Annals of Joint最新文献

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.

Background: Adequate vitamin D is essential for maintaining optimal bone health, preventing and treating of osteoporosis. However, in recent years, large clinical trials and meta-analyses on the efficacy of vitamin D supplementation to prevent fractures in populations at different risks have been equivocal. The optimal level of 25-hydroxyvitamin D (25[OH]D) remains controversial. Recommendations vary between societies. The lack of standardized assays also poses a challenge in interpreting available research data.

Methods: We systematically searched for articles in MEDLINE database through PubMed, which included meta-analysis, systematic reviews of randomized controlled trials (RCTs) and observational studies that assessed measurement, diagnosis and treatment about vitamin D deficiency. The experts evaluated the available literature, graded references according to the type of study and described the strength recommendations.

Results: This expert consensus is based on the review of relevant clinical evidence and provides nine key recommendations on vitamin D deficiency in populations at different risks, especially in patients with osteoporosis. Supporting information is provided in the subsequent appendix box.

Conclusions: This expert consensus is a practical tool for endocrinologists, general physicians for the diagnosis, assessment, and treatment of populations at different risks of vitamin D deficiency, especially in patients with osteoporosis. Clinicians should be aware of the evidence but make individualized decisions based on specific patients or situation.

Background and objective: The role of positron emission tomography (PET) in evaluating musculoskeletal lesions has evolved significantly over the past several decades. When combined with conventional imaging, PET can provide substantial value, but understanding its optimal use and potential pitfalls is crucial. This literature review highlights the current role of PET in common bone and soft tissue sarcomas (STS), PET-positive benign lesions, differentiating between benign and malignant lesions, and evaluating skeletal lesions from primary carcinomas. Furthermore, we review the future potential of PET in this evolving landscape.

Methods: In this literature review article, PubMed, Cochrane Library, and Google Scholar databases were searched for studies and reviews on the management of musculoskeletal tumors with PET-computed tomography (CT) scans with focus on bone and STS.

Key content and findings: This review elucidates the optimal scenarios for employing PET/CT in managing musculoskeletal tumors and highlights potential pitfalls. A key strength of this study is the correlation of patient case imaging, effectively demonstrating practical applications of PET/CT.

Conclusions: PET imaging serves as a valuable tool for diagnosis, staging, and surveillance of musculoskeletal tumors, particularly sarcomas. With a multidisciplinary approach and ongoing research, PET/CT is poised to become a leading method in the management of musculoskeletal tumors.

Background: Although the likelihood of recurrence decreases with age, there is a dearth of comprehensive literature on the effectiveness of arthroscopic Bankart repair for older patients. The purpose of this review is to systematically assess the indications, surgical techniques, outcomes, and complications of arthroscopic Bankart repair for patients aged 30 years or older.

Methods: The electronic databases PubMed, MEDLINE and EMBASE were searched for relevant studies from database inception to February 2023. Studies of all levels of evidence investigating the utility of arthroscopic Bankart repair in patients aged 30 years or older were included. Studies with populations that underwent concomitant major shoulder procedures, or non-surgical management populations were excluded. The Methodological Index for Non-Randomized Studies (MINORS) appraisal tool was used to asses non-randomized studies. Meanwhile, randomized controlled trials (RCTs) were evaluating using the Cochrane Risk of Bias Tool Descriptive statistics including counts, proportions, means, ranges, and measures of variance (e.g., standard deviations, 95% confidence intervals) are presented where applicable.

Results: Thirteen studies were identified, comprising of 495 patients (496 shoulders) with a mean age of 46.0±6.9 years and 57.1±48.2 months of follow-up. The most common indication for surgery was recurrent instability with minimal glenoid bone loss and the absence of rotator cuff tears. Overall, there appears to be value in treating middle-aged patients experiencing anterior shoulder instability with arthroscopic Bankart repair given the moderate complication (5.4%) and revision rates (4.6%) at short-term follow-up. Postoperatively, patients experienced significant improvements in pain, function, and activities of daily living. However, this was at the expense of stiffness as there were deficits in external rotation and forward flexion.

Conclusions: This study was primarily limited by the quality of evidence and heterogeneity. There is a need for future studies using long-term follow-up to determine optimal surgical management and rehabilitation protocols for this patient population based on history and clinical factors.

