Viable cartilage allograft outperforms existing treatments for focal knee cartilage defects

PURPOSE

Viable cartilage allograft (VCA) is a cartilage tissue matrix that contains cryopreserved viable allogeneic cartilage fibres. This study aimed to assess safety and benefits in treating focal knee cartilage defects with VCA. We hypothesized that VCA is a safe single-stage procedure in isolated chondral defects.

METHOD

In vitro analysis, in vivo studies and a prospective case series were performed. VCA was evaluated in a goat cartilage repair model. Symptomatic International Cartilage Repair Society grade 3/4A lesions of the femoral condyle or patella were implanted with VCA. International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome (KOOS) subscales, Lysholm, Short Form-12, Visual Analog Scale and pain frequency levels were assessed. Radiographic and magnetic resonance imaging (MRI) was performed at regular intervals postoperatively. Data were analysed by statisticians to determine the power and significance of the results.

RESULTS

The goat study confirmed that VCA is effective for cartilage repair. Twenty patients were implanted; the mean age was 28.1 (16-56), the mean body mass index (BMI) was 27.9 ± 5.6 and the mean follow-up was 24.1 months (range = 12.0-36.0 months). Lesions were in either the femoral condyle (7) or patella (13). Lesion sizes ranged from 1.5 to 6.0 cm2 (mean = 4.58 cm2 ). Outcome scores improved from preoperative baseline (POB): IKDC (78.2), Lysholm (89.0), KOOS: Pain (95.8), Symptoms (86.3), ADL (87.8), Sports (85.0) and QOL (75.0). MRI imaging demonstrated excellent osteochondral allograft assimilation. Second-look arthroscopy (two patients) demonstrated complete fill and incorporation (Brittberg scores 11/12). Functional scores were maintained at 24 (M): IKDC (86.24 ± 17.2), Lysholm (87.23 ± 15.0), KOOS: Pain (91.72 ± 17.3), Symptoms (84.92 ± 16.1), ADLs (93.80 ± 16.1), Sports (84.45 ± 27.7), QOL (81.30 ± 20.8).

CONCLUSION

VCA is an off-the-shelf, single-stage, conformable allogeneic graft that treats chondral defects with no additional fixation. Preclinical and short-term prospective clinical studies show that VCA can safely treat chondral defects with potential advantages to existing options.

LEVEL OF EVIDENCE

Level IV study.

The Evidence for the Use of Osteobiologics in Hybrid Constructs (Anterior Cervical Discectomy and Fusion and Total Disc Replacement) in Multilevel Cervical Degenerative Disc Disease: A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVE

Examine the clinical evidence for the use of osteobiologics in hybrid surgery (combined anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR)) in patients with multilevel cervical degenerative disc disease (DDD).

METHODS

PubMed and Embase were searched between January 2000 and August 2020. Clinical studies investigating 18-80 year old patients with multilevel cervical DDD who underwent hybrid surgery with or without the use of osteobiologics were considered eligible. Two reviewers independently screened and assessed the identified articles. The methodological index for non-randomized studies (MINORS) tool and the risk of bias (RoB 2.0) assessment tool were used to assess risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to evaluate quality of evidence across studies per outcome.

RESULTS

Eleven studies were included. A decrease in cervical range of motion was observed in most studies for both the hybrid surgery and the control groups consisting of stand-alone ACDF or TDR. Fusion rates of 70-100% were reported in both the hybrid surgery and control groups consisting of stand-alone ACDF. The hybrid surgery group performed better or comparable to the control group in terms of adjacent segment degeneration. Studies reported an improvement in visual analogue scale for pain and neck disability index values after surgery compared to preoperative scores for both treatment groups. The included studies had moderate methodological quality.

CONCLUSIONS

There is insufficient evidence for assessing the use of osteobiologics in multilevel hybrid surgery and additional high quality and controlled research is deemed essential.

Staged Tendon Repair to Improve Range of Motion in Tamai Zone 4 Replantation: Two Case Reports

Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation.

Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method® and Exercise Therapy

BACKGROUND

The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method.

METHODS

A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period.

RESULTS

Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L.

CONCLUSIONS

The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.

Passive Movements Do not Appear to Prevent or Reduce Joint Stiffness in Medium to Long-Stay ICU Patients: A Randomized, Controlled, Within-Participant Trial

OBJECTIVES

ICU patients have an increased risk of joint stiffness because of their critical illness and reduced mobility. There is a paucity of evidence evaluating the efficacy of passive movements (PMs). We investigated whether PMs prevent or reduce joint stiffness in ICU patients.

DESIGN

A randomized, controlled, within-participant, assessor-blinded study.

SETTING

A 48-bed tertiary care adult ICU.

PATIENTS

Intubated patients who were expected to be invasively mechanically ventilated for greater than 48 hours with an ICU length of stay greater than or equal to 5 days, and unable to voluntarily move their limbs through full range of motion (ROM).

INTERVENTIONS

The ankle and elbow on one side of each participant's body received PMs (10 min each joint, morning and afternoon, 5 d/wk). The other side acted as the control. The PMs intervention continued for as long as clinically indicated to a maximum of 4 weeks.

MEASUREMENTS

The primary outcome was ankle dorsiflexion ROM at cessation of PMs. Plantarflexion, elbow flexion and extension ROM, and participant-reported joint pain and stiffness (verbal analog scale [VAS]) were also measured. Outcomes were recorded at baseline and cessation of PMs. For participants whose PMs intervention ceased early due to recovery, additional post-early-cessation of PMs review measurements were undertaken as near as possible to 4 weeks.

MAIN RESULTS

We analyzed data from 25 participants with a median (interquartile range) ICU stay of 15.6 days (11.3-25.4). The mean (95% CI) between-side difference for dorsiflexion ROM (with knee extension) at cessation of PMs was 0.4 degrees (-4.4 to 5.2; p = 0.882), favoring the intervention side, indicating there was not a clinically meaningful effect of 5 degrees. No statistically significant differences were found between the intervention and control sides for any ROM or VAS data.

CONCLUSIONS

PMs, as provided to this sample of medium to long-stay ICU patients, did not prevent or reduce joint stiffness.

Oral health quality of life is associated to jaw function and depression in patients with myogenous temporomandibular dysfunction

OBJECTIVE

To determine which factors influence and better differentiate between good and poor oral health-related quality of life (OHRQoL) in patients with myogenous TMD and which cut-off could predict a good/poor OHRQoL.

METHODS

Fifty-eight women with myogenous TMD were included. Factors of interest were collected (i.e., demographic variables, depression symptoms (Symptom Checklist-90 R (RDC/TMD)), pain intensity (Visual Analog Scale), jaw function (Mandibular Functional Limitation Questionnaire), and OHRQoL (Oral Health Impact Profile-14). A multivariable regression model, logistic regression, and receiver operating curve (ROC) analyses were conducted.

RESULTS

Depression symptoms (β = 0.139) and jaw function (β = 0.478) were significantly associated with OHRQoL in the multivariable model. The best model to discriminate between good/poor OHRQoL included only jaw function (AUC = 0.90), with the best cut-off of 17 points (sensitivity: 0.93; specificity: 0.79).

CONCLUSION

Depression symptoms and jaw function were significantly associated with OHRQoL. The best model and cut-off to discriminate good/poor OHRQoL included only jaw function.

Outcomes of Total Ankle Arthroplasty in Postfracture Ankle Arthritis

BACKGROUND

Ankle arthritis that develops after fracture accounts for a significant portion of ankle arthritis necessitating total ankle arthroplasty (TAA). It remains unknown whether TAA in postfracture patients produces equivalent outcomes to those without fracture history. The purpose of this study was to evaluate the medium-term outcomes of TAA in postfracture ankle arthritis compared to those without fracture history.

METHODS

This study reviewed 178 ankles from 171 consecutive patients who underwent TAA in our institution between 2007 and 2017 and completed a minimum 5-year follow-up. Four different TAA systems were utilized by 6 surgeons. Based on fracture history, patients were divided into 2 groups: the postfracture group (n = 63; median age 65.7 years; median follow-up 5.9 years) and the nonfracture group (n = 115; median age 64.4 years; median follow-up 6.2 years). Types and rates of complications including revision and reoperation were compared. Minimum 5-year Foot and Ankle Outcome Score (FAOS) and postoperative improvement were investigated. A subgroup analysis was performed to determine whether outcomes differ between intraarticular fracture patients (n = 43) and extraarticular fracture patients (n = 20).

RESULTS

Both groups exhibited comparable postoperative improvement and final FAOS scores. The postfracture group had a significantly higher reoperation rate than the nonfracture group (20 of 63, 31.7%, vs 17 of 115, 14.8%; P = .011), with gutter impingement being the most common cause. There were 3 revisions in each group. In the subgroup analysis, we found no evidence of statistical difference between the intraarticular fracture group and the extraarticular fracture group in terms of FAOS scores, revision, and reoperation rates.

