C. Yiannakopoulos, Iakovos E. Vlastos, N. Sideri, O. Papakonstantinou
Knee injuries involving the Anterior cruciate ligament (ACL) are common sports injuries with over two million cases occurring every year. The number of ACL injuries has increased over the years due to increasing participation of young adults in sporting activities. ACL is commonly injured in athletic activities involving rapid deceleration, change of direction, pivoting and jumping. Most ACL tears (approximately 80%) are complete, occurring around the middle one-third of the ACL (90%) or less frequently close to the femoral (7%) or tibial (3%) attachments. Less frequently, (approximately 20%), ACL tears are incomplete with partial disruption of the ACL fibers. The majority of ACL injuries can be diagnosed on the basis of history of injury and clinical examination. However, the accuracy of clinical examination is not adequately high thus it has to be complemented with MR imaging (MRI) evaluation. Currently, MRI and arthroscopy are the reference standards for diagnosing an ACL injury. The purpose of this study is to present a wide spectrum of MRI appearances with arthroscopic correlation in a series of patients with an acute or chronic ACL injury. Materials and Methods
{"title":"MRI and arthroscopic findings in acute and chronic ACL injuries. A pictorial essay","authors":"C. Yiannakopoulos, Iakovos E. Vlastos, N. Sideri, O. Papakonstantinou","doi":"10.22540/jrpms-02-098","DOIUrl":"https://doi.org/10.22540/jrpms-02-098","url":null,"abstract":"Knee injuries involving the Anterior cruciate ligament (ACL) are common sports injuries with over two million cases occurring every year. The number of ACL injuries has increased over the years due to increasing participation of young adults in sporting activities. ACL is commonly injured in athletic activities involving rapid deceleration, change of direction, pivoting and jumping. Most ACL tears (approximately 80%) are complete, occurring around the middle one-third of the ACL (90%) or less frequently close to the femoral (7%) or tibial (3%) attachments. Less frequently, (approximately 20%), ACL tears are incomplete with partial disruption of the ACL fibers. The majority of ACL injuries can be diagnosed on the basis of history of injury and clinical examination. However, the accuracy of clinical examination is not adequately high thus it has to be complemented with MR imaging (MRI) evaluation. Currently, MRI and arthroscopy are the reference standards for diagnosing an ACL injury. The purpose of this study is to present a wide spectrum of MRI appearances with arthroscopic correlation in a series of patients with an acute or chronic ACL injury. Materials and Methods","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"4 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":"134176408","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}
Panagiotis Kouloumentas, E. Kavroudakis, Ioannis Tsekouras, E. Charalampidis, G. Triantafyllopoulos, Dimitris Kavroudakis
Arthroscopic anterior cruciate ligament (ACL) reconstruction is a commonly performed orthopaedic procedure. Nowadays, there is a widespread use of the semitendinosus (ST) and gracilis (G) tendons (hamstrings) as autografts. ST and G tendons are harvested through an incision over the anteromedial aspect of the knee at the level of their insertion site at the pes anserinous. Several authors have reported an increased incidence of injury to the saphenous nerve itself, as well as to its two terminal branches, the infrapatellar (IBSN) and sartorial branch (SBSN), during ST and G tendon harvesting through the anterior approach. The IBSN supplies sensory innervation to the anteromedial aspect of the knee and the SBSN continues along the great saphenous vein to provide sensation to the medial aspect of the lower leg. Iatrogenic nerve damage may cause hypoesthesia, dysesthesia, painful neuroma, reflex sympathetic dystrophy, anterior knee pain and kneeling pain. Some investigators advocate that the size and orientation of the anterior skin incision for graft harvesting is responsible for the nerve injury (mainly to the IBSN), thus suggesting a small oblique skin incision. Others, however, believe that SBSN injury may be an intrinsic problem associated with blind, distal-to-proximal direction of G tendon harvesting and that the flexor tendons should be harvested with the knee placed in a “figure-four” position so as to relieve the pressure on the saphenous nerve. Despite these Abstract There are several reports of iatrogenic injury to the saphenous nerve branches during anterior cruciate ligament (ACL) reconstruction attributed to tendon harvesting through an anterior approach. Other investigators advocate that there is virtually no nerve damage when the tendons are harvested through a posteromedial knee incision. The aim of the present study was to compare the incidence of iatrogenic injury to the infrapatellar and sartorial branches of the saphenous nerve with anterior and posterior tendon harvesting. A prospective, randomized clinical study was conducted comparing patients treated with ACL reconstruction employing the conventional technique with a semitendinosus/gracilis autograft versus the all-inside technique with a short, quadrupled semitendinosus autograft. Tendon harvesting for these two groups was performed through the anterior and the posterior approach, respectively. Skin sensation of the anterior aspect of the operated knee and tibia was assessed by the pin prick test and was compared to the contralateral side. No sensory alterations were noted on the anteromedial aspect of the operated knee and tibia in patients of the posterior harvest group.
