Scoliosis is a three dimensional deformity of the spine characterized by rotation of the vertebrae in the transverse plane and curvatures in the frontal and sagittal plane. The key radiographical tool for diagnosis is Cobb angle, which is the angle created by lines crossing over the upper limit of the first vertebra in the curve and the lower limit of the lowest and final vertebra in the anterior-posterior radiography. Although this cannot entirely describe all spinal abnormalities , it is easy to calculate and to assess and has become the gold standard for scoliotic diagnosis. Deformity is the main clinical sign during the examination, not followed by the presence of pain. The spine may be obviously deviated from the midline ,or this may become apparent only when the patient bends forward (the Adams test). The major curvature may be located at the thoracic, thoracolumbar or lumbar part of the vertebral column and the convexity may point to the left or right side, with compensatory and smaller curvatures above and below. The most common pattern is a thoracic curvature with right convexity with a compensatory left convexity at the lumbar vertebrae. Scoliosis is divided, in terms of etiology, into idiopathic (no known cause or disease), congenital (present at birth due to congenital etiological factors), and secondary(where it is caused by another disease). Idiopathic scoliosis consists, moreover, of three sub-categories, according to the age of diagnosis, as infantile (between 0-3 years old), juvenile (between 4-9 years old) and adolescent (age 10 up to maturity). Adolescent idiopathic scoliosis (AIS) has a prevalence rate between 1-3% and is more common in girls during puberty. The number of girls with AIS is two times higher than the number of boys with this disease and the prevalence is eight times higher among girls than boys when the deformation consists of curvatures greater than 30 degrees. Research into the etiopathogenesis of idiopathic scoliosis (IS) has spread through the years to multiple areas and a great number of suggestions has been made during the last decades concerning hormones, genetic , metabolic and biomechanical factors. Although a lot of theories have been proposed, none is capable to fully describe the pathophysiology of the disease, underlying the complexity and the multifactorial etiology of the condition. The purpose of this review is to summarize the main concepts of etiology Abstract Scoliosis is a three-dimensional deformity of the spine. The key radiographical tool for diagnosis is the Cobb angle and the most common form is a right thoracic convexity with a compensatory left lumbar convexity. Scoliosis is divided, in terms of etiology, into idiopathic, congenital, and secondary. Research into the etiology of idiopathic scoliosis has focused on multiple areas and a great number of suggestions has been made during the last decades concerning hormones, genetic, metabolic and biomechanical factors. Although a lot of the
{"title":"Etiopathogenesis of idiopathic scoliosis","authors":"Apostolos M. Papadoudis, Kleopatra L. Skourti","doi":"10.22540/JRPMS-03-078","DOIUrl":"https://doi.org/10.22540/JRPMS-03-078","url":null,"abstract":"Scoliosis is a three dimensional deformity of the spine characterized by rotation of the vertebrae in the transverse plane and curvatures in the frontal and sagittal plane. The key radiographical tool for diagnosis is Cobb angle, which is the angle created by lines crossing over the upper limit of the first vertebra in the curve and the lower limit of the lowest and final vertebra in the anterior-posterior radiography. Although this cannot entirely describe all spinal abnormalities , it is easy to calculate and to assess and has become the gold standard for scoliotic diagnosis. Deformity is the main clinical sign during the examination, not followed by the presence of pain. The spine may be obviously deviated from the midline ,or this may become apparent only when the patient bends forward (the Adams test). The major curvature may be located at the thoracic, thoracolumbar or lumbar part of the vertebral column and the convexity may point to the left or right side, with compensatory and smaller curvatures above and below. The most common pattern is a thoracic curvature with right convexity with a compensatory left convexity at the lumbar vertebrae. Scoliosis is divided, in terms of etiology, into idiopathic (no known cause or disease), congenital (present at birth due to congenital etiological factors), and secondary(where it is caused by another disease). Idiopathic scoliosis consists, moreover, of three sub-categories, according to the age of diagnosis, as infantile (between 0-3 years old), juvenile (between 4-9 years old) and adolescent (age 10 up to maturity). Adolescent idiopathic scoliosis (AIS) has a