Annals of Joint最新文献

Background and objective: Brachial plexus injuries (BPIs) are a rare but potentially devastating injury among contact athletes. More common injuries, such as "burners" or "stingers", indicate a temporary and less severe insult to either the nerve roots or plexus. The aim of this review is to discuss this spectrum of injuries in their epidemiology, mechanism in contact sports, diagnosis, and treatment.

Methods: This literature review utilized key terms to search manuscripts available in English from inception to October 2024 within three research databases.

Key content and findings: BPIs among contact athletes occur on a spectrum from neuropraxia to neurotmesis. Neuropraxia is very common among contact athletes with approximately a 49-65% incidence among career football players with the most common mechanism being a traction injury. Most of these resolve within minutes to hours. Axonotmesis and neurotmesis can be far more severe injuries and require further investigation if not resolved by 2-3 weeks. The majority of athletes who suffer neuropraxic injuries will return to sport with minimal to no time missed, however, more severe injuries portend variable outcomes.

Conclusions: BPIs are common among contact athletes and involve a spectrum of nerve damage, of which most are self-limiting. However, further evaluation is warranted when symptoms last beyond 2-3 weeks. Future studies should focus on treatment algorithms and long-term outcomes, including return to sport.

Background: Managing complex fracture-dislocations of the proximal interphalangeal (PIP) joint poses significant clinical challenges, necessitating innovative treatment strategies.

Case description: This case report highlights the successful treatment of a severe PIP joint fracture-dislocation in a 49-year-old male carpenter who sustained a traumatic laceration to the right index finger. The injury's complexity led to the pioneering use of an osteochondral autograft from the patient's second toe proximal phalanx, marking a novel approach in autologous tissue utilization for joint reconstruction. This method effectively achieved fracture resolution and joint stabilization. A comprehensive literature search was conducted up to May 2024 across multiple databases, including PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The search strategy employed a combination of Medical Subject Headings (MeSH) terms and keywords related to PIP joint fracture-dislocations and osteochondral autografts. Inclusion criteria were articles in English involving human subjects, focusing on osteochondral autografts for PIP joint fracture-dislocations. Exclusion criteria included studies involving animals or cadaveric models and those not focused on osteochondral grafts. Postoperative assessments of the patient revealed successful graft integration and notable recovery in finger mobility, alongside positive functional hand outcomes as confirmed by patient-reported measures.

Conclusions: The significant enhancements in structural and functional aspects highlight the potential of this technique. Despite its sparse representation in the literature, the favourable outcomes of this case strongly support further exploration of using second toe proximal phalanx osteochondral autografts. This report underscores the need for extensive, prospective research to comprehensively ascertain the method's effectiveness and safety in addressing intricate PIP joint fracture dislocations.

Osteotomies around the knee are an effective method for preserving the knee joint by correcting overall alignment. Although osteotomies have historically been used in treatment of knee pathology, they have recently regained a renewed interest as a treatment strategy for alignment correction, ligamentous stability, and cartilage preservation. Osteotomies are a powerful way to correct alignment in both the sagittal and coronal plane to preserve and/or protect the cartilage in the medial, lateral, and patellofemoral compartments of the knee and improve the ligamentous stability of the knee. Medial opening wedge high tibial osteotomy (MOW-HTO) and lateral closing wedge high tibial osteotomy (LCW-HTO) are commonly performed osteotomies for correcting varus malalignment, each with distinct indications, surgical techniques, and associated complications. Similarly, distal femoral osteotomy (DFO) plays a critical role in the correction of both varus and valgus malalignment, and may be particularly important in cases where a tibial osteotomy alone would lead to excessive joint line obliquity (JLO). In complex cases where single-level osteotomy does not provide optimal correction, double-level osteotomy may be necessary to achieve appropriate mechanical axis restoration while maintaining joint congruence. Beyond coronal plane corrections, increasing attention has been given to sagittal plane osteotomies for managing ligamentous instability, particularly anterior and posterior cruciate ligament (PCL) deficiencies. Modifying the posterior tibial slope (PTS) through anterior closing wedge or anterior opening wedge high tibial osteotomy can improve knee biomechanics and stability in both anterior cruciate ligament (ACL) and PCL-deficient patients. Additionally, tibial tubercle osteotomies (TTO) have emerged as an important surgical adjunct in the treatment of patellofemoral malalignment and cartilage preservation strategies. The goal of knee osteotomies is to offload the affected compartment, preserve and protect cartilage and menisci, and enhance ligamentous stability, thereby delaying the need for arthroplasty. Therefore, osteotomies represent an intriguing procedure for young and active patients. Recently, with the renewed interest in osteotomy procedures about the knee, studies have demonstrated that osteotomies continue to play a critical role in treatments for limb alignment and cartilage protection.