{"title":"Posterior semitendinosus tendon harvesting minimizes the risk of injury to the infrapatellar and sartorial branches of the saphenous nerve","authors":"Panagiotis Kouloumentas, E. Kavroudakis, Ioannis Tsekouras, E. Charalampidis, G. Triantafyllopoulos, Dimitris Kavroudakis","doi":"10.22540/jrpms-02-131","DOIUrl":"https://doi.org/10.22540/jrpms-02-131","url":null,"abstract":"Arthroscopic anterior cruciate ligament (ACL) reconstruction is a commonly performed orthopaedic procedure. Nowadays, there is a widespread use of the semitendinosus (ST) and gracilis (G) tendons (hamstrings) as autografts. ST and G tendons are harvested through an incision over the anteromedial aspect of the knee at the level of their insertion site at the pes anserinous. Several authors have reported an increased incidence of injury to the saphenous nerve itself, as well as to its two terminal branches, the infrapatellar (IBSN) and sartorial branch (SBSN), during ST and G tendon harvesting through the anterior approach. The IBSN supplies sensory innervation to the anteromedial aspect of the knee and the SBSN continues along the great saphenous vein to provide sensation to the medial aspect of the lower leg. Iatrogenic nerve damage may cause hypoesthesia, dysesthesia, painful neuroma, reflex sympathetic dystrophy, anterior knee pain and kneeling pain. Some investigators advocate that the size and orientation of the anterior skin incision for graft harvesting is responsible for the nerve injury (mainly to the IBSN), thus suggesting a small oblique skin incision. Others, however, believe that SBSN injury may be an intrinsic problem associated with blind, distal-to-proximal direction of G tendon harvesting and that the flexor tendons should be harvested with the knee placed in a “figure-four” position so as to relieve the pressure on the saphenous nerve. Despite these Abstract There are several reports of iatrogenic injury to the saphenous nerve branches during anterior cruciate ligament (ACL) reconstruction attributed to tendon harvesting through an anterior approach. Other investigators advocate that there is virtually no nerve damage when the tendons are harvested through a posteromedial knee incision. The aim of the present study was to compare the incidence of iatrogenic injury to the infrapatellar and sartorial branches of the saphenous nerve with anterior and posterior tendon harvesting. A prospective, randomized clinical study was conducted comparing patients treated with ACL reconstruction employing the conventional technique with a semitendinosus/gracilis autograft versus the all-inside technique with a short, quadrupled semitendinosus autograft. Tendon harvesting for these two groups was performed through the anterior and the posterior approach, respectively. Skin sensation of the anterior aspect of the operated knee and tibia was assessed by the pin prick test and was compared to the contralateral side. No sensory alterations were noted on the anteromedial aspect of the operated knee and tibia in patients of the posterior harvest group.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"31 11 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":"130770307","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}
L. Kostretzis, Kaori Nakamura, Maja Siebold, C. Fink, R. Śmigielski, R. Siebold
A thorough understanding of the ACL anatomy is essential to create an anatomical ACL reconstruction, that will be able to reproduce the kinematics of the knee joint and mimic its biomechanical properties. The surgical techniques to replicate the native anatomy of the ACL were always driven by the contemporary understanding of its anatomy and biomechanical function. The idea of creating a double-bundle construct was already implemented in 1938 by Palmar to mimic the anatomical structure of the ACL. In the study of Girgis et al 1975 the ACL was divided in bundles (anteromedial and posterolateral bundle) in an order to address their biomechanical properties. For many years, that has been the basis for ACL reconstruction. Some authors even reported a triple bundle anatomy others detected a flat continuous structure of the ACL without a bundle distinction (Figure 1).
