1
|
Heighes LA, Abelleyra Lastoria DA, Beni R, Iftikhar A, Hing CB. The relationship between joint hypermobility and patellar instability: A systematic review. J Orthop 2024; 56:40-49. [PMID: 38784948 PMCID: PMC11109350 DOI: 10.1016/j.jor.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to determine if joint hypermobility leads to an increased risk of patellar instability, and to evaluate outcomes of treatment for patellar instability in those who exhibit hypermobility. Methods Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included. Results We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p < 0.001).Five studies found surgical intervention aimed at correcting patellar dislocation in patients with idiopathic hypermobility led to satisfactory outcomes. There was conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following medial patellofemoral ligament reconstruction (MPFLR) in two studies. In addition, this procedure had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS), with hypermobility associated with a higher failure rate (p = 0.03). One study showed the type of graft used made no difference in outcome scores or re-dislocation rates (p > 0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69). Conclusion Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required.
Collapse
Affiliation(s)
| | | | - Rebecca Beni
- St George's, University of London, London, SW17 0RE, United Kingdom
| | - Ahsan Iftikhar
- St George's, University of London, London, SW17 0RE, United Kingdom
| | - Caroline Blanca Hing
- St George's University Hospitals NHS Foundation Trust, London, SW17 0RE, United Kingdom
| |
Collapse
|
2
|
Aukštuolytė-Bačienė E, Daunoravičienė A, Tamulionytė V, Berškienė K, Narbutaitė J, Razon S, Slapšinskaitė-Dackevičienė A. Present but Ignored: Physical Condition and Health-Related Quality of Life in College-Aged Females with Generalized Joint Hypermobility. Healthcare (Basel) 2024; 12:1065. [PMID: 38891140 PMCID: PMC11171803 DOI: 10.3390/healthcare12111065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is prevalent among young adults, necessitating effective monitoring of musculoskeletal health, particularly among college-aged females. This study aimed to identify physical fitness and health-related quality of life (HR-QoL) characteristics associated with GJH. METHODS A total of 67 participants were assessed: 26 with GJH (mean age 20.06, SD 1.2 years), and 41 without (mean age 20.15, SD 2.2 years). Assessments included hypermobility, anthropometric data, foot posture, balance, flexibility, strength, and HR-QoL. We used the Mann-Whitney test for two independent samples, categorical variables were analyzed with Cramer's V test. The results indicated that participants with GJH exhibited inferior balance and back muscle static strength endurance but greater flexibility compared to those without GJH. Significant differences were observed in foot posture. However, handgrip strength, explosive strength, and abdominal muscle static strength endurance did not differ significantly between groups. No significant differences were observed in HR-QoL components between the two groups. In conclusion, there appears to be a link between GJH and increased flexibility, impaired balance, reduced back muscle static strength endurance, and altered posture of both feet.
Collapse
Affiliation(s)
- Ernesta Aukštuolytė-Bačienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Algė Daunoravičienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Vilma Tamulionytė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Kristina Berškienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Jurgita Narbutaitė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Selen Razon
- Department of Kinesiology, College of Health Sciences, West Chester University of Pennsylvania, West Chester, PA 19383, USA;
| | - Agnė Slapšinskaitė-Dackevičienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
- Health Research Institute, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania
| |
Collapse
|
3
|
Di Libero T, Falese L, Corrado S, Tosti B, Diotaiuti P, Rodio A. Italian Canyoning Guides: Physiological Profile and Cardiometabolic Demand during Rope Activities. Sports (Basel) 2024; 12:129. [PMID: 38786998 PMCID: PMC11125781 DOI: 10.3390/sports12050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Canyoning activities require physical effort, highlighting the importance of maintaining a proper physical fitness. Canyoning guides emerge as key figures, not only to ensure safety during the experience but also to handle unforeseen situations promptly. This study aims to assess the physiological profile of canyoning guides and the cardiorespiratory demands experienced during rope activities by means of oxygen uptake and heart rate measurements. Seventeen canyoning guides (42.6 y ± 10.78; BMI of 24.0 kg/m2 ± 2.95) carried out coordinative and conditional tests. The participants showed good values in strength tests (27.3 cm ± 5.97 and 23.3 rep ± 8.06 in SJ and PUp tests, respectively), while the flexibility of males and females was below and well above the average, respectively. A noteworthy result was observed in the reaction test, in which a better performance was recorded with the non-dominant hand (168.1 ms vs. 202.0 ms). All subjects exhibited a low aerobic capacity by means of an RD test (10.6 ua ± 6.62). During rope activities and emergency/support simulations, metabolic and cardiovascular data indicated that a moderate/high effort was exerted, confirmed by an oxidative stress analysis. In conclusion, this study demonstrated how canyoning guides face significant physical requirements, but their physiological profile regarding aerobic power was not appropriate. Therefore, these findings could offer valuable insights into the development of specific training to ensure an appropriate aerobic fitness to perform canyoning safely.
Collapse
Affiliation(s)
- Tommaso Di Libero
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Campus Folcara, Via S. Angelo, 03043 Cassino, FR, Italy; (L.F.); (S.C.); (B.T.); (P.D.); (A.R.)
| | | | | | | | | | | |
Collapse
|
4
|
Arshad Z, Marway P, Shoman H, Ubong S, Hussain A, Khanduja V. Hip Arthroscopy in Patients With Generalized Joint Hypermobility Yields Successful Outcomes: A Systematic Review. Arthroscopy 2024; 40:1658-1669. [PMID: 37952744 DOI: 10.1016/j.arthro.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To evaluate the outcomes of hip arthroscopy in patients with generalized joint hypermobility (GJH). METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An electronic record search was performed in PubMed, Web of Science, Cochrane Library, and Embase. A 2-stage title/abstract and full-text screening was performed using the following inclusion criteria: (1) observational studies, cohort studies, and randomized controlled trials; (2) describing more than 5 patients with a mean age over 18 years and GJH; (3) undergoing arthroscopy of the hip; (4) reporting patient-reported outcome measures (PROMs), return to sport, or complications/reoperations; and (5) published in English. RESULTS Of the 517 articles identified, 10 studies meeting all selection criteria were included. Included studies report significant improvements in a range of different functional and pain-based PROMs. Most patients (25.0%-97.0%) in each study achieved a clinically important improvement postoperatively in at least 1 PROM. No complications were described in any of the 4 studies reporting this metric. One study each found an association between GJH and an increased risk of postoperative deep gluteal syndrome and iliopsoas tendinitis. The rate of revision arthroscopy ranged from 0% to 11.4%, and only 2 patients in a single study of 11 hips required conversion to total hip arthroplasty. No statistically significant differences were reported between patients with and without GJH with respect to any of the described outcomes. CONCLUSIONS Patients with GJH may achieve good outcomes following hip arthroscopy with respect to PROMs, perioperative complications, reoperation, and return to sport. With effective labral repair and capsular closure, outcomes achieved in patients with GJH are comparable to those reported in patients without hypermobility. LEVEL OF EVIDENCE Level IV, systematic review of level III to IV studies.
Collapse
Affiliation(s)
- Zaki Arshad
- University Hospitals Leicester NHS Trust, Leicester, England
| | | | - Haitham Shoman
- Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sonia Ubong
- Department of Surgery, University of Cambridge, Cambridge, England
| | - Ali Hussain
- East Kent Hospitals University NHS Foundation Trust, Kent, England
| | - Vikas Khanduja
- Young Adult Hip Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England.
| |
Collapse
|
5
|
Karagiannopoulos C, Griech SF. Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults. J Hand Ther 2024; 37:209-217. [PMID: 38342640 DOI: 10.1016/j.jht.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established. PURPOSE This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based. STUDY DESIGN This was a quasi-experimental cross-sectional study. METHODS Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation. RESULTS A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function. CONCLUSIONS CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.
Collapse
Affiliation(s)
- Christos Karagiannopoulos
- DeSales University Division of Healthcare, Doctor of Physical Therapy Program, Center Valley, PA, USA.
| | - Sean F Griech
- DeSales University Division of Healthcare, Doctor of Physical Therapy Program, Center Valley, PA, USA.
| |
Collapse
|
6
|
Wang A, Jiang Y, Su T, Xie X, Jiao C, Hu Y, Zhang Z, Guo Q, Jiang D. Clinical Outcomes and Return to Preinjury Sports After Anatomic Reconstruction With a Gracilis Autograft Versus the Modified Broström Procedure in Patients With Generalized Joint Laxity. Orthop J Sports Med 2024; 12:23259671241229443. [PMID: 38455150 PMCID: PMC10919140 DOI: 10.1177/23259671241229443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 03/09/2024] Open
Abstract
Background Generalized joint laxity (GJL) is a risk factor for inferior outcomes after the modified Broström procedure for chronic lateral ankle instability, while anatomic reconstruction with tendons is more inclined to be recommended. However, whether anatomic reconstruction could achieve better results than the modified Broström procedure in patients with GJL is unknown. Purpose To compare clinical outcomes and return to sports between anatomic reconstruction and the modified Broström procedure in patients with GJL. Study Design Cohort study; Level of evidence, 3. Methods Patients with GJL (Beighton score ≥4) who underwent either the modified Broström procedure or anatomic reconstruction with gracilis autografts between 2017 and 2020 were reviewed. Included were 19 patients who underwent anatomic reconstruction (reconstruction group) and 49 patients who underwent the modified Broström procedure (MBP group). Clinical outcomes were compared using the Foot and Ankle Outcome Score (FAOS) and the Karlsson score. The rates of return to preinjury level in high-demand sports, sprain recurrence, and range of motion between the 2 groups were also compared. Results The mean follow-up duration was 38.3 months in the reconstruction group and 43.7 months in the MBP group. The FAOS and Karlsson scores improved significantly after surgery in both groups (P < .001 for all), with the reconstruction group having significantly higher postoperative FAOS-Sports scores (87.9 ± 8.9 vs 80.5 ± 11.6; P = .015) and Karlsson scores (86.9 ± 6.1 vs 82 ± 8.4; P = .025) than the MBP group. The rate of return to preinjury high-demand sports was higher in the reconstruction group than in the MBP group (73.3% vs 38.9%; P = .034). The MBP group had a significantly higher rate of sprain recurrence (22.4% vs 0%; P = .027). More patients reported dorsiflexion restriction in the reconstruction group (n = 4; 21.1%) than in the MBP group (n = 1; 2%) (P = .019); nonetheless, there was no noticeable effect on daily life and sports. Conclusion Better clinical outcomes, less sprain recurrence, and a higher rate of return to preinjury high-demand sports were found after anatomic reconstruction with free tendons compared with the modified Broström procedure in patients with GJL. Anatomic tendon reconstruction can be recommended for such patients, especially those participating in high-demand sports.
Collapse
Affiliation(s)
- Anhong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xing Xie
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| |
Collapse
|
7
|
Kuhn AW, Clohisy JC, Troyer SC, Cheng AL, Hillen TJ, Pascual-Garrido C, Tatman J, Bloom N, Schoenecker PL, Nepple JJ. Team Approach: Hip Preservation Surgery. JBJS Rev 2023; 11:01874474-202310000-00001. [PMID: 37793005 DOI: 10.2106/jbjs.rvw.23.00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The evaluation and treatment of adolescents and young adults with hip pain has seen tremendous growth over the past 20 years. Labral tears are well established as a common cause of hip pain but often occur because of underlying bony abnormalities. Femoroacetabular impingement (FAI) and acetabular dysplasia are now well-established causes of hip osteoarthritis and are increasingly treated in the prearthritic stage in hopes of improving symptoms and prolonging the longevity of the native hip. Beyond FAI and acetabular dysplasia, this patient population can present with a complex and variable group of underlying conditions that need to be taken into account. Expertise in the conservative management of this population, including physical therapy, is valuable to maximize the success. Preoperative, surgical, and postoperative decision-making and care in this population is complex and evolving. A comprehensive, multidisciplinary approach to the care of this patient population has been used for over 20 years by our institution with great success. The purpose of this article is to review the "team-based approach" necessary for successful management of the spectrum of adolescent and young adult hip disorders.