Background and objective: The evaluation of both femoral and tibial torsional profiles remains a challenge in the orthopedic practice since there is no agreement on the most precise and reliable measurement method and technique. The aim of this review is to collect and critically report the most relevant and up-to-date evidence on the radiological techniques available to determine lower limb torsional deformities and to discuss the advantages and limitations of each technique to better define their optimal field of application.

Methods: Literature research on PubMed, Embase, and Google Scholar databases was performed, utilizing the following search string: "torsion" AND ("lower limb" OR "femur" OR "tibia"). Relevant clinical and preclinical studies evaluating different radiological techniques to assess lower limb torsional deformities, and possibly comparing them, were collected and critically reviewed.

Key content and findings: Computed tomography (CT) is still considered the best method to measure both femoral and tibial torsional angles. Its main limitation, the radiation exposure, has been recently addressed with ultra-low dose protocols that were proven to be as accurate as standard protocols. On the other hand, magnetic resonance imaging (MRI) offers a nonionizing, radiation-free option that is now considered almost equivalent to CT. However, MRI consists in a long and expensive procedure that can be hindered by issues linked to metal implants, patient's positioning and measurement variabilities. Lastly, three-dimensional (3D) reconstructions derived from low-dose biplanar radiographies (LD-BRs) have been proposed as a low-radiating, quick and reliable solution to overcome the limitations of both MRI and CT scans.

Conclusions: To date, CT has still to be considered the gold standard for the radiological assessment of lower limb torsional deformities. Nonetheless, MRI and LD-BR have been proven to be valid and reliable alternatives, especially in specific clinical settings.

An understanding of the embryonic and fetal formation of the knee can help elucidate the relationships between the various structures and clinical conditions. While there have been studies published on the steps of knee development by sectioning human embryos and fetuses, the goal of this review is to consolidate these findings and images into one cohesive work. The timing and appearance of the structures in the knee are outlined with a focus on the cruciate and meniscofemoral ligaments (MFLs). In particular, the posterior cruciate ligament is emphasized with its relationship to other intraarticular structures and congenital anomalies that may arise. The steps of embryological development are outlined by the 23 stages of Carnegie embryonic staging system, which are distinguished by morphological criteria seen on histology of embryo sections. These images highlight the mesenchymal tissue within the interzone of the knee that form the primitive cruciate ligaments and menisci and the subsequent development of the cavitations within the knee that start to give it an appearance similar to that of an adult knee. The steps of fetal development are outlined by the weeks of development with the histological images showing the development of articulations between structures. This review paper consolidates various sources throughout the literature to outline the embryological and fetal appearance and relationship of intraarticular structures in the knee, such as the cruciate and MFLs, and how their altered development may contribute to the congenital anomalies and clinical conditions that may arise.

Background: Coccygodynia, characterised by localised pain in the coccyx and surrounding tissues, presents challenges in diagnosis and management given its low prevalence and varied aetiology. Traumatic injury, particularly backward falls, is commonly implicated, while non-traumatic causes include degenerative joint disease, overloading stress forces from obesity and morphological variations of the coccyx. Diagnostic evaluation involves medical history, physical examination, and radiographic imaging. While conservative management is often successful, refractory cases necessitate intervention. However, optimal treatment strategies still need to be clarified. The present systematic review discusses the clinical evidence on the management of coccygodynia.