{"title":"Flat anatomy of ACL and “ribbon like” ACL reconstruction","authors":"L. Kostretzis, Kaori Nakamura, Maja Siebold, C. Fink, R. Śmigielski, R. Siebold","doi":"10.22540/jrpms-02-113","DOIUrl":"https://doi.org/10.22540/jrpms-02-113","url":null,"abstract":"A thorough understanding of the ACL anatomy is essential to create an anatomical ACL reconstruction, that will be able to reproduce the kinematics of the knee joint and mimic its biomechanical properties. The surgical techniques to replicate the native anatomy of the ACL were always driven by the contemporary understanding of its anatomy and biomechanical function. The idea of creating a double-bundle construct was already implemented in 1938 by Palmar to mimic the anatomical structure of the ACL. In the study of Girgis et al 1975 the ACL was divided in bundles (anteromedial and posterolateral bundle) in an order to address their biomechanical properties. For many years, that has been the basis for ACL reconstruction. Some authors even reported a triple bundle anatomy others detected a flat continuous structure of the ACL without a bundle distinction (Figure 1).","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"8 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":"132953833","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}
Sophia A. Syngouna, P. Mitsikostas, E. Fandridis, I. Triantafyllopoulos
External fixation is a commonly used method in pediatric populations. Supracondylar fractures Gartland II, IIIa, IIIb, the 60% of all elbow fractures, are treated with close reduction and percutaneous pinning. Moreover, external fixation is applied to open fractures, congenital and acquired deformities, infected non-unions, mobilisation of stiff joints. Pin track infection is the most common complication encountered. High rates of morbidity are reported, especially when the treatment is prolonged. PTIs do not follow a uniform definition and a classification, so the rates are ranging from 1 to 100%. Current literature proposes to define PTI infection as the signs and symptoms of inflammation around the pins and wires, that require antibiotics, pin or wire removal or even surgical debridement.
外固定是儿科人群常用的方法。髁上骨折Gartland II, IIIa, IIIb占所有肘关节骨折的60%，采用闭合复位和经皮钉住治疗。此外，外固定还可用于开放性骨折、先天性和后天性畸形、感染不愈合、僵硬关节活动。针道感染是最常见的并发症。据报道，发病率很高，特别是当治疗时间延长时。pti没有统一的定义和分类，因此比率从1到100%不等。目前的文献建议将PTI感染定义为针和导线周围炎症的体征和症状，需要抗生素，拔出针或导线甚至手术清创。
{"title":"Pin site infections in pediatric population, microbiology, treatment and long-term functional disability","authors":"Sophia A. Syngouna, P. Mitsikostas, E. Fandridis, I. Triantafyllopoulos","doi":"10.22540/JRPMS-02-081","DOIUrl":"https://doi.org/10.22540/JRPMS-02-081","url":null,"abstract":"External fixation is a commonly used method in pediatric populations. Supracondylar fractures Gartland II, IIIa, IIIb, the 60% of all elbow fractures, are treated with close reduction and percutaneous pinning. Moreover, external fixation is applied to open fractures, congenital and acquired deformities, infected non-unions, mobilisation of stiff joints. Pin track infection is the most common complication encountered. High rates of morbidity are reported, especially when the treatment is prolonged. PTIs do not follow a uniform definition and a classification, so the rates are ranging from 1 to 100%. Current literature proposes to define PTI infection as the signs and symptoms of inflammation around the pins and wires, that require antibiotics, pin or wire removal or even surgical debridement.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134354540","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}
Stylianos S. Pernientakis, P. Masouros, Christos P. Margiannis, A. Vasilopoulos
Osteoporotic vertebral fractures are a leading cause of disability among the elderly population. Their incidence in Europe has been estimated to be approximately 500.000 fractures per year rendering treatment options of particular importance. While conservative management remains the mainstay of treatment, minimally invasive techniques such as kyphoplasty (KF) and vertebroplasty (VP) offer valuable alternatives, especially in cases of lasting pain. Both of them have well established clinical outcomes in terms of pain relief and functionality improvement. However, concerns regarding the destruction of bone microarchitecture and cement extravasation has led to the introduction of Radiofrequency kyphoplasty, as an alternative. It is a relatively new technique, called also radiofrequencytargeted vertebral augmentation (RF-TVA), which appears to provide comparable outcomes, while it reduces potential adverse effects. It was approved in 2007 in the USA and in 2009 in Germany for the treatment of painful vertebral fractures. RF kyphoplasty is primarily indicated for osteoporotic compression fractures, while it can be reserved in cases of an underlying bone pathology, such as multiple myeloma. Through a unipedicular approach, a navigational osteotome is used to create specific paths inside the cancellous bone preserving to a great extent the microarchitecture of the trabeculae. RF are used to warm the cement and transform it into an ultra-high viscosity mass, thus reducing evidently the risk of cement leakage. This article aims to provide a short review of all available published data evaluating the effectiveness and the benefits of this technique.
