BMC Musculoskeletal Disorders最新文献

Background: According to the mobilization technique of the intraoperative patella, total knee arthroplasty (TKA) can be categorized into patellar eversion (PE) and patellar lateral retraction (PLR). Comparisons between the two procedures are inconclusive; therefore, the study purpose was to assess the postoperative clinical efficacy to identify the most suitable procedure.

Methods: Electronic databases were searched, including Web of Science, ScienceDirect, PubMed, Embase, OVID, the Cochrane Library, CINAHL, CNKI, and WANFANG, to identify clinical trials of PLR versus PE from inception to May 2023. The statistical software Stata 15.0 and Review Manager 5.4 were applied to the data analysis.

Results: Fifteen studies evaluating a total of 1349 patients and 1409 knees were ultimately included. Statistically significant differences emerged between the PLR and PE groups with respect to blood loss (P = 0.02), incision length (P < 0.001), operation time (P = 0.01), straight leg raise (P < 0.001), knee range of motion (ROM; P < 0.05), the Knee Society Score (KSS) functional score (P = 0.0003), the visual analogue scale (VAS) score (1 and 3 months, both P < 0.05), and operative complications (P = 0.02). Furthermore, the PLR and PE groups had similar clinical efficacy in terms of quadriceps strength, VAS score (1 week and 1 year), Hospital for Special Surgery score, KSS pain score, Insall-Salvati ratio, and the occurrence of patella baja (all P ≥ 0.05).

Conclusions: The PLR procedure is superior to PE in terms of blood loss, incision length, straight leg raise, knee ROM, VAS score (1 and 3 months), KSS functional score, and operative complications, although PE could decrease the operation time. PLR could achieve better postoperative clinical outcomes than could PE. Therefore, it is recommended that experienced surgeons prioritize PLR in TKA.

Registration: This study was registered in the PROSPERO international registry (Registration ID: CRD42023440722).

Background: Prader-Willi syndrome (PWS) is a rare disease. Hip dysplasia is an orthopedic-related disease of PWS. Limited literature exists on the prevalence, diagnosis, and surgical management of late diagnosed hip dysplasia in PWS. This study assessed the prevalence of hip dysplasia in children with PWS and evaluated the outcomes following surgical intervention of late diagnosed hip dysplasia.

Methods: A retrospective analysis was conducted on patients diagnosed with PWS at our institution from January 1, 2017 to December 31, 2021. Patient demographics were collected, the acetabular index (AI) and the central edge angle (CEA) were measured. A single fellowship-trained pediatric orthopedic surgeon determined the presence of hip dysplasia based on radiographic measurements.

Results: The prevalence of hip dysplasia with PWS is 33.3%. There was no significant association between prevalence and sex or genetic subtype. The mean age at the time of diagnosis was 34.4 months (6 months to 109 months). Five patients (2 right side, 3 bilateral) underwent surgical intervention at an average age of 82.4 months. The acetabular index decreased from 42.8 ± 5.9 degrees preoperatively to 21.7 ± 7.7 degrees postoperatively. No serious postoperative complications were reported during the follow-up.

Conclusions: The present study demonstrated a higher prevalence of hip dysplasia in patients with PWS than in the general population. The prevalence does not significantly differ across sexes or genetic subtypes. While preliminary findings suggest outcomes may be comparable to those of HD without PWS, further studies with larger cohorts are required to validate these observations.

Purpose: The purposes of the present study are to investigate the effects of reduced muscle loading by prolonged immobilization on the regeneration of fibrocartilaginous enthesis through endochondral ossification in rabbits.

Methods: Forty-eight rabbits underwent standard partial patellectomy were randomly divided into the control group and the prolonged immobilization (PIM) group. The immobilized cast was only maintained for the first 4 weeks in the control group, while for the first 12 weeks or until euthanization in the PIM group. The Patella-patella tendon complexes were harvested for Micro-CT and histology at week 6, 12 and 18.

Results: There was significantly lower bone volume in the PIM group than the control group at week 12, but not at week 6 and 18. At week 6, new bone was formed at the osteotomy site of the residual patella through endochondral ossification. At week 12, the chondrocytes in the tendon to bone interface were ordered and arranged in longitudinal rows separated by collagen fibres in the control group. While there were no visible fibers running continuously from tendon into bone in the PIM group. At week 18, a nearly normal fibrocartilaginous enthesis were regenerated in the control group. A similar fibrocartilaginous enthesis were also formed at the tendon to bone interface in the PIM group, but the four zones were not as distinct as that in the control group.

Conclusion: Muscle loading and endochondral ossification are involved in the regeneration of a fibrocartilaginous enthesis during tendon to bone healing in this partial patellectomy model.