Collapse
Affiliation(s)
- Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | | | - Abby L Cheng
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Travis J Hillen
- Department of Radiological Science, Washington University in St. Louis, St. Louis, Missouri
| | | | - Justin Tatman
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Nancy Bloom
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Perry L Schoenecker
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
8
|
Wang AH, Su T, Jiang YF, Zhu YC, Jiao C, Hu YL, Guo QW, Jiang D. Arthroscopic modified Broström procedure achieved similar favorable short term outcomes to open procedure for chronic lateral ankle instability cases with generalized joint laxity. Knee Surg Sports Traumatol Arthrosc 2023; 31:4043-4051. [PMID: 37162539 DOI: 10.1007/s00167-023-07431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To compare the short-term clinical outcomes of the open versus arthroscopic modified Broström procedure in generalized joint laxity (GJL) patients. METHODS From January 2018 to January 2020, 64 consecutive patients with chronic lateral ankle instability (CLAI) and GJL (Beighton score ≥ 4) were prospectively enrolled into two groups: those who underwent the open modified Broström procedure (open group, n = 32) and those who underwent the arthroscopic modified Broström procedure (arthroscopic group, n = 32). Patients underwent an open or arthroscopic modified Broström procedure based on the time when they attended the clinic for consultation. All patients were followed-up at 3, 6, 12, and 24 months postoperatively. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Karlsson score, and the radiographic outcomes were assessed using stress radiography at 24 months postoperatively. The time to return to work and the failure rate were also evaluated and compared. RESULTS Follow-up was completed for 31 patients in the open group and 30 patients in the arthroscopic group. No significant differences were found between the two groups in terms of demographic characteristics, Beighton score (6.2 ± 1.9 vs. 5.5 ± 1.4, n.s.), or duration of symptoms. There were no significant differences in the functional scores before surgery and at 6, 12 and 24 months postoperatively or in the mean anterior translation of the talus and talar tilt angle on stress radiography at 24 months postoperatively between the open and arthroscopic groups. Compared to the open group, the arthroscopic group showed a significantly earlier return to work (6.8 ± 2.1 vs. 8.1 ± 2.4 weeks, p = 0.006). There was no significant difference in terms of the failure rate between the open and arthroscopic groups (16.1% vs. 23.3%, n.s.). CONCLUSION Arthroscopic modified Broström procedure achieved similar short-term outcomes to the open procedure for GJL patients. Arthroscopic modified Broström procedure showed an earlier return to work than the open modified Broström procedure and was an alternative to open surgery for CLAI patients with GJL. LEVEL OF EVIDENCE III. CLINICAL TRIAL REGISTRATION This study is a prospective study NCT05284188.
Collapse
Affiliation(s)
- An-Hong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yi-Chuan Zhu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| |
Collapse
|
9
|
Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes. Clin Orthop Surg 2023; 15:521-533. [PMID: 37529197 PMCID: PMC10375816 DOI: 10.4055/cios23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 08/03/2023] Open
Abstract
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
Collapse
Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| |
Collapse
|
10
|
Yılmaz N, Çukurlu M. The Association Between Joint Laxity and Post-Dural Puncture Headache. Cureus 2023; 15:e41304. [PMID: 37539432 PMCID: PMC10394969 DOI: 10.7759/cureus.41304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Objective This study aimed to investigate the relationship between joint laxity and post-dural puncture headache (PDPH). Methods A total of 123 patients with PDPH - 73 females and 50 males - were included in the study. The patients were examined regarding joint laxity and classified into two groups according to the Beighton score. Those with a Beighton score between 0 and 3 were classified as Group I, and those with a score greater than 4 were classified as Group II. Data related to the demographic characteristics of the patients, time of onset of PDPH, severity, need for medical treatment, need for an epidural blood patch, and length of hospital stay were recorded, and a comparison was made between the two groups. Results There was no significant difference between the groups in terms of age, gender distribution, and PDPH onset time (p>0.05). In Group II, which included patients positive for joint laxity, total headache duration, headache severity, need for medical treatment, need for epidural blood patch, and hospital stay were significantly higher than in Group I (p<0.05). Conclusion Joint laxity may increase the risk of PDPH after spinal anesthesia and may affect treatment processes. The Beighton score can determine the development and severity of PDPH in patients with joint laxity. Assessing joint laxity and Beighton score can improve clinical decision-making in managing PDPH and positively affect patient outcomes.
Collapse
Affiliation(s)
- Nezir Yılmaz
- Department of Anesthesiology and Reanimation, Adıyaman University Training and Research Hospital, Adıyaman, TUR
| | - Mustafa Çukurlu
- Department of Orthopaedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, TUR
| |
Collapse
|
11
|
Wilson JM, Markos JR, Krych AJ, Berry DJ, Trousdale RT, Abdel MP. Total Knee Arthroplasty in Patients Who had a Prior Anterior Cruciate Ligament Reconstruction: Balancing Remains the Issue. J Arthroplasty 2023; 38:S71-S76. [PMID: 36801476 PMCID: PMC10461606 DOI: 10.1016/j.arth.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Following anterior cruciate ligament (ACL) injury, 20% of patients will develop osteoarthritis. Despite this, there remains a paucity of data describing outcomes of total knee arthroplasty (TKA) after prior ACL reconstruction. We aimed to describe survivorships, complications, radiographic results, and clinical outcomes of TKA after ACL reconstruction in one of the largest series to date. METHODS We identified 160 patients (165 knees) who underwent primary TKA following prior ACL reconstruction between 1990 and 2016 using our total joint registry. The mean age at TKA was 56 years (range, 29-81), 42% were women, and their mean body mass index was 32. Ninety percent of knees were posterior-stabilized designs. Survivorship was assessed using the Kaplan-Meier method. The mean follow-up was 8 years. RESULTS The 10-year survivorships free of any revision and any reoperation were 92 and 88%, respectively. Seven patients were revised for instability (6 global and 1 flexion), 4 for infection, and 2 for other reasons. There were 5 additional reoperations: 3 manipulations under anesthesia, 1 wound debridement, and 1 arthroscopic synovectomy for patellar clunk. Nonoperative complications occurred in 16 patients, 4 of which were flexion instability. Radiographically, all nonrevised knees were well-fixed. Knee Society Function Scores significantly improved from preoperative to 5 years postoperative (P < .0001). CONCLUSION Survivorship of TKA in post-ACL reconstruction knees was lower than expected with instability being the most common reason for revision. In addition, the most common nonrevision complications were flexion instability and stiffness requiring manipulations under anesthesia, indicating that achieving soft tissue balance in these knees may be difficult.
Collapse
Affiliation(s)
- Jacob M. Wilson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - James R. Markos
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Robert T. Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| |
Collapse
|
12
|
Ma Y, Wu X, Shen S, Hong W, Qin Y, Sun M, Luan Y, Zhou X, Zhang B. Relationship between Locomotive Syndrome and Musculoskeletal Pain and Generalized Joint Laxity in Young Chinese Adults. Healthcare (Basel) 2023; 11:healthcare11040532. [PMID: 36833063 PMCID: PMC9956093 DOI: 10.3390/healthcare11040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
This study aims to investigate the prevalence of locomotive syndrome (LS) and to examine the relationship of LS with musculoskeletal symptoms (pain, generalized joint laxity (GJL)) in young Chinese adults. Our study population (n = 157; mean age of 19.8 ± 1.2 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Musculoskeletal pain was assessed by self-report and visual analog scale (VAS), and joint body laxity was evaluated using the GJL test. The prevalence of LS was 21.7% of all participants. Musculoskeletal pain affected 77.8% of the college students with LS and was strongly associated with LS. A total of 55.0% of college students with LS had four or more site joints that were positive for GJL, and higher scores of GJL were associated with a higher prevalence rate of LS. Young Chinese college students have a relatively high prevalence of LS, and musculoskeletal pain and GJL were significantly related to LS. The present results suggest that we need early screening of musculoskeletal symptoms and LS health education in young adults to prevent the mobility limitations of LS in the future.
Collapse
Affiliation(s)
- Yixuan Ma
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Xinze Wu
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi 980-8574, Japan
| | - Shaoshuai Shen
- School of Education and Welfare, Aichi Prefectural University, 1522-3 Ibaragabasama, Nagakute, Aichi 480-1198, Japan
| | - Weihao Hong
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Ying Qin
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Mingyue Sun
- Department of Physiotherapy, Planet Rehabilitation Center, Planet Rehabilitation Technology Co., Ltd., Guangzhou 510623, China
| | - Yisheng Luan
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Xiao Zhou
- School of Physical Education, Huazhong University of Science and Technology, Wuhan 430074, China
- Correspondence: (X.Z.); (B.Z.); Tel.: +86-138-0592-5552 (X.Z.); +86-135-2205-1883 (B.Z.)
| | - Bing Zhang
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
- Correspondence: (X.Z.); (B.Z.); Tel.: +86-138-0592-5552 (X.Z.); +86-135-2205-1883 (B.Z.)
| |
Collapse
|
13
|
Massy-Westropp C, Massy-Westropp N, Wechalekar H. Normative Values for Pinch Strength—Relationship With Joint Hypermobility as Measured With the Beighton Criteria. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
|
14
|
Stokes DJ, McCarthy TP, Frank RM. Physical Therapy for the Treatment of Shoulder Instability. Phys Med Rehabil Clin N Am 2023; 34:393-408. [PMID: 37003660 DOI: 10.1016/j.pmr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability is the separation of the humeral head from the glenoid. Injury to the static and dynamic stabilizers can result in instability. Anterior shoulder instability is the predominant form of instability. It is usually a result of trauma. Posterior shoulder instability often presents with an insidious onset of pain. Multidirectional instability of the shoulder is symptomatic laxity in more than one plane of motion. The primary goal of rehabilitation is to restore pain-free mobility, strength, and functioning. Rehabilitation implements range of motion and strengthening exercises to restore proprioceptive control and scapular kinematics.
Collapse
|
15
|
Higo A, Pearce G, Palmer S, Grant L. The value of dynamic elastomeric fabric orthoses in the management of a complex hypermobile Ehlers-Danlos syndrome patient: A case report. Clin Case Rep 2023; 11:e6821. [PMID: 36694653 PMCID: PMC9842784 DOI: 10.1002/ccr3.6821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023] Open
Abstract
The use of dynamic elastomeric fabric orthoses is examined in a young woman with hypermobile Ehlers-Danlos syndrome (hEDS) referred for physiotherapy with hip dysplasia, prior to a right periacetabular osteotomy. Dynamic elastomeric fabric orthoses plus rigorous subjective examination, therapists' listening skills, and patient-centered goals were useful for this hEDS patient.
