All Articles

Júlia Benini Kohler¹, Jader Joel Machado Junqueira¹, Taysa Cristiane Moreira da Silva³, Marco Antonio Gonçalves Pontes Filho^3,4, Iolanda De Fátima L C Tibério¹, Fernanda Degobbi T Q S Lopes¹, Alexandre Póvoa Barbosa^1,2*

¹Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

²Department of Orthopaedics, Hospital do Coração - SP Brazil

³Department of Rheumatology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

⁴Departments of Orthopaedics and Rheumatology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

Despite of clinical evidence of increased incidence of bone diseases amongst smokers as well as worsening recovery in orthopedic surgeries, it is still unclear which pathological mechanisms are induced by smoking and how these events impair bone turnover.

Animal models and in vitro studies have been used to better elucidate these questions and smoking-induced oxidative stress have been pointed as playing crucial role in the worsening of bone cells activities leading bone damage.

Oxidative stress is a physiological mechanism characterized by an imbalance between oxidants and antioxidants components. This imbalance leads cell damage and consequent release of inflammatory mediators, resulting in structural changes that impair the functionality of compromised organ.

In this review, we summarize findings from clinical, animal models and in vitro studies that have elucidated the importance of the oxidative stress induced by smoking in different bone cells activities, leading bone mineral and organic matrix structural changes.

Highlights

We present the newest findings in understanding the impact of smoking in bone matrix composition. Review the clinical and experimental evidence for smoking-induced oxidative stress potential roles in bone turnover. Descript future directions for research and clinical management.

Sagar Tontanahal¹, Gahukamble Abhay Deodas¹, Deeptiman James¹, Anand Kurian², Thomas Palocaren^1*

¹Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India

²Department of Orthopaedics, Christian Medical College, Vellore, India

Background: The management of malignant bone tumors in children has come a long way in the past few decades. The transition from amputation to limb salvage has been made possible due to the rapid development in the diagnosis and the oncological management of these malignant tumors. However, there exist significant reservations regarding endoprosthetic reconstruction in children.

Material and methods: A mini-review was conducted of articles detailing the use of prosthetic reconstruction following tumor resection in children. The data regarding complications and functional outcomes following surgery were collected and presented.

Results: The studies reviewed reported a 5-year survival rate between 60 – 70 %. Uniform across the studies was the need for multiple surgeries when endoprosthesis was used for limb reconstruction, ranging between 2.8 – 3.5 surgeries. The most common complication noted across the studies was related to soft tissue problems such as joint instability followed by structural failure of the prosthesis. Infections were noted with a frequency of 10 – 15 %. Studies showed successful management of limb length discrepancy with expandible prosthesis. Musculoskeletal Tumor Society (MSTS) score used to evaluate the functional outcome showed satisfactory outcomes.

Conclusion: Limb salvage surgery, with recent advances in technique and prosthesis design, is an attractive option in children with extremity malignant bone tumors. In recent time, endoprosthetic reconstruction of extremities have yielded good functional results and are well accepted by the child and the parents. The purpose of this mini-review is to shed some light on the use of endoprosthetic reconstruction in children following tumor resection with its potential benefits and drawbacks.

Adrienn Markovics^1*, Daniel M. Toth², Tibor T. Glant¹, Katalin Mikecz¹

¹Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

²Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Rheumatoid arthritis (RA) is a systemic autoimmune disease leading primarily to the inflammatory destruction of the synovial joints, ultimately resulting in loss of mobility and a decreased quality of life. Recent advances in RA-related research resulted in the introduction of Janus kinase (JAK) inhibitors to the therapeutic arsenal. JAK inhibitors are orally available and provide efficacy similar to that of disease-modifying anti-rheumatic drugs. However, due to the limited selectivity of these drugs, many RA patients experience adverse effects. The potential benefit of modulating protein tyrosine phosphatases, instead of inhibiting kinases, has not been explored. Using an animal model of RA, our group investigated the role of the Src homology region 2 domain-containing phosphatase 1 (SHP-1) in inflammatory arthritis. The purpose of the present article is to highlight important conclusions of our previous paper entitled “Regulation of autoimmune arthritis by the SHP-1 tyrosine phosphatase”. Herein we briefly present and discuss the observations of this study. We also outline future directions toward investigating the therapeutic potential of targeting SHP-1 in inflammatory arthritis in order to develop a new type of orally available drugs for the treatment of RA.