Background and objective: Proximal humerus fractures (PHFs) occur in all age groups but more in elderly population with variety of treatment options. The choice of treatment of PHFs is rather controversial in the middle-aged and active elderly population. This review article highlights the current literature on the efficacy of treatment options for PHFs in middle-aged and active elderly patients which could help surgeons in decision making in clinical practice.

Methods: PubMed and Scopus databases from January 1953 to February 2024 were searched and screened for studies, including systematic reviews, on the treatment of PHFs in middle-aged and elderly that served for narrative review of rationale behind such design.

Key content and findings: Patients with minimally displaced fractures should be treated nonoperatively. Internal fixation with intramedullary nailing is a viable option in cases of two-part surgical neck fractures, those with diaphyseal involvement and no significant displacement of the tuberosities, or pathologic fractures. Those elderly patients with displaced three- or four-part PHFs fractures with intact rotator cuff muscles should be treated with locking plate fixation if anatomical reduction of fracture fragments including tuberosity is possible, as the results after union despite avascular necrosis are favorable. Moreover, patients with failed fixation treated with salvage reverse shoulder arthroplasty (RSA) have similar outcomes to RSA for acute PHFs. Hemiarthroplasty should be reserved for select group of young active patients with unconstructable fracture, intact rotator cuff, and good tuberosity bone stock. RSA should be offered as first option for elderly patients with poor bone stock, rotator cuff insufficiency, fracture dislocations, head-split fractures, and severely displaced 3- and 4-part PHFs.

Conclusions: The treatment of choice in middle-aged and active elderly patients with three- or four-part PHFs depends on several factors such as fracture pattern, bone quality, possibility of anatomical reduction, status of rotator cuff, and patient expectations. The success of treatment is based on patient selection while setting correct patient expectations.

Background: Long-term exposure to weightlessness can result in bone and muscle degradation, significantly impacting musculoskeletal function. Recent studies have also indicated damage to articular cartilage due to weightlessness. This study aims to observe the effects of simulated weightlessness on the cartilage microstructure of the quadriceps muscle and the muscular knee joint in rats.

Methods: A total of 30 rats were used in this study, of which 20 rats were subjected to simulated weightlessness by tail suspension, which may be suitable for clinical long-term bedridden patients. At 14 and 28 days, the microscopic morphology of knee cartilage and quadriceps femoris muscle was observed by transmission electron microscopy, and the collagen and water content of cartilage was evaluated by magnetic resonance imaging. The mitochondrial activity of knee muscle and the levels of inflammatory factors in synovial fluid were detected by enzyme-linked immunosorbent assay (ELISA). Biomechanical and histological evaluation of cartilage was performed.

Results: On day 14, T2 mapping revealed no significant loading effect. However, transmission electron microscopy revealed altered mitochondrial inner membrane structure in cartilage, with vacuolization, disrupted endoplasmic reticulum, alongside mitochondrial ultrastructural damage in muscle. ELISA results showed that a large number of mitochondria in muscle were inactivated, and the levels of inflammatory factors in synovial fluid were increased. The staining results showed slight fracture of the cartilage surface and the type II collagen-positive cells were reduced. Nanoindentation showed that the cartilage microsurface was uneven, and the elastic modulus and hardness were decreased. On day 28, T2 mapping analysis indicated increased cartilage T2 values. Transmission electron microscopy showed alterations in the structure of the mitochondrial inner membrane in cartilage, severe vacuolization, disrupted endoplasmic reticulum, and substantial mitochondrial damage in muscle tissue. Muscle mitochondrial activity was markedly decreased, inflammatory factors levels were elevated, and the cartilage surface exhibited severe damage. The type II collagen positive cells were further reduced, the micro-surface of cartilage was uneven, and the elastic modulus and hardness were significantly decreased.

Conclusions: The weightless environment resulted in the damage of endoplasmic reticulum and mitochondria of cartilage, mitochondrial damage of quadriceps muscle, inactivation of muscle mitochondria (P=0.01), increased intra-articular inflammation (P=0.01), decreased elastic modulus and hardness (P=0.03), and damaged cartilage surface, which aggravated cartilage degeneration.