Collapse
Affiliation(s)
- Anna Higo
- Centre for Healthcare ResearchCoventry UniversityCoventryUK,Physiocure Physiotherapy ClinicLeedsUK
| | - Gemma Pearce
- Centre for Healthcare ResearchCoventry UniversityCoventryUK
| | - Shea Palmer
- Centre for Care ExcellenceCoventry University and University Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | | |
Collapse
|
16
|
SHIOTANI HIROTO, TAKAHASHI KATSUKI, HONMA YUKI, TOMARI KAZUKI, HAYASHI HIDETAKA, SADO NATSUKI, KAWAKAMI YASUO. Mechanical Linkage between Achilles Tendon and Plantar Fascia Accounts for Range of Motion of Human Ankle-Foot Complex. Med Sci Sports Exerc 2023; 55:66-73. [PMID: 35977106 PMCID: PMC9770132 DOI: 10.1249/mss.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The human ankle-foot complex possesses a passive range of motion (ROM) through changes in tibiocalcaneal ( θcal ) and foot arch ( θarch ) angles. Based on the anatomical linkage between the Achilles tendon (AT) and plantar fascia (PF), we hypothesized that AT and PF with different mechanical properties conjointly modulate the passive ROM of the human ankle-foot complex. We examined the association of AT and PF stiffness with passive ankle-foot ROM and further addressed differences between sexes. METHODS A series of sagittal magnetic resonance images of the foot and passive ankle plantar flexion torque were obtained for 20 men and 20 women with their ankle-foot passively rotated from 30° of plantar flexion to 20° of dorsiflexion. Based on the measured changes in AT and PF lengths, θcal , θarch , and passive torque, AT and PF stiffness were determined. RESULTS Upon passive ankle dorsiflexion, AT and PF were lengthened; their length changes were inversely correlated. Men showed a stiffer AT, more compliant PF, less calcaneal rotation, and greater foot arch deformation compared with women. Furthermore, we found inverse correlations between AT stiffness and ROM of θcal , and between PF stiffness and ROM of θarch in men and women. CONCLUSIONS Passive AT and PF extensibility counter each other. AT and PF stiffness and passive ROM of ankle-foot components were countered between sexes; however, associations between stiffness and passive ROM of the ankle-foot complex were consistent between sexes. Our findings support the notion that the balanced mechanical interaction between the AT and PF can account for the passive ROM of the human ankle-foot complex in vivo , and the differences between sexes.
Collapse
Affiliation(s)
- HIROTO SHIOTANI
- Faculty of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Human Performance Laboratory, Comprehensive Research Organization of Waseda University, Tokyo, JAPAN
| | - KATSUKI TAKAHASHI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Research Fellow of Japan Society for the Promotion of Science, Tokyo, JAPAN
| | - YUKI HONMA
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - KAZUKI TOMARI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - HIDETAKA HAYASHI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - NATSUKI SADO
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, JAPAN
| | - YASUO KAWAKAMI
- Faculty of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Human Performance Laboratory, Comprehensive Research Organization of Waseda University, Tokyo, JAPAN
| |
Collapse
|
17
|
Sit RWS, Wu RWK, Ling SKK, Yung PSH, Wang B, Chan DCC, Yip BHK, Wong SYS, Reeves KD, Rabago D. A protocol for a randomized clinical trial assessing the efficacy of hypertonic dextrose injection (prolotherapy) in chronic ankle instability. Trials 2022; 23:1063. [PMID: 36581935 PMCID: PMC9800057 DOI: 10.1186/s13063-022-07037-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lateral ankle sprain (LAS) is a common injury. Conservative care is not uniformly effective. Chronic ankle instability (CAI) results in up to 70% of patients with LAS in the physically active population. LAS, together with subsequent osteochondral lesions and pain in many patients, leads to the development of post-traumatic osteoarthritis, resulting in a substantial direct and indirect personal and societal health burden. Dextrose prolotherapy (DPT) is an injection-based therapy for many chronic musculoskeletal conditions but has not been tested for CAI. This protocol describes a randomized controlled trial to test the efficacy of DPT versus normal saline (NS) injections for chronic ankle instability (CAI). METHODS AND ANALYSIS A single-center, parallel-group, randomized controlled trial will be conducted at a university-based primary care clinic in Hong Kong. A total of 114 patients with CAI will be randomly allocated (1:1) to DPT and NS groups. The primary outcome will be the Cumberland Ankle Instability Tool scores at 1 year. The secondary outcomes will be the number of re-sprains in 1 year, the Star Excursion Balance Test, the 5-level of EuroQol 5-dimension questionnaire, and the Foot and Ankle Ability Measure. All outcomes will be evaluated at baseline and at 16, 26, and 52 weeks using a linear mixed model. DISCUSSION We hypothesized the DPT is a safe, easily accessible, and effective treatment for patients with CAI. This RCT study will inform whether DPT could be a primary non-surgical treatment for CAI. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000040213 . Registered on 25 November 2020.
Collapse
Affiliation(s)
- Regina Wing Shan Sit
- The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
| | - Ricky Wing Keung Wu
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China ,The Hong Kong Insititute of Musculoskeletal Medicine, Hong Kong, China
| | - Samuel Ka Kin Ling
- grid.10784.3a0000 0004 1937 0482The Department of Orthopedic and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu Hang Yung
- grid.10784.3a0000 0004 1937 0482The Department of Orthopedic and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Bo Wang
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Dicken Cheong Chun Chan
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Hon Kei Yip
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung Shan Wong
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | | | - David Rabago
- grid.29857.310000 0001 2097 4281Department of Family and Community Medicine, Pennsylvania State University, Hershey, USA
| |
Collapse
|
18
|
Taylor-Gjevre RM, Nair B, Lourens JA, Leswick D, Obaid H. Early Detection of First Carpometacarpal Joint Osteoarthritis Using Magnetic Resonance Imaging Assessment in Women With High Hypermobility Scores. J Clin Rheumatol 2022; 28:402-408. [PMID: 35981296 DOI: 10.1097/rhu.0000000000001892] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore association between hypermobility and osteoarthritis (OA) at the first carpometacarpal (CMC) joint, using magnetic resonance imaging (MRI) to identify early change in women at high risk of developing OA but without yet established diagnoses. METHODS For this observational study, 33 women (aged 30-50 years) with self-reported history of maternal hand OA but without personal diagnoses of OA were recruited. Participants completed a 5-point hypermobility questionnaire. The 20 participants with 2 or more positive responses were categorized with "high hypermobility scores." The remaining 13 were categorized with "low hypermobility scores." Data collection included functional index, hand pain measure, parity, smoking status, and body mass index. Each participant underwent dominant hand radiographic and MRI examination. Imaging studies were interpreted by assessors blinded to hypermobility score categorization. RESULTS No significant differences in age, body mass index, parity, functional index, or pain scores were observed between higher and lower hypermobility score groups. Similarly, there were no significant differences between groups for radiographic changes. However, significantly higher proportions of women with higher hypermobility scores were observed on MRI to have abnormalities of trapezium cartilage (75% vs. 38%), metacarpal cartilage (80% vs. 38%), and trapezium bone (70% vs. 31%); p < 0.05 for all. CONCLUSIONS First CMC joint structural abnormalities were more frequently observed in women with higher hypermobility scores. Identification of early preradiographic changes in this group supports the concept that early-life joint laxity may contribute to future OA predisposition. Magnetic resonance imaging may be a preferred imaging test for detection of early cartilage changes in people at high risk of CMC joint OA.
Collapse
Affiliation(s)
| | - Bindu Nair
- From the Division of Rheumatology, Department of Medicine
| | | | - David Leswick
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Haron Obaid
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
19
|
Zeng X, Zhong G, Xie Z, Jiang Y, Chen W, Zhou Z, Ma L, Yang T, Huang W, Zhang Y. Upslope walking increases anterior tibial translation deficiency in patients with generalized joint hypermobility. Gait Posture 2022; 98:9-16. [PMID: 36027736 DOI: 10.1016/j.gaitpost.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/22/2022] [Accepted: 08/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is a highly prevalent disease that frequently affects the knee joint. The current literature has conflicting results about whether patients with GJH had knee kinematics deficiency during gait. This could be because most of the testing environment (level walking) was gentle and low-demanding for patients when studying their knee kinematics. With a high-demanding knee function and sagittal firm structure requirement, upslope walking was thought to stimulate sagittal knee kinematics deficiency in patients with GJH. RESEARCH QUESTIONS However, only little investigation reported whether upslope walking could stimulate knee kinematic deficiency or not. We hypothesize that upslope walking can increase sagittal knee kinematic deficiency between GJH subjects and healthy controls. METHODS A three-dimensional motion analysis was conducted to explore whether upslope walking could stimulate sagittal knee kinematic deficiency in patients with GJH. A total of 44 patients with GJH and 44 healthy controls were recruited. Subjects walked on both level and upslope (15%) conditions when the kinematic data were collected. SPM1D analysis was taken to explore the differences between groups. RESULTS Our results showed that upslope walking could significantly increase knee flexion angle and anterior tibial translation in both GJH patients and healthy controls (p < 0.05). The increments of anterior tibial translation (values in upslope walking minus values in level walking) of GJH patients were greater than those of healthy controls (magnitude varying from 2.5 to 2.9 mm during 0-3% gait cycles (GC), p = 0.034; 1.4-2.9 mm during 93-100%GC, p = 0.012). SIGNIFICANCES The findings partially confirmed our hypothesis and suggested that upslope walking could increase anterior tibial translation deficiency in patients with GJH. Upslope walking may be a practical motion task in studying the weakness of knee kinematics of GJH subjects for researchers and scholars. Patients with GJH may face a more challenging knee kinematic environment than healthy controls in up-sloped activities.
Collapse
Affiliation(s)
- Xiaolong Zeng
- School of medicine, South China University of Technology, Guangzhou 510006, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515041, China
| | - Zhenyan Xie
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515041, China
| | - Yuxuan Jiang
- Shantou University Medical College, Shantou 515041, China
| | - Wentao Chen
- Shantou University Medical College, Shantou 515041, China
| | - Zhongming Zhou
- Shantou University Medical College, Shantou 515041, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
| | - Yu Zhang
- School of medicine, South China University of Technology, Guangzhou 510006, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
| |
Collapse
|
20
|
Lee JH, Houck DA, Gruizinga BA, Garabekyan T, Jesse MK, Kraeutler MJ, Mei-Dan O. Correlation of Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) Value With Hip Arthroscopy Intraoperative Findings and Midterm Periacetabular Osteotomy Outcomes. Orthop J Sports Med 2022; 10:23259671221117606. [PMID: 36081408 PMCID: PMC9445473 DOI: 10.1177/23259671221117606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an advanced imaging technique that is purported to quantify cartilage damage in acute and chronic joint disease and predict periacetabular osteotomy (PAO) outcomes. There is a paucity of literature relating dGEMRIC values to arthroscopic findings before PAO and postoperative outcomes after PAO. Purpose: To assess the utility and validity of dGEMRIC as a preoperative and prognostic assessment tool of cartilage status and integrity as it relates to intraoperative findings and midterm postoperative outcomes after PAO. Study Design: Case series; Level of evidence, 4. Methods: We analyzed a cohort of 58 patients (70 hips) with a median age of 30.1 years (range, 15-50) with hip dysplasia who underwent hip arthroscopy, followed by a PAO with preoperative dGEMRIC. The primary outcome measures were intraoperative assessment and correlation with cartilage damage (presence of cartilage flap, Outerbridge grade of the acetabulum and femoral head). Secondary outcome measures were postoperative patient-reported outcome (PRO) scores, including the International Hip Outcome Tool and Non-arthritic Hip Score. Correlation analyses were performed to determine the relationship between dGEMRIC values and (1) PROs and (2) intraoperative assessment of cartilage damage. Results: There were significant negative linear relationships between dGEMRIC values and the primary outcome measures: presence of a cartilage flap (coronal, P = .004; sagittal, P < .001), Outerbridge grade of acetabular articular cartilage lesion (coronal, P = .002; sagittal, P = .003), and Outerbridge grade of femoral head articular cartilage lesion (coronal, P = .001; sagittal, P < .001). Despite significant overall improvement in all patients, there was no significant correlation between preoperative dGEMRIC values and improvement in PROs from presurgery to latest postoperative follow-up (median, 2.2 years; range, 1.0-5.0 years). Conclusion: Although dGEMRIC values (sagittal and coronal) were significant predictors of the intraoperative presence of cartilage flaps and overall cartilage integrity, they were not associated with midterm outcomes after PAO.