Sophia L. Mancini¹, Clark Dickin¹, Dorice A. Hankemeier², Lindsey Rolston³, Henry Wang¹*

¹Biomechanics Laboratory, Ball State University, Muncie, IN, USA

²Ball State University, Muncie, IN, USA

³Henry County Center for Orthopedic Surgery & Sports Medicine, New Castle, IN, USA

Soccer is becoming an increasingly popular sport amongst women. Common movements during play, such as jumping and cutting, require rapid acceleration and deceleration of multiple lower-limb joints. The anterior cruciate ligament (ACL), which contributes to stabilization of the knee, is often injured during these events. ACL injury typically requires costly surgery, extended time away from sports, and jeopardizes long-term joint health. Due to sex-specific factors such as menstruation and anatomical disadvantages, women are more susceptible to tearing their ACL. Injury often occurs in non-contact scenarios during rapid acceleration or deceleration movements. Research has examined these movements and established several kinematic and kinetic mechanisms as well as muscle activation patterns that frequently occur at the time of injury, however results tend to vary based on population. This article summarizes recent and relevant literature of ACL injury mechanisms and highlights the lack of specific research in the high-risk female soccer athlete population. Due to inconclusive risk factors, injury prevention programs within this population have been inconsistent. ACL injury risk for female soccer athletes should be closer examined so that more specific injury risks can be established, and effective protective measures can be taken. Raised awareness of this need may capture attention in the research and medical communities and potentially stimulate the development of strategies that limit future ACL injury and thus the challenges it brings to the high-risk female soccer athlete.

Kentaro Amaha

Department of Orthopedic Surgery, Foot and Ankle; St. Luke's International Hospital, Tokyo, Japan

Metatarsalgia is one of the most common causes of forefoot pain, and it is characterized by pain in the front part of the foot under the head of the metatarsal bones. Primary metatarsalgia is idiopathic, but it has been suggested to be related to forefoot plantar compression. Because of the various causes of metatarsalgia, there is the need to thoroughly consider the etiology of metatarsalgia to find novel, effective, and conservative treatments for metatarsalgia to avoid surgical treatment. Pressure reduction or redistribution can be achieved using toe exercise, flat shoe inserts, metatarsal pads, custom-molded inserts, and rockerbars. There was no need for one treatment. If toe function was poor, toe exercises were recommended. If dorsiflexion of the ankle joint was limited, the Achilles tendon was stretched. If the pain was localized to the plantar aspect of the 2nd MTP, a decompression insole was applied. If the pain was limited to the plantar aspect of the 2nd MTP, a decompression insole was worn. If swelling occurred, anti-inflammatory drugs were indicated to reduce inflammation. The combination of the two was appropriate for this condition. Toe exercises can improve balance and are worth trying. An in-depth understanding of the various etiologies of metatarsal and toe deformities is essential for successful treatment.

Shaan S. Patel*, Julian Gatta, Adrienne Lee, Blaine T. Bafus

Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA

Background: Transolecranon distal humerus fractures are uncommon injuries. The purpose of this study is to review the outcomes and complications associated with transolecranon distal humerus fractures.

Material and Methods: We performed a systematic search of PubMed for articles published between 1990 and 2021. Included studies reported outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, injury characteristics, outcome measurements, and complications.

Results: A total of 4 studies met inclusion criteria for data extraction and analysis. Two studies evaluated an adult cohort of a total of 18 patients. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range 4.2 – 76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, 61%) was the most common complication. Eleven patients (61%) underwent more than one procedure. Two studies evaluated a pediatric cohort of a total of 9 patients. Five patients (56%) underwent non-operative treatment with immobilization and four patients (44%) underwent open reduction and internal fixation. There were no complications reported. All the pediatric patients regained near full range of motion of the elbow at their final follow-up.

Conclusion: Transolecranon distal humerus fractures are complex elbow injuries. In the adult population, they remain a challenge for orthopaedic surgeons. Complications, including elbow stiffness and infection, are high with frequent long-term functional limitations as represented by DASH scores. In contrast, pediatric patients have good outcomes and minimal complications that are similar to isolated olecranon and distal humerus fractures in children.

