Ligaments Of Joint Research Articles

The coordination patterns of the foot segments in relation to lateral ankle sprain injury mechanism during unanticipated changes of direction

Preventing lateral ankle sprain injuries (LAS) in females competing in court sports is a high priority, as an athlete’s risk for re-injury and developing long term dysfunction increases significantly after sustaining an acute LAS. Stability to the ankle joint is passively provided by the joint congruity and ligaments, and actively by the muscles acting on the foot. The ankle joint is most stable when loaded and dorsiflexed. However, during unanticipated changes of direction, typical in court sports, the foot is often in a vulnerable unloaded, plantarflexed position. Stability of the forefoot and controlling rearfoot movement to avoid excessive ankle inversion and adduction thus becomes imperative. Information regarding the coupling relationship between the forefoot (hallux and metatarsal segments) and the rearfoot (calcaneus segment) during unanticipated changes of direction is lacking. The aim of this study was to supplement current LAS prophylactic knowledge by describing and quantifying hallux-calcaneus and metatarsal-calcaneus coupling. The coupling angles between sagittal plane hallux, tri-planar metatarsal and frontal- and transverse plane calcaneus movement, respectively, were calculated with a modified vector coding technique which used segmental velocities in a local, anatomical reference frame instead of segmental angles in a global reference frame. Coupling relationships revealed anti-phase movement between sagittal- metatarsal and frontal plane calcaneus movement throughout stance. During loading, sagittal- and frontal plane metatarsal acceleration/deceleration were coupled with frontal-transverse plane calcaneus acceleration/deceleration respectively. The remainder of the braking phase was characterized by calcaneus eversion deceleration. During propulsion, the hallux and metatarsal segments increased plantar flexion velocity in response to calcaneus inversion and adduction acceleration. As the forefoot was the only point of contact during stance, the coupling between segments were most likely neuromuscular. Strengthening intrinsic and extrinsic foot muscles may thus contribute to foot and ankle stability, adding to current prophylactic LAS strategies.

Frame Coating of Single-Walled Carbon Nanotubes in Collagen on PET Fibers for Artificial Joint Ligaments.

The coating formation technique for artificial knee ligaments was proposed, which provided tight fixation of ligaments of polyethylene terephthalate (PET) fibers as a result of the healing of the bone channel in the short-term period after implantation. The coating is a frame structure of single-walled carbon nanotubes (SWCNT) in a collagen matrix, which is formed by layer-by-layer solidification of an aqueous dispersion of SWCNT with collagen during spin coating and controlled irradiation with IR radiation. Quantum mechanical method SCC DFTB, with a self-consistent charge, was used. It is based on the density functional theory and the tight-binding approximation. The method established the optimal temperature and time for the formation of the equilibrium configurations of the SWCNT/collagen type II complexes to ensure maximum binding energies between the nanotube and the collagen. The highest binding energies were observed in complexes with SWCNT nanometer diameter in comparison with subnanometer SWCNT. The coating had a porous structure—pore size was 0.5—6 μm. The process of reducing the mass and volume of the coating with the initial biodegradation of collagen after contact with blood plasma was demonstrated. This is proved by exceeding the intensity of the SWCNT peaks G and D after contact with the blood serum in the Raman spectrum and by decreasing the intensity of the main collagen bands in the SWCNT/collagen complex frame coating. The number of pores and their size increased to 20 μm. The modification of the PET tape with the SWCNT/collagen coating allowed to increase its hydrophilicity by 1.7 times compared to the original PET fibers and by 1.3 times compared to the collagen coating. A reduced hemolysis level of the PET tape coated with SWCNT/collagen was achieved. The SWCNT/collagen coating provided 2.2 times less hemolysis than an uncoated PET implant. MicroCT showed the effective formation of new bone and dense connective tissue around the implant. A decrease in channel diameter from 2.5 to 1.7 mm was detected at three and, especially, six months after implantation of a PET tape with SWCNT/collagen coating. MicroCT allowed us to identify areas for histological sections, which demonstrated the favorable interaction of the PET tape with the surrounding tissues. In the case of using the PET tape coated with SWCNT/collagen, more active growth of connective tissue with mature collagen fibers in the area of implantation was observed than in the case of only collagen coating. The stimulating effect of SWCNT/collagen on the formation of bone trabeculae around and inside the PET tape was evident in three and six months after implantation. Thus, a PET tape with SWCNT/collagen coating has osteoconductivity as well as a high level of hydrophilicity and hemocompatibility.