Collapse
Affiliation(s)
- Jessica H. Lee
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Darby A. Houck
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Brandt A. Gruizinga
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Mary K. Jesse
- Department of Radiology, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Matthew J. Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Omer Mei-Dan
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
21
|
Bajaj A, Blum K, Bowirrat A, Gupta A, Baron D, Fugel D, Nicholson A, Fitch T, Downs BW, Bagchi D, Dennen CA, Badgaiyan RD. DNA Directed Pro-Dopamine Regulation Coupling Subluxation Repair, H-Wave® and Other Neurobiologically Based Modalities to Address Complexities of Chronic Pain in a Female Diagnosed with Reward Deficiency Syndrome (RDS): Emergence of Induction of “Dopamine Homeostasis” in the Face of the Opioid Crisis. J Pers Med 2022; 12:jpm12091416. [PMID: 36143203 PMCID: PMC9503998 DOI: 10.3390/jpm12091416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Addiction is a complex multifactorial condition. Established genetic factors can provide clear guidance in assessing the risk of addiction to substances and behaviors. Chronic stress can accumulate, forming difficult to recognize addiction patterns from both genetic and epigenetic (environmental) factors. Furthermore, psychological/physical/chemical stressors are typically categorized linearly, delaying identification and treatment. The patient in this case report is a Caucasian female, aged 36, who presented with chronic pain and partial disability following a surgically repaired trimalleolar fracture. The patient had a history of unresolved attention deficit disorder and an MRI scan of her brain revealed atrophy and functional asymmetry. In 2018, the patient entered the Bajaj Chiropractic Clinic, where initial treatment focused on re-establishing integrity of the spine and lower extremity biomechanics and graduated into cognitive behavior stabilization assisted by DNA pro-dopamine regulation guided by Genetic Addiction Risk Severity testing. During treatment (2018–2021), progress achieved included: improved cognitive clarity, focus, sleep, anxiety, and emotional stability in addition to pain reduction (75%); elimination of powerful analgesics; and reduced intake of previously unaddressed alcoholism. To help reduce hedonic addictive behaviors and pain, coupling of H-Wave with corrective chiropractic care seems prudent. We emphasize the importance of genetic assessment along with attempts at inducing required dopaminergic homeostasis via precision KB220PAM. It is hypothesized that from preventive care models, a new standard is emerging including self-awareness and accountability for reward deficiency as a function of hypodopaminergia. This case study documents the progression of a patient dealing with the complexities of an injury, pain management, cognitive impairment, anxiety, depression, and the application of universal health principles towards correction versus palliative care.
Collapse
Affiliation(s)
- Anish Bajaj
- Bajaj Chiropractic Clinic, New York, NY 10010, USA
| | - Kenneth Blum
- Division of Addiction Research & Education, Center for Psychiatry, Medicine, and Primary Care, (Office of the Provost), Western University Health Sciences, Pomona, CA 91766, USA
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA
- Correspondence:
| | - Abdalla Bowirrat
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Psychiatry, Medicine, and Primary Care, (Office of the Provost), Western University Health Sciences, Pomona, CA 91766, USA
| | - David Fugel
- Bajaj Chiropractic Clinic, New York, NY 10010, USA
| | | | - Taylor Fitch
- Bajaj Chiropractic Clinic, New York, NY 10010, USA
| | - B. William Downs
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, Long School of Medicine, University of Texas Medical Center, San Antonio, TX 78229, USA
| | - Debasis Bagchi
- Department of Pharmaceutical Sciences, Southern University College of Pharmacy, Houston, TX 77004, USA
| | - Catherine A. Dennen
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, Long School of Medicine, University of Texas Medical Center, San Antonio, TX 78229, USA
| |
Collapse
|
22
|
Hershkovich O, Gordon B, Derazne E, Tzur D, Afek A, Lotan R. Symptomatic Joint Hypermobility Is Associated with Low Back Pain: A National Adolescents Cohort Study. J Clin Med 2022; 11:jcm11175105. [PMID: 36079031 PMCID: PMC9456634 DOI: 10.3390/jcm11175105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Low back pain (LBP) is a widespread medical complaint affecting many people worldwide and costing billions. Studies suggest a link between LBP and joint hypermobility. This study aimed to examine the association between symptomatic joint hypermobility (SJH), LBP, and gender. Methods: Data were obtained from a medical database containing 17-year-old candidates’ records before recruitment into mandatory military service. According to the Regulations of Medical Fitness Determination, information on disability codes associated with LBP and SJH was retrieved. Results: According to this national survey, the prevalence of SJH is 0.11% (1355 cases out of 1,220,073 subjects). LBP was identified in 3.7% of the cohort (44,755 subjects). Subjects were further subdivided into LBP without objective findings (LBPWF) (3.5%) and LBP with objective findings (LBPOF) (0.2%). The association between SJH and LBP was examined: the Odds Ratio (OR) was 2.912 (p < 0.0001). The odds rations for LBPWF and LBPOF were further calculated to be 2.914 (p < 0.000) and 2.876 (p < 0.000), respectively. Subjects with SJH were almost three times more prone to LBPWF and LBPOF. Conclusion: SJH is strongly associated with LBP in young adults. Further pathophysiological research is needed.
Collapse
Affiliation(s)
- Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Ha-Lokhamim St 62, Holon 5822012, Israel
- Medical Corps, Israeli Defense Forces, Jerusalem 9112102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-5028383; Fax: +972-3-5028774
| | - Barak Gordon
- Medical Corps, Israeli Defense Forces, Jerusalem 9112102, Israel
- Department of Military Medicine, Faculty of Medicine, Institute for Research in Military Medicine (IRMM), The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Estela Derazne
- Medical Corps, Israeli Defense Forces, Jerusalem 9112102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit Tzur
- Medical Corps, Israeli Defense Forces, Jerusalem 9112102, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Ha-Lokhamim St 62, Holon 5822012, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
23
|
Long M, Kiru L, Kassam J, Strutton PH, Alexander CM. An investigation of the control of quadriceps in people who are hypermobile; a case control design. Do the results impact our choice of exercise for people with symptomatic hypermobility? BMC Musculoskelet Disord 2022; 23:607. [PMID: 35739514 PMCID: PMC9219138 DOI: 10.1186/s12891-022-05540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background People with symptomatic hypermobility have altered proprioception however, the origin of this is unclear and needs further investigation to target rehabilitation appropriately. The objective of this investigation was to explore the corticospinal and reflex control of quadriceps and see if it differed between three groups of people: those who have symptomatic hypermobility, asymptomatic hypermobility and normal flexibility. Methods Using Transcranial Magnetic Stimulation (TMS) and electrical stimulation of peripheral nerves, motor evoked potentials (MEPs) and Hoffman (H) reflexes of quadriceps were evoked in the three groups of people. The threshold and latency of MEPs and the slope of the input–output curves and the amplitude of MEPs and H reflexes were compared across the groups. Results The slope of the input–output curve created from MEPs as a result of TMS was steeper in people with symptomatic hypermobility when compared to asymptomatic and normally flexible people (p = 0.04). There were no other differences between the groups. Conclusion Corticospinal excitability and the excitability at the motoneurone pool are not likely candidates for the origin of proprioceptive loss in people with symptomatic hypermobility. This is discussed in the light of other work to suggest the receptor sitting in hypermobile connective tissue is a likely candidate. This suggests that treatment aimed at improving receptor responsiveness through increasing muscle tone, may be an effective rehabilitation strategy.
Collapse
Affiliation(s)
- Michael Long
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Louise Kiru
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jamila Kassam
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul H Strutton
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Therapies, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK.
| |
Collapse
|
24
|
Porter MD, Trajkovska A, Georgousopoulou E. Ligament Augmentation Reconstruction System (LARS) for Ankle Lateral Ligament Reconstruction in Higher-Risk Patients: A 5-Year Prospective Cohort Study. Orthop J Sports Med 2022; 10:23259671221093968. [PMID: 35571967 PMCID: PMC9092589 DOI: 10.1177/23259671221093968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The modified Broström-Gould (MBG) procedure is the gold standard for patients
with chronic ankle instability (CAI), but it is relatively contraindicated
for patients with higher body weight or generalized ligamentous laxity
(GLL). The use of the ligament augmentation reconstruction system (LARS) is
an alternative. Hypothesis: It was hypothesized that clinical outcomes would be similar in patients with
increased body weight (>90 kg) or GLL, relative to controls. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 66 patients satisfying the inclusion criteria were invited to
participate and were divided into 3 groups: controls (no risk factors for
inferior clinical outcome), patients with body weight >90 kg, and
patients with GLL (Beighton score, ≥5 of 9). All patients underwent
imbrication of the lateral collateral ligament complex augmented with the
LARS. Primary outcomes of interest were Tegner activity scale (TAS) and Foot
and Ankle Outcome Score (FAOS) subscale scores. Secondary outcomes were
recurrence of ankle instability, the need for further surgery, and/or
complications. Patients were reviewed at 2 and 5 years postoperatively, and
outcomes between groups were compared using repeated-measures analysis of
variance. Results: Complete data were available for 63 patients (21 patients in each group). TAS
improved in all groups from preoperatively to 2 years and 5 years
postoperatively (P < .001 for all). Relative to the
controls, the TAS scores were lower in the >90-kg group at 2 years and 5
years (P < .001 for both periods), while the GLL group
had similar scores to controls at both postoperative periods. Both the
>90-kg and the GLL groups showed no significant difference in improvement
on any FAOS subscale scores relative to the controls, at both 2 and 5 years
postoperatively. There were no recurrences, repeat surgeries, or major
complications. Conclusion: Relative to controls, patients with body weight >90 kg or GLL had similar
FAOSs, and TAS scores were lower in the >90-kg group, at 2 and 5 years,
after the use of the LARS to augment lateral collateral ligament imbrication
for CAI. Use of the LARS in this manner is a viable option in patients for
whom the MBG procedure is relatively contraindicated.
Collapse
Affiliation(s)
- Mark D. Porter
- Canberra Orthopaedics and Sports Medicine, Deakin, Australian Capital Territory, Australia
| | | | | |
Collapse
|
25
|
Plantar Venous Pump Activity, Generalized Joint Hypermobility, and Foot Mobility in Ballerinas: A Case-Control Study. J Sport Rehabil 2022; 31:582-588. [PMID: 35245893 DOI: 10.1123/jsr.2021-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT The plantar venous pump (PVP) is a vascular network located between the muscles of the foot arch. It has been suggested foot mobility is critical for PVP activation. OBJECTIVE This study investigates the effect of generalized joint hypermobility (GJH) on foot mobility and PVP activity in ballerinas and to determine how a short-term warm-up exercise impacts these parameters in the presence of GJH. DESIGN Prospective study. METHODS Twelve ballerinas (age = 16.73 [1.8] y) and 15 non-dancer-matched controls (age = 16.31 [2.1] y) were included. When performing weight-bearing activities, venous return parameters (diameter, velocity, and flow volume) from the posterior tibial vein were measured using color and spectral Doppler ultrasonography. Foot mobility was determined using navicular drop test. The participants performed a 10-minute cycling exercise to reveal its effect on reducing tissue stiffness. All measurements were performed synchronously and twice-before and after the cycling exercise. RESULTS The results showed the navicular height obtained before and after exercise in the ballerinas was significantly different compared with that obtained in the sitting position, and the values obtained in the 3 measurement positions in the nondancer group were significantly different from each other (P < .05). The difference between the venous diameter values measured before and after exercise and the reference value was significant in both groups (P < .001). There was a significant decrease in venous velocity following exercise in the nondancer group (P = .044). The venous volume values obtained after exercise were significantly different between the groups (P = .039). CONCLUSIONS The GJH has no distinctive effect on foot mobility and PVP activity in ballerinas. The presence of GJH did not influence the effect of short-term warm-up exercise on foot mobility and PVP activity. We believe that measuring the navicular drop and venous return with a more precise synchronization may provide additional information regarding the link between arch tension and venous return.