prevalence rate between 1-3% and is more common in girls during puberty. The number of girls with AIS is two times higher than the number of boys with this disease and the prevalence is eight times higher among girls than boys when the deformation consists of curvatures greater than 30 degrees. Research into the etiopathogenesis of idiopathic scoliosis (IS) has spread through the years to multiple areas and a great number of suggestions has been made during the last decades concerning hormones, genetic , metabolic and biomechanical factors. Although a lot of theories have been proposed, none is capable to fully describe the pathophysiology of the disease, underlying the complexity and the multifactorial etiology of the condition. The purpose of this review is to summarize the main concepts of etiology Abstract Scoliosis is a three-dimensional deformity of the spine. The key radiographical tool for diagnosis is the Cobb angle and the most common form is a right thoracic convexity with a compensatory left lumbar convexity. Scoliosis is divided, in terms of etiology, into idiopathic, congenital, and secondary. Research into the etiology of idiopathic scoliosis has focused on multiple areas and a great number of suggestions has been made during the last decades concerning hormones, genetic, metabolic and biomechanical factors. Although a lot of the","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134532185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abstracts of the Scientific Meeting of the Hellenic Osteoporosis Foundation Clinical Guidelines on Calcium and Vitamin D supplementation. Certainties and concerns on the osteoporosis treatment","authors":"G. Trovas","doi":"10.22540/jrpms-03-032","DOIUrl":"https://doi.org/10.22540/jrpms-03-032","url":null,"abstract":"","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114530083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Calcium is a mineral that is crucial for life, necessary for the completion of essential and fundamental functions. In the extracellular environment, calcium behaves as a major protein co-factor assuring the integrity of the plasma membrane. It is also the main ingredient of the inorganic part of bone (hydroxyapatite), ensuring bone strength in an important extent. Calcium is also essential for intracellular functions, such as muscle contractions and neural stimulation. It also operates as a significant intracellular second messenger, modifying various cellular processes, such as mitosis, gene expression, energy metabolism and cell death. Moreover, a recent study concluded that calcium ions act as key points in controlling cellular lipid homeostasis, suggesting that ERCa status is an important regulator of basic sensitivity of the sterol detection mechanism. Moreover, research studies suggest the correlation between calcium intake and small reductions of arterial hypertension. Keeping serum calcium within a certain range, through regulatory mechanisms, is vital to the completion of the above functions. It has been observed that adequate calcium intake is critical for skeletal health. Over the age of 50 years old, for both women and men, the Recommended Nutrient Intakes (RNI) are at least 1.000 mg of calcium and 800 IU of vitamin D per day. The combination of calcium and vitamin D supplementation is generally recommended for people receiving medication for osteoporosis treatment. According to the European guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis, the dietary calcium intake is recommended. Supplemental calcium (SC) can be provided if people cannot meet their dietary needs. Abstract Calcium covers a wide range of body functions. Adequate calcium intake is critical for skeletal health. Dietary calcium intake is considered safe, while supplemental calcium raises concerns, regarding cardiovascular health. Calcium can be administered alone or in combination with vitamin D. Supplemental calcium can be provided if people cannot meet their dietary needs or as a prescription in patients receiving medication for osteoporosis. The last ten years, a major research debate has been ongoing, regarding the possible relationship between calcium intake and cardiovascular risk. Possible mechanisms have been investigated, concerning the possible effect of calcium supplementation on cardiovascular calcifications. Further analysis is needed regarding levels of calcium intake that could possibly promote calcifications. It is also significant to evaluate the effect of the duration of supplemental calcium administration and the possible protective effect of concomitant administration of vitamin D supplementation. Until there are clinical studies to address those hypotheses, the current recommendations include that calcium (dietary and supplemental) can be given safely, within normal limits, to all healthy people and patients, possibly exclu
