgery Results: Overall, 9 studies met all the inclusion criteria for this review. All were published between 2006 and 2019. The search resulted in one comparative case series (Level III), four prospective cohort studies (Level III) and four case series (Level IV). From these studies, 249 patients were identified.Conclusions: The combination of UKR and ACL reconstruction appears a safe and effective procedure providing satisfying outcomes and limited complications in selected patients with medial OA and ACL insufficiency. Further comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are lacking.

The advancement of deformity-specific implants and surgical techniques has improved the surgical treatment of Adult Spine Deformity (ASD), allowing surgeons to treat more complex deformities. Simultaneously, high rates of medical and surgical complications have been reported. The aim of this study is to describe the risk factors, the rate and the clinical impact of mechanical complications in ASD surgery. A retrospective review of a large, single-center database of consecutive ASD patients was conducted. Inclusion criteria were as follows: Cobb coronal curve > 20° or alteration of at least one of sagittal vertical axis (SVA > 40 mm), thoracic kyphosis (TK > 60°), pelvic tilt (PT > 20°) and pelvic incidence minus lumbar lordosis mismatch (PI-LL > 10°), at least four levels of posterior instrumented fusion and 2-year follow-up. At the baseline and at each follow-up end point, the authors collected clinical and radiographic outcomes and recorded any mechanical complications that occurred. One hundred and two patients were enrolled. Clinical outcomes significantly were improved at the last follow-up (mean 40.9 months). Postoperative mechanical complications occurred in 15 patients (14.7%); proximal junctional disease was the most common complication (60%) and the revision rate was 53.3%. Patients who experienced mechanical complications were older (61.2 vs. 54.8 years, p = 0.04); they had also a higher rate of pelvic fusion and posterior-only approach, a lower LL (−37.9 vs. −46.2, p = 0.02) and a higher PT (26.3 vs. 19.8, p = 0.009), TK (41.8 vs. 35.7, p = 0.05), PI–LL (12.9 vs. 5.4, p = 0.03) and Global Alignment and Proportion score (6.9 vs. 4.3, p = 0.01). This study showed a significant improvement in pain and disability after ASD surgery. Regarding the risk of developing a mechanical complication, not only postoperative radiographic parameters affected the risk but also patient age and surgical features.