Collapse
|
26
|
Krueger VS, Shigley C, Bokshan SL, Owens BD. Humeral Avulsion of the Glenohumeral Ligament: Diagnosis and Management. JBJS Rev 2022; 10:01874474-202202000-00002. [PMID: 35113820 DOI: 10.2106/jbjs.rvw.21.00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The most common type of humeral avulsion of the glenohumeral ligament (HAGL) is a purely ligamentous avulsion involving the anterior inferior glenohumeral ligament (IGHL), but other variants are seen, including posterior lesions and those with an osseous avulsion. » A central lesion between the intact anterior and posterior bands of the IGHL is gaining recognition as a distinct clinical entity. » HAGL lesions are most commonly seen in patients with anterior instability without a Bankart tear or in those with persistent symptoms despite having undergone a Bankart repair. » Magnetic resonance imaging is the most sensitive imaging modality. An arthrogram is helpful with subacute and chronic lesions when the joint is not distended. Arthroscopy is the gold standard for diagnosis. » While some have reported success with nonoperative management, surgical repair with either arthroscopic or open techniques has provided a high rate of successful outcomes; however, the literature is limited to mostly Level-IV and V evidence.
Collapse
Affiliation(s)
- Van S Krueger
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | | | | | | |
Collapse
|
27
|
Abstract
OBJECTIVE In this narrative review, we highlight sex-specific anatomic and biomechanical features of the hip region in female athletes, as well as the potential impact of these characteristics on observed disparities in both intra-articular and extra-articular injury patterns between female and male athletes. It is our goal to broaden the scope of knowledge related to hip pathology in active female athletes among sports medicine providers with the hope of better optimizing sport participation and performance in female athletes. DATA SOURCES A literature review was conducted using PubMed database and Google Scholar search engine. Search terms included sport, female, athlete, sex differences, injury, hip, and all diagnoses discussed in this review. Cross-reference of these articles identified additional resources. MAIN RESULTS Sex-specific differences in both static design and dynamic function contribute to disparities in hip injury patterns between female and male athletes. Intra-articular injuries, including labral and ligamentum teres pathology, as well as extra-articular injuries, including iliopsoas tendon dysfunction, gluteal and proximal hamstring tendinopathy, ischiofemoral impingement, bone stress injuries, and certain nerve entrapment syndromes, seem to affect female athletes more commonly than male counterparts. CONCLUSIONS Given unique anatomic and functional considerations, the growing population of female athletes worldwide warrants specialized care and consideration. Potential predisposition to specific hip injuries should be taken into consideration during diagnostic evaluation of hip pain in the female athlete.
Collapse
|
28
|
Zhang ZY, Wang C, Maimaitimin M, Huang HJ, Pan XY, Maimaitijiang P, He ZY, Wang XW, Zhang X, Wang JQ. Anterior and rotational tibial subluxation in the setting of anterior cruciate ligament injuries: An MRI analysis. Knee 2021; 33:365-373. [PMID: 34753026 DOI: 10.1016/j.knee.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/10/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The relationship between preoperative tibiofemoral position and failure of anterior cruciate ligament (ACL) reconstruction has been widely discussed. Most established methods for measuring tibiofemoral position on magnetic resonance imaging (MRI) mainly focus on anterior tibial subluxation (ATS), while a quantitative measuring method for rotational tibial subluxation (RTS) is still undetermined. Moreover, there are still controversies about the related factors for ATS. The aim of this study was to quantitatively describe preoperative ATS and RTS in ACL-injured and ACL-intact knees and identify the related factors for ATS and RTS based on MRI images. METHODS Demographic data and preoperative MRIs of 104 ACL-injured patients were retrospectively analyzed. ACL-intact knees were 1:1 matched as control group. ATS was measured using longitudinal tibial axis, and RTS was determined by the difference between lateral and medial ATS. Related factors for ATS and RTS were examined. RESULTS Increased lateral ATS (P < 0.0001), medial ATS (P < 0.0001) and RTS (P = 0.0479) were observed in ACL-injured knees compared with the control group. Increased posterior tibial slope (PTS), Beighton Score ≥ 4, presence of meniscal injury and long injury-to-MRI time were identified as being correlated with the increase of ATS. Factors for the increase of RTS were increased lateral PTS, Beighton score ≥ 4, presence of lateral meniscal injury, and left side. CONCLUSIONS In ACL-injured knees, tibia not only subluxated anteriorly in both lateral and medial compartments, but also rotated internally. During preoperative planning, attentions should be paid to the factors that are correlated with altered tibiofemoral position.
Collapse
Affiliation(s)
- Zhi-Yu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Xiao-Yu Pan
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Pakezhati Maimaitijiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zi-Yi He
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Xue-Wen Wang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China.
| |
Collapse
|
29
|
The Effectiveness of Physical Therapy in Patients with Generalized Joint Hypermobility and Concurrent Temporomandibular Disorders-A Cross-Sectional Study. J Clin Med 2021; 10:jcm10173808. [PMID: 34501255 PMCID: PMC8432079 DOI: 10.3390/jcm10173808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 01/06/2023] Open
Abstract
Temporomandibular disorders (TMD) consist of a group of symptoms such as: pain of temporomandibular joints, masticatory muscles or surrounding tissues, dysfunctions of TMJs’ mobility, and crepitation. The Hypermobility Joint Syndrome (HJS) manifests in the flaccidity of joint structures, an increase in the range of joint motion, and occurs more often in the young and women. The aim of this study was to present the occurrence of HJS among patients with myogenic TMD and disc displacement with reduction. The secondary goal was to assess the effectiveness of physiotherapy directed to TMD with coexisting HJS. The study involved 322 patients with symptoms of TMD. HJS was diagnosed using the Beighton Scale, which confirmed its occurrence in 26 cases. 79 subjects (7 males and 72 females; mean age, 33.9 ± 10.4 years) were selected and divided into two groups: HJS + TMD (n = 26; 2 males and 24 females; mean age, 27.1 ± 9.4 years) and TMD (n = 53; 5 males and 48 females; mean age, 37.4 ± 9.2 years). These patients completed 3-week physiotherapy management. Before and after physiotherapy, the myofascial pain severity on Numeric Pain Rating Scale, linear measurement of maximum mouth opening, and opening pattern, were assessed. To demonstrate differences between the results, the level of significance for statistical analysis was set at α = 0.05. A statistically significant improvement was obtained in decreasing myofascial pain in both groups. Coordination of mandibular movements was achieved in both groups. Generalized joint hypermobility occurred among patients with TMD. Physiotherapy directed to TMD was effective in reducing myofascial pain and restoring TMJ’s coordination also in patients with HJS.
Collapse
|
30
|
Teo BJX, Gatot C, Cheng DZC, Koo K. Location of Talar Osteochondral Defects in Chronic Lateral Ankle Instability in an Asian Population. J Foot Ankle Surg 2021; 60:689-691. [PMID: 33546989 DOI: 10.1053/j.jfas.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/20/2020] [Accepted: 01/13/2021] [Indexed: 02/03/2023]
Abstract
Osteochondral defect of the talus is traditionally described to involve the anterolateral and posteromedial portion of the talar dome in patients with chronic lateral ankle instability. Recent studies challenged this notion with advances in preoperative imaging and arthroscopy. Since Asian patients are more prone to ligamentous laxity, we postulate that the morphology and severity of osteochondral defects may be different in this population. Intraoperative records of 272 patients undergoing modified Broström-Gould procedure were reviewed for arthroscopic evidence of osteochondral defects. We characterized the morphology according to an anatomical 9-grid classification. Talar osteochondral defects were seen in 52 (19.1%) patients with a double lesion present in 1 patient. Medial-sided lesions account for nearly 3-quarters (n = 38, 73.1%) of all lesions and tend to be larger (79.4 ± 55.7 mm2 vs 51.0 ± 28.6 mm2, p =.08). There was no osteochondral defect seen in the central zones. There was no significant gender or age differences between patients with medial and lateral lesions. The most commonly performed procedure was microfracture. Osteochondral defects are commonly encountered in our Asian patients undergoing surgery for chronic lateral ankle instability. Contrary to published data, medial lesions are prevalent with no central lesions seen.
Collapse
Affiliation(s)
- Bryon J X Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Daryl Z C Cheng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore; The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
| |
Collapse
|
31
|
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Describe a comprehensive spine telemedicine examination. METHODS We discuss telemedicine examination techniques for commonly encountered spine conditions. RESULTS Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment. CONCLUSIONS While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.
Collapse
Affiliation(s)
- Alexander M. Satin
- Texas Back Institute, Plano, TX, USA,Alexander M. Satin, Texas Back Institute, 6020 West Parker Road, #200, Plano, TX 75093, USA.
| | | |
Collapse
|
32
|
Guimarães RB, Filho CRC, Norberto AR, Salatini R, Zangirolami-Raimundo J, Raimundo RD. Relationship of the mobility of the sacroiliac joint with foot plant pressure. J Phys Ther Sci 2021; 33:444-449. [PMID: 34177106 PMCID: PMC8219602 DOI: 10.1589/jpts.33.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
[Purpose] To evaluate mobility of the sacroiliac joint and plantar pressure changes.
[Participants and Methods] This was an analytical study comprised of 300 participants,
using a functional kinetic evaluation involving the test of standing flexion (SFT), the
test of Downing, the test of Gillet, and the analysis of baropodometry. [Results] There
was an association between mobility of the sacroiliac joint and the standing center of
gravity. However, the mobility of this joint was not associated with plantar pressure and
the plantar contact area. [Conclusion] These data suggest that sacroiliac mobility is
linked to the center of gravity. This connection may precede sacroiliac dysfunction and
may help to improve the accuracy of the tests.
Collapse
Affiliation(s)
| | | | - Alex Rey Norberto
- Departamento de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Renata Salatini
- Laboratório de Delineamento de Estudo e Escrita Científica, Faculdade de Medicina do ABC: Avenida Príncipe de Gales, 667, Príncipe de Gales, Santo André, CEP 09060-590, Brazil
| | - Juliana Zangirolami-Raimundo
- Departamento de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil.,Laboratório de Delineamento de Estudo e Escrita Científica, Faculdade de Medicina do ABC: Avenida Príncipe de Gales, 667, Príncipe de Gales, Santo André, CEP 09060-590, Brazil
| | - Rodrigo Daminello Raimundo
- Laboratório de Delineamento de Estudo e Escrita Científica, Faculdade de Medicina do ABC: Avenida Príncipe de Gales, 667, Príncipe de Gales, Santo André, CEP 09060-590, Brazil
| |
Collapse
|
33
|
Labèr R, Reissner L, Nagy L, Schweizer A. Feasibility of ultrasound-based measurement of dorsal scaphoid displacement: A 3D-model study. HAND SURGERY & REHABILITATION 2021; 40:595-601. [PMID: 34058396 DOI: 10.1016/j.hansur.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
The present study aimed to develop a reliable dynamic measurement technique, which can be used directly in the outpatient setting, based on dorsal subluxation of the scaphoid on scaphoid shift test. This study was designed to evaluate feasibility and to quantify dorsal subluxation of the scaphoid in relation to the lunate. Based on a scaphoid shift test under ultrasonography, a standardized 3D test model was developed to measure subluxation. Sagittal subluxation ranged between 0 and 6 mm, as checked on the implemented scale. Four hand surgeons trained in ultrasonography (experience level II-V) performed blinded measurements (total of 52, n = 13 per investigator) with a standardized measurement protocol. Dorsal subluxation of the scaphoid was measured in relation to the lunate. Interobserver reliability on intraclass correlation coefficient (ICC) was excellent, at 0.97 (95% confidence interval, 0.930-0.992). Mean overall absolute measurement error was 0.27 mm ± 0.21. Dorsal subluxation of the scaphoid can thus be accurately measured on ultrasound with excellent interobserver reliability, quantifying and improving clinical assessment of scapholunate instability.
