Degenerative Joint Changes Research Articles

Assessment of analgesic effects of different initial doses of transdermal buprenorphine in the treatment of chronic pain in the elderly diagnosed with osteoarthritis.

The aim of the study was to evaluate analgesia, adverse effects, and quality of life of elderly patients diagnosed with osteoarthritis during treatment with different initial doses of transdermal buprenorphine. Transdermal buprenorphine was used for 10 days in 60 patients over 64 years old with chronic pain of severe intensity - Numerical Rating Scale (NRS > 5) caused by degenerative changes in joints. All patients were randomly assigned to 3 groups. A starting dose for the treatment was respectively: 8.75 μg/h, 17.5 μg/h or 35 μg/h, in each group. The severity and impact of pain on everyday activities performed by the patients were assessed at baseline and daily for 10 days using the Brief Pain Inventory - Short Form. In order to identify the components of neuropathic pain, except for the symptoms (hyperalgesia and allodynia), the DN4 (Douleur Neuropathique en 4 questionnaire) was used. During buprenorphine treatment a decrease in pain severity was obtained in all groups of patients as well as an improvement in pain interference with general activity, mood, walking ability, relations with other people, sleep and enjoyment of life with no differences between patient groups treated with different initial doses of transdermal buprenorphine. No differences regarding DN4 scores were find between patient groups. Several adverse effects (drowsiness, confusion, vomiting) occurred less frequently in groups of patients treated with lower initial doses (8.75 μg/h and 17.5 μg/h) in comparison to a starting dose of 35 μg/h. We concluded that treatment of elderly patients with chronic pain of severe intensity with transdermal buprenorphine provided effective analgesia and improvement of quality of life with respect to general functioning of patients. Treatment tolerance seemed to be better with lower initial doses of transdermal buprenorphine: 8.75 μg/h and 17.5 μg/h in comparison with the dose of 35 μg/h.

Articular Cartilage- and Synoviocyte-Binding Poly(ethylene glycol) Nanocomposite Microgels as Intra-Articular Drug Delivery Vehicles for the Treatment of Osteoarthritis.

Intra-articular (IA) injection is an attractive route of administration for the treatment of osteoarthritis (OA). However, free drugs injected into the joint space are rapidly cleared and many of them can induce adverse off-target effects on different IA tissues. To overcome these limitations, we designed nanocomposite 4-arm-poly(ethylene glycol)-maleimide (PEG-4MAL) microgels, presenting cartilage- or synoviocyte-binding peptides, containing poly(lactic-co-glycolic) acid (PLGA) nanoparticles (NPs) as an IA small molecule drug delivery system. Microgels containing rhodamine B (model drug)-loaded PLGA NPs were synthesized using microfluidics technology and exhibited a sustained, near zero-order release of the fluorophore over 16 days in vitro. PEG-4MAL microgels presenting synoviocyte- or cartilage-targeting peptides specifically bound to rabbit and human synoviocytes or to bovine articular cartilage in vitro, respectively. Finally, using a rat model of post-traumatic knee OA, PEG-4MAL microgels were shown to be retained in the joint space for at least 3 weeks without inducing any joint degenerative changes as measured by EPIC-μCT and histology. Additionally, all microgel formulations were found trapped in the synovial membrane and significantly increased the IA retention time of a model small molecule near-infrared (NIR) dye compared to that of the free dye. These results suggest that peptide-functionalized nanocomposite PEG-4MAL microgels represent a promising intra-articular vehicle for tissue-localized drug delivery and prolonged IA drug retention for the treatment of OA.