{"title":"Radiofrequency kyphoplasty for the treatment of osteoporotic vertebral fractures: A review of the literature","authors":"Stylianos S. Pernientakis, P. Masouros, Christos P. Margiannis, A. Vasilopoulos","doi":"10.22540/JRPMS-02-085","DOIUrl":"https://doi.org/10.22540/JRPMS-02-085","url":null,"abstract":"Osteoporotic vertebral fractures are a leading cause of disability among the elderly population. Their incidence in Europe has been estimated to be approximately 500.000 fractures per year rendering treatment options of particular importance. While conservative management remains the mainstay of treatment, minimally invasive techniques such as kyphoplasty (KF) and vertebroplasty (VP) offer valuable alternatives, especially in cases of lasting pain. Both of them have well established clinical outcomes in terms of pain relief and functionality improvement. However, concerns regarding the destruction of bone microarchitecture and cement extravasation has led to the introduction of Radiofrequency kyphoplasty, as an alternative. It is a relatively new technique, called also radiofrequencytargeted vertebral augmentation (RF-TVA), which appears to provide comparable outcomes, while it reduces potential adverse effects. It was approved in 2007 in the USA and in 2009 in Germany for the treatment of painful vertebral fractures. RF kyphoplasty is primarily indicated for osteoporotic compression fractures, while it can be reserved in cases of an underlying bone pathology, such as multiple myeloma. Through a unipedicular approach, a navigational osteotome is used to create specific paths inside the cancellous bone preserving to a great extent the microarchitecture of the trabeculae. RF are used to warm the cement and transform it into an ultra-high viscosity mass, thus reducing evidently the risk of cement leakage. This article aims to provide a short review of all available published data evaluating the effectiveness and the benefits of this technique.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129807904","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}
Scoliosis is a common orthopaedic condition in children and adolescents. It is a complex three-dimensional deformity of the spine, featuring lateral spinal curvature and a rotational deformity of the vertebrae and ribs. According to the Scoliosis Research Society, scoliosis can be classified into functional or organic. Functional scoliosis can be compensatory, antalgic and static. Organic scoliosis can be classified as idiopathic, congenital, and neuromuscular (paralytic). Idiopathic scoliosis is divided into three sub-groups according to the age of the patient at the time of diagnosis: infantile (age 0-3), juvenile (age 4-9) and adolescent (age 10 up to maturity). The diagnosis of adolescent idiopathic scoliosis is based on physical and radiological examination (Cobb’s angle) and has a prevalence in the general population of 1-3%. Scoliosis can be treated either conservatively or surgically depending on the severity of the disease. Conservative treatment includes the use of a brace and physiotherapeutic scoliosisspecific exercises (PSSE) for mild curves. The brace is recommended for patients with curves between 25° and 40°. The Schroth method is a type of Physiotherapeutic Scoliosis-Specific Exercises (PSSE) program, that involves posture training and exercises effective in reducing pain and improving scoliosis curves, respiratory function, and overall quality of life in scoliosis patients. It was developed in 1921 by Katharina Schroth (1894-1985). According to Hans-Rudolf Weiss (2011), Schroth was suffering from scoliosis herself and underwent treatment with a steel brace at the age of 16 years. Consequently, she decided to develop a more functional approach to the treatment herself. Inspired by a balloon, she tried to selfcorrect by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. In the 1970’s, the Schroth method was improved by her daughter Christa Lehnert-Schroth. Together they founded a rehabilitation center in Germany, which provided a specifically designed intensive rehabilitation program for patients with adolescent idiopathic scoliosis. The therapeutic approach in these patients lasted for 6 consecutive weeks performed by certified therapists of the Schroth method. It then became known in a broad network of therapists not only in Germany, Russia and other European countries, but also in Canada and the United States, in Australia, and several countries in Asia. The method constitutes of specific exercises of isometric contraction aiming at a three-dimensional selfcorrection of posture and the extension of the spine (selfelongation). It also endorses the application of rotational breathing (rotational angular breathing) and the education of corrective exercises in daily activities.