Francisco Molina-Rueda¹, Alicia Cuesta-Gómez^1*, María Carratalá-Tejada¹, Pilar Fernández-González¹, Juan Carlos Miangolarra-Page^1,2, Isabel Mª Alguacil-Diego¹

¹Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine. Faculty of Health of Sciences. Rey Juan Carlos University, Madrid, Spain

²Physical Medicine and Rehabilitation Service of the University Hospital of Fuenlabrada, Madrid, Spain

Background: Subjects with a unilateral transtibial amputation (UTA) that have used prosthesis for over five years have a higher occurrence rate of osteoarthritis at the knee and hip joints of the intact limb.
Objective: To research the joint internal moments of the hip, knee, and ankle in the sagittal and frontal planes during gait in persons with UTA.
Methods: 25 individuals with UTA (50.26 years ± 13.76) and 25 subjects without amputation (46.71 years ± 13.76) participated in this study. Gait analysis was carried out using a Vicon® Motion System (Oxford Metrics, Oxford, UK) with eight 100 Hz cameras with infrared strobes, two 1000 Hz AMTI® force-plates.
Results: People with UTA walk with a greater hip extensor moment in both intact and prosthetic limbs. The hip abductor moment was lower on the prosthetic limb compared to the intact limb and the control group. At the knee joint, the subjects with UTA walked with a reduced knee extensor and valgus moment on their prosthetic limb compared to the control group. At the ankle joint, the statistical analysis showed that the individuals with UTA walked with a reduced plantarflexor moment during the stance period on the intact limb compared to the people without amputation.
Conclusions: Subjects with UTA walk with a different joint kinetic pattern in the sagittal and frontal planes compared to non-disabled individuals.

Joshua CY Ong*, Mahmoud A Awadallah, Andrew J White, Paul M Robinson

Trauma & Orthopaedic Department, Peterborough City Hospital, Bretton Gate, UK

Background: Fracture of the proximal humerus combined with dislocation of the glenohumeral joint and a soft tissue or bony Bankart lesion are rare. Management options are largely surgical and different approaches to fixation have been described. The reported outcomes are generally poor.

Methods: We present a series of three rare cases of traumatic dislocations of the shoulder associated with combined fractures of the proximal humerus and glenoid that were treated with surgical fixation. We describe the surgical technique and clinical outcomes.

Results: Our patients had multiple medical comorbidities; and coupled with the burden of injury, made a slow post-operative recovery (mean Constant-Murley score of 48 points over a mean follow-up time of 20 months).

Conclusion: A high index of suspicion and appropriate imaging is required to properly diagnose and surgically manage this uncommon pattern of injury. We recommend surgical treatment of these severe injuries, to stabilise the glenohumeral joint, and to achieve optimal clinical outcomes.

Shiraz A. Sabah¹*, William F. M. Jackson²

¹Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

²Nuffield Orthopaedic Centre, Oxford, UK

Henry Magill¹*, Mazin Ibrahim², Foad Mohamed², Samuel Grant³, Branavan Rudran⁴, Warwick Radford⁵

¹Orthopaedic Registrar, Chelsea and Westminster Hospital, London, UK

²Orthopaedic Registrar, University College London Hospital, London, UK

³Orthopaedic Resident, University of Toronto, Toronto, Canada

⁴Orthopaedic Research Fellow, Chelsea and Westminster Hospital, London, UK

⁵Orthopaedic Consultant, Chelsea and Westminster Hospital, London, UK

The use of digital templating for Total Hip Arthroplasty (THA) is now the standard approach for pre-operative planning. Digital templating holds potential to reduce operative time and post-op complications however, this often relies on imprecise assumptions. The relationship between the X-ray source, subject and detector alters the perceived magnification. We therefore determine if Body Mass Index (BMI) is positively correlated with true magnification and if a predictive model based these parameters exists. A single surgeon series (n=107) was included in this study. Two independent observers assessed both pre- and post-operative AP pelvis radiographs using TraumaCad™. Post-operative radiographs were assessed to calculate the true magnification by calibrating from a known femoral head prosthesis size. Finally, a scatter plot with regression was used to determine if a predictive model of magnification existed using the Body Mass Index. The mean pre-operative magnification using a scaling marker was 124.2 ± 8.90%. The mean post-operative magnification using a known femoral head prosthesis size (true magnification) was 123.7 ± 3.98%. Significant variability exists in pre-operative marker data. Regression modelling showed no significant correlation between BMI and true magnification (post-op magnification). This study’s suggests that the precision and reliability of the radiographic marker in daily practice is poor. Regression modelling showed no significant correlation between BMI and the true magnification factor. Therefore, a pre-op predictive model cannot be reliably used. The data from this study suggest that a fixed magnification factor of 124% remains the most reliable and accurate method.