CONCLUSION

In this single-center, retrospective comparative study, we found total ankle arthroplasty in patients with a history of fractures around the ankle joint had no evidence of statistical difference in patient-reported outcomes and implant survivorship but led to a higher rate of nonrevision reoperation following surgery. In the much smaller subset of patients with previous fracture, we did not find that those with a history of intraarticular fracture had inferior outcomes after TAA when compared to those with a history of extraarticular fracture.

LEVEL OF EVIDENCE

Level III, case-control study.

A study of fracture lines distribution characteristics in complete articular fractures of the patella

Objective

The objective of this study was to unveil the characteristics of fracture lines distribution and explore its clinical significance of complete articular fractures of the patella.

Methods

A consecutive series of image data from 88 patients with complete articular patella fractures were retrospectively included. Three-dimensional reconstruction images of the patella fractures were created and collected. Subsequently, these reconstructed images were visually overlaid onto a standard anterior and posterior patella template. The fracture lines were then identified, traced onto the template, and utilized to generate patella fracture maps. Furthermore, the incidence rate of patella fracture lines involving the distal pole was analyzed.

Results

The maps depict the fracture lines of complete articular patella fractures. For simple and complex patella fractures, the primary fracture lines primarily converge within the Middle and Lower regions, exhibiting a transverse pattern. Conversely, the primary fracture lines in comminuted patella fractures are randomly dispersed across the patella. Examining the maps, approximately 63.6% (56/88) of complete articular patella fractures exhibited involvement of the distal pole in the anterior view, while 48.9% (43/88) displayed distal pole fractures in the posterior view. The incidence of distal pole injury increased progressively with the severity of patella fractures.

Conclusion

The patterns and distribution of fracture lines in cases of complete articular patella fractures are prominently illustrated on the constructed fracture maps. Familiarity with these common characteristics of complete articular patella fracture, especially with the distal pole injury, can aid surgeons in developing preoperative planning, executing surgical strategies effectively, and reducing inappropriate treatment.

T2 mapping magnetic resonance imaging of cartilage in hemophilia

Background

In hemophilia, recurrent hemarthrosis may lead to irreversible arthropathy. T2 mapping MRI may reflect cartilage changes at an earlier reversible stage of arthropathy as opposed to structural MRI.

Objectives

To evaluate interval changes of T2 mapping compared with the International Prophylaxis Study Group (IPSG) structural MRI scores of ankle cartilage in boys with hemophilia receiving prophylaxis.

Methods

Eight boys with hemophilia A (median age, 13; range, 9-17 years), 7 age- and sex-matched healthy boys (controls, median age, 15; range, 7-16 years). A multiecho spin-echo T2-weighted MRI sequence at 3.0T was used to obtain T2 maps of cartilage of boys with hemophilia and controls. Structural joint status was evaluated using the IPSG MRI score.

Results

T2 relaxation times of ankle cartilage increased significantly over time in both persons with hemophilia and controls (P = .002 and P = .00009, respectively). Changes in T2 relaxation time strongly correlated with changes in IPSG cartilage scores (rs = 0.93 to rs = 0.78 [P = .0007 to P = .023]), but not with changes in age (P = .304 to P = .840). Responsiveness of T2 relaxation times were higher than that of IPSG cartilage scores, with standardized response means >1.4 for T2 mapping in all regions-of-interest compared with 0.84 for IPSG cartilage scores. Baseline T2 relaxation time strongly correlated with timepoint 2 IPSG cartilage score (rs = 0.93 to rs = 0.82 [P = .001 to P = .012]) and T2 relaxation time (rs = 0.98 to rs = 0.88 [P = .00003 to P = .004]) changes in most regions-of-interest.

Conclusion

T2 mapping shows sensitivity to biochemical changes in cartilage prior to detectable damage using conventional MRI, offering potential for early detection of bleed-related cartilage damage in boys with hemophilia.

Effectiveness of patient education on total knee arthroplasty: A systematic review and meta-analysis

AIMS AND OBJECTIVES

This study was designed to examine the contents and methods of patient educational interventions about total knee arthroplasty (TKA) and their effectiveness in reducing postoperative pain and enhancing range of motion (ROM) in the literature.

BACKGROUND

Patient education has been provided to facilitate recovery after TKA; however, little is known about the contents and methods of the interventions and their effectiveness in reducing postoperative pain and enhancing ROM.

DESIGN

This is a systematic review and meta-analysis of randomised controlled trials (RCTs).

METHODS

Published studies from June 1998-June 2021 were identified from electronic databases. Two independent investigators assessed the quality of the studies by using the revised Cochrane risk-of-bias tool. Meta-analyses with random-effects models were conducted to assess the effectiveness of the interventions using the Comprehensive Meta-Analysis Software. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

RESULTS

Among 12 articles that met the inclusion criteria, three interventions provided education on pain management and mobility/exercises. The most common educational methods were the combinations of oral explanation, written materials, and audiovisual materials, group discussion, while four studies used information technology (IT) devices. The meta-analysis demonstrated that the educational interventions using IT devices were effective in improving pain and ROM, but not the interventions that did not use IT devices.

CONCLUSION

Structured education for pain management, communication and/or exercise support programs utilising diverse methods have been provided to patients undergoing TKA. Using IT devices could successfully enhance the effectiveness of educational interventions for patients undergoing TKA.

RELEVANCE TO CLINICAL PRACTICE

Integration of postoperative pain management and mobility/exercises with the use of IT devices should be actively considered in providing patient education in clinical nursing practice.

Articular Cartilage Lesions Pathomechanism, Diagnosis, Epidemiology, Possibilities for Conservative Treatment

Osteoarthritis, which is the most common joint disorder, is one of major reasons for hospitalizations and one of the greatest burdens to health care systems. Osteoarthritis has a complex etiology, but lesions of articular cartilage are a major risk factor. These lesions are often encountered in young active people and usually remain asymptomatic for a long time. Depending on the extent of injury, chondral lesions can be managed conservatively or surgically. An important factor influencing the effectiveness of conservative treatment is the morphology and location of injury. Conservative treatment should be based on patient education and rehabilitation, and supported by pharmacotherapy.

The ligamentum mucosum: A new classification

The ligamentum mucosum (LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Fifty-one, 12 females (mean age 83.1 ± 3.4 years) and 39 males (mean age 84.2 ± 6.8 years) fixed in 10% formalin were examined. Upon dissection, the following morphological features of the LM were assessed: the types of LM, morphometric measurement and histological analysis of each type. The LM was present in 66.7% of all examined specimens. Three different types were recognized: Type I (55.9%)-single band with attachment to the intercondylar notch, Type IIa-bifurcated ligament with attachment to the anterior cruciate ligament, Type IIb-bifurcated ligament with both attachments to the intercondylar notch, Type III-double ligament with two independent bands and attachments to the intercondylar notch and to the knee joint capsule. The LM is variable and probably evolutionary changes are the reason. In our study we propose the new clinically useful classification supported by its anatomical and histological characteristics. Type IIa seems to be the most important from the clinical point of view, as it may be responsible for clinical issues and should be paid attention while diagnosing patients suffering from anterior cruciate ligament torn or anterior knee pain.

Physical fitness of military policemen who practice CrossFit

Introduction

The practice of physical activity is directly related to the maintenance of health. Thus, the individual who is in the habit of practicing and who is well conditioned is able to perform various day-to-day functions with the least possible effort. In addition, good physical fitness is a requirement made for professionals of different categories, such as members of the security forces. Within this context, the military police officer must be within the standards of physical activity in order to exercise their ostensive functions. CrossFit is a training method that uses high intensity functional movements and aims to improve the physical form and health of the practitioner, thereby influencing its physical capacities.

Objectives

To assess the physical fitness of military police officers who practice CrossFit.

Methods

The sample consisted of 16 male active military police officers, practitioners of the institutional physical exercises, divided between CrossFit practitioners for at least 5 months (n = 10) and non-practitioners of extra-institutional exercises (n = 6). The following parameters were evaluated: level of physical activity, body mass index, fat percentage, flexibility, upper limb strength, and cardiorespiratory capacity.

Results

The practice of CrossFit complementary to military physical training increased the values of upper limb strength, flexibility, and cardiorespiratory capacity among the components of physical fitness that were evaluated.

Conclusions

The regular practice of CrossFit by military police suggests positive interference in some of the components of physical fitness and in the balance in strength gain, however more studies need to be conducted to investigate the significance of this effect.

Retrospective evaluation of surgical technique, complications and long-term outcome of lateral and medial humeral condylar fractures in 80 dogs

CASE HISTORY

Medical records of a single veterinary teaching hospital in Giessen, Germany were retrospectively reviewed for dogs presented for medial or lateral humeral condylar fractures (HCF) between 2007 and 2019. Data regarding surgical technique and complications were collected from the medical records. The latter was supplemented through information obtained from telephone interviews with referral veterinarians and from an owner questionnaire completed ≥12 months after surgical repair, which also provided data regarding outcome.

