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Bareggi A, Giuffra V, Riccomi G. Proposed complementary osteological indicators: Advancing the estimation of puberty stages in Bioarcheology. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024:e24996. [PMID: 38994920 DOI: 10.1002/ajpa.24996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/08/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The study of puberty is a well-established area of bioarcheological research, which greatly enhances our understanding of adolescence and growth in the past. Since the publications of Shapland and Lewis' works, which have become "standards" for estimating puberty in skeletal material, no additional osteological indicators of puberty have been proposed. Nevertheless, clinical practice constantly develops skeletal maturation markers that could be useful in bioarcheology. This study aims to assess the applicability and reliability of novel puberty indicators as a complementary tool to estimate puberty in skeletal remains. MATERIALS AND METHODS Four new maturation markers including spheno-occipital synchondrosis, humeral head ossification, calcaneal apophysis ossification, and mandibular premolar mineralization were selected and applied to a sample of 85 adolescents from pre-Roman southern Italy (Pontecagnano, 7th-4th BCE). RESULTS Despite some limits in adapting the original clinical methods to osteoarcheological material, the use of these novel skeletal indicators had moderate to excellent scoring repeatability and an overall high agreement with the puberty and menarche status previously estimated with standard methods. These results encourage us to apply these markers in bioarcheology. In some cases, minor adaptations of the original scoring systems are suggested to enhance reliability. DISCUSSION Including the proposed indicators in routine puberty data collection allows us to refine puberty estimation and improve the ability to identify key growth milestones in poorly preserved skeletons. Further application to osteological collections with diverse chronology and geographical differences is needed to assess how and to what extent the newly proposed maturation markers perform.
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Affiliation(s)
- Alessia Bareggi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- BoCAS, Bonn Center for ArchaeoSciences, Institute for Archaeology and Cultural Anthropology, University of Bonn, Bonn, Germany
| | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulia Riccomi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Department of Archaeology, Max Planck Institute of Geoanthropology, Jena, Germany
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Hanlon SL, Whitney KE, DeJong Lempke AF. Youth Athletes With Sever's Disease Exhibit Altered Achilles Tendon Ultrasound Characteristics: A Retrospective Case-Control Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1303-1312. [PMID: 38526138 DOI: 10.1002/jum.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/12/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Calcaneal apophysitis (Sever's disease) is an overuse condition caused by repetitive traction stress to the calcaneal apophysis. Whether Achilles tendon morphology is altered in this young patient population remains unknown. Therefore, we aimed to identify differences in Achilles tendon morphology between youth athletes diagnosed with calcaneal apophysitis and healthy controls. METHODS This retrospective chart review included 46 patients (n = 23 Sever's disease, 15F/8M, 12.4 ± 2.3 years old) and (n = 23 healthy controls, 13F/10M, 15.9 ± 1.5 years old) who sought care in a Children's Hospital Sports Medicine/Orthopedics Department between 2012 and 2022. We measured ultrasound-derived degree of tendon thickening, Achilles tendon thickness (cm), and cross-sectional area (CSA [cm2]). Separate multivariate analyses of covariance (MANCOVAs) were used to compare degree of thickening, mass-normalized Achilles tendon thickness, and CSA between participant groups, covarying for age. Cohen's d effect sizes were used to assess the magnitude of mean differences and standard error (MDSE) between groups. RESULTS Young athletes with Sever's disease had a significantly greater degree of tendon thickening with a large effect compared with healthy controls (MDSE: 0.07 [0.01] mm P < .001, d = 1.39). Achilles tendon thickness and CSA did not statistically differ between groups; however, the magnitude of between-group differences for these measures (MDSE: 0.18 [0.05] cm, MDSE: 0.27 [0.07] cm2, respectively) were moderate. CONCLUSIONS Our findings demonstrate previously unrecognized differences in Achilles tendon morphology between young athletes with clinically diagnosed Sever's disease and healthy controls. Our study supports incorporating diagnostic ultrasound as part of a comprehensive examination to ensure appropriate diagnosis and clinical management for adolescents with heel pain.
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Affiliation(s)
- Shawn L Hanlon
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristin E Whitney
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra F DeJong Lempke
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Ganji E, Lamia SN, Stepanovich M, Whyte N, Goulet RW, Abraham AC, Killian ML. Optogenetic-induced muscle loading leads to mechanical adaptation of the Achilles tendon enthesis in mice. SCIENCE ADVANCES 2023; 9:eadf4683. [PMID: 37352350 PMCID: PMC10289645 DOI: 10.1126/sciadv.adf4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/17/2023] [Indexed: 06/25/2023]
Abstract
Skeletal shape depends on the transmission of contractile muscle forces from tendon to bone across the enthesis. Loss of muscle loading impairs enthesis development, yet little is known if and how the postnatal enthesis adapts to increased loading. Here, we studied adaptations in enthesis structure and function in response to increased loading, using optogenetically induced muscle contraction in young (i.e., growth) and adult (i.e., mature) mice. Daily bouts of unilateral optogenetic loading in young mice led to radial calcaneal expansion and warping. This also led to a weaker enthesis with increased collagen damage in young tendon and enthisis, with little change in adult mice. We then used RNA sequencing to identify the pathways associated with increased mechanical loading during growth. In tendon, we found enrichment of glycolysis, focal adhesion, and cell-matrix interactions. In bone, we found enrichment of inflammation and cell cycle. Together, we demonstrate the utility of optogenetic-induced muscle contraction to elicit in vivo adaptation of the enthesis.