Case-Control Comparison of Cervical Spine Radiographs From Horses With a Clinical Diagnosis of Cervical Facet Disease With Normal Horses

The accuracy of using radiographs to diagnose cervical facet osteoarthritis (CFA) in horses is undetermined. Further investigation is required to determine the clinical significance of radiographic evidence of CFA, the prevalence of radiographic changes in horses without clinical signs, and the long-term efficacy of intra-articular CFA treatment. The objectives of this study is to compare degenerative changes of the cervical facet joints of the cervical vertebrae on radiographs of horses with clinical signs of CFA with healthy cohort-matched horses, to compare clinical findings between groups, and to obtain follow-up information on the long-term outcome in treated horses. This is a retrospective case-control cohort-matched comparison study of horses treated for cervical facet disease versus horses with no clinical signs of cervical facet disease. Horses diagnosed with CFA and treated with intra-articular injection of corticosteroids were included. Follow-up information on recovery from treatment was obtained via telephone survey of owners/trainers. Healthy horses with no clinical signs of CFA were matched to treated horses by breed, sex, age, and sport as the control group. Two blinded radiologists reviewed cervical spine radiographs for each horse and recorded CFA score and intravertebral/intervertebral measurements. Clinical and radiographic parameters were compared between treatment and control groups. There was a significant difference in CFA grades for C5-6 and C6-7 between horses with presence of clinical signs and healthy horses. However, interobserver agreement between radiologists for grading CFA was moderate and only 56% of values were identical for both observers. Atrophy of the neck was present on clinical examination in most cases in the treatment group. Dressage horses were overrepresented. Overall, 64% of horses returned to their previous level of performance after treatment. Clinical examination data collected for the treatment group were retrospective and were obtained by different clinicians. Eight owners/trainers were not able to be reached for the survey. There was a significant difference in CFA grades for C5-6 and C6-7 between horses with presence of clinical signs and healthy horses. Despite these statistical differences, the clinical diagnosis of CFA based on radiographic grading alone is questionable because of the lack of agreement between the radiologists. To strengthen the diagnosis, clinical signs of facet disease, in particular atrophy of the neck muscles, need to be present to make this diagnosis. Intra-articular corticosteroid injection was effective at allowing most treated horses to return to athletic use..

No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee?

PurposeTo investigate the periarticular degenerative changes of the knee joint in association with osteoarthritis (OA). More tendinosis was expected to be found in the semitendinosus tendon in patients with knee OA than in patients without knee OA.MethodsSamples from 41 patients were included between January 2016 and October 2017. Twenty-one patients median age 53 (33–63) years with mild to moderate OA underwent high tibial osteotomy (HTO) and 20 patients median age 38 (31–57) years without OA underwent anterior cruciate ligament reconstruction (ACLR). Biopsies from the semitendinosus tendon were obtained at the time of surgery and examined histologically, morphologically and ultrastructurally using light and electron microscope.ResultsThe histological evaluation of the semitendinosus tendon revealed the presence of more hemosiderin in the ACLR group. No significant morphological or ultrastructural differences were shown between patients in the HTO and ACLR group.ConclusionPatients with mild and moderate medial compartment knee OA displayed no more degenerative changes in their semitendinosus tendon than patients without OA, as seen in both the light and the electron microscope.Level of evidenceIII.

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient.

Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient’s family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.

Multiple hereditary exostoses and enchondromatosis.

Multiple hereditary exostoses (MHE) and enchondromatosis are rare multifocal benign disorders usually causing skeletal deformities appearing already in childhood. MHE is a dominant autosomal inherited disorder characterized by multiple osteochondromas (exostoses) growing outward from the metaphyses of long bones as well as from flat bones. They may cause reduced joint motion and pain due to tendon, muscle, and nerve compression. Enchondromatosis (or Ollier's disease) is a noninherited disorder characterized by the presence of multiple intraosseous enchondromas located asymmetrically in the skeleton and with a wide variation regarding location, size, and number ranging from the involvement of a single hand to the involvement of the entire skeleton. It can occur together with soft-tissue hemangiomas in Maffucci's syndrome. Clinical problems caused by the enchondromas are mainly related to skeletal deformities causing malalignment and restricted motion of joint. In both disorders, there is a risk of malignant transformation as well as secondary degenerative joint changes.

Are Signs of Degenerative Joint Disease Associated With Chin Deviation?