{"title":"The role of the calcium intake in the development of cardiovascular calcification","authors":"Evaggelia E. Pitaraki","doi":"10.22540/JRPMS-03-026","DOIUrl":"https://doi.org/10.22540/JRPMS-03-026","url":null,"abstract":"Calcium is a mineral that is crucial for life, necessary for the completion of essential and fundamental functions. In the extracellular environment, calcium behaves as a major protein co-factor assuring the integrity of the plasma membrane. It is also the main ingredient of the inorganic part of bone (hydroxyapatite), ensuring bone strength in an important extent. Calcium is also essential for intracellular functions, such as muscle contractions and neural stimulation. It also operates as a significant intracellular second messenger, modifying various cellular processes, such as mitosis, gene expression, energy metabolism and cell death. Moreover, a recent study concluded that calcium ions act as key points in controlling cellular lipid homeostasis, suggesting that ERCa status is an important regulator of basic sensitivity of the sterol detection mechanism. Moreover, research studies suggest the correlation between calcium intake and small reductions of arterial hypertension. Keeping serum calcium within a certain range, through regulatory mechanisms, is vital to the completion of the above functions. It has been observed that adequate calcium intake is critical for skeletal health. Over the age of 50 years old, for both women and men, the Recommended Nutrient Intakes (RNI) are at least 1.000 mg of calcium and 800 IU of vitamin D per day. The combination of calcium and vitamin D supplementation is generally recommended for people receiving medication for osteoporosis treatment. According to the European guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis, the dietary calcium intake is recommended. Supplemental calcium (SC) can be provided if people cannot meet their dietary needs. Abstract Calcium covers a wide range of body functions. Adequate calcium intake is critical for skeletal health. Dietary calcium intake is considered safe, while supplemental calcium raises concerns, regarding cardiovascular health. Calcium can be administered alone or in combination with vitamin D. Supplemental calcium can be provided if people cannot meet their dietary needs or as a prescription in patients receiving medication for osteoporosis. The last ten years, a major research debate has been ongoing, regarding the possible relationship between calcium intake and cardiovascular risk. Possible mechanisms have been investigated, concerning the possible effect of calcium supplementation on cardiovascular calcifications. Further analysis is needed regarding levels of calcium intake that could possibly promote calcifications. It is also significant to evaluate the effect of the duration of supplemental calcium administration and the possible protective effect of concomitant administration of vitamin D supplementation. Until there are clinical studies to address those hypotheses, the current recommendations include that calcium (dietary and supplemental) can be given safely, within normal limits, to all healthy people and patients, possibly exclu","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132512683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
them 2 . Two more centuries went by until Albert Einstein completely transformed our perception about gravity. In Abstract The entrance of mankind into the Space Age , accomplished by the second half of the 20 th century, and the advances in modern physics have completely transformed the way we perceive the role of gravity. The musculoskeletal system is long known to be heavily affected by the gravitational forces, resulting in marked loss in bone mineral density in the setting of microgravity. The meticulous study of the underlying pathophysiologic mechanisms is pivotal in order to identify possible therapeutic targets for the management of the microgravity-induced changes in bone physiology during spaceflight missions, as well as the osteopenia induced changes in the setting of osteoporosis affecting a vast majority of elder individuals. In the present bibliographic narrative review, the importance of mechanisms employed by cells in order to perceive and respond to altered gravity are discussed. Current in vitro and in vivo studies focusing on the effect of hypergravity on the musculoskeletal system are also presented. Overall, the variability in study design of the available published data makes the deduction of safe conclusions rather challenging and uncertain. It is important that future studies address the matter by employing similar research methodology and study design in order to increase the comparability of their results.