CLINICAL FINDINGS

Eighty dogs with 85 HCF were identified: 13 (15.3%) HCF were medial (bilateral in two dogs) and 72 (84.7%) were lateral (bilateral in three dogs). French Bulldogs (n = 19/80; 23.8%) were most commonly affected. Patients were predominantly skeletally immature and light-weight, with a median age at the time of presentation of 3 (min 2, max 118) months and with a median body weight of 6.4 (min 1, max 46) kg. There were 38 female (47.5%) and 42 male (52.5%) dogs. Fractures developed most frequently secondary to minor trauma (67/77; 87.0%). Dogs were presented in 35/84 (41.7%) cases more than 24 hours after fracture occurrence.

TREATMENT AND OUTCOME

Surgical treatment was performed in 80/85 (94.1%) HCF. An open reduction and internal fixation approach was chosen in all cases. A transcondylar screw (TS) combined with a supracondylar (SC) K-wire (67/80; 83.8%) was the most frequently used fixation technique. Considering all fracture fixation methods, complications (26/80; 32.5%) were classed as minor in 10 (12.5%), major in 14 (17.5%) and catastrophic in two (2.5%) of the 80 surgically treated HCF. Long-term outcome was excellent in 68.6% (24/35 HCF) and very good in 22.9% (8/35 HCF) of the cases for which follow-up information was obtained. Additionally, owner information revealed that 85.7% of dogs (30/35 HCF) were free of lameness in the long-term.

CLINICAL RELEVANCE

This case series demonstrates that surgical repair of lateral and medial HCF with a TS and SC K-wire is a viable option to consider in skeletally immature and light-weight patients. Complications occur frequently after surgical fixation of HCF, but owners can expect a very good to excellent long-term outcome in the majority of cases.

Differential Protein Expression of the Marginal Transitional Zone in Foals with Osteochondrosis

The marginal transitional zone is peripherally located within the diarthrodial joint, and represents the interface of articular cartilage, periosteum, and the fibrous joint capsule. The purpose of this study is to characterize the protein expression of matrix and molecular regulators in the marginal transitional zone of foals having osteochondrosis (OC) compared to normal foals. Several families of proteins with known roles in cartilage and bone development are investigated, including matrix molecules, Wnt signaling, apoptotic factors and paracrine cell signaling molecules. Our results demonstrate differential protein expression in the marginal transitional zone from the lateral femoral trochlear ridge of foals affected by osteochondrosis. Alterations in protein expression of OC-affected foals mainly involve components of extracellular matrix homeostasis and canonical Wnt signaling. Matrix expression of collagen type IIB and lubricin are decreased and matrix metalloproteinase-3 expression is increased in OC-affected marginal transitional zone samples. Canonical Wnt signaling is inhibited in OC-affected marginal transitional zone samples, based on increased Dickkopf-1 and decreased β-catenin protein expression. Most apoptotic and paracrine signaling proteins are not altered in OC-affected marginal transitional zone samples.

Impact of Hyaluronic Acid on the Viability of Mesenchymal Cells Derived from Adipose Tissue Grown in Collagen Type I/III Membrane

Objective  To evaluate in vitro the viability of mesenchymal stem cells derived from adipose tissue (AD-MSCs) in different commercial solutions of hyaluronic acid (HA) before and after being sowed in collagen I/III membrane. Methods  In the first stage, the interaction between AD-MSCs was analyzed with seven different commercial products of HA, phosphate buffered saline (PBS), and bovine fetal serum (BFS), performed by counting living and dead cells after 24, 48 and 72 hours. Five products with a higher number of living cells were selected and the interaction between HA with AD-MSCs and type I/III collagen membrane was evaluated by counting living and dead cells in the same time interval (24, 48 and 72 hours). Results  In both situations analyzed (HA + AD-MSCs and HA + AD-MSCs + membrane), BFS presented the highest percentage of living cells after 24, 48 and 72 hours, a result higher than that of HA. Conclusion  The association of HA with AD-MSCs, with or without membrane, showed no superiority in cell viability when compared with BFS.

Nonsurgical spinal decompression system traction combined with electroacupuncture in the treatment of multi-segmental cervical disc herniation: A case report

RATIONALE

With the spread of computers and mobile phones, cervical spondylosis has become a common occupational disease in clinics, which seriously affects the quality of life of patients. We used a nonsurgical spinal decompression system (SDS) combined with physical therapy electroacupuncture (EA) to treat a case of mixed cervical spondylosis caused by multi-level cervical disc herniation, and we achieved satisfactory results.

PATIENT CONCERNS

A 44-year-old Caucasian Asian woman presented with neck pain and numbness on the left side of the limb. MRI showed the patient's C3-C7 segment cervical disc herniation, and the flexion arch of the cervical spine was reversed.

DIAGNOSIS

The patient was diagnosed with a mixed cervical spondylosis.

INTERVENTIONS

The patient received a month of physical therapy (SDS traction combined with EA).

OUTCOMES

Before and after treatment: VAS score of neck pain decreased from 8 to 0; Cervical spine mobility returned to normal; The grip strength of left hand increased from 7.5 kg to 19.2 kg; Cervical curvature index changed from -16.04% to -3.50%; the physiological curvature of the cervical spine was significantly restored. There was no dizziness or neck discomfort at 6 month and 1 year follow-up.

LESSONS SUBSETIONS

SDS traction combined with EA is effective for the treatment of cervical disc herniation and can help restore and rebuild the biomechanical balance of the cervical spine.

Osteochondral lesions of the talar dome: an up-to-date approach to multimodality imaging and surgical techniques

Osteochondral lesions (OCLs) of the talar dome consist of a multifactorial pathology of the articular cartilage and subchondral bone and can result in persistent ankle pain and osteoarthritis (OA). Along with a physical examination and clinical history, an imaging evaluation plays a pivotal role in the diagnosis of these lesions and is fundamental for making treatment decisions and determining prognosis by providing information regarding the size, location, and cartilage and subchondral bone statuses as well as associated lesions and degenerative changes. Multiple surgical techniques for OCLs of the talar dome have been developed in recent decades, including cartilage repair, regeneration, and replacement strategies, and radiologists should be acquainted with their specific expected and abnormal postoperative imaging findings to better monitor the results and predict poor outcomes. The present article proposes a thorough review of the ankle joint anatomy and biomechanics, physiopathology, diagnosis, and treatment of OCLs of the talar dome, highlighting the radiological approach and imaging findings in both pre- and postoperative scenarios.

Management of a rare intra-articular fracture of the lateral femoral condyle: case report

Unicondylar fractures of the femur are uncommon injuries that can occur in the sagittal or, less frequently, in the coronal plane (Hoffa fractures).  Distal femoral fractures are usually described following the AO/OTA Classification system which includes extra-articular, partial articular and intra-articular injuries, further divided in three types based on the pattern and comminution.  Accurate reduction and stable fixation are needed especially in articular injuries in order to allow early mobilization and reduce complications such as knee stiffness, malunion or secondary osteoarthritis. The aim of this paper is to report a case of an unusual articular fracture of the lateral femoral condyle in a 39 years old man. This fracture reminds the pattern of a typical tibial plateau injury, not embedded in the most common descriptions of femoral traumas. Indeed, in most cases, high energy traumas in valgus of the knee result in a damage to the tibial plateau because of the condyles impact on the tibial articular surface, while in the present case the opposite occurred. The patient was successfully treated with an open reduction and fixation with two cannulated leg screws, reporting  good clinical outcome and excellent healing of the fragment evidenced with CT scan at 6 months follow-up.

Management of extra-articular shaft fractures of the non-thumb metacarpals: plate-screw fixation versus K-wire fixation

Metacarpal fractures are common injuries and comprise nearly 36% to 42% of all fractures in the hand. The majority of these can be managed non-surgically. Operative fixation when needed, can be done by a variety of techniques. In this study, we have compared the outcomes of two techniques, plate-screw fixation and K-wire fixation. We have conducted a prospective, non-randomized, comparative study of patients who presented with extra-articular metacarpal shaft fractures of non-thumb metacarpals over a period of 18 months. 30 patients were enrolled according to the inclusion criteria and were alternately allotted to the plate-screw group and the K-wire group. At admission, patient demographics, clinical features, number of fractures, and fracture patterns were recorded, and radiographs were taken. In the plate-screw group, low-profile plates and screws were used, and in the K-wire group, 1 or 2 K-wires were used for fixation after fracture reduction. Hand mobilization exercises were started within one week in the plate-screw group, while in the K-wire group full mobilization was allowed at 4 weeks post-surgery. The Disabilities of Arm, Shoulder and Hand (DASH) score was calculated and compared between the two groups at 6 months and 12 months after surgery. The mean 6-month DASH score in the plate-screw group was 6.3287±2.2453, while it was 17.1627±6.2103 in the K-wire group (p value <0.001). At the end of 1-year follow-up, the mean DASH score in the plate-screw group was 5.1080±1.6637, and in the K-wire group, it was 5.1073±1.9392 (p value =0.848). In conclusion, extra-articular metacarpal shaft fractures of the non-thumb metacarpals treated by plate-screw fixation had significantly better DASH scores and hence better functional outcomes at the end of 6 months. However, at the end of 1 year, the DASH scores in both the groups were almost similar, suggesting similar functional outcomes in the long term.

Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT)

CONTEXT

Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values.

OBJECTIVES

This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT).

METHODS

In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic (K) were utilized.

RESULTS

The construct validity was determined for STFT (70% agreement; K=0.49; p<0.01) and SIFT (56.7% agreement; K=0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K=0.43; p<0.01) and SIFT (56.7% agreement; K=0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K=-0.02; p=0.825) and SIFT (13.3% agreement; K=0.01; p=0.836).

CONCLUSIONS

The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.

Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: two-year radiologic and clinical outcomes from a prospective multicenter study

BACKGROUND

Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears.

METHODS

We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. After arthroscopic subacromial decompression without a traditional rotator cuff repair, a bioinductive implant was secured over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores (CMS) preoperatively and at 3 months, 1 year, and 2 years postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site.

RESULTS

At 2-year follow-up, mean ASES and CMS scores improved both clinically and statistically at 1 and 2 years, compared with baseline, for intermediate- and high-grade tears. There was magnetic resonance imaging evidence of new tissue fill-in within the original baseline tear in 100% of the intermediate-grade tears and 95% of the high-grade tears. In 90.9% of the intermediate-grade tears and 84.2% of the high-grade tears, this new tissue fill-in represented at least an additional 50% of the volume of the initial lesion. From baseline to 2-year follow-up, the mean tendon thickness increased by 1.2 mm (standard deviation, 1.3; P = .012) and 1.8 mm (standard deviation, 2.2; P = .003) in the intermediate- and high-grade tears, respectively. The analysis of tear grade and location revealed no statistically significant difference in the change in mean tendon thickness at any time point. One patient with a high-grade articular lesion demonstrated progression to a full-thickness tear; however, the patient was noncompliant and the injury occurred while shoveling snow 1 month after surgery. Neither tear location nor treatment of bicep pathology affected the ASES or CMS scores at any follow-up point. No serious adverse events related to the implant were reported.

CONCLUSION

Final results from this 2-year prospective study indicate that the use of this resorbable bovine collagen implant for isolated bioinductive repair of intermediate- and high-grade partial-thickness rotator cuff tears of the supraspinatus is safe and effective, regardless of tear grade and location.

Compositional Variation and Functional Mechanism of Exosomes in the Articular Microenvironment in Knee Osteoarthritis

Osteoarthritis (OA) is a major cause of disability worldwide with increasing age. Knee OA (KOA) is the most prevalent type of OA. Recently, it is considered that KOA is a whole joint disease, including articular cartilage, subchondral bone, synovium, ligaments, joint capsules, and muscles around the joint. Exosomes in knee joint are mainly secreted by articular chondrocytes and synoviocytes. They participate in cell and tissue cross-talk by carrying a complex cargo of proteins, lipids, nucleic acids, etc. Under normal conditions, exosomes maintain the microenvironmental homeostasis of the joint cavity. Under pathological conditions, the composition and function of exosomes changes, which in turn, disrupts the balance of anabolism and catabolism of articular chondrocyte and facilitates inflammatory responses, thus accelerating KOA progression. As a regenerative medicine, mesenchymal stem cells (MSCs) are promised to facilitate repair of degenerated cartilage and decelerate OA process. The therapeutic function of MSC mainly depends on MSC-derived exosomes, which can restore the homeostasis of the articular microenvironment. In the future, the specific mechanism of exosomes for OA treatment needs further elucidation, and the treatment effect of exosomes for long-term and/or severe OA needs further exploration.

Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial

BACKGROUND

Few randomized controlled trials with a midterm follow-up have compared matrix-assisted autologous chondrocyte transplantation (MACT) with microfracture (MFx) for knee cartilage lesions.

PURPOSE

To compare the structural, clinical, and safety outcomes at midterm follow-up of MACT versus MFx for treating symptomatic knee cartilage lesions.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

A total of 48 patients aged between 18 and 50 years, with 1- to 4-cm² International Cartilage Repair Society (ICRS) grade III to IV knee chondral lesions, were randomized in a 1:1 ratio to the MACT and MFx treatment groups. A sequential prospective evaluation was performed using magnetic resonance imaging (MRI) T2 mapping, the MOCART (magnetic resonance observation of cartilage repair tissue) score, second-look arthroscopic surgery, patient-reported outcome measures, the responder rate (based on achieving the minimal clinically important difference for the Knee injury and Osteoarthritis Outcome Score [KOOS] pain and KOOS Sport/Recreation), adverse events, and treatment failure (defined as a reoperation because of symptoms caused by the primary defect and the detachment or absence of >50% of the repaired tissue during revision surgery).

RESULTS

Overall, 35 patients (18 MACT and 17 MFx) with a mean chondral lesion size of 1.8 ± 0.8 cm² (range, 1-4 cm²) were followed up to a mean of 6 years postoperatively (range, 4-9 years). MACT demonstrated significantly better structural outcomes than MFx at 1 to 6 years postoperatively. At final follow-up, the MRI T2 mapping values of the repaired tissue were 37.7 ± 8.5 ms for MACT versus 46.4 ± 8.5 ms for MFx (P = .003), while the MOCART scores were 59.4 ± 17.3 and 42.4 ± 16.3, respectively (P = .006). More than 50% defect filling was seen in 95% of patients at 2 years and 82% at 6 years in the MACT group and in 67% at 2 years and 53% at 6 years in the MFx group. The second-look ICRS scores at 1 year were 10.7 ± 1.3 for MACT and 9.0 ± 1.8 for MFx (P = .001). Both groups showed significant clinical improvements at 6 years postoperatively compared with their preoperative status. Significant differences favoring the MACT group were observed at 2 years on the KOOS Activities of Daily Living (P = .043), at 4 years on all KOOS subscales (except Symptoms; P < .05) and the Tegner scale (P = .008), and at 6 years on the Tegner scale (P = .010). The responder rates at 6 years were 53% and 77% for MFx and MACT, respectively. There were no reported treatment failures after MACT; the failure rate was 8.3% in the MFx group. Neither group had serious adverse events related to treatment.

CONCLUSION

Patients who underwent MACT had better structural outcomes than those who underwent MFx at 1 to 6 years postoperatively. Both groups of patients showed significant clinical improvements at final follow-up compared with their preoperative status. MACT showed superiority at 4 years for the majority of the KOOS subscales and for the Tegner scale at 4 to 6 years. The MACT group also had a higher responder rate and lower failure rate at final follow-up.

REGISTRATION

NCT01947374 (ClinicalTrials.gov identifier).

Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial

OBJECTIVE

We evaluated the effect of ultrasound (US)-guided injection of platelet-rich plasma (PRP) into the shoulder joint in patients with adhesive capsulitis (AC) and compared its effect with that of conventional physiotherapy (CPT).

METHODS

Sixty-four subjects with AC were included and randomly allocated into two groups, as follows: PRP (n=32; intra-articular [IA] PRP [4 mL] was injected); and CPT (n=32; short wave diathermy and exercise therapy were performed at three sessions/week for 6 weeks). Treatment outcomes evaluated therapeutic effectiveness before and at 1, 3, and 6 weeks after PRP injection and CPT initiation.

RESULTS

Subjects in both groups showed a significant decrease in the visual analogue scale score for pain and shoulder and hand scores, and they a significant increase in shoulder passive range of motion at all evaluation time points. There was no significant difference in the measured outcomes between the two groups. However, there was less acetaminophen consumption after IA PRP injection compared with that after CPT.

CONCLUSIONS

IA PRP injection is a useful option for treating patients with AC, particularly those who have low therapeutic compliance for exercise therapy or have contraindications for corticosteroid injection or oral pain reduction medication.

Considerations surrounding remote medicolegal assessments: a systematic search and narrative synthesis of the range of motion literature

Remote telehealth practices were forced to advance 10 years in a few short weeks in March 2020 due to the onset of a global pandemic. In the sphere of non‐clinical medicine, a dramatic element of uncertainty entered the psyche of doctors and lawyers in relation to the validity of remote or virtual independent medical examination (vIME). This paper considers the key issues surrounding the virtual assessment of clients for medicolegal purposes. Our main hypothesis was that, within certain defined parameters, the vIME technique can deliver reliable and accurate assessments. To explore this, a systematic literature search focusing on advanced device‐based range of motion measurement was conducted, along with an historical snapshot of observation‐based range of motion measurement considering application to remotely performed IME. While some specialists are of the view that observational measurement may be applied reliably to some joints when conducted by experienced orthopaedic surgeons, evidence for this is scant. The results, instead, support the notion of using task substitution, that is specialists appropriately assisted in conducting vIMEs by musculoskeletal trained allied health practitioners, regardless of the measurement tool, for permanent impairment assessments. Moreover, self‐performed examinations by injured individuals using advanced technology are not reliable in this setting. Our final contention is that remote examinations with limited clinical assessment have utility for legal matters, such as the assessment of causation of injury, treatment advice or approvals and fitness for pre‐employment tasks or safe variations, with objective clinical adjunct support such as Picture Archiving and Communication System‐based modern radiology systems.