Degenerative joint changes commonly affect the temporomandibular joint (TMJ) and can result in chin deviation. However, the extent of degenerative TMJ changes and chin deviation has not been well-characterized. The present study sought to correlate degenerative TMJ changes with condylar volume, grayscale measures, and chin deviation. The present cross-sectional study had enrolled women with skeletal Class III malocclusion. Cone-beam computed tomography scans were acquired preoperatively. For each condyle, degenerative TMJ signs were analyzed and the condylar volume and grayscale were measured. The predictor variable was the presence of degenerative TMJ signs, classified as categorical data: 0, if none; 1, only present in 1 joint; and 2, present in both joints. The primary outcome variable was a chin deviation of 3mm or more. Other associated variables were grouped by age, cephalometric data, and 3-dimensional condylar measurements. Descriptive bivariate statistics were computed, and univariate and multiple logistic regression analyses were conducted to identify any associations between degenerative TMJ disease and chin deviation. We included 85 patients, who were classified into 2 groups: less than 3mm of chin deviation (n=43) and 3mm or more of chin deviation (n=42). The presence of more than 10 degenerative TMJ signs was significantly associated with the presence of 3mm or more of chin deviation (P<.001). In multiple regression models, the presence of subcortical sclerosis in 1 joint and in both joints (adjusted odds ratio [OR], 3.698; 95% confidence interval [CI], 1.051 to 13.012; adjusted OR, 5.001; 95% CI, 1.461-17.119, respectively) correlated significantly with the presence of 3mm or more of chin deviation (P<.05). The volume difference between the 2 condyles was significantly greater in the group with more than 10 degenerative TMJ signs and 3mm or more of chin deviation than in the group with 10 or fewer degenerative TMJ signs and less than 3mm of chin deviation (P=.016 and P<.001, respectively). In women with skeletal Class III malocclusion, the presence of more than 10 degenerative TMJ signs increased the prevalence of 3mm or more of chin deviation. The presence of subcortical sclerosis in either 1 or both joints and volume differences between the 2 condyles were associated with greater chin deviation.

Ankle joint pressure change in varus malalignment of the tibia

BackgroundVarus malalignment of the tibia could alter ankle biomechanics, and might lead to degenerative changes of the ankle joint. However, previous studies failed to report the detailed changes of ankle biomechanics in varus malalignment of the tibia. The aim of this biomechanical study was to evaluate how the ankle joint pressure would change in response to the incremental increases in varus malalignment of the tibia.MethodsEight fresh-frozen human cadaver legs were tested in this study. Varus malalignment of the tibia and a total of 600 N compressive force was simulated using a custom made fixture. Intra-articular sensors (TeckScan) were inserted in the ankle joint to collect the ankle joint pressure data. The testing sequence was 0°, 2°,4°,6°,8°,10°,12°,14°,16°,18°,20° of tibial varus.ResultsAs the tibial varus progressed, the center of force (COF) shifted laterally both for the medial and lateral aspect of the ankle joint. For the medial aspect of the ankle joint, the lateral shift reached its maximum at 8° [2.76 (1.62) mm, p = 0.002] of tibial varus, while for the lateral aspect of the ankle joint, the lateral shift reached its maximum at 12° [2.11 (1.19) mm, p = 0.002] of tibial varus. Thereafter, the COF shifted medially as the tibial varus progressed. For the lateral aspect of the ankle joint, The Pmean increased from 2103.8 (625.1) kPa at 0° to 2295.3 (589.7) kPa at 8° of tibial varus (p = 0.047), significant difference was found between the Pmean at 0° and 8° (p = 0.047) of tibial varus. Then as the tibial varus progressed, the Pmean decreased to 1748.9 (467.2) kPa at 20° of tibial varus (p = 0.002). The lateral joint pressure ratio also increased from 0.481 (0.125) at 0° to 0.548 (0.108) at 10° of tibial varus (p = 0.002), then decreased to 0.517 (0.101) at 20° of tibial varus (p = 0.002) .ConclusionsFor mild tibial varus deformities, there was a lateral shift of COF and lateral stress concentration within the ankle joint. However, as the tibial varus progressed, the COF shifted medially and the lateral stress concentration decreased.