{"title":"Hypergravity and its effects on bones and the musculoskeletal system: a narrative review","authors":"C. Argyrou, G. Lambrou","doi":"10.22540/JRPMS-03-001","DOIUrl":"https://doi.org/10.22540/JRPMS-03-001","url":null,"abstract":"them 2 . Two more centuries went by until Albert Einstein completely transformed our perception about gravity. In Abstract The entrance of mankind into the Space Age , accomplished by the second half of the 20 th century, and the advances in modern physics have completely transformed the way we perceive the role of gravity. The musculoskeletal system is long known to be heavily affected by the gravitational forces, resulting in marked loss in bone mineral density in the setting of microgravity. The meticulous study of the underlying pathophysiologic mechanisms is pivotal in order to identify possible therapeutic targets for the management of the microgravity-induced changes in bone physiology during spaceflight missions, as well as the osteopenia induced changes in the setting of osteoporosis affecting a vast majority of elder individuals. In the present bibliographic narrative review, the importance of mechanisms employed by cells in order to perceive and respond to altered gravity are discussed. Current in vitro and in vivo studies focusing on the effect of hypergravity on the musculoskeletal system are also presented. Overall, the variability in study design of the available published data makes the deduction of safe conclusions rather challenging and uncertain. It is important that future studies address the matter by employing similar research methodology and study design in order to increase the comparability of their results.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132046786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
with oral manifestations, as well as the medication intended for these patients, can affect the oral epithelium, as well as the bone quality, which are both important factors of implant osseointegration and long term success 4 . Abstract Oral mucosal autoimmune diseases include a variety of disorders, like oral lichen planus (OLP), pemphigus vulgaris (PV), mucous membrane (MMP) and bullous pemphigoid (BP), epidermolysis bullosa acquisita (EBA), systemic lupus erythematosus (SLE) and Sjögren syndrome (SS) and can cause painful erosions, blisters and ulceration at the oral epithelium. Such diseases complicate dental hygiene and can lead to tooth loss. When natural teeth are missing, dental implants can improve quality of life for these patients. Osseointegration is necessary for dental implant success and is not contraindicated for patients with oral mucosal autoimmune diseases. However, the clinical dentist must consider the possible impact of oral autoimmune diseases on the oral epithelium that might affect implant success, also due to the difficulty of everyday oral hygiene, leading to bone absorption around the implant. Moreover, medication approved for the therapy of such diseases, such as corticosteroids, immunosuppressants and non-steroidal anti-inflammatory drugs (NSAIDs) could provoke osseointegration, as it compromises bone quality and affects the patient’s general health. However, the impact of these drugs on implant surgery depends on dose and duration of the drug and usually dental implantation is possible.
{"title":"Dental implants in patients with oral autoimmune diseases","authors":"T. Tounta","doi":"10.22540/JRPMS-03-009","DOIUrl":"https://doi.org/10.22540/JRPMS-03-009","url":null,"abstract":"with oral manifestations, as well as the medication intended for these patients, can affect the oral epithelium, as well as the bone quality, which are both important factors of implant osseointegration and long term success 4 . Abstract Oral mucosal autoimmune diseases include a variety of disorders, like oral lichen planus (OLP), pemphigus vulgaris (PV), mucous membrane (MMP) and bullous pemphigoid (BP), epidermolysis bullosa acquisita (EBA), systemic lupus erythematosus (SLE) and Sjögren syndrome (SS) and can cause painful erosions, blisters and ulceration at the oral epithelium. Such diseases complicate dental hygiene and can lead to tooth loss. When natural teeth are missing, dental implants can improve quality of life for these patients. Osseointegration is necessary for dental implant success and is not contraindicated for patients with oral mucosal autoimmune diseases. However, the clinical dentist must consider the possible impact of oral autoimmune diseases on the oral epithelium that might affect implant success, also due to the difficulty of everyday oral hygiene, leading to bone absorption around the implant. Moreover, medication approved for the therapy of such diseases, such as corticosteroids, immunosuppressants and non-steroidal anti-inflammatory drugs (NSAIDs) could provoke osseointegration, as it compromises bone quality and affects the patient’s general health. However, the impact of these drugs on implant surgery depends on dose and duration of the drug and usually dental implantation is possible.