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Affiliation(s)
- Elahe Ganji
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Ave., Urbana, IL 61801, USA
- Department of Biomedical Engineering, University of Delaware, 540 S. College Ave., Newark, DE 19713, USA
| | - Syeda N. Lamia
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, MI 48109, USA
| | - Matthew Stepanovich
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Noelle Whyte
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Robert W. Goulet
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Adam C. Abraham
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Megan L. Killian
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Delaware, 540 S. College Ave., Newark, DE 19713, USA
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Tsutsui T, Iizuka S, Takei S, Sakamaki W, Maemichi T, Torii S. Growth pattern of lumbar maturity stage at L1 to L5 during adolescent growth spurt. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2164-2170. [PMID: 37014437 DOI: 10.1007/s00586-023-07686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE This study aimed to clarify the order of the lumbar maturity stage, each at L1 to L5, and the relationships between age at peak height velocity (APHV) and the lumbar maturity stage. METHODS A total of 120 male first-grade junior high school soccer players were enrolled and followed for two years, and measurements were performed five times (T1 to T5). The lumbar maturity stage was assessed according to the degree of lesion of the epiphyseal from L1 to L5 using magnetic resonance imaging and classified into three stages: cartilaginous stage, apophyseal stage, and epiphyseal stage. The relationships between T1 and T5 temporal changes and developmental stages divided by 0.5 year increments based on APHV and the lumbar maturity stage at L1 to L5 were examined. For the apophyseal stage, developmental age calculated based on the difference between APHV and chronological age between each lumbar vertebra was compared. RESULTS We found that part of the cartilaginous stages decreased as time progressed, while that of the apophyseal and epiphyseal stages increased at L1 to L5 (chi-square test, p < 0.01). L5 matured earlier with the apophyseal stage than L1 to L4 (p < 0.05). The lumbar maturity stage was attained toward L1 from L5, comparing different lumbar levels. CONCLUSION The lumbar maturity stage progresses from L5 toward L1, and the apophyseal and epiphyseal stages would replace the cartilaginous stage at approximately 14 years of age or after APHV.
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Affiliation(s)
- Toshiharu Tsutsui
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Satoshi Iizuka
- Japan Institute of Sport Sciences, 3-15-1 Nishigaoka, Kita-Ku, Tokyo, Japan
| | - Seira Takei
- University of Tokyo Sports Science Initiative, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
- Institute of Human Growth and Development, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, Japan
| | - Wataru Sakamaki
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, Japan
| | - Toshihiro Maemichi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan.
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Ganji E, Lamia SN, Stepanovich M, Whyte N, Abraham AC, Killian ML. Optogenetic-Induced Muscle Loading Leads to Mechanical Adaptation of the Achilles Tendon Enthesis in Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.11.536376. [PMID: 37090593 PMCID: PMC10120626 DOI: 10.1101/2023.04.11.536376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The growth of the skeleton depends on the transmission of contractile muscle forces from tendon to bone across the extracellular matrix-rich enthesis. Loss of muscle loading leads to significant impairments in enthesis development. However, little is known about how the enthesis responds to increased loading during postnatal growth. To study the cellular and matrix adaptations of the enthesis in response to increased muscle loading, we used optogenetics to induce skeletal muscle contraction and unilaterally load the Achilles tendon and enthesis in young (i.e., during growth) and adult (i.e., mature) mice. In young mice, daily bouts of unilateral optogenetic loading led to expansion of the calcaneal apophysis and growth plate, as well as increased vascularization of the normally avascular enthesis. Daily loading bouts, delivered for 3 weeks, also led to a mechanically weaker enthesis with increased molecular-level accumulation of collagen damage in young mice. However, adult mice did not exhibit impaired mechanical properties or noticeable structural adaptations to the enthesis. We then focused on the transcriptional response of the young tendon and bone following optogenetic-induced loading. After 1 or 2 weeks of loading, we identified, in tendon, transcriptional activation of canonical pathways related to glucose metabolism (glycolysis) and inhibited pathways associated with cytoskeletal remodeling (e.g., RHOA and CREB signaling). In bone, we identified activation of inflammatory signaling (e.g., NFkB and STAT3 signaling) and inhibition of ERK/MAPK and PTEN signaling. Thus, we have demonstrated the utility of optogenetic-induced skeletal muscle contraction to elicit structural, functional, and molecular adaptation of the enthesis in vivo especially during growth.