Methods: In December 2024, a systematic review followed PRISMA guidelines, accessing PubMed, Web of Science, and Embase databases. Eligible studies included solely clinical trials investigating coccygodynia management. The risk of bias was assessed using Cochrane risk of bias assessment tool (RoB2) for randomized controlled trials (RCTs) and the Risk of Bias in nonrandomized Studies of Interventions (ROBINS-I) for non-RCTs. Data extraction and statistical analyses followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.

Results: Of 407 identified articles, 16 met inclusion criteria, comprising 858 patients, primarily women. Risk of bias assessment revealed varying methodological quality among included studies. Conservative treatments, including physiotherapy and shockwave therapy, showed promise in pain management. Interventional therapies, such as corticosteroid injections and ganglion-impair blockade, demonstrated efficacy in refractory cases. Surgical interventions, particularly coccygectomy, yielded moderate success rates but were associated with notable risks.

Conclusions: A multidisciplinary approach is advocated for managing coccygodynia, with conservative measures as initial strategies. Physical therapy-based interventions and interventional treatments, such as corticosteroid injections and ganglion impair blockade, offer viable options for refractory cases. Surgical intervention should be considered judiciously, weighing risks and benefits based on patient-specific factors and treatment response. Further research is needed to establish standardized guidelines for coccygodynia management based on high-quality evidence.

Background and objective: While hand paresthesia and numbness are commonly associated with nerve compression, these symptoms also manifest in shoulder conditions not typically linked to direct nerve involvement, prompting questions about their underlying causes. This review aimed to explore the existing literature on hand paresthesia and numbness in patients with common shoulder pathologies. The goal was to identify gaps in our understanding of the prevalence and mechanisms behind these symptoms.

Methods: To conduct this review, a search strategy was formulated to target key terms related to hand paresthesia, numbness, and various shoulder pathologies. PubMed, Scopus, Embase via OVID, and Cochrane Library were searched, resulting in an initial pool of 33 articles. After screening and removing duplicates, three relevant studies were included for analysis.

Key content and findings: Our review analyzed three current studies that demonstrated varying rates of preoperative hand paresthesia and numbness among patients with different shoulder pathologies. Specifically, 54% of patients with subacromial impingement syndrome, 35% of patients with rotator cuff tears, and 40% of patients with either Bankart tears or superior labrum anterior and posterior (SLAP) tears reported experiencing hand paresthesia. Hand numbness was reported by 29% of patients with rotator cuff tears, 40% with Bankart tears, and 55% with superior labrum anterior and posterior tears. The prevalence of hand paresthesia and numbness was positively correlated with higher intensity of shoulder pain among all included studies.

Conclusions: Hand paresthesia and numbness have been reported by patients with subacromial impingement syndrome, rotator cuff tears, and glenohumeral labral tears. The prevalence of hand paresthesia and numbness across other shoulder pathologies and their pathophysiology remain to be investigated.

Background and objective: The reverse total shoulder arthroplasty (RSA) is a widely used innovative procedure for managing shoulder pathologies like severe rotator cuff arthropathy, osteoarthritis with significant glenoid deformity, or proximal humerus fractures. RSA prosthesis designs utilize the deltoid muscle to bypass the role of the rotator cuff, and to generate most of the force required for shoulder elevation. As such, preoperative deltoid insufficiency or injury, as well as any intraoperative or postoperative complications involving the deltoid, can significantly impact patient outcomes, rehabilitation, and recovery following RSA. The aim of our review is to highlight the critical role of the deltoid muscle in RSA and discuss the different perioperative challenges that may impact its function and the overall success of the procedure.

Methods: The PubMed/MEDLINE database was screened for studies describing or reporting peri-operative deltoid or axillary nerve pathologies in the setting of RSA, from database inception until August of 2023. Articles were excluded if animals subjects were involved, or if they were written in the non-English language. Relevant search terms were used, and additional articles were retrieved from the reference lists of included articles.