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128241571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The last 40 years, due to advanced therapeutic strategic, there has been significant improvement in the survival rates of childhood cancer, now exceeding 80% 5-year survival rates and radiation therapy is established, either as the main treatment or as an adjuvant therapy to reduce the risk of recurrence after surgery. However, the side-effects of radiation therapy are very frequent and approximately the two thirds of the survivors suffer from musculoskeletal complications, half of them suffering from life-threatening conditions, sometimes decades following radiation therapy. Despite the high 5-year survival rates and the advanced treatment options, approximately 16 % of the deaths during the first 5 years from the diagnosis are caused by treatment complications. Unfortunately today, there are no systematic studies examining the complications of the therapy, especially the rare ones, and also there are no standardized guidelines for long-term follow-up of these patients. In this study, the effects of radiation therapy in the musculoskeletal system will be analyzed and interventions to prevent or delay these chronic health conditions will be suggested. The studies selected to review, were retrieved from PubMed database. We searched the PubMed using the terms “childhood cancer”, “musculoskeletal effects”, “radiation therapy”, “radiotherapy complications”. We selected 10 articles with relevant abstracts. Effects of radiation therapy in musculoskeletal system
{"title":"The effects of radiation therapy in musculoskeletal system of children","authors":"C. Lappa","doi":"10.22540/jrpms-03-005","DOIUrl":"https://doi.org/10.22540/jrpms-03-005","url":null,"abstract":"The last 40 years, due to advanced therapeutic strategic, there has been significant improvement in the survival rates of childhood cancer, now exceeding 80% 5-year survival rates and radiation therapy is established, either as the main treatment or as an adjuvant therapy to reduce the risk of recurrence after surgery. However, the side-effects of radiation therapy are very frequent and approximately the two thirds of the survivors suffer from musculoskeletal complications, half of them suffering from life-threatening conditions, sometimes decades following radiation therapy. Despite the high 5-year survival rates and the advanced treatment options, approximately 16 % of the deaths during the first 5 years from the diagnosis are caused by treatment complications. Unfortunately today, there are no systematic studies examining the complications of the therapy, especially the rare ones, and also there are no standardized guidelines for long-term follow-up of these patients. In this study, the effects of radiation therapy in the musculoskeletal system will be analyzed and interventions to prevent or delay these chronic health conditions will be suggested. The studies selected to review, were retrieved from PubMed database. We searched the PubMed using the terms “childhood cancer”, “musculoskeletal effects”, “radiation therapy”, “radiotherapy complications”. We selected 10 articles with relevant abstracts. Effects of radiation therapy in musculoskeletal system","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128589498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens KAT, Greece; Postgraduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Athens, Greece; First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Goudi, Athens, Greece
{"title":"Signaling pathways that overactivate metabolism and drive neoplasia, in rhabdomyosarcoma","authors":"C. Tselios, G. Lambrou","doi":"10.22540/jrpms-03-017","DOIUrl":"https://doi.org/10.22540/jrpms-03-017","url":null,"abstract":"Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens KAT, Greece; Postgraduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Athens, Greece; First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Goudi, Athens, Greece","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124572630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Yiannakopoulos, Iakovos E. Vlastos, Theodoros Zekis, Georgios Theotokatos, E. Rousanoglou