[Corrigendum: Meryem Lemsanni et al. Sub- and intercondylar fractures of the distal humerus in adults doi: 10.11604/pamj.2020.36.346.24516]

Ce corrigendum modifie l´article “Fractures sus et inter-condyliennes de l´humérus distal chez l´adulte”. Access corrected manuscript Pan African Medical Journal. 2020; 36: 346. doi: 10.11604/pamj.2020.36.346.24516.

The Beighton Score as a measure of generalised joint hypermobility

The Beighton Score (BS) is a set of manoeuvres in a nine-point scoring system, used as the standard method of assessment for Generalised Joint Hypermobility (GJH). It was originally developed as an epidemiological tool used in screening large populations for GJH, but later adopted as a clinical tool for diagnostic purposes. Its ability to truly reflect GJH remains controversial, as joints within the scoring system are predominantly of the upper limb and disregard many of the major joints, preventing a direct identification of GJH. Furthermore, a consistent finding in the literature whereby the BS failed to identify hypermobility in joints outside the scoring system suggests its use as an indirect indicator of GJH is also not viable. As such, the collective findings of this review demonstrate a need for a change in clinical thinking. The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH. Greater emphasis should be placed on a clinician’s judgement to identify or exclude GJH, according to its full definition.

In Vivo Cartilage Regeneration with Cell-Seeded Natural Biomaterial Scaffold Implants: 15-Year Study

Articular cartilage can be easily damaged from human's daily activities, leading to inflammation and to osteoarthritis, a situation that can diminish the patients' quality of life. For larger cartilage defects, scaffolds are employed to provide cells the appropriate three-dimensional environment to proliferate and differentiate into healthy cartilage tissue. Natural biomaterials used as scaffolds, attract researchers' interest because of their relative nontoxic nature, their abundance as natural products, their easy combination with other materials, and the relative easiness to establish Marketing Authorization. The last 15 years were chosen to review, document, and elucidate the developments on cell-seeded natural biomaterials for articular cartilage treatment in vivo. The parameters of the experimental designs and their results were all documented and presented. Considerations about the newly formed cartilage and the treatment of cartilage defects were discussed, along with difficulties arising when applying natural materials, research limitations, and tissue engineering approaches for hyaline cartilage regeneration.

Classification of lower extremity venous malformations and risk of knee involvement: A retrospective cohort study

BACKGROUND

Venous malformation (VM) is the most common vascular anomaly in the lower extremity. VMs can be classified as focal, multifocal, or diffuse types. Intraarticular VM (IA-VM) of the knee portends morbidity. Association of the lower extremity VM type with IA-VM is not well defined.

OBJECTIVE

To classify a large cohort of lower extremity, nonsyndromic VMs by type and determine associations with IA-VM.

METHODS

Retrospective cohort study.

RESULTS

We assessed 156 patients with nonsyndromic, lower extremity VM; 71 (46%) were focal and 85 (54%) were diffuse type VM, and 97 (62%) were IA-VM. Of diffuse VMs, 26 (31%) were Bockenheimer and 59 (69%) were localized subtypes. Pure VM had a significantly elevated risk of IA-VM (relative risk [RR], 2.34; 95% confidence interval [CI], 1.42-3.89). IA-VM was more common in diffuse (73%) versus focal (49%) types. Risk of IA-VM in diffuse type VM was significantly elevated (RR, 1.48; 95% CI, 1.13-1.94). One hundred percent of diffuse Bockenheimer type VM had IA-VM, and this subtype had the highest risk (RR, 1.83; 95% CI, 1.56-2.14) of IA-VM.

LIMITATIONS

Retrospective, single-institution study.

CONCLUSIONS

Intraarticular involvement of the knee should be considered in all lower extremity VMs. Pure VM and the Bockenheimer diffuse VM subtype had the highest risk of IA-VM.

[Sub- and intercondylar fractures of the distal humerus in adults]

Introduction

les fractures articulaires complètes de l’extrémité inférieure de l’humérus de l’adulte sont des lésions rares et graves. Les options thérapeutiques sont nombreuses mais le traitement chirurgical par ostéosynthèse est ardemment défendu. L’objectif de notre travail a été de décrire les caractéristiques épidémiologiques, clinico-radiologiques et thérapeutiques de ces fractures, ainsi que d’évaluer les résultats fonctionnels obtenus chez nos patients.

Méthodes

nous avons mené une étude prospective sur une période de 3 ans, portant sur 38 patients admis pour fracture articulaire complète sus et inter-condylienne de l’humérus distal (classée type C selon la classification de l’AO), traités chirurgicalement par voie postérieure trans-olécranienne avec un recul moyen de 34 mois.

Résultats

nous avons remarqué une distribution bimodale avec une atteinte du sujet jeune de sexe masculin d’une part, et une survenue chez les femmes âgées d’autre part. Les étiologies étaient dominées par les accidents de la voie publique chez 78%. Lors du suivi, nous avons noté un seul cas d’infection superficielle du site opératoire et il n’y a eu aucun cas de démontage du matériel ni de pseudarthrose. De surcroit, aucune complication de l’ostéosynthèse de l’olécrane n’a été enregistrée. Les résultats fonctionnels ont été très satisfaisants avec un score de Mayo-Clinic Elbow Performance Score (MEPS) moyen de 86.

Conclusion

nous considérons que la voie postérieure trans-olécranienne semble être la meilleure voie d’abord de ces fractures puisqu’elle permet une bonne exposition articulaire, condition sine qua non pour une restitution anatomique parfaite et une ostéosynthèse stable afin d’entreprendre une rééducation précoce et adaptée.

Intrarater and Interrater Reliability of a Passive Shoulder Flexion Range of Motion Measurement for Latissimus Dorsi Flexibility in Young Competitive Swimmers

CONTEXT

The latissimus dorsi plays a major role in generating the propulsive force during swimming. In addition, stiffness of this muscle may result in altered stroke biomechanics and predispose swimmers to shoulder pain. Measuring the flexibility of the latissimus dorsi can be of interest to reduce injury. However, the reliability of such measurement has not yet been investigated in competitive swimmers.

OBJECTIVE

To assess the within-session intrarater and interrater reliability of a passive shoulder flexion range of motion measurement for latissimus dorsi flexibility in competitive swimmers.

DESIGN

Within-session intrarater and interrater reliability.

SETTING

Competitive swimming clubs in Flanders, Belgium.

PARTICIPANTS

Twenty-six competitive swimmers (15.46 [2.98] y; 16 men and 10 women).

INTERVENTION

Each rater performed 2 alternating (eg, left-right-left-right) measurements of passive shoulder flexion range of motion twice, with a 30-second rest period in between.

MAIN OUTCOME MEASURES

The intraclass correlation coefficients were calculated to assess intrarater and interrater reliability.

RESULTS

Interrater intraclass correlation coefficient ranged from .54 (95% confidence interval [CI], -.16 to .81) to .57 (95% CI, -.24 to .85). Results for the intrarater reliability ranged from .91 (95% CI, .81 to .96) to .94 (95% CI, .87 to .97).

CONCLUSION

Results of this study suggest that shoulder flexion range of motion in young competitive swimmers can be measured reliably by a single rater within the same session.

Regenerative effects of human chondrocyte sheets in a xenogeneic transplantation model using immune-deficient rats

Although cell transplantation has attracted much attention in regenerative medicine, animal models continue to be used in translational research to evaluate safety and efficacy because cell sources and transplantation modalities are so diverse. In the present study, we investigated the regenerative effects of human chondrocyte sheets on articular cartilage in a xenogeneic transplantation model using immune‐deficient rats. Osteochondral defects were created in the knee joints of immune‐deficient rats that were treated as Group A, untreated (without transplantation); Group B, transplantation of a layered chondrocyte sheet containing 5.0 × 10⁵ cells (layered chondrocyte sheet transplantation); Group C, transplantation of a synoviocyte sheet containing 5.0 × 10⁵ cells (synoviocyte sheet transplantation); or Group D, transplantation of both a synoviocyte sheet plus a layered chondrocyte sheet, each containing 5.0 × 10⁵ cells (synoviocyte sheet plus layered chondrocyte sheet transplantation). Histological evaluation demonstrated that Group B showed cartilage regeneration with hyaline cartilage and fibrocartilage. In Groups C and D, the defect was filled with fibrous tissue but no hyaline cartilage. Transplanted cells were detected at 4 and 12 weeks after transplantation, but the number of cells had decreased at 12 weeks. Our results indicate that layered chondrocyte sheet transplantation contributes to articular cartilage regeneration; this model proved useful for evaluating these regenerative effects.

