Hss Journal最新文献

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, presenting clinically as inflammatory arthritis in children younger than 16 years. To date, while evidence supports physical activity for children with JIA, there is limited evidence on the recommended approach to physical activity and sports participation in this population, and no single structured therapeutic exercise program has been established as best practice. This review article presents what is known on the management of physical activity in children with JIA, including recommendations from the pediatric rheumatology and rehabilitation literature, where available, for sports participation, structured therapeutic exercise programs, and return to activity.

Background: Axial spondyloarthritis (AxSpA) is a chronic rheumatic disease characterized by spine inflammation, abnormal bone growth, and paradoxically osteoporosis and vertebral fractures. The pathogenesis of skeletal deficits in this disease is poorly understood.

Purpose: We sought to evaluate volumetric bone mineral density (vBMD) and bone microarchitecture in patients with AxSpA and to identify disease-related factors associated with skeletal abnormalities.

Methods: We enrolled patients between 2018 and 2021 as part of a 2-year prospective study at a single institution investigating skeletal health and the skeletal effects of interleukin-17 (IL-17) treatment. Patients with AxSpA who met Assessment in SpondyloArthritis International Society (ASAS) classification criteria by X-ray or had evidence of active inflammation on magnetic resonance imaging suggestive of sacroiliitis were referred to the study by their rheumatologists. We excluded those with a history of fragility fracture, multiple myeloma, Cushing's disease, primary hyperparathyroidism, osteomalacia, untreated vitamin D deficiency, secondary osteoporosis, or other systemic rheumatic diseases, as well as use of oral steroids for 2 or more weeks in the 6 months prior or current use of hormone replacement therapy, current oral bisphosphonate, past or current intravenous bisphosphonate, teriparatide, or denosumab therapies. A total of 1606 patients were screened for eligibility. Of these, 30 participants were enrolled (mean age 43 years, 50% male). Patients with AxSpA had dual-energy X-ray absorptiometry (DXA) measurements of areal BMD (aBMD) and high-resolution peripheral quantitative computed tomography (HR-pQCT) measurements of vBMD microarchitecture and failure load by finite element analysis. Standardized disease assessment tools used included the Bath Ankylosing Spondylitis Disease Activity (BASDAI), Metrology Index (BASMI), and Functional Index (BASFI).

Results: In the 30 included patients, mean DXA and HR-pQCT Z-scores were within 1 standard deviation (SD) of normal for all indices, except for total vBMD in males (-1.2 SD below mean). Mean symptom duration was 11.7 years and mean scores for BASDAI, BASFI, and BASMI were 4.6, 3.6, and 2.7, respectively (range 1-10, 10 = severe limitation). Longer disease duration was associated with more severe skeletal deficits at the hip and tibia-specifically, lower hip aBMD, lower meta- and inner-trabecular vBMD, lower trabecular number, and higher trabecular separation and heterogeneity.

Conclusion: This study of 30 patients with AxSpA found that abnormalities in bone density and microarchitecture at weightbearing sites were associated with longer disease duration. Because of its small sample size, larger studies are needed to better characterize the pathogenic disease factors that govern skeletal damage in AxSpA.

Background: To improve outcomes following anterior cruciate ligament (ACL) reconstruction, bridge-enhanced ACL restoration (BEAR) was introduced. Bridge-enhanced ACL restoration uses a collagen-based implant saturated with infused autologous blood to bridge the torn proximal and distal ACL fibers.

Purpose: We sought to analyze the short-term complications, clinical outcomes, and patient-reported outcome measures (PROMs) in patients undergoing BEAR outside of the initial clinical trials.

Methods: We conducted a retrospective cohort study of all skeletally mature patients who had a midsubstance or proximal ACL tear treated with BEAR by 2 surgeons at a single institution and had a minimum follow-up of 6 weeks. A total of 58 patients were included (average age was 38 years, average time from injury to surgery was 45 days). Data on demographic factors, functional outcomes, and complications were collected from electronic medical records. Patient-reported outcome measures and a descriptive return-to-activity survey were analyzed utilizing paired t-tests and Wilcoxon signed-rank tests.