Anterior cruciate ligament tear (ACL) is a relatively common yet serious knee injury, and is more prevalent in young, athletic individuals. Traumatic ACL injuries have local and systemic consequences, affecting bone metabolism not only around the knee but also at distant bone locations. Following an ACL injury, sarcopenia gradually occurs in the quadriceps and hamstring muscles as well as osteopenia around the knee or at distal sites, which can develop quickly in animals and humans. Considerable posttraumatic osteopenia occurs soon after the ACL injury or reconstruction and does not completely recover, or the loss is only partially reversible. The loss of knee stability, the altered joint loading environment and knee kinematics, and the osteopenia in the cancellous bone induce loss of anatomical and functional integrity in the tissues in and around the knee joint, eventually leading to loss of function and knee osteoarthritis in animal models and humans. ACL tears are also associated with concomitant menisci tears and cartilage degeneration and can lead to secondary osteoarthritis, regardless of surgical or conservative treatment. Following ACL injury or experimental ACL transection, several methods have been employed for the measurement of bone density changes around the knee joint and at distant sites, including quantitative computed tomography (QCT), dual energy X-ray absorptiometry (DEXA), dual-energy photon absorptiometry (DPA),6 and quantitative computed tomography (pQCT). Abstract Purpose: To evaluate the effect of acute and chronic knee instability secondary to anterior cruciate ligament (ACL) deficiency on the ultrasound-measured density and bone quality of the calcaneus, implementing quantitative ultrasound densitometry. Methods: Bilateral measurements of the speed of sound (SOS) and broadband ultrasound attenuation (BUA) of the calcaneus were performed on a cohort of 97 male patients with acute (n=38) or chronic (n=57) unilateral ACL deficiency. Results: In the acute ACL tear group, BUA was 56.181±3.731 dB/ MHz on the affected extremity calcaneus and 57.030±6.564 dB/MHz on the uninjured side, whilst the SOS was 1577.265±14.04 m/sec and 1584.675±11.484 m/sec respectively. The difference between the two sides was not significant. In the chronic ACL deficiency group, however, there was significant difference between both calcanei for both BUA (p<0.01) and SOS (p<0.001). BUA was 47.307±3.786 dB/MHz on the affected extremity calcaneus and 59.011±3.64 dB/MHz on the uninjured extremity calcaneus, whilst the SOS was 1457.873±9.467 m/sec and 1579.413±8.404 m/sec respectively. Conclusion: Chronic ACL deficiency adversely affects the structural properties and the bone quality of the calcaneus. Level of evidence: Level II, prospective comparative study.
{"title":"Quantitative ultrasound densitometry of the calcaneus in acute and chronic anterior cruciate ligament deficiency","authors":"C. Yiannakopoulos, Iakovos E. Vlastos, Theodoros Zekis, Georgios Theotokatos, E. Rousanoglou","doi":"10.22540/JRPMS-02-118","DOIUrl":"https://doi.org/10.22540/JRPMS-02-118","url":null,"abstract":"Anterior cruciate ligament tear (ACL) is a relatively common yet serious knee injury, and is more prevalent in young, athletic individuals. Traumatic ACL injuries have local and systemic consequences, affecting bone metabolism not only around the knee but also at distant bone locations. Following an ACL injury, sarcopenia gradually occurs in the quadriceps and hamstring muscles as well as osteopenia around the knee or at distal sites, which can develop quickly in animals and humans. Considerable posttraumatic osteopenia occurs soon after the ACL injury or reconstruction and does not completely recover, or the loss is only partially reversible. The loss of knee stability, the altered joint loading environment and knee kinematics, and the osteopenia in the cancellous bone induce loss of anatomical and functional integrity in the tissues in and around the knee joint, eventually leading to loss of function and knee osteoarthritis in animal models and humans. ACL tears are also associated with concomitant menisci tears and cartilage degeneration and can lead to secondary osteoarthritis, regardless of surgical or conservative treatment. Following ACL injury or experimental ACL transection, several methods have been employed for the measurement of bone density changes around the knee joint and at distant sites, including quantitative computed tomography (QCT), dual energy X-ray absorptiometry (DEXA), dual-energy photon absorptiometry (DPA),6 and quantitative computed tomography (pQCT). Abstract Purpose: To evaluate the effect of acute and chronic knee instability secondary to anterior cruciate ligament (ACL) deficiency on the ultrasound-measured density and bone quality of the calcaneus, implementing quantitative ultrasound densitometry. Methods: Bilateral measurements of the speed of sound (SOS) and broadband ultrasound attenuation (BUA) of the calcaneus were performed on a cohort of 97 male patients with acute (n=38) or chronic (n=57) unilateral