Tissue Engineering: An Alternative to Repair Cartilage

Herein we review the state-of-the-art in tissue engineering for repair of articular cartilage. First, we describe the molecular, cellular, and histologic structure and function of endogenous cartilage, focusing on chondrocytes, collagens, extracellular matrix, and proteoglycans. We then explore in vitro cell culture on scaffolds, discussing the difficulties involved in maintaining or obtaining a chondrocytic phenotype. Next, we discuss the diverse compounds and designs used for these scaffolds, including natural and synthetic biomaterials and porous, fibrous, and multilayer architectures. We then report on the mechanical properties of different cell-loaded scaffolds, and the success of these scaffolds following in vivo implantation in small animals, in terms of generating tissue that structurally and functionally resembles native tissue. Last, we highlight future trends in this field. We conclude that despite major technical advances made over the past 15 years, and continually improving results in cartilage repair experiments in animals, the development of clinically useful implants for regeneration of articular cartilage remains a challenge

Ablation of the miRNA Cluster 24 Has Profound Effects on Extracellular Matrix Protein Abundance in Cartilage

MicroRNAs (miRNAs) regulate cartilage differentiation and contribute to the onset and progression of joint degeneration. These small RNA molecules may affect extracellular matrix organization (ECM) in cartilage, but for only a few miRNAs has this role been defined in vivo. Previously, we showed that cartilage-specific genetic ablation of the Mirc24 cluster in mice leads to impaired cartilage development due to increased RAF/MEK/ERK pathway activation. Here, we studied the expression of the cluster in cartilage by LacZ reporter gene assays and determined its role for extracellular matrix homeostasis by proteome and immunoblot analysis. The cluster is expressed in prehypertrophic/hypertrophic chondrocytes of the growth plate and we now show that the cluster is also highly expressed in articular cartilage. Cartilage-specific loss of the cluster leads to increased proteoglycan 4 and matrix metallopeptidase 13 levels and decreased aggrecan and collagen X levels in epiphyseal cartilage. Interestingly, these changes are linked to a decrease in SRY-related HMG box-containing (SOX) transcription factors 6 and 9, which regulate ECM production in chondrocytes. Our data suggests that the Mirc24 cluster is important for ECM homoeostasis and the expression of transcriptional regulators of matrix production in cartilage.

Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures: a randomized controlled trial

The aim of this study was to determine the difference in functional outcomes after open reduction and internal fixation (ORIF) with and without arthroscopic debridement in adults with displaced intra-articular distal radius fractures. In this multicentre trial, 50 patients were randomized between ORIF with or without arthroscopic debridement. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcome measures were Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, pain scores, range of wrist motion, grip strength, and complications. Median PRWE was worse for the intervention group at 3 months and was equal for both groups at 12 months. The secondary outcome measures did not show consistent patterns of differences at different time-points of follow-up. We conclude that patients treated with additional arthroscopy to remove intra-articular hematoma and debris did not have better outcomes than those treated with ORIF alone. We therefore do not recommend arthroscopy for removal of hematoma and debris when surgically fixing distal radius fractures. Level of evidence: I.

Fragment-specific fixation of trimalleolar fractures utilizing the posterolateral approach: A preliminary experience

INTRODUCTION

Ankle fractures involving posterior malleolus are disabling injuries if not managed properly. Clinical and functional outcome of ankle fractures involving posterior tibial plafond is significantly worse. Although the surgical approach and techniques to reduce and fix this fracture are well described in the literature, there still seems to be divided consensus among orthopedic surgeons regarding the same.

METHODS

In this case series of eight patients with trimalleolar fractures, a posterolateral approach was used for fixation of posterior malleolus in all the cases. A preoperative computed tomography scan formed an integral part of management of such injuries. The Olerud and Molendar scoring system was employed at 12 months of follow-up to assess the functional outcome. Weight-bearing X-rays were taken to assess for any ankle arthritis.

RESULTS

The average age of patients was 48.8 years. The most common mode of sustaining injury was twisting of the ankle joint ( n = 5). The average time to union and full weight-bearing was 12.8 weeks (range 10-16 weeks). An excellent functional outcome in four patients and a good outcome in the rest of the four patients were obtained at the end of 12 months of follow-up. No significant ankle arthritis or complications were encountered.

CONCLUSION

Appropriate preoperative imaging evaluation is an integral part of planning for these complex injuries. The posterolateral approach provides good exposure for appropriate visualization. Stable fixation of posterior malleolus in trimalleolar fractures plays a vital role in obtaining a positive clinical and functional outcome.

Three-dimensional in vivo scapular kinematics and scapulohumeral rhythm: a comparison between active and passive motion

BACKGROUND

The aim of this study was to compare the scapular kinematics and scapulohumeral rhythm of healthy participants during arm elevation and lowering and to find the difference between active motion and passive motion of the shoulder.

METHODS

The study examined the shoulders of 10 healthy men (mean age, 23.5 years; age range, 22-28 years). The shoulders of participants were elevated and lowered while fluoroscopic images were taken, and 3-dimensional bone models were created from 2-dimensional to 3-dimensional images using model registration techniques. The Euler angle sequences of the models' scapular kinematics and scapulohumeral rhythm were compared during active and passive shoulder motion.

RESULTS

There was a significant statistical difference of upward rotation during arm elevation between active and passive shoulder movements (P = .027). In particular, the upward rotation between 45° and 90° of elevation showed a statistically significant difference (P < .001). When the scapula was tilted posteriorly by active motion, it resulted in a statistically significant difference as there was more tilting in the high-degree range of motions than when it was tilted by passive motion (P < .001). There was no statistically significant difference between the 2 groups in scapular external rotation. However, during arm lowering, scapular kinematics did not show statistically significant difference between active and passive motion.

CONCLUSIONS

The scapular kinematics showed statistically significant differences between active and passive motion of upward rotation and posterior tilting of the scapula during arm elevation, but there were none during lowering. In terms of upward rotation, active shoulders rotated more upward during arm elevation.

Survival Analysis of Revision Autologous Chondrocyte Implantation for Failed ACI

BACKGROUND

Autologous chondrocyte implantation (ACI) provides a successful outcome for treating articular cartilage lesions. However, there have been very few reports on the clinical outcomes of revision ACI for failed ACI.

PURPOSE

To evaluate clinical outcomes in patients who underwent revision ACI of the knee for failure of an initial ACI and to determine the factors affecting the survival rate.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A review of a prospectively collected data set was performed from patients who underwent revision ACI of the knee for failure of an initial ACI between 1995 and 2014 by a single surgeon. The authors evaluated 53 patients (53 knees; mean age, 38 years) over a mean 11.2-year follow-up (range, 2-20). A total of 62 cartilage lesions were treated for failed graft lesions after an initial ACI, and 31 new cartilage lesions were treated at revision ACI, as there was progression of disease. Overall, 93 cartilage lesions (mean, 1.8 lesions per knee) with a total surface area of 7.4 cm² (range, 2.5-18 cm²) per knee were treated at revision ACI. Survival analysis was performed with the Kaplan-Meier method, with ACI graft failure or conversion to a prosthetic arthroplasty as the endpoint. The modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, and 36-Item Short Form Health Survey were used to evaluate clinical outcomes. Patients also self-reported knee function and satisfaction. Standard radiographs were evaluated with Kellgren-Lawrence grades.

RESULTS

Survival rates were 71% and 53% at 5 and 10 years, respectively. Survival subanalysis revealed a trend that patients without previous cartilage repair procedures before an initial ACI had better survival rates than those with such procedures (81% vs 62% at 5 years, 64% vs 42% at 10 years, P = .0958). Patients with retained grafts showed significant improvement in pain and function, with a high level of satisfaction. At a mean 5.1 years postoperatively, 18 of 27 successful knees were radiographically assessed with no significant osteoarthritis progression. Outcomes for 26 patients were considered failures (mean, 4.9 years postoperatively), in which 15 patients had prosthetic arthroplasty (mean, 4.6 years) and the other 11 patients had revision cartilage repair (mean, 5.4 years) and thus could maintain their native knees.

CONCLUSION

Results of revision ACI for patients who failed ACI showed acceptable clinical outcomes. Revision ACI may be an option for young patients after failed initial ACI, particularly patients without previous cartilage repair procedures and those who desire to maintain their native knees.

Evaluation of the Isokinetic Calf Muscle Strength and the Range of Motion of Joint in C3 Chronic Venous Insufficiency

Purpose

The present study aimed to compare the isokinetic muscle strength and range of motion (ROM) values of the ankle between patients diagnosed with C₃ chronic venous insufficiency (group 1, n=57) and healthy individuals (group 2, n=30).