Collapse
Affiliation(s)
- R Labèr
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - L Reissner
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - L Nagy
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - A Schweizer
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| |
Collapse
|
34
|
Clinical assessment of generalized ligamentous laxity using a single test: is thumb-to-forearm apposition enough? J Pediatr Orthop B 2021; 30:296-300. [PMID: 32301823 DOI: 10.1097/bpb.0000000000000732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The complete Beighton criteria, commonly used to establish the diagnosis of generalized ligamentous laxity (GLL), include nine discrete examination maneuvers. However, busy examiners may perform only a single maneuver (e.g. passive apposition of the thumb to the forearm) as a rapid method of assessment. We hypothesize that the use of a single-joint hypermobility test does not reliably identify the presence of GLL. Healthy patients 2-18 years old presenting to a general pediatric orthopaedic clinic were screened for participation. Exclusion criteria included the presence of a systemic illness, neuromuscular disease, and inability to complete the examination. Subjects were assessed for GLL according to the Beighton criteria, using a cutoff score of 5. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated for the thumb-to-forearm apposition test with the composite Beighton score used as the gold standard. Two hundred and four patients were included in the study, 111 females and 93 males, with an average age of 10.7 years. The prevalence of GLL was 13.3%. When thumb-to-forearm apposition was performed unilaterally, the PPV was poor (34%). Conversely, the NPV was excellent (99%). Sensitivity of thumb-to-forearm motion was extremely high (99%), although the specificity of this test was modest (67%). The likelihood ratio was fair (+3.3). Performing the test bilaterally did not significantly change its utility. Thumb-to-forearm apposition testing was equally effective in identifying the presence of GLL in males and females. When performed in isolation, assessment of thumb-to-forearm apposition has a poor PPV, excellent NPV, and modest likelihood ratio. It is an extremely sensitive test, with only fair specificity. Other upper extremity tests of GLL perform similarly. Therefore, while single tests like thumb-to-forearm apposition may be helpful for 'ruling out' GLL, they are less reliable at identifying it correctly. When single tests are used to identify GLL in either clinical or research settings, the results should be interpreted with caution. Level of evidence Level I (diagnostic).
Collapse
|
35
|
Wessel LE, Eliasberg CD, Bowen E, Sutton KM. Shoulder and elbow pathology in the female athlete: sex-specific considerations. J Shoulder Elbow Surg 2021; 30:977-985. [PMID: 33220412 DOI: 10.1016/j.jse.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
Unique biologic and biomechanical aspects of the female body make women more prone to certain orthopedic injuries. Sex differences are well understood with regard to certain orthopedic pathologies such as anterior cruciate ligament injury, hallux valgus, carpal tunnel, and carpometacarpal joint arthritis; however, sex differences are less commonly discussed with regard to shoulder and elbow pathology. The purpose of this review is to elucidate sex differences specific to sports-related shoulder and elbow injuries in the female athlete population.
Collapse
Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Edward Bowen
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karen M Sutton
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| |
Collapse
|
36
|
侯 宗, 敖 英, 胡 跃, 焦 晨, 郭 秦, 黄 红, 任 爽, 张 思, 谢 兴, 陈 临, 赵 峰, 皮 彦, 李 楠, 江 东. [Characteristics and related factors of plantar pressure in the chronic ankle instability individuals]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:279-285. [PMID: 33879898 PMCID: PMC8072434 DOI: 10.19723/j.issn.1671-167x.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals. METHODS From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed. RESULTS The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side (P>0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area (t=-3.86, P=0.03) of the affected side, lower peak force in the 1st (t=2.99, P=0.02), 2nd metatarsal head areas (t=2.09, P=0.01) of the affected side, medial hindfoot areas of both sides (affected, t=2.33, P=0.01; unaffected, t=3.74, P=0.02) and toes areass of both sides (affected, t=2.23, P=0.01; unaffected, t=3.28, P=0.02) and a delay to peak force in the 4th metatarsal head area (t=3.33, P=0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction (P < 0.05) and lateral/medial direction (P < 0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction (P < 0.05). (3) The women (P < 0.05) and the individuals with higher Beighton scores (P < 0.05) showed worse balance control deficit in the lateral/medial direction. CONCLUSION CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.
Collapse
Affiliation(s)
- 宗辰 侯
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 英芳 敖
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 跃林 胡
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 晨 焦
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 秦炜 郭
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 红拾 黄
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 爽 任
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 思 张
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 兴 谢
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 临新 陈
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 峰 赵
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 彦斌 皮
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 楠 李
- 临床流行病学研究中心,北京 100191Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - 东 江
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|
37
|
Haskel JD, Kaplan DJ, Kirschner N, Fried JW, Samim M, Burke C, Youm T. Generalized Joint Hypermobility Is Associated With Decreased Hip Labrum Width: A Magnetic Resonance Imaging-Based Study. Arthrosc Sports Med Rehabil 2021; 3:e765-e771. [PMID: 34195643 PMCID: PMC8220610 DOI: 10.1016/j.asmr.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the relationship between generalized joint hypermobility and hip labrum width. Methods A retrospective review was performed of a single-surgeon database containing patients who underwent hip arthroscopy between 2014 and 2017. Patients were assessed for generalized laxity via Beighton Test Scoring (BTS), which tests for hyperextension of the fifth metacarpophalangeal joint, thumb apposition, elbow hyperextension, knee hyperextension, and trunk flexion on a 9-point scale. Patients were stratified into a "high BTS cohort" with a BTS ≥4, and a control cohort with BTS <4. Magnetic resonance imaging measurements of labral width for each patient were conducted by 2 blinded, musculoskeletal fellowship-trained radiologists at standardized "clockface" locations using a previously validated technique. Statistical analyses used to determine associations between BTS and labral width included Mann-Whitney U and Fisher exact testing as well as linear regression. Results Thirty-four patients met inclusion criteria (17 cases, 17 controls). Both groups were composed exclusively of female patients. There was no significant difference between cases or controls in terms of age (33.3 ± 10.4 years vs 35.2 ± 8.3 years, P = .57) or body mass index (26.1 ± 9.3 vs 23.6 ± 3.4, P = .36). The high Beighton score cohort had significantly thinner labrae at the indirect rectus (5.35 ± 1.2 mm vs 7.1 ± 1.1 mm, P < .001) and anterosuperior position (5.53 ± 1.4 mm vs 7.27 ± 1.6 mm, P = .003). There was no statistical difference between the high Beighton score cohort and controls at the psoas U position (6.47 ± 1.6 mm vs 7.43 ± 1.7 mm, P = .112). Linear regression analysis demonstrated Beighton score was significantly negatively associated with labrum width at the indirect rectus position (R2 = 0.33, P < .001) and the anterosuperior position (R2 = 0.25, P = .004). Conclusions Patients with a BTS ≥4 were found to have significantly thinner labra than those with a BTS of <4. Level of Evidence III, retrospective comparative trial.
Collapse
Affiliation(s)
- Jonathan D Haskel
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Daniel J Kaplan
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Noah Kirschner
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Jordan W Fried
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Mohammad Samim
- Department of Radiology, NYU Langone Health, New York, New York, U.S.A
| | - Christopher Burke
- Department of Radiology, NYU Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| |
Collapse
|
38
|
L Biernacki J, Stracciolini A, Fraser J, J Micheli L, Sugimoto D. Risk Factors for Lower-Extremity Injuries in Female Ballet Dancers: A Systematic Review. Clin J Sport Med 2021; 31:e64-e79. [PMID: 30589745 DOI: 10.1097/jsm.0000000000000707] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ballet dancers have a high prevalence of injuries to the lower extremity. Many studies have investigated the relationship between dance injury and risk factors. However, risk factors for lower-extremity injury comparing recreational- and elite-level ballet dancers are scarce. OBJECTIVE To systematically review available original studies to assess risk factors for lower-extremity injury in female ballet dancers between recreational and elite ballet dancers. DATA SOURCES Five online databases [Web of Science, PubMed, OVID (Medline), EBSCO, and ProQuest] were searched systematically. STUDY SELECTION Included studies had an analytic study design published in the past 11 years and investigated an association between potential risk factors and lower-extremity injury in female ballet dancers. STUDY APPRAISAL Assessed independently by 2 reviewers using the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine. RESULTS Seventeen studies were included. Alignment was a risk factor for lower-extremity injury in both recreational and elite ballet dancers. In elite ballet dancers, poor lumbopelvic movement control, inappropriate transversus abdominis contraction, decreased lower-extremity strength, and poor aerobic fitness were risk factors for lower-extremity injury. In recreational ballet dancers, hypermobility of the hip and ankle and longer training hours were risk factors for lower-extremity injury. Mean DB score was 15.94 (SD 1.57). The majority of studies were retrospective cohort studies or had poor follow-up, with 7 level 2b studies, 6 level 3b studies (cross-sectional), and 4 level 1b studies (prospective cohort with good follow-up). CONCLUSIONS Alignment was identified as a common risk factor for recreational and elite ballet dancers. Other risk factors differed between recreational ballet dancers and elite ballet dancers. Future studies are warranted to use a prospective study design, identify dance level-specific risk factors, and implement evidence-based prevention strategies.
Collapse
Affiliation(s)
- Jessica L Biernacki
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Joana Fraser
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Lyle J Micheli
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
39
|
Torgutalp ŞŞ, Babayeva N, Özkan Ö, Yilmaz S, Dönmez G, Korkusuz F. Do Plantar Pressure and Loading Patterns Vary with Joint Hypermobility in Young Females? J Am Podiatr Med Assoc 2021; 111:441321. [PMID: 32701151 DOI: 10.7547/18-146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Joint hypermobility is a connective tissue disorder that increases joint range of motion. Plantar pressure and foot loading patterns may change with joint hypermobility. We aimed to analyze static plantar pressure in young females with and without joint hypermobility. METHODS Joint laxity in 27 young females was assessed cross sectionally using the Beighton and Horan Joint Mobility Index. Participants were divided into the hypermobility (score, 4-9) and no hypermobility (score, 0-3) groups according to their scores. Static plantar pressure and forces were recorded using a pedobarographic mat system. RESULTS Higher peak pressures (P = .01) and peak pressure gradients (P = .025) were observed in the nondominant foot in the hypermobility group. According to the comparison of dominant and nondominant feet in each group, the hypermobility group showed significantly higher peak pressures (P = .046), peak pressure gradients (P = .041), and total force values (P = .028) in the nondominant foot. CONCLUSIONS The plantar pressure and loading patterns vary in young females with joint hypermobility. Evaluation of plantar loading as an injury prevention tool in individuals with joint hypermobility syndrome can be suggested.