Background: An oligopeptide hepcidin is encoded by the human HAMP gene (Hamp in mice). Its deficiency can result in iron overload, while excess may lead to iron deficiency. Hepcidin knockout mice exhibited iron accumulation in multiple tissues, accompanied by degeneration of bone microarchitecture and reduced biomechanical properties. Astronauts who are exposed to weightlessness during prolonged spaceflight experience bone loss. After space missions, an interrelation exists between iron stores and bone mineral density (BMD). Bone loss in mice due to unloading is linked to iron excess and involves hepcidin. The potential role of hepcidin in unloading-induced bone loss remains unclear.

Methods: Our study conducted relevant experiments using hepcidin knockout mice and their primary osteoblasts as the research subjects. We used the hindlimb unloading (HLU) model and the random positioning machine (RPM) system to simulate weightlessness in vivo and in vitro.

Results: HLU mice exhibited reduced hepcidin levels in the serum and liver. Hepcidin knockout further diminished BMD and bone mineral content (BMC) in the femurs of HLU mice. Similarly, the bone volume fraction (BV/TV) and connectivity density (Conn.Dn) followed this downward trend, whereas trabecular separation (Tb.Sp) showed an inverse pattern. Moreover, hepcidin knockout decreased the ultimate load and elastic modulus in the tibias of HLU mice. Hepcidin knockout decreased PINP levels in the serum, a commonly used marker for bone formation, alongside elevated iron levels in the serum, liver, and bone of HLU mice. We also found higher serum MDA and SOD levels in these mice. In vitro, experimental data indicated that hepcidin knockout suppresses the osteoblastic differentiation capacity under RPM conditions. Additionally, this condition upregulates SOST protein levels and downregulates LRP6 and β-catenin protein levels in osteoblasts.

Conclusion: Hepcidin knockout exacerbates bone loss in HLU mice, most likely due to reduced osteoblastic activity.

Background: Although movement representation techniques has originally been used in neurological rehabilitation, growing researches suggests that it may also introduce advantageous effects to individuals with orthopaedic injuries. This systematic review and meta-analysis aimed to investigate the effects of these techniques on pain, range of motion, muscle strength, functional performance and fear of movement in individuals after orthopaedic surgeries.

Method: Five electronic databases were searched until April 2024. Two reviewers independently conducted study selection and data extraction. Randomized controlled studies containing individuals after limb surgeries were identified. The quality of enrolled studies and the overall certainty of evidence was assessed by scales, respectively. Egger's test and funnel plot were used to assess publication bias. Subgroup analysis was also conducted to explore the source of heterogeneity.

Results: Twenty-one randomized controlled trials involving 659 postsurgical participants were identified. The meta-analysis suggested moderate-quality evidence of a positive effect on pain intensity (SMD=-0.85; 95% CI -1.26, -0.43; p < 0.001). A low quality of evidence pointed toward a positive effect on functional scales (SMD=-0.84, 95% CI -1.27, -0.41, p < 0.001) and range of motion (SMD = 0.8, 95% CI 0.24, 1.35, p = 0.005). The very low quality of evidence suggested a significant effect on the functional test results (SMD=-0.8, 95% CI -1.01, -0.58, p < 0.001). The results remained nonsignificant for muscle strength and fear of movement. Intervention quantity, Disability of Arm, Shoulder, and Hand (DASH) score and intervention content were the sources of heterogeneity for pain intensity, functional scale score and range of motion, respectively.

Conclusion: Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion. Our results support the use of mental practice techniques in individuals after orthopaedic surgeries, with moderate to very low-quality evidence.

Review registration: This trial was registered on PROSPERO on 10 August, 2024 (CRD42024583380).

Adult spinal deformity (ASD) is a spectrum of abnormalities of the thoracic and lumbar spine and has an increasing prevalence. It is associated with significant physical and mental disability in symptomatic patients. Given the increased rates and the morbidity associated with this disease, novel innovation in the diagnosis and treatment of such deformity is required. The SRS-Schwab classification system described coronal scoliotic deformity with sagittal modifiers. Other parameters, such as the sagittal vertical axis, pelvic tilt, T1 pelvic angle, pelvic incidence and lumbar lordosis attempted to quantify global sagittal balance. More recently, a focus on more patient specific parameters has been targeted to improve patient outcomes. The Roussouly classification system attempted to predict sagittal alignment parameters based on fixed parameters of the pelvis. Others determined the parameters based on patient age. Technological advances have also enhanced our understanding of ASD. Long cassette films and automated analyses have allowed standardization of these measurements across physicians. 3D printing has been used as an adjunct for both surgical planning and implants, both generic and patient specific, to improve outcomes. With these, advances in minimally invasive approaches have allowed ASD correction with lower complications and blood loss. Intraoperative navigation and the use of robotics has allowed improved accuracy in the care of these patients. Development of complex osteotomies have allowed for correction of advanced deformity. Fusion, however, is the ultimate goal of surgical ASD correction. Advances in biologics such as the use of recombinant Human Bone Morphogenetic Protein-2 have been used to improve fusion rates and combat pseudoarthrosis. Finally, post-operative advances in ASD patient care with emphasis on enhanced recovery after surgery has allowed improvements in hospital length of stay and pain scores. ASD is becoming a more ubiquitous diagnosis for spine surgeons with an increasing aging population. Improvement in the understanding of the diagnosis, spinopelvic parameters, imaging techniques, and post operative care are all aimed toward helping patients in whom care can be extremely difficult. Further study in ASD patient care will target advanced innovation to provide optimal treatment to these patients and allow for best possible outcomes.