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Affiliation(s)
- Elahe Ganji
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, Michigan, 48109
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Ave., Urbana, Illinois, 61801
| | - Syeda N Lamia
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, Michigan, 48109
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, Michigan, 48109
| | - Matthew Stepanovich
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, Michigan, 48109
| | - Noelle Whyte
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, Michigan, 48109
| | - Adam C Abraham
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, Michigan, 48109
| | - Megan L Killian
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, Michigan, 48109
- Department of Biomedical Engineering, University of Delaware, 540 S. College Ave., Newark, Delaware, 19713
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Abstract
This article provides researchers with the background and guidance necessary to practically incorporate skeletal maturity estimation into any study of adolescents with imaging of the shoulder, elbow, hand, hip, knee, or foot. It also provides clinicians with a comprehensive, concise synopsis of systems that can be used to estimate skeletal maturity in clinical practice. In the article, we provide a relatively brief overview of each currently available skeletal maturity system that has been validated on a longitudinal dataset. The supplementary files include 2 PowerPoint files for each skeletal maturity system. The first PowerPoint file offers examples and instructions for using each radiographic system. The second PowerPoint file includes 20 graded radiographs that can be used for reliability analyses in the research setting. We have also developed a free mobile application available on the iOS and Android platforms named "What's the Skeletal Maturity?" that allows clinicians to rapidly estimate skeletal maturity on any patient using any commonly obtained orthopaedic radiograph.
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Affiliation(s)
- Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
| | - James O Sanders
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Daniel R Cooperman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Raymond W Liu
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
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Schultz M, Tol JL, Veltman L, Kaaden, van der L, Reurink G. Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors. Phys Ther Sport 2022; 55:98-105. [DOI: 10.1016/j.ptsp.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/10/2023]
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Materne O, Chamari K, Farooq A, Weir A, Hölmich P, Bahr R, Greig M, McNaughton LR. Association of Skeletal Maturity and Injury Risk in Elite Youth Soccer Players: A 4-Season Prospective Study With Survival Analysis. Orthop J Sports Med 2021; 9:2325967121999113. [PMID: 33869641 PMCID: PMC8020116 DOI: 10.1177/2325967121999113] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The association between injury risk and skeletal maturity in youth soccer has received little attention. PURPOSE To prospectively investigate injury patterns and incidence in relation to skeletal maturity in elite youth academy soccer players and to determine the injury risks associated with the skeletal maturity status, both overall and to the lower limb apophysis. STUDY DESIGN Descriptive epidemiology study. METHODS All injuries that required medical attention and led to time loss were recorded prospectively during 4 consecutive seasons in 283 unique soccer players from U-13 (12 years of age) to U-19 (18 years). The skeletal age (SA) was assessed in 454 player-seasons using the Fels method, and skeletal maturity status (SA minus chronological age) was classified as follows: late, SA >1 year behind chronological age; normal, SA ±1 year of chronological age; early, SA >1 year ahead of chronological age; and mature, SA = 18 years. An adjusted Cox regression model was used to analyze the injury risk. RESULTS A total of 1565 injuries were recorded; 60% were time-loss injuries, resulting in 17,772 days lost. Adjusted injury-free survival analysis showed a significantly greater hazard ratio (HR) for different status of skeletal maturity: early vs normal (HR = 1.26 [95% CI, 1.11-1.42]; P < .001) and early vs mature (HR = 1.35 [95% CI, 1.17-1.56]; P < .001). Players who were skeletally mature at the wrist had a substantially decreased risk of lower extremity apophyseal injuries (by 45%-61%) compared with late (P < .05), normal (P < .05), and early (P < .001) maturers. CONCLUSION Musculoskeletal injury patterns and injury risks varied depending on the players' skeletal maturity status. Early maturers had the greatest overall adjusted injury risk. Players who were already skeletally mature at the wrist had the lowest risk of lower extremity apophyseal injuries but were still vulnerable for hip and pelvis apophyseal injuries.
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Affiliation(s)
- Olivier Materne
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Aspire Health Centre, Aspire Academy, Doha, Qatar
- Rangers Football Club, Glasgow, Scotland
| | - Karim Chamari
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Adam Weir
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Sport Medicine and Exercise, Clinic Haarlem (SBK), Haarlem, the
Netherlands
- Department of Orthopaedics, Erasmus MC University Medical Centre,
Rotterdam, the Netherlands
| | - Per Hölmich
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Sports Orthopaedic Research Center, Copenhagen (SORC-C), Copenhagen
University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Sports Medicine, Oslo Sports Trauma Research Center,
Norwegian School of Sport Sciences, Oslo, Norway
| | - Matt Greig
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Lars R. McNaughton
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
- Department of Sport and Movement Studies, Faculty of Health
Science, University of Johannesburg, Auckland Park, South Africa
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