Intra-articular Radial Head Fractures: A Deceptive Type of Injury

Isolated intra-articular radial head (IARH) fractures in skeletally immature patients represent a rare injury. Despite their initial benign radiologic appearance, these fractures are at risk for progressive radial head subluxation and may end with degenerative irreversible changes of the radiocapitellar joint. The aim of this study is to highlight the seriousness of these injuries and the importance of early diagnosis and a proper follow-up to achieve optimal outcomes. We retrospectively reviewed 6 patients with IARH fractures treated at our institution between 2011 and 2016. All patients presented with Salter-Harris types III or IV fracture. Five of 6 fractures were initially undisplaced. Treatment, clinical, and radiographic results were analyzed. Patients were divided into 2 groups according to treatment: patients included in group A were treated conservatively, whereas patients of group B were treated with early surgery. The final functional outcome was assessed using the Oxford Elbow Score (OES). The Broberg-Morrey classification was used for the radiographic results. Group A included 3 patients (average age, 11±2 y). They developed an initially missed posterior subluxation of the radiocapitellar joint that caused to all of them a painful elbow and limited range of motion (ROM). Despite rescue surgery, they all presented with limited ROM at the final follow-up, although no functional limitations (OES, 46.3±2.9). The radiographs showed early degenerative changes. Group B included 3 patients (average age, 11±1 y) all treated surgically within 1 week from the injury. They showed no limitation of ROM and good functional (OES, 47.7) and radiologic outcomes. IARH fractures in skeletally immature children are deceptive injuries which are often underestimated. Surgeons should be aware of these fractures, especially when a discrepancy between the clinical signs and symptoms, and the radiologic appearance exists, as this may be the only red flag that allows their identification in the acute setting. An early and accurate diagnosis followed by prompt and more aggressive treatment when necessary is mandatory for successful results. Level IV-case series.

Degenerative and inflammatory hand joint changes in osteoarthritis according to magnetic resonance imaging

Erosive osteoarthritis (EOA) of the hand is an osteoarthritis (OA) phenotype that is characterized by central and marginal erosions of the articular surfaces in the distal and proximal interphalangeal (DIP and PIP) joints and in some cases by a fairly aggressive course with obvious pain syndrome and a high level of functional impairment. Diagnostic criteria and management tactics for EOA patients are still under investigation. Objective: to evaluate the nature of the changes detected by hand joint magnetic resonance imaging (MRI) in patients with EOA and non-erosive OA (NEOA) of the hand. Subjects and methods . Examinations were made in 61 females meeting the American College of Rheumatology (ACR) diagnostic criteria for hand OA; the patients' mean age was 66.34+5.79 years; the median age at disease onset was 50 [45; 56] years; the duration of pain was 15 [11; 20] years. All the patients underwent MRI of the second-fifth DIP, PIP, and metacarpophalangeal (MCP) joints of the right hand. The patients also filled out the AUSCAN questionnaire. EOA and NEOA were detected in 30 and 31 patients, respectively. Results and discussion . The patients with EOA and those with NEOA were matched for gender, age, and disease duration. The DIP joints in patients with EOA were found to have significantly more frequently and a greater number of large osteophytes (OPs), (53 and 16%, respectively), joint space narrowing (JSN) (73 and 35%), degenerative collateral ligament changes (DCLCs) (93 and 55%), subluxations (47 and 13%), and bone marrow edema (BME) (57 and 19%) than in those with NEOA. Synovitides and subchondral cysts occurred with approximately the same frequency in EOA and NEOA. The PIP joints in patients with EOA significantly more frequently showed BME (37%) and DCLCs (97%) than in those with NEOA. Subluxations in the PIP joint of the right hand were encountered exclusively in patients with EOA. Their incidence was 17%. Degenerative symptoms (small, less often moderate sizes of OPs, JSN, and DCLCs) were identified with approximately the same frequency in both groups (p>0.05). The PIP joints in patients with EOA were significantly more often found to have BME (53 and 26%, respectively; (p 0.05). Large OPs in the PIP joint were found relatively rarely. Subluxations in the PIP joints were undetected in both groups. Conclusion. The symptoms of active inflammation are predominant and degenerative changes are more pronounced in patients with EOA unlike those with NEOA. Articular surface defects in the PIP joints in patients with hand OA differ from erosions in those with rheumatoid arthritis. These CDs in EOA are much more common than those in NEOA; however, the nature of their occurrence is unclear; therefore, the patients in whom they have been found need dynamic monitoring.