Materials and Methods

After identifying the venous refilling time (VRT) of all participants, the active ROM of the ankle joint and plantar flexion (PF) and dorsi-flexion (DF) muscle strength in the concentric/concentric mode at angular velocities of 60°/sec and 120°/sec were measured.

Results

No statistically significant differences were found between the demographic data of groups 1 and 2 (P>0.05). In total, 102 lower extremities were included in group 1 and 60 lower extremities in group 2. The VRT of the patients in group 1 was 15.5±5.6 seconds, the PF ROM of the ankle joint was 39.3°±9.5°, and the DF ROM of the ankle joint was 27°±8°; in group 2, the VRT, PF ROM, and DF ROM were 36±8.1 seconds, 41°±6.2°, and 27.2°±7.5°, respectively. Statistically significant differences were found between the two groups in terms of VRT (P<0.05); however, no statistically significant difference was observed in terms of ankle ROM (P>0.05). Statistically significant difference was found in terms of all parameters of isokinetic muscle strength measurements, such as peak torque, peak torque/body weight, total work done, and ratio (DF/PF) in group 1 (P=0.001).

Conclusion

The lower extremity muscle strength of patients with chronic venous insufficiency was low, and this weakness was prominent particularly in the direction of PF.

Accuracy of classifying the movement strategy in the functional reach test using a markerless motion capture system

The purpose of this study was to examine the accuracy of classifying the movement strategy in the functional reach test (FRT) using a markerless motion capture system (MLS) on the basis of values acquired with a marker-based motion capture system (MBS). Sixty young, injury-free individuals participated in this study. The task action involved reaching forward in the standing position. Using the Microsoft Kinect v2 as an MLS and Vicon as a MBS, the coordinates of the hip joints, knee joints and ankle joints were measured. The hip and ankle joint angles during the task were calculated from the coordinate data. These angles between MLS and MBS were compared using a paired t-test. The accuracy of movement strategy defined using MLS was examined based on the MBS. A t-test showed a significant difference in both the hip and ankle joint angles between systems (p < .01). However, in case of using data of left ankle joint, indices of the classification accuracy of MLS were 0.825 for sensitivity, 1.000 for specificity, infinity for positive likelihood ratio and 0.175 for negative likelihood ratio. The results for the right joint angle were similar to those of the left joint angle. Although the absolute measures in the hip and joint angles obtained using MLS differ from MBS, the MLS may be useful for accurately classifying the movement strategy adopted in the FRT.

Autologous Chondrocyte Implantation "Segmental-Sandwich" Technique for Deep Osteochondral Defects in the Knee: Clinical Outcomes and Correlation With Magnetic Resonance Imaging Findings

Background

Symptomatic osteochondral defects are difficult to manage, especially in patients with deep (>8-10 mm) empty defects. The restoration of articular congruence is crucial to avoid the progression to osteoarthritis (OA).

Purpose

To describe the autologous chondrocyte implantation (ACI) "segmental-sandwich" technique for restoration of the osteochondral unit and to evaluate midterm outcomes in patients treated with this procedure. Correlations between magnetic resonance imaging (MRI) and radiographic findings with outcomes were assessed.

Study Design

Case series; Level of evidence, 4.

Methods

Outcomes were evaluated for a consecutive cohort of 15 patients with symptomatic deep (>8 mm) osteochondral lesions who underwent autologous bone grafting plus the ACI segmental-sandwich technique performed by a single surgeon between 2003 and 2011. Patients with a minimum 2-year follow-up were included. All patients completed validated clinical outcome scales and a patient satisfaction survey. The Kellgren-Lawrence (K-L) grade was assessed for the progression to OA. The repair site was evaluated with the MOCART (magnetic resonance observation of cartilage repair tissue) score. Filling and tissue characteristics of the bone defect were analyzed with MRI.

Results

All patients (mean age at surgery, 31.0 ± 9.1 years) were available for follow-up (mean follow-up, 7.8 ± 3.0 years; range, 2-15 years). The mean chondral lesion size was 6.0 ± 3.5 cm² (range, 1.5-13.5 cm²), with a mean bone defect area of 1.7 cm² (27%-40% of overall surface area treated by ACI) and depth of 1.0 cm. All patients had successful clinical outcomes, and all functional scores improved significantly (P < .05). Patients reported a very high satisfaction rate (93%). The K-L grade demonstrated no significant progression to OA over a mean follow-up of 4.7 years. For 12 patients with MRI results available, the mean MOCART score at a mean of 3.3 years was 64.2 ± 19.9, with complete or near-complete (≥75% of defect volume) chondral defect filling (83%) and complete integration to adjacent cartilage (83%). Bone defects were completely filled in 83% of patients.

Conclusion

The ACI segmental-sandwich technique provides significant functional improvements at midterm follow-up and excellent survival rates. This unique treatment allows for the resurfacing of cartilage defects and the repair of underlying segmental bone lesions.

The reliability and concurrent validity of a new iPhone® application for measuring active lumbar spine flexion and extension range of motion in patients with low back pain

Objective: To investigate the reliability and validity of an iPhone® application (iHandy® Level) for measuring active lumbar flexion-extension range of motion (ROM) in chronic nonspecific low back pain (CNLBP) patients. Methods: Fifteen CNLBP patients were recruited. The participants stood in a relaxed position and the T12-L1 and S1-S2 spinal levels were identified through palpation and were marked on the skin. Two blinded examiners used a gravity-based inclinometer and the application in order to measure ROM. The instruments were lined up appropriately and the participants were asked to perform maximum lumbar flexion following by maximum extension. First, each examiner placed the instruments over the T12-L1 level and then over the S1-S2 level during the movements. In order to calculate flexion-extension ROM, the measurement which was obtained from T12-L1 was subtracted from S1-S2. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used in order to determine the intrarater and inter-rater reliability, respectively. The Spearman's correlation coefficients (r_s ) and Bland-Altman plots were used in order to examine the validity. Results: Fair-to-excellent intrarater (ICC = 0.39-0.89) and moderate-to-good inter-rater reliability (ICC = 0.55-0.77) were observed using the inclinometer. Moreover, poor-to-good intrarater (ICC = 0.30-70) and inter-rater (ICC = 0.13-0.70) reliability were found with the application. The Spearman's correlation coefficients demonstrated low-to-moderate associations between the measures of the two instruments (r_s ≥ 0.22). The Bland-Altman plots indicated that there was a significant difference between the instruments for measuring flexion ROM. The difference was not significant for measuring extension ROM. Conclusion: The iHandy® Level application does not have sufficient validity for measuring active lumbar flexion ROM in CNLBP patients.

Effect of breast cancer surgery on chest tightness and upper limb dysfunction

This study aimed to investigate the possible changes in anterior chest tightness after breast cancer surgery. We also try to investigate whether anterior chest tightness is associated with upper-limb dysfunction after breast cancer surgery. Eighty-three women who underwent breast cancer surgery were evaluated before and 2 weeks, 3 months, and 9 months after surgery. Anterior chest tightness was measured using the length of the pectoralis minor muscle through 2 methods (length from the coracoid process to the fourth rib and linear distance from the table to the posterior acromion with supine position). Shoulder range of motion and the K-DASH (Korean version of Disability Arm and Shoulder Questionnaire) score were measured to quantify functional performance of upper limb. Anterior chest tightness of patients with breast cancer significantly increased after surgery. Upper limb dysfunction was observed such as reduced shoulder range-of-motion and increased K-DASH score over time. Increase in chest tightness was correlated with shoulder range-of-motion reduction. Chest tightness was not correlated with K-DASH score directly. However, shoulder range-of-motion reduction was significantly correlated with K-DASH score. Chest tightness and upper limb dysfunction increased in breast cancer survivor. Increase in chest tightness after surgery is associated with upper limb dysfunction and careful attention is required.

Tissue Engineering: An Alternative to Repair Cartilage

Herein we review the state-of-the-art in tissue engineering for repair of articular cartilage. First, we describe the molecular, cellular, and histologic structure and function of endogenous cartilage, focusing on chondrocytes, collagens, extracellular matrix, and proteoglycans. We then explore in vitro cell culture on scaffolds, discussing the difficulties involved in maintaining or obtaining a chondrocytic phenotype. Next, we discuss the diverse compounds and designs used for these scaffolds, including natural and synthetic biomaterials and porous, fibrous, and multilayer architectures. We then report on the mechanical properties of different cell-loaded scaffolds, and the success of these scaffolds following in vivo implantation in small animals, in terms of generating tissue that structurally and functionally resembles native tissue. Last, we highlight future trends in this field. We conclude that despite major technical advances made over the past 15 years, and continually improving results in cartilage repair experiments in animals, the development of clinically useful implants for regeneration of articular cartilage remains a challenge

Continuous Passive Motion After Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Associated Effects on Clinical Outcomes

OBJECTIVE

To evaluate the efficacy of continuous passive motion (CPM) after total knee arthroplasty (TKA) and whether the use of CPM is related to improved clinical and functional outcomes.