Key content and findings: Ensuring the health and integrity of the deltoid muscle is essential for obtaining successful RSA outcomes. At the preoperative stage, deltoid insults can occur due to imbalances in glenohumeral musculature, pre-existing axillary nerve injury and subsequent deltoid atrophy, and concurrent viral infections. Remaining vigilant regarding diagnosis is important at this stage, as surgical treatment should be delayed until symptomatic resolution occurs. Intraoperatively, deltoid injuries can occur due to significant retraction, dissection, or iatrogenic fractures or nerve injuries. Conducting periodic intraoperative axillary nerve assessments and utilizing intraoperative nerve monitoring allow surgeons to potentially intervene in order to help minimize nerve damage. Postoperatively, pathologies can occur due to deltoid fatigue or acromial stress fractures. At that stage, educating patients about potential setbacks is important to set appropriate expectations and minimize injury risk.

Conclusions: Considering the importance of the deltoid in achieving proper RSA outcomes, significant attention should be garnered towards its integrity and health throughout the perioperative process.

Background: Several recent studies have demonstrated that the alteration of tendon microcirculation is one of the main causes of rotator cuff degeneration and tear. The aim of this study was to assess if patients with a rotator cuff tear (RCT) exhibit altered levels of endothelin-1 (ET-1), a powerful vasoconstrictor that could play a key role in the pathogenesis of RCTs, as well as in other tendon structures.

Methods: A case-control study was conducted on 103 participants, divided into 60 cases and 43 controls. A sample of peripheral venous blood was collected from each participant. Each sample underwent centrifugation to obtain plasma, which was then analyzed using a specific enzyme-linked immunosorbent assay (ELISA) kit for human ET-1.

Results: A total of 54 cases and 25 controls were recruited. Initially, we compared the mean plasma concentration of ET-1 of the two study groups. Although there is a higher mean value in controls compared to cases, the difference is not statistically significant (P>0.05). Subsequently, we compared the mean values of ET-1 based on the severity of the tear. Twenty-four patients had a small RCT, and their mean concentration of ET-1 was of 88.39 pg/mL, eight patients had a large tear and a mean ET-1 concentration of 72.07 pg/mL, while twenty-two patients showed a massive tear and a mean concentration of ET-1 of 78.27 pg/mL. However, this difference in ET-1 concentration was not statistically significant (P>0.05).

Conclusions: From the preliminary results obtained, we can observe that, in terms of plasma ET-1 concentration, there are no statistically significant differences between cases with rotator cuff rupture and controls. Given the current limitations of the study, we expect to further expand the sample size to verify if these preliminary results will be confirmed.

Background: Alterations in corticospinal excitability (CSE) to the quadriceps persist after anterior cruciate ligament reconstruction (ACLR). Centrally targeted interventions, such as transcranial direct current stimulation (tDCS), may be necessary to increase CSE and quadriceps muscle strength. The purpose of this study was to determine (I) the feasibility and safety of a single session of tDCS and (II) the effects of a single session of tDCS on CSE and quadriceps muscle performance in participants after ACLR.

Methods: This was a randomized crossover design of a single session of active vs. sham tDCS, including 20 participants (nine male) 4-6 months post-ACLR. Surgical limb quadriceps performance [peak torque normalized to body mass, rate of torque development from onset to 100 ms (RTD100), and RTD from 100 to 200 ms (RTD200)] and CSE [active motor threshold (AMT) and slope of a stimulus-response curve (SLOPE)] were measured using an isokinetic dynamometer and transcranial magnetic stimulation (TMS), respectively. Anodal tDCS (a-tDCS) was delivered over the primary motor cortex while the participant rode a stationary bike for 20 minutes. Adverse events were collected after each tDCS session. Repeated measures 2×2 analyses of variance (ANOVAs) were used to test the effect of condition and time on CSE and quadriceps performance.

Results: There were no adverse events reported and no participant drop out. There was no significant condition by time interactions for CSE (P≥0.17) or quadriceps performance (P≥0.53). There was a significant main effect of time for RTD200 (P=0.02) with decreased RTD200 post-intervention regardless of condition.

Conclusions: TDCS is safe and feasible for participants recovering from ACLR. There were no acute effects of a single session of a-tDCS on CSE and quadriceps performance measures. Multiple sessions of tDCS and/or tDCS during other tasks (e.g., during isolated quadriceps exercises) may lead to improved CSE and quadriceps performance.

Trial registration: ClinicalTrials.gov ID: NCT04504344.