Results: All 58 patients demonstrated a grade of 1A on the Lachman test at 6 weeks postoperatively. At 6 months postoperatively, the mean active flexion was 135° ± 5°, and all patients achieved 0° extension. Although not all patients completed PROM questionnaires, among those who did we observed a significant increase in PROMs between preoperative and postoperative measurements; more than half achieved the minimal clinically important difference in all PROMs, and 26 patients (87%) had a 1-level decrease in function. There were no cases of retear or instability. Three patients (5%) had postoperative arthrofibrosis.

Conclusion: Early results of this preliminary post-market approval study suggest that BEAR may provide a safe and non-inferior approach to ACL reconstruction in selected patients. Studies are needed to investigate the long-term outcomes of this novel technique.

Background: Younger patients are more likely than older patients to experience shoulder instability and to rely on online educational resources. Although the Internet has increased patient access to medical information, this may not translate to increased health literacy. Purpose: We sought to analyze the quality and readability of online information on shoulder instability. Methods: We conducted a Google search using 6 terms related to shoulder instability. We collected the first 20 non-sponsored results for each term. Readability was evaluated using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Gunning Fox Index (GFI) instruments. Quality was assessed using a Quality Grading Sheet (QGS) and the validated DISCERN instrument. Results: A total of 64 of 120 patient educational materials (PEMs) met the inclusion criteria. The mean FKGL, FRE, and GFI scores were 9.45 ± 0.552, 50.51 ± 3.4, and 11.5 ± 0.6, respectively. The mean DISCERN score and QGS rating were 33.09 ± 2.02 and 10.52 ± 1.28, respectively. While 49 (76.6%) articles discussed operative treatment for persistent shoulder instability, only 4 (6.3%) mentioned risks associated with surgery. Non-institutional sources had higher DISCERN scores than those from medical institutions. Conclusions: This review of online shoulder instability-related PEMs suggests that many do not meet current recommendations, with an average quality rating of "poor" and a mean ninth-grade reading level. Surgeons should be aware of the relative paucity of information on the risks and outcomes associated with operative treatment of shoulder instability contained in these PEMs.

Introduction: Instability after total knee arthroplasty (TKA) remains a leading cause of revision TKA and can lead to patient dissatisfaction. While many companies have developed midlevel constrained (MLC) polyethylene inserts in primary TKAs, there is little data on their outcomes.

Purpose: We sought to analyze short-term outcomes including survivorship, rates of manipulation under anesthesia (MUA), and improvements in patient-reported outcome measures (PROMs) preoperatively to postoperatively in one design of MLC TKA.

Methods: We prospectively followed consecutive primary TKA patients who received constrained inserts (Journey II or Legion Genesis II, Smith and Nephew) from 5 surgeons, 2019 to 2020, at a single academic institution. We analyzed revision-free survivorship, MUA rates, and PROMs, preoperatively to postoperatively.

Results: A total of 356 patients were included with a mean age of 64 years; 49% were male and the mean body mass index (BMI) was 31 kg/m². Sixteen patients (4.5%) underwent MUA and 3 patients (0.8%) underwent revision. Two patients underwent polyethylene exchange and patellar resection for patellar loosening. One patient underwent liner exchange for instability. The 2-year revision-free survivorship was 98.5% (95% confidence interval [CI]: 96.6%-100%). Survivorship free from revision for tibial or femoral aseptic loosening was 100% at 2 years. The 2-year survivorship free from MUA was 92.3% (95% CI: 88.6%-96.1%). The mean Knee Osteoarthritis and Injury Outcomes Score Joint Replacement (KOOS JR) was 81 at 2 years follow-up, while the Lower Extremity Activity Score (LEAS) score was 10.5.

Conclusion: At a mean of 3 years follow-up, 2 types of MLCs used in primary TKA were associated with a low rate of early revision, low rate of MUA, and reliable improvement in functional outcomes. These MLCs were not associated with early loosening or unique failure modes.