1
|
Ye J, Peng L, Ding A, Chen S, Cai B, Yao Y. Ultrasound Elastography Assessment of Knee Intra-Articular Adhesions at Varying Knee Angles. Bioengineering (Basel) 2024; 11:706. [PMID: 39061788 PMCID: PMC11274046 DOI: 10.3390/bioengineering11070706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to verify the feasibility of using shear wave elastography (SWE) to quantify knee scars and the elastic modulus of scar tissues. Overall, 16 participants underwent SWE assessments and range-of-motion measurement and completed the Knee Injury and Osteoarthritis Outcome Score. The inter-rater reliability for SWE in the suprapatellar bursa, below the patellar tendon, and in the medial and lateral trochlear groove remained within 0.861-0.907. The SWE values in the four regions increased with increasing knee angle, and significant differences were observed between the values for below the patellar tendon and the suprapatellar bursa at knee flexion angles of 60° and 90°. The SWE values of the medial and lateral trochlear groove at 30°, 60°, and 90° knee flexion were higher on the affected side. A negative correlation was observed between the SWE values for the lateral trochlear groove at 0°, 30°, and 60° and those for below the patellar tendon at 0° and the suprapatellar bursa at 30° with both active and passive knee extension. The suprapatellar bursa value at 60° exhibited a positive correlation with both knee flexion and passive knee flexion, whereas that of the suprapatellar bursa at 90° exhibited a positive correlation with both the range of motion and passive range of motion. SWE is a replicable and effective method for detecting scar strength in the knee joint.
Collapse
Affiliation(s)
- Jiling Ye
- Rehabilitation Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200023, China;
| | - Linjing Peng
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China;
| | - Angang Ding
- Ultrasound Medicine Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200023, China;
| | - Shijie Chen
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Ookayama, Meguro-ku, Tokyo 152-8550, Japan;
| | - Bin Cai
- Rehabilitation Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200023, China;
| | - Yifei Yao
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China;
| |
Collapse
|
2
|
Ramos MS, Pasqualini I, Surace PA, Molloy RM, Deren ME, Piuzzi NS. Arthrofibrosis After Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00001. [PMID: 38079496 DOI: 10.2106/jbjs.rvw.23.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.
Collapse
Affiliation(s)
- Michael S Ramos
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | | | | | | |
Collapse
|
3
|
Rupp M, Walter N, Szymski D, Taeger C, Langer M, Alt V. The antibiotic bead pouch - a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery. J Bone Jt Infect 2023; 8:165-173. [PMID: 37818255 PMCID: PMC10561378 DOI: 10.5194/jbji-8-165-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/23/2023] [Indexed: 10/12/2023] Open
Abstract
Soft tissue defects resulting from trauma and musculoskeletal infections can complicate surgical treatment. Appropriate temporary coverage of these defects is essential to achieve the best outcomes for necessary plastic soft tissue defect reconstruction. The antibiotic bead pouch technique is a reasonable surgical approach for managing temporary soft tissue defects following adequate surgical debridement. This technique involves the use of small diameter antibiotic-loaded bone cement beads to fill the dead space created by debridement. By applying antibiotics to the bone cement and covering the beads with an artificial skin graft, high local dosages of antibiotics can be achieved, resulting in the creation of a sterile wound that offers the best starting position for soft tissue and bone defect reconstruction. This narrative review describes the rationale for using this technique, including its advantages and disadvantages, as well as pearls and pitfalls associated with its use in daily practice. In addition, the article provides a comprehensive overview of the literature that has been published since the technique was introduced in surgical practice.