Effect of total joint replacement in hip osteoarthritis on serum COMP and its correlation with mechanical-functional parameters of gait analysis

To study the effect of total hip replacement (THR) on serum cartilage oligomeric matrix protein concentration (sCOMP) and its correlation with joint loading during gait in patients with unilateral hip osteoarthritis. In this prospective multimodal (clinical, biomechanical, biochemical) study blood samples from 15 patients were taken before and up to three times after THR (7 days, 3 months and 1 year), each after a resting period of at least 30min, for analysis of sCOMP. Gait analysis was performed before and 1 year after THR to determine hip and knee joint moments. Seven days after THR, sCOMP decreased significantly compared to the preoperative measurement (p<0.001). Three months and 1 year postoperatively, sCOMP reverted to concentrations in the range of the preoperative value. One year postoperatively, a linear correlation between sCOMP and the maximum hip flexion moment was indicated in the first half of the stance phase on the unaffected side (r=-0.736, p=0.024). No further correlations could be determined. Surprisingly, the removal of a joint affected by osteoarthritis did not have a sustained effect on sCOMP. Both before and after THR there was no scientifically substantiated correlation between sCOMP and joint moments from gait analysis. Consequently, the examination of sCOMP is not useful to detect altered joint loads that may influence degenerative changes of adjacent joints after THR.The registration number in the German Registry of Clinical Trials is DRKS00015053.

Can a fibular malunion be corrected by a Z-shaped fibular osteotomy?

The aim of this study was to assess the short-term clinical and radiographic outcomes in patients who underwent realigning Z‑shaped fibular osteotomy. Between January 2007 and December 2014, 28patients with apainful fibular malunion underwent aZ-shaped realignment fibular osteotomy. The mean age was 42.2 ± 14.1 years (range 19.1-67.8 years) and the mean follow-up was 7.0 ± 1.7 years (range 4.0-9.7 years), with no loss to follow-up. Weight-bearing radiographs were used to determine the distal fibula alignment based on Weber's criteria. Degenerative changes of the tibiotalar joint were assessed using the Kellgren-Lawrence scale. Clinical assessment included pain evaluation, measurement of ankle range of motion (ROM), sports activities, and quality of life outcomes. There were no intraoperative or perioperative complications. No delayed unions or nonunions were observed. One patient had radiographic progression of degenerative changes in the tibiotalar joint. Postoperative complications included removal of hardware (n = 15) and arthroscopic tibiotalar joint debridement (n = 2). At the last follow-up the mean visual analog scale (VAS) decreased from 6.5 ± 1.1 to 2.1 ± 1.1 (p < 0.001),the ROM improved from 39º ± 6º to 45º ± 4.5º (p < 0.001), the short form health survey questionnaire (SF-36) physical and mental outcome scores improved from 49 ± 8 to 84 ± 7 (p < 0.001) and from 61 ± 4 to 83 ± 5 (p < 0.001), respectively. The Z‑shaped realignment osteotomy of the distal fibula can provide pain relief and functional improvement in the treatment of fibular malunion. Further studies are needed to address long-term outcomes in this patient cohort.