ACL deficiency. Results: In the acute ACL tear group, BUA was 56.181±3.731 dB/ MHz on the affected extremity calcaneus and 57.030±6.564 dB/MHz on the uninjured side, whilst the SOS was 1577.265±14.04 m/sec and 1584.675±11.484 m/sec respectively. The difference between the two sides was not significant. In the chronic ACL deficiency group, however, there was significant difference between both calcanei for both BUA (p<0.01) and SOS (p<0.001). BUA was 47.307±3.786 dB/MHz on the affected extremity calcaneus and 59.011±3.64 dB/MHz on the uninjured extremity calcaneus, whilst the SOS was 1457.873±9.467 m/sec and 1579.413±8.404 m/sec respectively. Conclusion: Chronic ACL deficiency adversely affects the structural properties and the bone quality of the calcaneus. Level of evidence: Level II, prospective comparative study.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130080720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stavros Papadopoulos, M. Tishukov, K. Stamou, T. Totlis, K. Natsis
The anterior cruciate ligament (ACL) tear (Figure 1) is a common sports injury in both males and females, particularly in sports that require cutting, jumping, or pivoting, with more than 200.000 incidents every year in the United States. Likewise, ACL reconstruction is a common operation (Figure 2), both in the USA and in Europe, with more than 100.000 syndesmoplasties being performed every year in the United States and 3.500 per year in Sweden. A patient with an ACL tear who is treated conservatively, with early activity modification and a neuromuscular rehabilitation programme, may be able in a few days or a couple of weeks to have a painless knee with no oedema. Later, he may also be able to return to sports (RTS), in some extend, by executing simple sports activities that do not include cutting, jumping, or pivoting movements. This way the patients may avoid the stress of the operation, however, as studies have shown, 2/3 of those patients do not return to their pre-injury activity level. When the patient decides to undergo surgical reconstruction of the ACL tear, he complies with the stress of the operation and the long post-operative rehabilitation programme, ranging from 6 to 12 months. Patients undergo surgery not only to avoid subsequent meniscal or chondral injuries and early osteoarthritis, but especially to return to their pre-injury level of activity. According to the current literature, only 40 to 70% of the cases achieve return to the pre-injury activity level following ACL reconstruction. A recent meta-analysis, which included 48 studies with a mean follow-up of 41 months, revealed that although 90% of the patients achieved normal or nearly-normal knee function, only 63% returned to their pre-injury level of participation. Thus, 1 out of 4 patients achieves complete restoration of the knee joint function, but does not return to the pre-injury level of activity. This disparity between physical function and the ability to RTS is attributed to psychosocial factors. The psychosocial factors that may affect RTS include fear of re-injury (19%), fear of job-loss due to re-injury (11%) and a change in lifestyle or family commitments (18%), when only 13% of Abstract Patients undergo ACL reconstruction not only to avoid subsequent meniscal or chondral injuries and early osteoarthritis, but especially to return to the pre-injury level of activity. Yet, this level of activity is achieved in only 40 to 70% of the cases. This inability to return to the pre-injury level of activity, even when functional tests allow medical clearance to continue sports, is mainly attributed to fear of re-injury or kinesiophobia. This fear affects the athlete’s physical abilities, function and return to sports. Thus, it should be considered as a real risk factor undermining the patients’ knee movement and should be one of the core targets for the rehabilitation programme. Healthcare professionals have to assess the athletes that present with fear of re-injury and
{"title":"Fear of re-injury following ACL reconstruction: an overview","authors":"Stavros Papadopoulos, M. Tishukov, K. Stamou, T. Totlis, K. Natsis","doi":"10.22540/JRPMS-02-124","DOIUrl":"https://doi.org/10.22540/JRPMS-02-124","url":null,"abstract":"The anterior cruciate ligament (ACL) tear (Figure 1) is a common sports injury in both males and females, particularly in sports that require cutting, jumping, or pivoting, with more than 200.000 incidents every year in the United States. Likewise, ACL reconstruction is a common operation (Figure 2), both in the USA and in Europe, with more than 100.000 syndesmoplasties being performed every year in the United States and 3.500 per year in Sweden. A patient with an ACL tear who is treated conservatively, with early activity modification and a