Collapse
Affiliation(s)
- Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christian Taeger
- Plastische Chirurgie & Ästhetik an der Isar, Widenmayerstraße 16, 80538 Munich, Germany
| | - Martin Franz Langer
- Department of Trauma, Hand and Reconstructive Surgery, Waldeyerstrasse 1, 48149 Muenster, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| |
Collapse
|
4
|
Mabrouk AM, Abd El Raaof MM, Hemaida TW, Bassiouny AM. Degenerative changes through MR cartilage mapping in anterior cruciate ligament-reconstructed knees. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:38. [DOI: 10.1186/s43055-022-00952-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/27/2022] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Anterior cruciate ligament (ACL) injury increases risk for post traumatic knee osteoarthritis. ACL injury causes lack of knee stability and frequently requires ACL-reconstruction (ACLR) in order to restore functional and anatomical joint stability. Magnetic resonance imaging with T2 mapping sequence is used to quantify the amount of water content in articular cartilage hence; it is considered a better tool and more beneficial than radiographic based assessment in early detection even before being symptomatic. The aim of work is to estimate the incidence of subclinical degenerative changes that happened early in patients who underwent ACL reconstruction and to identify the correlations of T2 mapping values with patients' BMI, meniscal state/operations, ACL graft assessment and presence of ACLR related complications.
Results
The study was conducted upon 71 patients, divided into 61 anterior cruciate ligament reconstructed knees and 10 control cases using 1.5 T MRI. Assessment of cartilage sub-compartment T2 values and comparison with average normal cartilage T2 values obtained from the control group. Multiple correlations of the grade of articular cartilage degeneration within anterior cruciate ligament reconstructed knees with Body Mass Index (BMI), time of operation as well associated meniscal operations and anterior cruciate ligament graft complications.
Conclusions
Adding the T2 cartilage mapping sequence improves the ability to detect subclinical early degenerative articular cartilage changes in patients who underwent anterior cruciate ligament reconstruction, taking into consideration the relation of the patients' BMI, previous meniscal injuries/operation, ACL graft status and related graft complications with the T2 cartilage mapping values.
Collapse
|
5
|
Bahramian M, Dabbaghipour N, Aria A, Sajadi moghadam fard tehrani B, Dommerholt J. Efficacy of Dry Needling in Treating Scars following Total Hip Arthroplasty: A Case Report. Med J Islam Repub Iran 2022; 36:156. [PMID: 36660004 PMCID: PMC9845656 DOI: 10.47176/mjiri.36.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background: In this case report of a 31-year-old female, we describe the effects of dry needling on scar tissue following total hip arthroplasty. Case report: A 31-year-old woman underwent an elective bilateral total hip replacement due to a motor vehicle accident. Based on physical examination, the patient had burning pain at the incision site at the time of menstruation and limited hip range of motion worse on the right side. The treatment program consisted of six sessions of dry needling over a three-week period alongside infrared radiation for 20 minutes during each session. The needles were spaced along the entire length of the scar tissue and rotation was performed back and forth across the scar region to release the adhesion between the scar line and the underlying tissue, focusing more on the painful-to-touch spots and adhesive points. Following the completion of the dry needling treatments hip range of motion and the patient's functional outcome improved. Dry needling may be an effective and rapid treatment for scar tissue adhesion after surgical procedures. High-quality randomized-controlled studies are needed to verify the efficacy of this method.