{"title":"The Schroth method of physical therapy for the treatment of idiopathic scoliosis","authors":"C. Stergiou","doi":"10.22540/JRPMS-02-095","DOIUrl":"https://doi.org/10.22540/JRPMS-02-095","url":null,"abstract":"Scoliosis is a common orthopaedic condition in children and adolescents. It is a complex three-dimensional deformity of the spine, featuring lateral spinal curvature and a rotational deformity of the vertebrae and ribs. According to the Scoliosis Research Society, scoliosis can be classified into functional or organic. Functional scoliosis can be compensatory, antalgic and static. Organic scoliosis can be classified as idiopathic, congenital, and neuromuscular (paralytic). Idiopathic scoliosis is divided into three sub-groups according to the age of the patient at the time of diagnosis: infantile (age 0-3), juvenile (age 4-9) and adolescent (age 10 up to maturity). The diagnosis of adolescent idiopathic scoliosis is based on physical and radiological examination (Cobb’s angle) and has a prevalence in the general population of 1-3%. Scoliosis can be treated either conservatively or surgically depending on the severity of the disease. Conservative treatment includes the use of a brace and physiotherapeutic scoliosisspecific exercises (PSSE) for mild curves. The brace is recommended for patients with curves between 25° and 40°. The Schroth method is a type of Physiotherapeutic Scoliosis-Specific Exercises (PSSE) program, that involves posture training and exercises effective in reducing pain and improving scoliosis curves, respiratory function, and overall quality of life in scoliosis patients. It was developed in 1921 by Katharina Schroth (1894-1985). According to Hans-Rudolf Weiss (2011), Schroth was suffering from scoliosis herself and underwent treatment with a steel brace at the age of 16 years. Consequently, she decided to develop a more functional approach to the treatment herself. Inspired by a balloon, she tried to selfcorrect by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. In the 1970’s, the Schroth method was improved by her daughter Christa Lehnert-Schroth. Together they founded a rehabilitation center in Germany, which provided a specifically designed intensive rehabilitation program for patients with adolescent idiopathic scoliosis. The therapeutic approach in these patients lasted for 6 consecutive weeks performed by certified therapists of the Schroth method. It then became known in a broad network of therapists not only in Germany, Russia and other European countries, but also in Canada and the United States, in Australia, and several countries in Asia. The method constitutes of specific exercises of isometric contraction aiming at a three-dimensional selfcorrection of posture and the extension of the spine (selfelongation). It also endorses the application of rotational breathing (rotational angular breathing) and the education of corrective exercises in daily activities.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127657095","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}
Michail Sarantis, P. Kollia, S. Samara, H. Athanasopoulou, Y. Gyftodimou, Dimitra Lianou, Evdoxia Mpourazani, A. Doulgeraki
Michail Sarantis, Panagoula Kollia, Stavroula Samara, Helen Athanasopoulou, Yolanda Gyftodimou, Dimitra Lianou, Evdoxia Mpourazani, Artemis Doulgeraki 4 Department of Trauma and Orthopaedics, KAT Hospital, Athens, Greece; Department of Genetics & Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece; Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece; Department of Clinical Genetics, Institute of Child Health, Athens, Greece; 1 Department of Pediatrics, “Aghia Sophia” Children’s Hospital, Athens, Greece
{"title":"A new COL1A1 mutation in a Greek patient with osteogenesis imperfecta: Response to a low-dose protocol of zoledronic acid and two-year follow-up","authors":"Michail Sarantis, P. Kollia, S. Samara, H. Athanasopoulou, Y. Gyftodimou, Dimitra Lianou, Evdoxia Mpourazani, A. Doulgeraki","doi":"10.22540/jrpms-02-075","DOIUrl":"https://doi.org/10.22540/jrpms-02-075","url":null,"abstract":"Michail Sarantis, Panagoula Kollia, Stavroula Samara, Helen Athanasopoulou, Yolanda Gyftodimou, Dimitra Lianou, Evdoxia Mpourazani, Artemis Doulgeraki 4 Department of Trauma and Orthopaedics, KAT Hospital, Athens, Greece; Department of Genetics & Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece; Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece; Department of Clinical Genetics, Institute of Child Health, Athens, Greece; 1 Department of Pediatrics, “Aghia Sophia” Children’s Hospital, Athens, Greece","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"352 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122339319","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}