neuromuscular rehabilitation programme, may be able in a few days or a couple of weeks to have a painless knee with no oedema. Later, he may also be able to return to sports (RTS), in some extend, by executing simple sports activities that do not include cutting, jumping, or pivoting movements. This way the patients may avoid the stress of the operation, however, as studies have shown, 2/3 of those patients do not return to their pre-injury activity level. When the patient decides to undergo surgical reconstruction of the ACL tear, he complies with the stress of the operation and the long post-operative rehabilitation programme, ranging from 6 to 12 months. Patients undergo surgery not only to avoid subsequent meniscal or chondral injuries and early osteoarthritis, but especially to return to their pre-injury level of activity. According to the current literature, only 40 to 70% of the cases achieve return to the pre-injury activity level following ACL reconstruction. A recent meta-analysis, which included 48 studies with a mean follow-up of 41 months, revealed that although 90% of the patients achieved normal or nearly-normal knee function, only 63% returned to their pre-injury level of participation. Thus, 1 out of 4 patients achieves complete restoration of the knee joint function, but does not return to the pre-injury level of activity. This disparity between physical function and the ability to RTS is attributed to psychosocial factors. The psychosocial factors that may affect RTS include fear of re-injury (19%), fear of job-loss due to re-injury (11%) and a change in lifestyle or family commitments (18%), when only 13% of Abstract Patients undergo ACL reconstruction not only to avoid subsequent meniscal or chondral injuries and early osteoarthritis, but especially to return to the pre-injury level of activity. Yet, this level of activity is achieved in only 40 to 70% of the cases. This inability to return to the pre-injury level of activity, even when functional tests allow medical clearance to continue sports, is mainly attributed to fear of re-injury or kinesiophobia. This fear affects the athlete’s physical abilities, function and return to sports. Thus, it should be considered as a real risk factor undermining the patients’ knee movement and should be one of the core targets for the rehabilitation programme. Healthcare professionals have to assess the athletes that present with fear of re-injury and","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127066352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Papastergiou, N. Koukoulias, T. Dimitriadis, Efstathios I. Kalivas, A. Papavasileiou, E. Ziogas
The incidence of anterior cruciate ligament (ACL) injury is rising, mainly due to the growing number of recreational and professional athletes. ACL insufficiency leads to knee instability and the optimal treatment is ACL reconstruction. More than 100000 ACL reconstructions are performed annually in the United States. Despite improvements in surgical technique and instrumentation of ACL reconstruction, complications do occur. We strongly believe that the incidence of complications is underreported in the literature because of the difficulties to recognize and record them. Awareness of the prevention and treatment of complications is mandatory in order to obtain the best clinical outcome after ACL reconstruction. In this article, we present the experience of a single Orthopaedic Department the last 27 years.
{"title":"Atlas of complications in anterior Cruciate Ligament Reconstruction","authors":"S. Papastergiou, N. Koukoulias, T. Dimitriadis, Efstathios I. Kalivas, A. Papavasileiou, E. Ziogas","doi":"10.22540/JRPMS-02-136","DOIUrl":"https://doi.org/10.22540/JRPMS-02-136","url":null,"abstract":"The incidence of anterior cruciate ligament (ACL) injury is rising, mainly due to the growing number of recreational and professional athletes. ACL insufficiency leads to knee instability and the optimal treatment is ACL reconstruction. More than 100000 ACL reconstructions are performed annually in the United States. Despite improvements in surgical technique and instrumentation of ACL reconstruction, complications do occur. We strongly believe that the incidence of complications is underreported in the literature because of the difficulties to recognize and record them. Awareness of the prevention and treatment of complications is mandatory in order to obtain the best clinical outcome after ACL reconstruction. In this article, we present the experience of a single Orthopaedic Department the last 27 years.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"171 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133640347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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