Collapse
|
40
|
Bockhorn LN, Vera AM, Dong D, Delgado DA, Varner KE, Harris JD. Interrater and Intrarater Reliability of the Beighton Score: A Systematic Review. Orthop J Sports Med 2021; 9:2325967120968099. [PMID: 33786328 PMCID: PMC7960900 DOI: 10.1177/2325967120968099] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023] Open
Abstract
Background: The Beighton score is commonly used to assess the degree of hypermobility in patients with hypermobility spectrum disorder. Since proper diagnosis and treatment in this challenging patient population require valid, reliable, and responsive clinical assessments such as the Beighton score, studies must properly evaluate efficacy and effectiveness. Purpose: To succinctly present a systematic review to determine the inter- and intrarater reliability of the Beighton score and the methodological quality of all analyzed studies for use in clinical applications. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the MEDLINE, Embase, CINAHL, and SPORTDiscus databases was performed. Studies that measured inter- or intrarater reliability of the Beighton score in humans with and without hypermobility were included. Non-English, animal, cadaveric, level 5 evidence, and studies utilizing the Beighton score self-assessment version were excluded. Data were extracted to compare scoring methods, population characteristics, and measurements of inter- and intrarater reliability. Risk of bias was assessed with the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) 2017 checklist. Results: Twenty-four studies were analyzed (1333 patients; mean ± SD age, 28.19 ± 17.34 years [range, 4-71 years]; 640 females, 594 males, 273 unknown sex). Of the 24 studies, 18 reported raters were health care professionals or health care professional students. For interrater reliability, 5 of 8 (62.5%) intraclass correlation coefficients and 12 of 19 (63.2%) kappa values were substantial to almost perfect. Intrarater reliability was reported as excellent in all studies utilizing intraclass correlation coefficients, and 3 of the 7 articles using kappa values reported almost perfect values. Utilizing the COSMIN criteria, we determined that 1 study met “very good” criteria, 7 met “adequate,” 15 met “doubtful,” and 1 met “inadequate” for overall risk of bias in the reliability domain. Conclusion: The Beighton score is a highly reliable clinical tool that shows substantial to excellent inter- and intrarater reliability when used by raters of variable backgrounds and experience levels. While individual components of risk of bias among studies demonstrated large discrepancy, most of the items were adequate to very good.
Collapse
Affiliation(s)
| | - Angelina M. Vera
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - David Dong
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | | | - Kevin E. Varner
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Joshua D. Harris
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
- Joshua D. Harris, MD, Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX 77030, USA ()
| |
Collapse
|
41
|
All-suture anchors versus metal suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A comparison of mid-term outcomes. Jt Dis Relat Surg 2021; 32:101-107. [PMID: 33463424 PMCID: PMC8073447 DOI: 10.5606/ehc.2021.75027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to compare metal suture anchors and all-suture anchors clinically and radiologically in arthroscopic Bankart repair. PATIENTS AND METHODS In this retrospective study, 67 patients (61 males, 6 females; mean age 26.0±5.8; range, 18 to 43 years) who underwent arthroscopic Bankart repair between April 2009 and October 2016 were divided into two groups depending on the type of the suture anchor used in different periods. Group A comprised 32 patients with arthroscopic Bankart repair performed with metal suture anchors, and Group B comprised 35 patients with arthroscopic Bankart repair performed with all-suture anchors. The patients were clinically evaluated using Rowe scores, Constant scores, redislocation rates, and positive apprehension test rates. Radiographic evaluation was performed using the Samilson-Prieto classification to observe the development of glenohumeral osteoarthritis. RESULTS The mean follow-up period was 41.1±10.4 (range, 30 to 60) months in Group A, and 39.6±9.4 (range, 28 to 60) months in Group B, with no significant difference between the two groups (p=0.559). No significant difference was observed between Group A and Group B in terms of mean Rowe score (89.2±13.8 [range, 40 to 100] vs. 88.7±16.9 [range, 25 to 100]; p=0.895) or Constant score (87.2±8.9 [range, 48 to 96] vs. 86.9±9.0 [range, 46 to 96]; p=0.878), which were the clinical outcomes at the final follow-up examination. Postoperative redislocation rates (3.1% vs. 2.9%, p=1.0) and positive apprehension test rates (6.3% vs. 8.6%, p=1.0) were found to be similar in both groups. According to the Samilson-Prieto classification, there was no evidence of glenohumeral osteoarthritis in any of the patients in either group. CONCLUSION Satisfactory outcomes were obtained with the use of all-suture anchors in arthroscopic Bankart repair for traumatic anterior shoulder instability. All-suture anchors and metal suture anchors, have similar outcomes in the mid-term and all-suture anchors are a reliable and effective option for arthroscopic Bankart repair.
Collapse
|
42
|
Abstract
Previous investigators have suggested a role for generalized joint hypermobility (GJH) in the etiology of clubfoot deformity, while others have suggested its presence may influence treatment outcomes. We sought to determine if GJH was associated with the demographics, treatment, or propensity to relapse of patients whose clubfeet were managed using the Ponseti method. Fifty-seven patients with Ponseti-treated clubfeet comprised the cohort; median age 61 months (range, 38-111 months). A physical therapist evaluated each patient using the nine-point Beighton scale to quantify hypermobility. The scores were then correlated with patient sex, laterality, Dimeglio severity score, treatment, relapse, and surgery. The median Beighton score was 5; 49 of 57 patients (86%) had Beighton scores ≥4. All feet were plantigrade without symptomatic overcorrection at the time of evaluation. Although there was a slightly lower probability of relapse in patients with higher Beighton scores, this was not statistically significant (P = 0.10). Accordingly, the sex, laterality, initial severity, number of pretenotomy casts, need for tenotomy, relapse, and need for tendon transfer surgery were not significantly influenced by the Beighton score. The outcome of Ponseti clubfoot treatment is not altered by the presence of GJH in young children. Joint hypermobility does not appear to influence the likelihood of relapse or surgery. Unlike clubfeet reportedly treated with release surgery, Ponseti-treated clubfeet were not prone to excessive overcorrection regardless of joint laxity. Last, the distribution of Beighton scores in the study's cohort supports an association between GJH and clubfoot deformity.
Collapse
|
43
|
Lamari MM, Lamari NM, Araujo-Filho GM, Medeiros MP, Pugliesi Marques VR, Pavarino ÉC. Psychosocial and Motor Characteristics of Patients With Hypermobility. Front Psychiatry 2021; 12:787822. [PMID: 35418881 PMCID: PMC8995653 DOI: 10.3389/fpsyt.2021.787822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify psychosocial and motor aspects related to joint hypermobility (JH) in a sample from almost all Brazilian states by age range and sex; to characterize JH by the Beighton total score ≥4, ≥5, and ≥6 according to sex and age and atypicality in the sitting position and in the hands; identify, in the total sample, manifestations of "growing pain" and its location, fatigue, attention deficit, anxiety, insomnia, drowsiness, apathy, depression, delay in walking, not crawling or crawling differently, school performance, spatial orientation and/or temporally impaired, social isolation, and being stigmatized as "lazy/clumsy/apathetic". METHODS This retrospective, observational, quantitative, and cross-sectional study used data obtained through analyses of descriptive and inferential crossings between 2012 and 2020 of 482 medical records of individuals between 1 and 76 years of age, from most Brazilian states. All patients previously diagnosed with "joint hypermobility syndrome" (JHS) and "Ehlers-Danlos syndrome hypermobility type" (EDS-HT) had their medical records reassessed, following the guidelines established in 2017. The analysis of GJH was performed using the updated method by Beighton method; atypical characteristics were investigated in the hands and the ability to sit in the "W" and the "concave" positions. The characteristics and manifestations of "growing pain" and its location were analyzed in the total sample, fatigue, insomnia, drowsiness, apathy, depression, social isolation, attention deficit, anxiety, stigmatization as "lazy," clumsy/restless, impaired school performance, and spatial and/or temporal orientation. Descriptive and inferential statistical methods were used, such as Mean, Median, Mode, Standard Deviation, Standard Error, Maximum Value, Minimum Value, Komolgorov-Smirnov, Significance, Relative Value, Absolute Value, Mann-Whitney U, and Correlation of Spearman. RESULTS JH in the total sample predominated in the upper limbs, the majority were women, represented by 352 (73.02%), 15 years old or older with 322 (66.80%), 312 (64.73%) had a Beighton total score ≥6, which decreased as the age increased. Always sitting in the "concave" position was represented by 54.15% and the ability to sit in the "W" position by 39.21%; signs on the hands totaled between 27.59 and 44.19% with a significant correlation between the variables. Among the characteristics, fatigue predominated, followed by an awkward/clumsy/restless individual, attention deficit, anxiety and stigmatized as "lazy," insomnia, drowsiness, apathy, depression, impaired spatial and/or temporal orientation, and social isolation. From the total sample, pain in the lower limbs was reported by 55.81% and having or having had "growing pain" was reported by 36.93%, delay in walking occurred in 19.92%, 15.35% did not crawl or crawled differently, and for 12.86%, school performance was impaired. Higher Beighton total scores showed a trend towards motor implications and correlation between variables. Ability to still sit in the "concave" position was possible for 54.15% and to sit in the "W" position for 39.21%. CONCLUSION In the total sample, the JH characteristic prevails in the upper limbs of female children, adolescents and adults, with a total Beighton score ≥6. Most sit in the "concave" position and less than half also sit in the "W" position and with atypical hand postures. The higher Beighton scores, which include the upper limbs, show a tendency to not crawl or crawl differently, delayed ambulation, and impaired school performance. The predominance of JH in the upper limbs is suggestive of a justification for not crawling or crawling differently. Characteristics of atypical motor performance in hands and sitting posture, in addition to fatigue, pain since childhood, anxiety, apathy, depression, sleep disorders, stigmatization, attention deficit, spatial and/or temporal orientation impairment, and social isolation are characteristics. suggestive of psychosocial implications at different ages. Future studies with motor and psychosocial aspects of people with JH will help to identify the phenotype of this population and consequent guidance for clinical management based on the motor and psychosocial aspects of people with JH.
Collapse
Affiliation(s)
- Mateus M Lamari
- SService of Physiotherapy, Fundação Faculdade Regional de Medicina de São José do Rio Preto, FUNFARME, São José do Rio Preto, São Paulo, Brazil
| | - Neuseli M Lamari
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Gerardo M Araujo-Filho
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Michael P Medeiros
- Graduated Student, Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, São Paulo, Brazil
| | | | - Érika C Pavarino
- Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, São Paulo, Brazil
| |
Collapse
|
44
|
Ali A, Andrzejowski P, Kanakaris NK, Giannoudis PV. Pelvic Girdle Pain, Hypermobility Spectrum Disorder and Hypermobility-Type Ehlers-Danlos Syndrome: A Narrative Literature Review. J Clin Med 2020; 9:jcm9123992. [PMID: 33317183 PMCID: PMC7764306 DOI: 10.3390/jcm9123992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 01/04/2023] Open
Abstract
Pelvic girdle pain (PGP) refers specifically to musculoskeletal pain localised to the pelvic ring and can be present at its anterior and/or posterior aspects. Causes such as trauma, infection and pregnancy have been well-established, while patients with hypermobile joints are at greater risk of developing PGP. Research exploring this association is limited and of varying quality. In the present study we report on the incidence, pathophysiology, diagnostic and treatment modalities for PGP in patients suffering from Hypermobility Spectrum Disorder (HSD) and Hypermobility-Type Ehlers-Danlos Syndrome (hEDS). Recommendations are made for clinical practice by elaborating on screening, diagnosis and management of such patients to provide a holistic approach to their care. It appears that this cohort of patients are at greater risk particularly of mental health issues. Moreover over, they may require a multidisciplinary approach for their management. Ongoing research is still required to expand our understanding of the relationship between PGP, HSD and hEDS by appropriately diagnosing patients using the latest updated terminologies and by conducting randomised control trials to compare outcomes of interventions using standardised patient reported outcome measures.