In the current issue of JRPMS, Dr Sarantis and colleagues report the interesting case of a Greek patient, a 7 years-old boy, with Osteogenesis Imperfecta due to a novel COL1A1 mutation. The authors also provide insight into their protocol of pharmacological treatment with iv zolendronic acid, a topic of increasing interest in the field, as there is currently no consensus regarding choice of pharmacological agent, dosing or even duration of treatment. Osteogenesis Imperfecta (OI) literally means “imperfect bone birth” in Latin, as derived from the original Greek word οστεογένεση (ὀστοῦν = bone + γένεσις = birth). It was termed by Vrolik in 1849 and represents a genetic disorder with multiple genotypes and phenotypes. OI is caused by mutations either of the COL1A1 or COL1A2 genes (in reportedly 85% of the cases) encoding the pro-α1 or α2 chains of type-I collagen or of other genes (i.e WNT1, LRP5, BMP1, CRTAP, P3H1/LEPRE1) involved in osteoblast differentiation or post-translational modification/transport of type I collagen. Type-I collagen is the major protein of bone, constituting by large its organic part, but exists also in significant quantities in tendons, ligaments, skin, sclerae and dentin. Patients with OI have lower quantity and/or quality of type-I collagen, thus presenting with multiple clinical phenotypes that usually include low-energy fractures, bone deformities, joint hypermobility, bone pain, short stature, and in some cases blue sclerae, dentinogenesis imperfecta and premature hearing loss. According to the original classification of Sillence, OI can be distinguished in four predominant types (I-IV). Type I is the milder form with usually no deformities, type II is the lethal form resulting in perinatal death, type III is the most severe in surviving neonates with multiple fractures and deformities, and type IV is intermediate in severity between types I and III with moderate deformities and short stature. Pharmacological treatment of OI in various clinical settings reportedly depends upon the age of the patient at the time of diagnosis as well as the severity of the disease, and there is currently no consensus regarding a treatment regimen of choice. In the past, unsuccessful attempts to control the disease have been made with vitamins, sodium fluoride, calcitonin or even growth hormone. Twenty years ago, Glorieux and colleagues reported the use of intravenous pamidronate (a second-generation nitrogen-containing bisphosphonate) in children with severe osteogenesis imperfecta. Ever since, there have been a few reports regarding the short-term effects of pamidronate treatment in various dosing regimens for sometimes up to 4 years in small numbers of patients with OI. These studies, comprising groups of children with OI types I, III and IV all reported significant increases in lumbar spine areal bone mineral density (BMD). One study reported beneficial effects on lumbar spine BMD during treatment for 2-9 years. A very interesting st
在最新一期的《JRPMS》杂志上，萨兰提斯博士和他的同事们报道了一个有趣的病例，一个7岁的希腊男孩，由于一种新的COL1A1突变而患有成骨不全症。作者还提供了他们对静脉注射唑来膦酸的药理学治疗方案的见解，这是该领域越来越感兴趣的话题，因为目前在药理学药物的选择、剂量甚至治疗持续时间方面没有达成共识。Osteogenesis Imperfecta (OI)在拉丁语中的字面意思是“不完美的骨骼出生”，源于希腊单词οστεογ η (ν στο ν = bone + γ ις = birth)。它于1849年由Vrolik命名，代表了具有多种基因型和表型的遗传疾病。OI是由编码I型胶原原α1或α2链的COL1A1或COL1A2基因(据报道占85%)或参与I型胶原成骨细胞分化或翻译后修饰/转运的其他基因(即WNT1、LRP5、BMP1、CRTAP、P3H1/LEPRE1)的突变引起的。i型胶原蛋白是骨骼的主要蛋白质，是骨骼的主要有机组成部分，但在肌腱、韧带、皮肤、巩膜和牙本质中也大量存在。成骨不全患者i型胶原蛋白的数量和/或质量较低，因此表现为多种临床表型，通常包括低能骨折、骨畸形、关节活动过度、骨痛、身材矮小，在某些情况下还会出现蓝巩膜、牙本质发育不全和过早听力丧失。根据silent的原始分类，OI可分为四种主要类型(I-IV)。I型是较轻的形式，通常没有畸形，II型是致命的形式，导致围产期死亡，III型是最严重的，在存活的新生儿中有多处骨折和畸形，IV型的严重程度介于I型和III型之间，有中度畸形和身材矮小。据报道，在各种临床环境中，成骨不全的药物治疗取决于诊断时患者的年龄以及疾病的严重程度，目前对于治疗方案的选择还没有达成共识。过去，人们曾试图用维生素、氟化钠、降钙素甚至生长激素来控制这种疾病，但都没有成功。20年前，Glorieux及其同事报道了静脉注射帕米膦酸盐(第二代含氮双膦酸盐)治疗严重成骨不全的儿童。从那以后，有一些关于帕米膦酸盐在不同剂量方案中治疗少数成骨不全患者的短期效果的报道，有时长达4年。这些包括I型、III型和IV型成骨不全儿童的研究均报告腰椎面积骨矿物质密度(BMD)显著增加。一项研究报告了治疗2-9年对腰椎骨密度的有益影响。一项对45例成骨不全患者进行的非常有趣的髂骨组织形态学研究表明，在治疗2年后，根据年龄，静脉注射不同剂量和剂量方案的帕米膦酸钠诱导皮质宽度(88%，p<0.001)和平均松质骨体积(46%，p<0.001)显著增加，这完全是由于小梁数量增加，而小梁厚度保持不变。骨形成率(BFR/BS)、类骨厚度和其他骨小梁重塑指标均显著降低(p<0.001)，作者得出结论，帕米膦酸盐通过抑制骨重塑诱导的骨小梁骨吸收，同时保留骨建模导致的皮质骨的骨形成，对骨骼生长具有双重作用。一项研究报告，静脉给予帕米膦酸4年导致统计学上的