Kelsey Millonig¹*, Christopher Bibbo²

¹Foot and Ankle Deformity Correction and Orthoplastics Fellow, Rubin Institute Advanced Orthopedics International Center for Limb Lengthening, Baltimore, USA

²Head of Foot and Ankle Surgery, Reconstructive Plastic and Microsurgery, Orthopaedic Trauma, Musculoskeletal Infections, Rubin Institute Advanced Orthopedics International Center for Limb Lengthening, Baltimore, USA

R. Spagnolo¹*, F. Pace², D. Porreca³

¹Department of Orthopaedic Surgery, Asst Hospital Treviglio, Bergamo, Italy

²First Orthopaedic Clinic-Hospital Gaetano Pini, University of Milan, Italy

³Physiotherapist ASST Bergamo, Ovest-Hospital Treviglio Caravaggio, Italy

Hip fractures are rare in children and are less than 1% of all pediatric fractures and less than 1% of all cases of hip fracture. The literature agrees that early treatment, whether surgical or conservative, reduces the risk of complications. The clinical case we present concerns a pertrochanteric fracture with displacement of the greater trochanter in a 4-year-old child. The fracture was a type 4 according to Delbet classification. Clinical evaluation was carried out using the Ratliff scheme. Clinical criteria include pain, movement, activity and X-ray evaluation of the fracture both from the point of view of the formation of the bone callus, and the alteration of the diaphyseal cervical angle (DCA). It was surgically treated with three cannulated screws and a hip spica plaster cast immobilization with a Kirschner wire to avoid secondary displacement. The cast was maintained during the 6 weeks healing period of the fracture. After plaster cast removal, the child begins physiotherapy with an experienced physio in pediatric trauma. The child healed without complications.

Eduardo Gonzalez Edery¹, Ximena Rios², Gerardo Vargas², Laura Arzuza³, Juan Reatiga Aguilar²*

¹Departamento de Ortopedia y Traumatología, Clínica Valle Salud, Cali, Valle del Cauca, Colombia

²Departamento de Ortopedia y Traumatología, Fundación Campbell, Barranquilla, Colombia

³Epidemiología, Grupo Campbell, Barranquilla, Colombia

Surgical site infections are clinically and epidemiologically critical in orthopedic surgery, as they lead to several complications affecting the quality of life of patients. Contamination may occur during the surgery, through instruments directly inserted into the wound acting as reservoirs for microorganisms. This study aimed to review the literature on suction tip colonization during orthopedic surgery, with an aim toward setting guidelines for its management during surgical procedures. Suction tips can be colonized primarily in two ways. The first is through direct contact with a surgical wound or poor handling by surgical staff and the second is through continuous airflow through the tip of the suction. Colonization rate between studies has decreased in the last years reporting in recent papers a 7.3% suction tips colonization rates in clean orthopedic. The most common germs isolated are S. epidermidis, S. aureus and E. cloacae. Suction tip colonization has a direct relationship with the duration of the surgical procedure, with a higher rate of colonization with longer surgeries. Multiple strategies have been proposed to reduce the risk of colonization of the suction tips used during a surgical procedure including systematically changing suction cannula after 1 hour of surgery or strategies to reduce active suction time. It is unclear if suction tip colonization is directly related to surgical site infection rates. Further studies are needed to corelate infection and colonization of the suction canula.

Douglas W. Van Pelt, Zachary R. Hettinger, Esther E. Dupont-Versteegden*

Department of Physical Therapy and Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA

Muscle atrophy is among the most common conditions during sickness, injury, aging and after orthopedic surgeries, and is associated with poor health outcomes. As such, it is important to understand the molecular machinery responsible for the control of muscle mass and function for development of therapeutic targets and strategies to combat muscle atrophy. We have identified the cold shock RNA binding protein, RNA-binding motif protein 3 (RBM3) as a critical regulatory node in the control of skeletal muscle mass and herein, we review our current knowledge of its actions in skeletal muscle. We also cover future directions of research and how this knowledge may translate into therapeutic interventions.