Collapse
Affiliation(s)
- Ahmed Ali
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Paul Andrzejowski
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
- NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| |
Collapse
|
45
|
Santore RF, Gosey GM, Muldoon MP, Long AA, Healey RM. Hypermobility Assessment in 1,004 Adult Patients Presenting with Hip Pain: Correlation with Diagnoses and Demographics. J Bone Joint Surg Am 2020; 102:27-33. [PMID: 32890043 DOI: 10.2106/jbjs.20.00060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The strength of the association between hypermobility and developmental dysplasia of the hip (DDH) in adults is unknown. We sought to analyze this relationship in a prospective, blinded, institutional review board-approved, observational study. The hypothesis was that the prevalence of generalized joint hypermobility (GJH) would be significantly higher in patients with hip dysplasia than in those with other hip diagnoses on the basis of clinical observations of joint laxity. METHODS One thousand and four consecutive new patients (390 males and 614 females) seen over a 4-year period were evaluated for hypermobility of the hip using 2 criteria: the Beighton 9-point physical examination criteria and the Hakim-Grahame 5-item history questionnaire. Diagnosis, age, sex, and race were tested as predictors of hypermobility. Patient-reported outcome scores from the International Hip Outcome Tool (iHOT-12) and the modified Harris hip score (mHHS) were also assessed. RESULTS DDH was the primary diagnosis in 33.2% of the patient population. Patients who had dysplasia without osteoarthritis (OA) had a significantly elevated prevalence of GJH (77.9%) compared with those with nondysplastic hips (32.8%; p < 0.0001) or with patients who had dysplasia and OA (35.7%; p < 0.0001) according to either method. The odds ratio (OR) for patients with DDH versus those with other diagnoses was 7.1 (95% confidence interval [CI]: 5.1 to 10.0). The prevalence of hypermobility was significantly greater in females than in males (OR = 4.2 [95% CI: 3.2 to 5.5]; p < 0.0001). The prevalence of GJH was inversely proportional to age. There was a significantly reduced prevalence of GJH observed in Hispanic patients (p < 0.05) compared with other races. GJH was not a predictor of patient-reported outcome scores (p = 0.51 for iHOT-12 and p = 0.44 for mHHS). CONCLUSIONS To our knowledge, this study is the first to establish a strong association between hypermobility and DDH in adults, confirming the hypothesis. We recommend utilizing both the Beighton and Hakim-Grahame scoring systems together as routine components of the history and physical examination for patients with hip dysplasia. Further research is warranted to explore the genetic basis and potential causal relationships between soft-tissue laxity and skeletal dysplasia, as well as improvements in assessment tools. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- R F Santore
- Sharp Memorial Hospital, San Diego, California.,University of California, San Diego, San Diego, California
| | - G M Gosey
- Sharp Memorial Hospital, San Diego, California.,University of California, San Diego, San Diego, California
| | - M P Muldoon
- Sharp Memorial Hospital, San Diego, California
| | - A A Long
- Sharp Memorial Hospital, San Diego, California
| | - R M Healey
- Sharp Memorial Hospital, San Diego, California
| |
Collapse
|
46
|
Hill JR, Eekhoff JD, Brophy RH, Lake SP. Elastic fibers in orthopedics: Form and function in tendons and ligaments, clinical implications, and future directions. J Orthop Res 2020; 38:2305-2317. [PMID: 32293749 PMCID: PMC7572591 DOI: 10.1002/jor.24695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/21/2020] [Accepted: 04/11/2020] [Indexed: 02/04/2023]
Abstract
Elastic fibers are an essential component of the extracellular matrix of connective tissues. The focus of both clinical management and scientific investigation of elastic fiber disorders has centered on the cardiovascular manifestations due to their significant impact on morbidity and mortality. As such, the current understanding of the orthopedic conditions experienced by these patients is limited. The musculoskeletal implications of more subtle elastic fiber abnormalities, whether due to allelic variants or age-related tissue degeneration, are also not well understood. Recent advances have begun to uncover the effects of elastic fiber deficiency on tendon and ligament biomechanics; future research must further elucidate mechanisms governing the role of elastic fibers in these tissues. The identification of population-based genetic variations in elastic fibers will also be essential. Minoxidil administration, modulation of protein expression with micro-RNA molecules, and direct injection of recombinant elastic fiber precursors have demonstrated promise for therapeutic intervention, but further work is required prior to consideration for orthopedic clinical application. This review provides an overview of the role of elastic fibers in musculoskeletal tissue, summarizes current knowledge of the orthopedic manifestations of elastic fiber abnormalities, and identifies opportunities for future investigation and clinical application.
Collapse
Affiliation(s)
- J. Ryan Hill
- Department of Orthopaedic Surgery, Washington University in St. Louis, 425 S. Euclid Avenue, Suite 5505, St. Louis, MO 63110
| | - Jeremy D. Eekhoff
- Department of Biomedical Engineering, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, 425 S. Euclid Avenue, Suite 5505, St. Louis, MO 63110
| | - Spencer P. Lake
- Department of Biomedical Engineering, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| |
Collapse
|
47
|
O'Neill DC, Mortensen AJ, Cannamela PC, Aoki SK. Clinical and Radiographic Presentation of Capsular Iatrogenic Hip Instability After Previous Hip Arthroscopy. Am J Sports Med 2020; 48:2927-2932. [PMID: 32877211 DOI: 10.1177/0363546520949821] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinical and radiographic features of iatrogenic hip instability following hip arthroscopy have been described. However, the prevalence of presenting symptoms and associated imaging findings in patients with hip instability has not been reported. PURPOSE To detail the prevalence of clinical and magnetic resonance arthrogram (MRA) findings in a cohort of patients with isolated hip instability and to determine midterm patient-reported outcomes in this patient population. STUDY DESIGN Case series; Level of evidence, 4. METHODS We retrospectively reviewed patients from 2014 to 2016 who underwent an isolated capsular repair in the revision hip arthroscopy setting. Patients were excluded if they underwent any concomitant procedures, such as labral repair, reconstruction, femoral osteoplasty, or any other related procedure. Several clinical data points were reviewed, including painful activities, mechanical symptoms, subjective instability, Beighton scores, axial distraction testing (pain, toggle, and apprehension), and distractibility under anesthesia. Patient-reported outcomes-including modified Harris Hip Score, Hip Outcome Score-Sports Subscale, Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function Computer Adaptive Test, and a return patient hip questionnaire-were collected pre- and postoperatively. Pre-revision radiographs were obtained, and lateral center-edge angle and alpha angle were measured on anteroposterior and frog-leg lateral views, respectively. Pre-revision MRAs were reviewed and evaluated for capsular changes. Capsular changes were defined as follows: 0, normal; 1, capsular redundancy; 2, focal capsular rent; and 3, gross extravasation of fluid from the capsule. RESULTS A total of 31 patients met inclusion criteria (5 male, 26 female; 14 right and 17 left hips). The mean age of patients was 36 years (range, 20-58 years). Overall, 27 (87%) reported hip pain with activities of daily living, and 31 (100%) experienced pain with sports or exercise. In addition, 24 (77%) had at least 1 positive finding on axial distraction testing. All patients had evidence of capsular changes on review of pre-revision MRAs. Out of 31 patients, 23 (74%) were available for follow-up at a minimum of 3.3 years and a mean ± SD of 4.6 ± 0.8 years. On average, modified Harris Hip Score improved by 20.3, Hip Outcome Score-Sports Subscale by 25.1, and PROMIS Physical Function Computer Adaptive Test by 6.4. Additionally, 20 (87%) patients reported improved or much improved physical ability, and 18 (78%) reported improved or much improved pain. CONCLUSION The current study suggests that patients with hip instability demonstrate high rates of pain with activities of daily living and exercise, positive findings on axial distraction testing, and evidence of capsular changes on magnetic resonance imaging. Furthermore, these patients improve with revision surgery for capsular repair at midterm follow-up.
Collapse
Affiliation(s)
- Dillon C O'Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
48
|
Homere A, Bolia IK, Juhan T, Weber AE, Hatch GF. Surgical Management of Shoulder and Knee Instability in Patients with Ehlers-Danlos Syndrome: Joint Hypermobility Syndrome. Clin Orthop Surg 2020; 12:279-285. [PMID: 32904109 PMCID: PMC7449847 DOI: 10.4055/cios20103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022] Open
Abstract
Ehlers-Danlos Syndrome (EDS) is a hereditary disorder of the connective tissue, which has been classified into numerous subtypes over the years. EDS is generally characterized by hyperextensible skin, hypermobile joints, and tissue fragility. According to the 2017 International Classification of EDS, 13 subtypes of EDS have been recognized. The majority of genes involved in EDS are either collagen-encoding genes or genes encoding collagen-modifying enzymes. Orthopedic surgeons most commonly encounter patients with the hypermobile type EDS (hEDS), who present with signs and symptoms of hypermobility and/or instability in one or more joints. Patients with joint hypermobility syndrome (JHS) might also present with similar symptomatology. This article will focus on the surgical management of patients with knee or shoulder abnormalities related to hEDS/JHS.
Collapse
Affiliation(s)
- Andrew Homere
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Tristan Juhan
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
49
|
Risk of Injury in Physically Active Students: Associated Factors and Quality of Life Aspects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072564. [PMID: 32276511 PMCID: PMC7177920 DOI: 10.3390/ijerph17072564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/18/2022]
Abstract
Background: The aim of this study was to assess the potential factors of hypermobility and pain threshold on the risk of injury in physically active students and to verify which domains of quality of life are rated lower by young people with a history of injuries. Methods: The study included 278 students (138 women and 140 men) who regularly undertake physical activity. Anthropometric measurements, body composition, pain threshold, incidence of hypermobility syndrome, information on the history of injuries to the locomotor system, and the quality of life of the study participants were collected. Results: In the group studied, hypermobility and pain threshold had a statistically significant related on the risk of injury. Participants with a history of injuries had lower scores for an individual’s overall perception of their own health and the physical domain. There were also significant differences in the psychological domain of the quality of life between males and females with a history of injuries. Conclusion: In the studied group, the risk of injuries was related to diagnosed hypermobility and pain threshold measured on the lower limbs. The study also showed that people with a history of injuries had statistically significantly lower scores in the individual general perception of their own health and in the physical domain. Gender had a significant impact on the quality of life of people with injuries.
Collapse
|
50
|
Lukmanova LZ, Davletshin RA, Khusainova RI, Tyurin AV. The level of microelements and heterogeneity of joint hypermobility as an endophenotype of undifferentiated connective tissue dysplasia. RUSSIAN OPEN MEDICAL JOURNAL 2020. [DOI: 10.15275/rusomj.2020.0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective — The aim of the work was to study serum concentrations of magnesium, copper, zinc, phosphorus and calcium in individuals with undifferentiated connective tissue dysplasia (uCTD) and joint hypermobility (JH) in an isolated and combined state. Material and methods — the concentrations of magnesium, copper, zinc, phosphorus and calcium were measured by the direct colorimetric method in 55 people with joint hypermobility and in 34 – without hypermobility. Results — There were no significant differences between serum concentrations of microelementsin groups with and without JH. In patients with mild and severe uCTD significant decrease in serum magnesium concentrations was noted (U=2.12, p=0.034 and U=3.7, p=0.012). In patients with isolated JH significant serum zinc concentrationdecrease was revealed compared with the control group (U=3.12, p=0.022). Serum magnesium concentrations were reduced in all patients with uCTD and JH; in the groups with isolated dysplasia and combined pathology, the differences reached the level of statistical significance (U=2.78, p=0.024 and U=3.2, p=0.018). Conclusion — The study revealed significant associations of a decrease in serum magnesium concentrations with the development of uCTD in an isolated and combined with JH state and decrease in serum zinc concentrations with the development of isolated JH.
Collapse
|