Cambios Degenerativos y Evaluación Funcional de Fracturas Intraarticulares de Tobillo en Pacientes Pediatricos

BackgroundAnkle fractures represent 12% of fractures in pediatric age. We hypothesized that patients with intra-articular ankle fractures will have an excellent functional result and will not present degenerative joint changes 6 months after surgery. The objective of the study is to carry out an analysis of the functional result, as well as the presence of early degenerative radiological changes in the follow-up of patients with intra-articular ankle fractures treated in our center. MethodsRetrospective cohort study, data were collected from patients with intra-articular ankle fractures between 2012 and 2016. They were classified and evaluated using AOFAS score and radiographs to classify according to Van Dijk. ResultsThe average age difference between triplanar and tillaux fractures is 17 months (p: 0.038). The mean AOFAS Score was 85.2%. 88.8% reported pain in relation to daily activities, despite having excellent or good functional results. There is no significant correlation between the AOFAS results in patients with transitional and non-transitional fractures. 43.4% had stage 0, 43.4% stage I, and 13% stage II Van Dijk. No case presented stage III. DiscussionBased on the findings of this study, and contrary to the hypothesized, most patients have a good functional result after the management of intra-articular ankle fractures and not excellent as previously thought. There is a group of patients who showed early degenerative changes demonstrable by radiography.

Accuracy of panoramic radiography for degenerative changes of the temporomandibular joint

Background:Temporomandibular joint (TMJ) morphologies are complex, and changes in joint components have been studied extensively. TMJ conditions have many different etiologies, appearances, and relevant clinical significance.Objective:The objective of this study was to evaluate the concordance of the diagnosis of degenerative changes in the TMJ in panoramic radiographs.Materials and Methods:Cone beam computed tomography (CBCT) was used as a reference standard. Images of 84 patients (168 TMJs), 61 females (72.6%) and 23 males (27.4%) with an average age of 47.4 years, were evaluated by three radiologists who established the presence or absence of degenerative changes in the jaw heads. The data were collected and organized in a spreadsheet. Concordance between evaluators was analyzed using agreement percentages, statistical κ, and confidence intervals. In the analysis of compliance with CBCT, sensitivity, specificity, predictive positive and negative values, and probabilities of false positives and negatives were also calculated. All inferential tests were performed with a 5% significance level.Results:The percentage of agreement among raters in panoramic radiographs ranged from 66.7% to 82.9%, considered mild to moderate. Correlation between radiographic and tomographic images ranged from 45.5% to 64.9% in the inter-evaluator reviews, representing a very mild agreement. Sensitivity ranged from 28.6% to 58.7% and specificity from 66.7% to 100.0%. Positive predictive value ranged from 77.1% to 100.0%; the negative predictive value was lower, ranging from 32.2% to 54.8%. The probability of false negatives was higher than that of false positives, ranging from 45.2% to 67.8%.Conclusion:The rater did not reach acceptable diagnosis levels.

Application of a Customized Total Talar Prosthesis for Revision Total Ankle Arthroplasty.

Background:The rate of revision surgery for total ankle arthroplasty (TAA) is higher than for hip and knee arthroplasties. Tibiotalocalcaneal arthrodesis is widely used; however, it requires a large allograft. Thus, the use of a customized total talar prosthesis in combination with the tibial component of TAA (combined TAA) may be an effective strategy for talar component subsidence. This study aimed to evaluate the clinical and radiographic effectiveness of the combined TAA in such revision cases.Methods:Between 2000 and 2015, 10 patients (10 women; 10 ankles) were treated using the combined TAA for revision after standard TAA or combined procedures that included the use of a talar body prosthesis. In 6 patients, the tibial component was concurrently replaced. The median follow-up period was 49 months (interquartile range [IQR], 24.5 to 90 months). The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score, a numerical rating scale (NRS) pain score, passive range of motion of the ankle, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at final postoperative follow-up.Results:The median NRS pain score improved significantly, from 7 (IQR, 6.25 to 8.75) to 2 (IQR, 1 to 3). The median JSSF ankle-hindfoot scale total score improved significantly, from 64 (IQR, 56.25 to 71.5) to 88.5 (IQR, 79.75 to 96). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20 to 27.5) to 35 (IQR, 30 to 40), and the median function score improved from 34 (IQR, 26.5 to 37) to 43.5 (IQR, 39.75 to 46). The median range of motion improved from 29° (IQR, 25.5° to 35°) to 35° (IQR, 31.25° to 43.75°). No significant difference in osteophyte formation was found. Degenerative changes in the adjacent joint were found only in the talonavicular joint.Conclusions:The combined TAA, used in revision for postoperative complications after standard TAA or combined procedures including the use of a talar body prosthesis, was associated with improved objective JSSF ankle-hindfoot scale scores, subjective pain assessment, and range of motion in the ankle.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Association between the Critical Shoulder Angle and Non-traumatic Rotator Cuff Tears