Seide Karasel

Department of Physical Medicine and Rehabilitation, Famagusta State Hospital, Famagusta, Cyprus

Low back pain is a common health problem that affects most adults at least one time in their lives, ranks second among the reasons for consulting a doctor, causing loss of labor and lowering the quality of life. We summarize a patient who has neurologic bladder after epiduroscopy.

Lawrence W. Judge¹, David Bellar², Beau Links³, Andrew Mullally³, Mark King³, Zachry Waterson³, Brian Fox^1,4, Makenzie Schoeff¹, Nicholas Nordmann¹, Henry Wang¹*

¹School of Kinesiology, Ball State University, Muncie IN, USA

²University of North Carolina at Charlotte, Charlotte, NC, USA

³Fort Wayne Medical Education Program, Fort Wayne, USA

⁴Denotes graduate student author

Coaches are trusted to create effective training plans based on the abilities of their athletes. However, there can exist a discrepancy between the coaches’ intended training intensity and the intensity perceived by their athletes. Thus, the purpose of this study was to evaluate athletes’ perceptions of training intensity and how they compared to their coach’s intended training intensity. Six female collegiate track and field athletes who ran >800 meter events were recruited for this study (Mean [SD]: 21.3 [1.2] years). Training duration, rate of perceived exertion (RPE), average heart rate for each training session and hours slept nightly were recorded for the next 14 weeks. Easy training days showed a discernible difference with actual session RPE rating higher than the target value (mean [SD] perception 3.25 [.847], target 1.51 [.692], p<.001), while hard training days were perceived as easier than intended (mean [SD] perception 6.26 [1.24], target 8.16 [.646], p<.001). Similarly, average training load (defined as the product of Session RPE and exercise duration) was higher than coach’s intentions on easy days (actual load mean [SD] 117.28 [19.15] p=.046), and lower than the coach’s intentions on hard days (p=.029). Workouts that are more intense than intended may lead to overtraining syndrome in athletes, and workouts that are less intense than intended may lead to undertraining, and athletes not achieving their full potential. Appropriate monitoring of training load can provide important information to athletes and coaches. Training load needs to be accurately determined to establish other recovery factors.

Robeci Alves Macedo-Filho, Tiago Ribeiro Leal, Andreia Medeiros Rodrigues Cardoso, Sandra Aparecida Marinho*

Dentistry Course, State University of Paraiba (Universidade Estadual da Paraíba-UEPB), Campus VIII, R. Coronel Pedro Targino, s/n. CEP: 58.233-000. Araruna, PB, Brazil

The practice of sports has become increasingly commonplace in the daily lives of individuals and sports-related injuries vary depending on the sport practiced. Oral and facial injuries are very common in many sports. Brazilian jiu-jitsu is a contact sport in which the stomatognathic system is exposed to injuries, and the most prevalent are soft tissue injuries, such as facial abrasions and lacerations and dental injuries, such as tooth fractures. Although not mandatory in Brazil for the practice of Brazilian jiu-jitsu, a mouthguard is an essential form of protection from orofacial injuries. When a blow is applied to the face, the mouthguard provides absorption and dissipation of force and also reduces of impact to the temporomandibular joint, by redistributing the force. For that, it is therefore of the utmost importance for athletes to visit a dentist periodically for examinations. Such protective devices (mouthguards) may be individualized and crafted by a dentist for better adaptation and less discomfort for the user.

N. K. Sferopoulos

Department of Pediatric Orthopaedics, “G. Gennimatas” Hospital, Thessaloniki, Greece

Subtalar and Chopart dislocations are extremely rare in childhood but become slightly more common in older children and adolescents. Subtalar dislocation involves dislocation of the subtalar and talonavicular joints, with intact tibiotalar and calcaneocuboid joints, in the absence of a talar neck fracture. It should be differentiated from the Chopart dislocation and from traumatic entities presenting radiographically as isolated talonavicular dislocations. Chopart joint injury involves the talonavicular and calcaneocuboid joints of the foot. The injury may appear as sprain, fracture, subluxation or dislocation. Diagnosis is made on plain radiographs; although initial views may not reveal the severity of the lesion, since spontaneous reduction may occur. The radiographic detection of an isolated talonavicular dislocation is probably indicative of a Chopart joint injury, in which a momentary subluxation or dislocation of the calcaneocuboid joint has occurred. The differential diagnosis of a radiographically detected isolated talonavicular dislocation should also include traumatic entities associated with intact calcaneocuboid joint, such as the swivel talonavicular dislocation and the isolated displacement of only the medial part of the Chopart joint. The swivel talonavicular dislocation is a subtype of the Chopart joint injury, in which the foot with the calcaneus is rotated beneath the talus, producing subtalar subluxation but not dislocation. In the isolated displacement of only the medial part of the Chopart joint the subtalar joint is not injured. The injury is usually associated with a fracture of the body of the tarsal navicular and it is believed to be the result of severe abduction or adduction of the forefoot.