Objective: Osteoarthritis (OA) is closely related to aging, and autophagy is implicated in the retardation of aging. Activated synoviocytes play important roles in OA; the synoviocytes could produce osteopontin (OPN) and its main receptors CD44 and integrin, which are all involved in OA. The purpose of this study is to investigate whether OPN has an effect on autophagy in osteoarthritic synoviocytes.

Methods: We cultured human OA fibroblast-like synoviocytes (FLS) and treated them with rhOPN and antibodies against CD44 and CD51/61 (αvβ3 integrin) or isotype IgG to block the interaction between receptors and ligands. Infection with lentivirus mRFP-GFP-LC3, laser confocal imaging and Western blotting were used to determine changes in the expression of autophagy markers, and cell proliferation of FLS was assessed with a CCK-8 assay.

Results: Our results showed the expression level of autophagy marker protein LC3 II and the mRFP-GFP-LC3 puncta were significantly decreased after treatment with rhOPN when compared with the control group, when the FLS were incubated with antibodies against CD44 or CD51/61 (αvβ3 integrin) or with control isotype IgG for 1 h, followed by rhOPN treatment for 48 h, rhOPN could suppress the relative expression of LC3 II and Beclin1 via integrin and CD44 in the FLS, CCK-8 assay also showed that rhOPN significantly increased the cell proliferation and viability of FLS.

Conclusions: OPN could inhibit autophagy via CD44 and αvβ3 integrin and promote the proliferation of FLS, playing an important role in OA synovitis.

Purpose: The purpose of this study was to evaluate whether the combination of preoperative planning software combined with arithmetic hip-knee-ankle angle (aHKA) can help patients who underwent uni-compartmental knee arthroplasty (UKA) recover the constitutional alignment of the lower limb, obtain a better prosthetic position, and achieve better early patient-reported outcome measurements (PROMs).

Methods: A total of 150 patients who underwent UKA (planning group: 50 patients using the preoperative planning software; conventional group: 100 patients using the conventional method) were included in the study. The aHKA was defined as 180° + mechanical medial proximal tibial angle (MPTA) - mechanical distal lateral femoral angle (LDFA). All patients in the planning group underwent UKA according to the planning software with the planned lower limb alignment of aHKA. All patients were divided into three groups: constitutional alignment group (postoperative HKA (post-HKA): aHKA ± 2.0°); overcorrection group (post-HKA > aHKA + 2.0°); under-correction group (post-HKA < aHKA - 2.0°). Comparisons between the planning and conventional groups were conducted: (1) the proportion of post-HKA restored to constitutional alignment group; (2) the postoperative prosthesis position parameter based on the guideline of the Oxford group; (3) the American Knee Society scores (KSS) at six months after surgery.

Results: The proportion of the constitutional alignment group in the planning group was higher than that in the conventional group (86% vs. 66%) (p = 0.033). There was no significant difference in postoperative prosthesis position parameters between the two groups. No significant difference was found between the KSS clinical score (91.02 ± 4.20 vs. 90.61 ± 4.24) and KSS functional score (86.10 ± 7.23 vs. 84.30 ± 6.82) in six months after surgery between the planning and conventional groups.

Conclusion: Patients who underwent UKA using preoperative planning software in combination with aHKA were able to recover a higher proportion of the constitutional alignment than those with the conventional method. In addition, the planning group could achieve similar postoperative prosthesis position and short-term PROMs compared to the conventional group.

Clinical trial number: Not applicable.

Background: Double crush syndrome (DCS) is a relatively rare nerve compression syndrome among peripheral nerve compression diseases. However, ulnar nerve double entrapment caused by peri-cubital tunnel ganglion cysts has been rarely reported.

Case presentation: Here, we present a case of a 54-year-old woman who experienced occasional pain, numbness and paralysis in her right half hand for 1 year. A B-ultrasound of the right elbow initially revealed cubital tunnel syndrome only. Further Magnetic Resonance Imaging (MRI) showed a ganglion cyst near the cubital tunnel. After evaluation, we performed open surgery to excise the cyst and incise the cubital tunnel, completely decompressing the ulnar nerve entrapment. Ulnar nerve anterior transposition was also performed simultaneously.

Conclusions: The patient was followed up for 1 month, and she experienced a complete recovery with no functional limitations.

Clinical trial number: Not applicable.