DATA SOURCES

A systematic MEDLINE search via Web of Science, Cochrane Library, and PubMed databases was conducted.

STUDY SELECTION

English-language articles published between January 2000 and May 2018 reporting the related clinical outcomes of CPM after TKA were included. A total of 3334 titles and abstracts were preliminarily reviewed, of which 16 studies were included according to the eligibility criteria.

DATA EXTRACTION

Two different reviewers were selected to perform the study extraction, independent of each other. If there were any disagreements regarding the final list of studies, the third reviewer reviewed the list as an arbitrator for completeness.

DATA SYNTHESIS

A total of 16 trials with 1224 patients were included. The pooled results revealed that use of CPM did not show a statistically significant improvement of postoperative knee range of motion (ROM) except for middle-term passive knee extension and long-term active knee flexion ROM. Also, CPM therapy did not show a significant positive effect on the functional outcomes. No significant reduction in length of stay (LOS) and incidence of adverse events (AEs) was identified.

CONCLUSION

Among patients undergoing TKA, neither the ROM nor the functional outcomes could be improved by CPM therapy. Moreover, the risk of AEs and LOS could not be reduced by application of CPM. The current available evidence suggested that this intervention was insufficient to be used routinely in clinical practice.

Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Patellofemoral Compartment: Clinical Outcomes at a Mean 9 Years' Follow-up

BACKGROUND

Treating bipolar chondral lesions in the patellofemoral (PF) compartment is a challenging problem. There are few reports available on the treatment of bipolar chondral lesions in the PF compartment.

PURPOSE

To evaluate the clinical outcomes and graft survivorship after autologous chondrocyte implantation (ACI) for the treatment of bipolar chondral lesions in the PF compartment.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The authors evaluated 58 patients who had ACI by a single surgeon for the treatment of symptomatic bipolar chondral lesions in the PF compartment between November 1995 and June 2014. All 58 patients (60 knees; mean age, 36.6 years) were included with a minimum 2-year follow-up. The mean ± SD sizes of the patellar and trochlear lesions were 5.6 ± 2.7 cm² and 4.2 ± 2.8 cm², respectively. Forty-two patients had osteotomy, as they had PF lateral maltracking, patellar instability, or tibiofemoral malalignment. Patients were evaluated with the modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, the 36-Item Short Form Health Survey, and a patient satisfaction survey. Radiographs were evaluated with the Iwano classification.

RESULTS

Overall, the survival rates were 83% and 79% at 5 and 10 years, respectively. Of the 49 (82%) knees with retained grafts, all functional scores significantly improved postoperatively with a very high satisfaction rate (88%) at a mean 8.8 ± 4.2 years after ACI (range, 2-16 years). At the most recent follow-up, 28 of 49 successful knees were radiographically assessed (mean, 4.9 years; range, 2-17 years), with no increase of the Iwano classification in 26 knees. Outcomes for 11 patients were considered failures at a mean 2.9 years. Forty-two knees (70%) required a mean 1.0 subsequent surgical procedure. The primary reasons for chondroplasty were hypertrophy of the ACI graft (17; periosteum in 14, collagen membrane in 3), delamination of the ACI graft (5; periosteum in 4, collagen membrane in 1), and new chondral lesions (3). The best survival rates were observed among patients who underwent ACI with concomitant tibial tubercle osteotomy (TTO) as the first procedure without previous failed TTO and/or marrow stimulation technique (91% at 5 and 10 years), while the worst survival rates were observed among patients who had previous marrow stimulation (43% at 5 and 10 years).

CONCLUSION

Results demonstrated that ACI with concomitant osteotomy, when it is necessary for the treatment of bipolar/kissing lesions in the PF compartments, gives significant improvement in pain and function, with good survival rates at 5 and 10 years (83% and 79%, respectively). The high patient satisfaction rate is encouraging, and a high survival rate can be expected when ACI with a concomitant TTO is performed at the initial surgery for this difficult condition.

Spontaneous calcium signaling of cartilage cells: from spatiotemporal features to biophysical modeling

Intracellular calcium ([Ca²⁺]_i) oscillation is a fundamental signaling response of cartilage cells under mechanical loading or osmotic stress. Chondrocytes are usually considered as nonexcitable cells with no spontaneous [Ca²⁺]_i signaling. This study proved that chondrocytes can exhibit robust spontaneous [Ca²⁺]_i signaling without explicit external stimuli. The intensity of [Ca²⁺]_i peaks from individual chondrocytes maintain a consistent spatiotemporal pattern, acting as a unique "fingerprint" for each cell. Statistical analysis revealed lognormal distributions of the temporal parameters of [Ca²⁺]_i peaks, as well as strong linear correlations between their means and sds. Based on these statistical findings, we hypothesized that the spontaneous [Ca²⁺]_i peaks may result from an autocatalytic process and that [Ca²⁺]_i oscillation is controlled by a threshold-regulating mechanism. To test these 2 mechanisms, we established a multistage biophysical model by assuming the spontaneous [Ca²⁺]_i signaling of chondrocytes as a combination of deterministic and stochastic processes. The theoretical model successfully explained the lognormal distribution of the temporal parameters and the fingerprint feature of [Ca²⁺]_i peaks. In addition, by using antagonists for 10 pathways, we revealed that the initiation of spontaneous [Ca²⁺]_i peaks in chondrocytes requires the presence of extracellular Ca²⁺, and that the PLC-inositol 1,4,5-trisphosphate pathway, which controls the release of calcium from the endoplasmic reticulum, can affect the initiation of spontaneous [Ca²⁺]_i peaks in chondrocytes. The purinoceptors and transient receptor potential vanilloid 4 channels on the plasma membrane also play key roles in the spontaneous [Ca²⁺]_i signaling of chondrocytes. In contrast, blocking the T-type or L-type voltage-gated calcium channel promoted the spontaneous calcium signaling. This study represents a systematic effort to understand the features and initiation mechanisms of spontaneous [Ca²⁺]_i signaling in chondrocytes, which are critical for chondrocyte mechanobiology.-Zhou, Y., Lv, M., Li, T., Zhang, T., Duncan, R., Wang, L., Lu, X. L. Spontaneous calcium signaling of cartilage cells: from spatiotemporal features to biophysical modeling.

Falls rate increase and foot dorsal flexion limitations are exhibited in patients who suffer from asthma: A novel case-control study

Purpose: Based on the possible association between reduced foot dorsiflexion and high risk of falls, the main objective was to determine the ankle and 1º metatarsophalangeal joint (1^stMTTP) dorsiflexion range of motion and falls rate in patients with asthma compared to healthy matched-paired controls. Methods: A case-control study was carried out. Eighty participants were recruited and divided into patients with asthma (case group; n=40) and matched-paired healthy participants (control group; n=40). Foot dorsal flexion range of motion (assessed by the Weight-Bearing Lunge Test [WBLT]) and falls rate (evaluated as falls number during the prior year) were considered as the primary outcomes. Indeed, ankle dorsiflexion was measured by a mobile app (º) and a tape measure (cm) as well as 1^stMTTP dorsiflexion was determined by and universal goniometer (º). Results: Statistically significant differences (P<.05) showed that patients with asthma presented a greater falls rate than healthy participants and reduced bilateral ankle and 1^stMTTP dorsiflexion ranges of motion than healthy participants, except for the left ankle dorsiflexion measured as degrees (P>.05). Conclusions: These study findings showed that a falls rate increase and bilateral foot dorsal flexion limitations of the ankle and 1^stMTTP joints are exhibited in patients who suffer from asthma.

Factors associated with limited hand motion after hand trauma

Hand injuries are common and have a significant impact on daily life. However, the factors associated with functional outcome after hand injuries are not well established. The purpose of this study was to identify factors that are independently associated with hand total active motion (TAM).A total of 50 patients with unilateral complex hand injury were included in this study. The associations between various demographic, injury-related, and clinical assessment factors and TAM were determined by univariate and multivariate linear regression analyses. Nerve injuries recognized during surgery and diagnosed with electrodiagnostic (EDX) studies were compared using Pearson chi-squared test.Among multiple injury-related and initial clinical assessment factors, nerve injury diagnosed with EDX studies, hospital stay length, elevated C-reactive protein, and skeletal injury were independently associated with TAM in the affected hand after adjusting for covariates. Nerve injuries diagnosed with EDX studies were not consistent with those recognized during surgery.Our results suggest that high-energy trauma leading to skeletal and nerve injury with inflammation is associated with limited hand motion after surgery and postoperative immobilization. A comprehensive EDX study may enable identifying occult or recovered nerve injuries, which would be helpful in understanding limitations in finger movements.