{"title":"Treatment with intravenous bisphosphonates in children and adolescents with Osteogenesis Imperfecta: are we towards a consensus of a protocol?","authors":"K. Stathopoulos","doi":"10.22540/jrpms-02-072","DOIUrl":"https://doi.org/10.22540/jrpms-02-072","url":null,"abstract":"In the current issue of JRPMS, Dr Sarantis and colleagues report the interesting case of a Greek patient, a 7 years-old boy, with Osteogenesis Imperfecta due to a novel COL1A1 mutation. The authors also provide insight into their protocol of pharmacological treatment with iv zolendronic acid, a topic of increasing interest in the field, as there is currently no consensus regarding choice of pharmacological agent, dosing or even duration of treatment. Osteogenesis Imperfecta (OI) literally means “imperfect bone birth” in Latin, as derived from the original Greek word οστεογένεση (ὀστοῦν = bone + γένεσις = birth). It was termed by Vrolik in 1849 and represents a genetic disorder with multiple genotypes and phenotypes. OI is caused by mutations either of the COL1A1 or COL1A2 genes (in reportedly 85% of the cases) encoding the pro-α1 or α2 chains of type-I collagen or of other genes (i.e WNT1, LRP5, BMP1, CRTAP, P3H1/LEPRE1) involved in osteoblast differentiation or post-translational modification/transport of type I collagen. Type-I collagen is the major protein of bone, constituting by large its organic part, but exists also in significant quantities in tendons, ligaments, skin, sclerae and dentin. Patients with OI have lower quantity and/or quality of type-I collagen, thus presenting with multiple clinical phenotypes that usually include low-energy fractures, bone deformities, joint hypermobility, bone pain, short stature, and in some cases blue sclerae, dentinogenesis imperfecta and premature hearing loss. According to the original classification of Sillence, OI can be distinguished in four predominant types (I-IV). Type I is the milder form with usually no deformities, type II is the lethal form resulting in perinatal death, type III is the most severe in surviving neonates with multiple fractures and deformities, and type IV is intermediate in severity between types I and III with moderate deformities and short stature. Pharmacological treatment of OI in various clinical settings reportedly depends upon the age of the patient at the time of diagnosis as well as the severity of the disease, and there is currently no consensus regarding a treatment regimen of choice. In the past, unsuccessful attempts to control the disease have been made with vitamins, sodium fluoride, calcitonin or even growth hormone. Twenty years ago, Glorieux and colleagues reported the use of intravenous pamidronate (a second-generation nitrogen-containing bisphosphonate) in children with severe osteogenesis imperfecta. Ever since, there have been a few reports regarding the short-term effects of pamidronate treatment in various dosing regimens for sometimes up to 4 years in small numbers of patients with OI. These studies, comprising groups of children with OI types I, III and IV all reported significant increases in lumbar spine areal bone mineral density (BMD). One study reported beneficial effects on lumbar spine BMD during treatment for 2-9 years. A very interesting st","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130028842","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. Chrysanthou, N. Laliotis, N. Galanis, G. Paraskevas, M. Potoupnis, F. Sayegh, G. Kapetanos
The meniscus plays an important role in the function and biomechanics of the knee. It is an essential part of the knee joint, increasing contact area and joint congruence, lubricating articular surfaces and at the same time decreasing contact forces and absorbing shock. Meniscal tear is the most common injury to the knee that requires surgery. Traumatic meniscal tears are common in young patients with sports-related injuries. Most tears are treated by partial meniscectomy. However, patients who underwent meniscectomy noted long-term arthritic changes. An in vitro study showed that the removal of 16% to 34% of the meniscus resulted in a 350% increase in contact forces. So efforts have been made to preserve meniscus, and meniscal repair has become the preferred treatment of choice over meniscectomy, especially for young active patients and for peripheral longitudinal tears. Augmentation techniques, such as fibrin clot, synovial rasping, vascular access channels, platelet-rich plasma, fibrin glue, fascial – sheath coverage, rasping of the intercondylar notch may extend the indication for repair and improve success rates after meniscal repair especially in the central avascular zone of the meniscus. Meniscal repair using a fibrin clot was first introduced by King in 1938 and became popular by Arnoczky and Warren in 1983. There have been a few experimental in animals as well as in human studies that show good results of meniscal repairs using fibrin clot. In this paper we explain in details, the procedure we follow treating a case Abstract