Collapse
Affiliation(s)
- Mehrdad Bahramian
- Department of Physiotherapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran ,Department of Physical Therapy, College of Health Science &Professions, University of North Georgia, Dahlonega, USA
| | - Narges Dabbaghipour
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran, Corresponding author:Narges Dabbaghipour,
| | - Amir Aria
- Department of Physiotherapy, School of Rehabilitation, Jondishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA , Myopain Seminars, Bethesda, MD, USA ,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
6
|
Premkumar A, Anatone A, Illescas A, Memtsoudis S, Cross MB, Sculco PK, Gonzalez Della Valle A. Perioperative Use of Antifibrotic Medications Associated With Lower Rate of Manipulation After Primary TKA: An Analysis of 101,366 Patients. J Arthroplasty 2022; 37:S1010-S1015.e1. [PMID: 35283229 DOI: 10.1016/j.arth.2022.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several commonly prescribed medications have known antifibrotic properties and have been shown to reduce postoperative scar formation in other clinical areas, but it is unknown whether the use of such medications perioperatively in patients undergoing TKA may improve rates of postoperative stiffness. METHODS A large US employer-sponsored healthcare database (Truven Marketscan) was queried for patients who underwent elective primary TKA for primary osteoarthritis between 2015-2019. Demographic information and comorbidities were recorded, along with whether patients were prescribed one of several medications with known antifibrotic properties during the three months before or after surgery. RESULTS Complete data were available for 101,366 patients undergoing TKA, of which 4,536 underwent MUA (4.5%). Perioperative use of any antifibrotic medication was associated with a lower likelihood of undergoing MUA (P < .001). When controlling for age, sex, comorbidities, opioid use, length of stay, among other variables, perioperative use of specific ACE inhibitors (OR 0.91, CI 0.84-1, P = .042), COX-2 inhibitors (OR 0.88, CI 0.81-0.96, P = .002), and angiotensin II receptor blockers, specifically losartan (OR 0.80, CI 0.70-0.91, P = .007) all remained significantly associated with lower rates of MUA. CONCLUSION This study, spanning over a hundred thousand primary TKA procedures over a recent five-year period, demonstrates an association between perioperative use of specific medications with antifibrotic properties and a decreased rate of MUA. These data will help inform future studies aimed to prospectively evaluate the potential of antifibrotic medications in preventing postoperative stiffness in high-risk patients undergoing knee arthroplasty.
Collapse
Affiliation(s)
- Ajay Premkumar
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Alex Anatone
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Alex Illescas
- Hospital for Special Surgery, Biostatistics Core, New York, NY
| | - Stavros Memtsoudis
- Hospital for Special Surgery, Department of Anesthesiology, Critical Care, and Pain Management, New York, NY
| | - Michael B Cross
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Peter K Sculco
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | | |
Collapse
|
7
|
Vibration Exposure and Transmissibility on Dentist's Anatomy: A Study of Micro Motors and Air-Turbines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084084. [PMID: 33924408 PMCID: PMC8069559 DOI: 10.3390/ijerph18084084] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/17/2022]
Abstract
The use of dental hand pieces endanger dentists to vibration exposure as they are subjected to very high amplitude and vibration frequency. This paper has envisaged a comparative analysis of vibration amplitudes and transmissibility during idling and drilling with micro motor (MM) and air-turbine (AT) hand pieces. The study aims to identify the mean difference in vibration amplitudes during idling, explore different grasp forces while drilling with irrigant injection by the dentist, and various vibration transmission of these hand pieces. The study utilized 22 separate frequency resonances on two new and eight used MMs and two new and eight used ATs of different brands by observing the investigator at 16 different dentist clinics. The study adopted a descriptive research design with non–probability sampling techniques for selecting dentists and hand pieces. Statistical methods like Levene Test of Homogeneity, Welch ANOVA, independent t-test, and Games–Howell test were utilized with SPSS version 22 and MS-Excel. The results reveal that vibration amplitudes and vibration transmissibility when measured at position 2 are higher than in another position 1. Vibrations during idling for used MMs are more than AT hand pieces, and the used MM (MUD) and used AT (AUA) hand pieces differ due to their obsolescence and over-usage. Vibration amplitudes increase every time with the tightening of grasping of the hand piece. Vibration amplitudes for each grasping style of MM hand piece differ from all other grasping styles of AT hand pieces. Routine exposure to consistent vibrations has ill physical, mental, and psychological effects on dentists. The used hand pieces more hazardous as compared to newer ones. The study suggests that these hand pieces must be replaced periodically, sufficient to break between two operations, especially after every hand piece usage. Hence, the present research work can be further extended by creating some control groups among dentists and then studying the vibration amplitude exposure of various dental hand pieces and subsequent transmissibility to their body parts.
Collapse
|