Background: Moor et al. developed a critical shoulder angle (CSA) as a radiological parameter for the development of rotator cuff injury and degenerative changes of the glenohumeral joint. The objective of this study is to evaluate the association between CSA and the development of non-traumatic rotator cuff tears (RCTs) to further validate this study. Materials and Methods: The study was performed as an observational study dividing subjects into control and study groups, differing in the presence of non-traumatic RCT. The study group comprised 50 subjects with 40 subjects in the control group. All acceptable radiographs were evaluated, to measure the CSA in accordance with Moor et al. Results: The mean CSA of control subjects was 31.79° (± 1.89°), while that of study subjects were 37.85° (± 2.25°). The relative variability in the control group was about 6% and that in the study group was also 6%, indicating internal homogeneity of the study groups. Chi-square test applied to the distribution gave a P = 0.00001, representing an excellent association between the study groups and the CSA. Conclusion: There is a significant association between larger CSA and RCTs (P = 0.00001). Individual (quantitative) anatomical parameters may imply altered biomechanics, which are likely to induce RCTs, independent of trauma and degenerative glenohumeral joint disease.

Does Incidence of Temporomandibular Disc Displacement With and Without Reduction Show Similarity According to MRI Results?

The aim of this study is to assess MRI reports of the patients and to provide retrospective analysis by conducting detailed evaluation of temporomandibular disc position. MRI images of 259 patients from 2008 to 2017 were reviewed retrospectively. Existence of disc displacement in joint with and without reduction, existence of effusion in joint gap, arthritis, degenerative changes in joints and limitation of movement of joint and anatomic characteristics were evaluated. One hundred and seventeen (45.2%) of the patients had healthy joint connection bilaterally. Anterior disc displacement was observed in 101 (38.9%) of the patients. The number of the patients having disc displacement with reduction was 50 (19.3%) and without reduction was 51 (19.6%) similarly. The incidence of anterior disc displacement with or without reduction was similar; besides this, the majority of the patients diagnosed with anterior disc displacement were unilateral.

A preliminary study on the use of EEMD-RQA algorithms in the detection of degenerative changes in knee joints

Degenerative changes, according to world literature, are one of the key reasons for disability, especially in the elderly population. Diagnosis and monitoring of the disease consist mainly in clinical examination, bedside interviews and imaging. However, during the healing process, there is currently no tool for fast, cheap, easily available and diagnostics that would be free from ionising radiation and that would enable evaluation of the course of the disease. Therefore, the scientific community is searching for new diagnostic methods, with the potential for wide application in medicine. Registration and analysis of knee joint vibration signals presents a chance for more accurate and faster diagnostics. The method is capable of detecting damage at an early stage, while specifying the selection of optimal treatment methods. Therefore, it seems crucial to develop methods of analysis appropriate for the nature of tested signals. The quality of low-frequency natural waveforms can be improved by filtration in selected bands, eliminating existing artefacts. This paper presents an application of the EEMD-RQA algorithm in the detection of degenerative changes in knee joints. Pre-processing in the form of filtration gives the opportunity to pre-test the usefulness of the algorithm RQA in the ability to create/subsequent development of indicators describing the condition of the joint surfaces examined without the need for surgical intervention.