Subtalar dislocations and Chopart joint injuries in children and adolescents seem to be comparable with their adult counterparts in the mechanism of injury, classification, treatment, complications and outcome. The challenges in treating these injuries are to achieve adequate diagnosis and prompt treatment. It appears mandatory that obtaining and maintaining an early anatomic reduction remains the key factor in achieving good outcomes. However, a high incidence of complications, such as compartment syndrome, soft tissue compromise, avascular necrosis of bone, bone growth deformities and debilitating early post-traumatic arthritis, have been reported.

The purpose of this report is to review the relevant publications on subtalar and Chopart dislocations in children and adolescents and to present illustrative cases treated at our institution.

Gu Yu-guo, Jiang Hong*

Department of Orthopaedics and Traumatology, Suzhou TCM Hospital, in affiliation with Nanjing University of Chinese Medicine, Suzhou, China

Purpose: The aim of this study was to guide the quantitative analysis of Traditional Chinese Medicine (TCM) syndromes by the measurement of magnetic resonance.

Methods: A total of 213 patients with knee osteoarthritis were selected for TCM dialectical classification, and their MRI images were scored on Whole-Organ Magnetic Resonance Imaging Score (WORMS) to evaluate the correlation between severity of synovitis and TCM syndrome types in the scores.

Results: Among the 213 patients, 25 were Anemofrigid-damp arthralgia syndrome (accounting for 11.7%), 84 were Pyretic arthralgia syndrome (39.4%), 43 were Blood stasis syndrome (20.2%), and 61 were Liver and kidney vitality deficiency syndrome (28.6%). In the WORMS score, 12 (5.6%) had a synovitis score of 0, 60 (28.2%) had a synovitis score of 1, 50 (23.5%) had a synovitis score of 2, and 91 (42.7%) had a synovitis score of 3. There was a statistically significant difference in the correlation analysis. The group with a synovitis score of 3 in WORMS was more likely to occur in the Pyretic arthralgia syndrome (X² = 194.424, P = 0.000).

Conclusion: In this study, Pyretic arthralgia syndrome (39.4%) was found to be the main clinical manifestation in patients with knee osteoarthritis synovitis. This finding has certain guiding significance for relevant treatment.

Collin LaPorte², Michael D. Rahl², Olufemi R. Ayeni³, Travis J. Menge^1,2*

¹Spectrum Health Medical Group Orthopedics & Sports Medicine, Grand Rapids, MI, USA

²Michigan State University College of Human Medicine, Grand Rapids, MI, USA

³Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada

Hip arthroscopy is a rapidly growing field due to its significant diagnostic and therapeutic value in treating a variety of hip disorders. Due to the lack of standardized protocol for pain management in these patients, adequate control of postoperative pain continues to be challenging. Several techniques have been employed to find a regimen that is effective at reducing postoperative pain, narcotic consumption and cost to the patient and healthcare system. The purpose of this article is to provide a review of important conclusions from the previous paper “Postoperative Pain Management Strategies in Hip Arthroscopy” and report on possible implications of the article.

Recent literature supports the use of a multi-modal approach to managing postoperative pain in patients undergoing hip arthroscopy. When a pre-and postoperative analgesic regimen is used in combination with peripheral nerve block or intraoperative anesthetic injection, patients experience less pain and postoperative narcotic consumption. Postoperative pain scores and opioid consumption are similar between the different techniques. However, postoperative complications are less in those receiving intra-articular (IA) injection or local anesthetic infiltration (LAI) compared to peripheral nerve blocks.