{"title":"Meniscal repair using fibrin clot from autologous blood: description of the surgical technique","authors":"C. Chrysanthou, N. Laliotis, N. Galanis, G. Paraskevas, M. Potoupnis, F. Sayegh, G. Kapetanos","doi":"10.22540/JRPMS-02-089","DOIUrl":"https://doi.org/10.22540/JRPMS-02-089","url":null,"abstract":"The meniscus plays an important role in the function and biomechanics of the knee. It is an essential part of the knee joint, increasing contact area and joint congruence, lubricating articular surfaces and at the same time decreasing contact forces and absorbing shock. Meniscal tear is the most common injury to the knee that requires surgery. Traumatic meniscal tears are common in young patients with sports-related injuries. Most tears are treated by partial meniscectomy. However, patients who underwent meniscectomy noted long-term arthritic changes. An in vitro study showed that the removal of 16% to 34% of the meniscus resulted in a 350% increase in contact forces. So efforts have been made to preserve meniscus, and meniscal repair has become the preferred treatment of choice over meniscectomy, especially for young active patients and for peripheral longitudinal tears. Augmentation techniques, such as fibrin clot, synovial rasping, vascular access channels, platelet-rich plasma, fibrin glue, fascial – sheath coverage, rasping of the intercondylar notch may extend the indication for repair and improve success rates after meniscal repair especially in the central avascular zone of the meniscus. Meniscal repair using a fibrin clot was first introduced by King in 1938 and became popular by Arnoczky and Warren in 1983. There have been a few experimental in animals as well as in human studies that show good results of meniscal repairs using fibrin clot. In this paper we explain in details, the procedure we follow treating a case Abstract","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134181308","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}
Surgical infections in spine surgery is a complication that can delay wound-healing and recovery, add impairments and increase the morbidity, the mortality and the overall financial constraints, Although the prophylaxis against infections has recently improved, the incidence of surgical site infections (SSI) varies from 0,7% to 16%. According to clinical studies, the postoperative wound-infections are the third most commonly hospital infections after pneumonia and urinary tract infection. The infection rate varies according to the relevant published literature, and risk factors are classified as: 1) patient-related factors and 2) procedure-related factors. The latter is further divided into: i) pre-operative, ii) intra-operative and iii) post-operative risk factors. The successful prevention of SSI is inevitably bound up coping with these risk-factors, as up to 60 % as SSIs are preventable by using evidence-based guidelines.
{"title":"Prevention of orthopaedic infection in spine surgery","authors":"Effrosyni Koutsoumpeli, Nikolaos Koutsoumpelis","doi":"10.22540/JRPMS-02-046","DOIUrl":"https://doi.org/10.22540/JRPMS-02-046","url":null,"abstract":"Surgical infections in spine surgery is a complication that can delay wound-healing and recovery, add impairments and increase the morbidity, the mortality and the overall financial constraints, Although the prophylaxis against infections has recently improved, the incidence of surgical site infections (SSI) varies from 0,7% to 16%. According to clinical studies, the postoperative wound-infections are the third most commonly hospital infections after pneumonia and urinary tract infection. The infection rate varies according to the relevant published literature, and risk factors are classified as: 1) patient-related factors and 2) procedure-related factors. The latter is further divided into: i) pre-operative, ii) intra-operative and iii) post-operative risk factors. The successful prevention of SSI is inevitably bound up coping with these risk-factors, as up to 60 % as SSIs are preventable by using evidence-based guidelines.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129135765","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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