Application of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures

To investigate the safety and effectiveness of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures. The clinical data of 53 patients with pronation ankle fractures between April 2015 and October 2016, who were treated with anatomical approach osteoligaments repair technique applied for fracture reduction and internal fixation, were analysed retrospectively. There were 35 males and 18 females with an average age of 33.1 years (range, 18-60 years). The cause of injury included traffic accidents in 27 cases, tumbling in 5 cases, fall from height in 4 cases, twisted injury in 6 cases, sports injuries in 4 cases, and bruises in 7 cases. According to Lauge-Hansen classification, there were 44 cases of pronation external rotation stage Ⅳ and 9 cases of pronation abduction stage Ⅲ. The interval between injury and operation was 4-10 days (mean, 7 days). Postoperative pain and function of ankles were assessed by American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue pain scale (VAS) score. The medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle were measured by X-ray films and CT of bilateral ankle joints. The tourniquet application time was 55-90 minutes (mean, 72.5 minutes); the frequency of fluoroscopy was 5-13 times (mean, 8.9 times). All incisions healed by first intention and no infection, deep vein thrombosis occurred after operation. All patients were followed up 28-48 months (mean, 36 months). There was no significant difference in postoperative MCS, TFCS, DFTL, the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle between bilateral ankle joints ( P>0.05). At last follow-up, no ankle instability occurred and the degenerative changes of ankle joints (Kellgren-Lawrence grading Ⅱ) occurred in 5 cases. The average AOFAS score of the ankle joint was 90.84 (range, 85-95); mean VAS score was 1.23 (range, 0-5). The average dorsiflexion and plantar flexion of ankle joints was 20.24° (range, 15-25°) and 42.56° (range, 30-50°), respectively. Anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures can expose the talocrural joint and lower tibiofibular syndesmosis clearly, repair the osteoligaments injury directly, and assist the syndesmosis and talocrural joint reduction, and decline the incidence of ankle degeneration.

MORPHOLOGICAL ASSESSMENT OF STRUCTURAL CHANGES IN KNEE JOIN IN MODELED OSTEOARTHROSIS AND APPLICATION OF AUTOLOGICAL BONE MARROW ASPIRATE

Background. Treatment of knee join osteoarthritis is one of challenging medico-social issues. Sometimes the conservative treatment fails to produce therapeutic effect, therefore, the use of cellular technologies in the treatment for progressive degenerative changes of the knee joint has been proposed. The objective of this study was to investigate the effect of bone marrow aspirate on the structural changes in the knee joint in modelled osteoarthritis. Materials and methods. The experimental osteoarthritis was simulated in rabbits. Autologous bone marrow aspirate was injected into the knee cavity in 1 month after surgery, and then in 2, 5 months the structural changes of the capsule, meniscus, proximal epiphysis of the tibia were studied. Results. There were the following structural changes in the capsule of the knee joint: stratification of structural elements and reduction of the cell density of the capsule, cell necrosis of the inner surface of the capsule. The defect area of the epiphyseal cartilage was lacking in cartilage, and the peripheral cartilage thickness was decreased by 30, 4% (p&lt;0,05); subchondral bone density made up an average 55,9% compared with the control. In the group with bone marrow aspirate, the density of fibroblasts in the joint capsule increased and the surface of the meniscus was partially preserved; the density of subchondral bone tissue was significantly higher by 79,5% (p&lt;0.05) compared with the control. Structural changes in osteoarthritis include progressive dystrophic changes of the joint surface, subchondral bone, meniscus, and joint capsule. The use of autologous bone marrow aspirate can prevent damage to the subchondral bone, meniscus and joint capsule and promote reticular tissue formation and induction of angiogenesis. The morphological changes of bone marrow through progressive osteoarthritis and its renovation after local application of autological bone marrow aspirate concentrate are promising approaches for the further studies.