Recent studies suggest that intraoperative techniques such as IA injection or LAI used in conjunction with a pre-and postoperative analgesic regimen may be the safest and most effective multi-modal strategy for reducing postoperative pain in these patients. In addition, omitting the use of peripheral nerve block may lead to decreased anesthesia procedural fees and operating room turnover time, resulting in decreased cost to the patient and increased efficiency of the facility.

AH Sabir¹*, S Mahesh², RT Freeman³, N Kiely³, A Mageuri⁴, D Lim⁵, T Cole⁵

¹Clinical Genetics Registrar, Birmingham Women’s and Children’s Hospital NHS Trust and Birmingham Health Partners, UK

²Foundation Doctor, Royal Wolverhampton Hospital NHS Trust, UK

³Paediatric Orthopaedic Consultant. Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK

⁴Clinical Genetic Scientist, Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands

⁵Consultant Clinical Geneticist. Birmingham Women’s and Children’s Hospital NHS Trust and Birmingham Health Partners, UK

Metaphyseal Chondrodysplasia Schmid Type (SMCD) is a rare dominant form of skeletal dysplasia, caused by heterozygous mutations in the COL10A1 (Collagen Type X alpha 1) gene which codes for α1 chains in type X collagen, and typically results in disproportionate short stature. We report two families with the clinical and radiological diagnosis of SMCD seen in our unit over 4 years. In the first family (A), the proband had a possible pathogenic COL10A1 variant (c.133C>T, p.Pro45Ser). However, his father had the same variant without any obvious signs of SMCD, causing uncertainty whether this mutation was pathogenic. In the second family (B), the proband and her affected father had the same variant. Almost at the same time, a large consanguineous family was reported to have segregation of the variant with SMCD phenotypes in that the homozygosity was related to severer phenotypes and the heterozygosity to milder phenotypes. Hence, we were convinced that the variant was pathogenic. The pathogenic variant (p.Pro45Ser) causes a wide phenotypic spectrum of SMCD and even subclinical features. In this report, we highlight attenuated phenotypes of SMCD, and also discuss the latest therapeutic advances in SMCD and its mechanism of action.

Brian D. Fox, Lawrence W. Judge, D. Clark Dickin, Henry Wang*

Biomechanics Laboratory, School of Kinesiology, Ball State University. Muncie, IN, USA

Load carriage is a common activity used in daily tasks for many occupations, so understanding its injury mechanisms, as well as the biomechanical modifications made to gait and posture during load carriage, could reduce injury risk during this activity. The purpose of this review was to compile the most recent literature regarding biomechanical adaptations to load carriage, including its effects on musculoskeletal injury, kinematic, spatiotemporal, and kinetic adaptations, and insights about the future of load carriage research. Researchers found a high degree of injury in personnel who participate in heavy load carriage activities as a part of their job, with lower back and lower extremity injuries being the most common. An observation of several studies that measured kinematic, spatiotemporal, and kinetic adaptations suggest that there may be a threshold in which typical gait kinematics must change to account for the additional load. Not adapting proper mechanisms to deal with increased load carriage forces may lead to lower extremity injury. Future studies should observe how persons untrained in load carriage respond to these loads, and how controlling for variables like speed and cadence affect gait adaptations.

Eric D Haunschild, Ron Gilat, Michael C Fu, Brian J Cole*

Midwest Orthopaedics at Rush, Chicago IL, USA

Meniscus injuries are a common presentation to orthopedic clinics, with hundreds of thousands of meniscectomies and meniscus repairs being performed every year¹. As the consequence of osteoarthritis progression has been found to be associated with functional meniscal deficiency, a significant increase in repair surgeries have occurred in recent years². However, in symptomatic patients with irreparable tears, partial meniscectomy remains the standard of care. Meniscectomy is not harmless and can result in increased contact stress, predisposing the patient to early-onset osteoarthritis¹.

In a select group of patients with persistent unicompartmental pain and symptomatic meniscus deficiency, meniscal allograft transplantation (MAT) has emerged as an acceptable surgical procedure aiming to restore function and improve pain. In many patients, MAT can result in long-term improvement, with a recent systematic review demonstrating favorable graft survival and functional outcomes at a minimum ten years after surgery³. These favorable outcomes demonstrate lasting symptomatic improvement and, though unproven at this time, may decrease the progression of osteoarthritis in the knee. The purpose of this article is to review five key points on the indications, pre-operative considerations and surgical preparation, surgical technique, and common concomitant procedures of MAT.