High incidence of spring ligament laxity in ankle fractures with complete deltoid ruptures and secondary first ray instability

AimsTo assess the incidence of spring ligament failure in patients who have complete deltoid ruptures. Patients and methodsThe authors retrospectively analysed ankle fractures in our trauma database from January 2015 to January 2019. 61 patients who sustained ankle fractures with complete deltoid ligament ruptures based on an AP ankle radiographs with increased medial joint space were identified. 25 patients attended clinic for assessment. Of these, 5 were found to have gross planovalgus with pre-existing spring ligament laxity in the uninjured control foot and these were excluded from the analysis. 20 patients were assessed for spring ligament failure /laxity. For each patient, the uninjured foot was used as the control. ResultsThe TMT instability score and the lateral translation score showed statistically significant increases in the injured compared to the uninjured foot. The ratio of increase in both TMT instability and lateral translation scores (strain) in the injured versus the uninjured foot was assessed. A strong correlation (+0.62 pearson correlation coefficient) was found between the two ratios. ConclusionAll 20 patients showed increased spring ligament laxity and 19 patients showed increased TMT instability. Our results show that with complete deltoid rupture, there is likely greater disruption of the medial ligamentous structures of the foot than previously recognised. The degree of increase in the spring ligament strain also correlates with the degree of strain at the plantar TMT joint ligaments, and thus first ray instability. This finding has significant implications for the long-term assessment and management of ankle fractures involving complete deltoid disruption. Early intervention with orthotics in this cohort may prevent progressive destabilisation of the midfoot and the first ray. This evolving understanding may lead to the prospect of earlier surgical intervention to reconstitute the integrity of the spring ligament and protect the foot progressing to stage 2 AAFD.

Computed tomographic and radiographic morphology of the pastern and coffin joints of One-Humped Camel (Camelus dromedarius).

The objective of the current study was to describe the structures of the pastern and coffin joints in dromedary camel using x-ray, bone and soft tissue windows computed tomography (CT) and three-dimensional volume rendering (3DVR) of CT imaging. 3DVR of CT was obtained at the slight flexed dorsal view, plantar view, dorsolateral view and lateral view which explained all the surfaces and structures of the digit bony parts even the parts of the articular surface. The processed images of 3DVR of CT showed different patterns of the cortical, cancellous, subchondral bones and medullary cavity of the bones of the digits. The present study showed clearly all the hard and soft tissues in the pastern and coffin joints of the camel in CT images; however, the plantar ligaments of the pastern joint and ligaments of the navicular cartilage identified on CT images. The CT soft tissue window visualized the joint cavity and their pouches and tendon sheath of the flexor tendons better than the bone window CT. The radiographic, CT and 3D images could be used as a normal reference for the interpretation of some clinical diseases in the pastern and coffin joints of the camel.

Ultrasound measurement of the effects of high, medium and low hip long-axis distraction mobilization forces on the joint space width and its correlation with the joint strain

BackgroundNo study has evaluated the mechanical effect of different magnitudes of long axis-distraction mobilization (LADM) force on hip joint space width (JSW) or the association between the separation of joint surfaces and the strain on hip capsular ligaments. ObjectiveTo compare the joint separation when applying three different magnitudes of LADM forces (low, medium and high) and to analyse the correlation between joint separation, strain on the inferior ilio-femoral ligament and magnitude of applied force. DesignRepeated measures controlled laboratory cadaveric study. MethodsThree magnitudes of force were applied to 11 cadaveric hip joints (mean age 73 years). Ultrasound images were used to measure joint separation, and strain gauges recorded inferior ilio-femoral ligament strain during each condition. ResultsThe magnitude of joint separation was significantly different between low (0.23 ± 0.19 mm), medium (0.72 ± 0.22 mm) and high (2.62 ± 0.43 mm) forces (p < 0.001). There were significant associations between magnitude of force, joint separation and the strain on the inferior ilio-femoral ligament during LADM (r > 0.723; p < 0.001). ConclusionHip joint separation and ligament strain during LADM are associated with the magnitude of the applied force.

The Value of Computed Tomography Three-Dimensional Imaging Technology in the Diagnosis and Treatment of Sports Knee Ligament Strain

Objective: To improve the efficiency and accuracy of the diagnosis and treatment of sports knee ligament strain, the application value of computerized tomography (CT) three-dimensional (3D) imaging technology in the diagnosis and treatment of sports knee ligament strain is studied. Methods: This study proposes a method for CT 3D image reconstruction based on the model clustering algorithm. First, the knee joint CT images of research objects are preprocessed. Second, based on the preprocessing, the healthy adult male knee ligament distribution structure map is used as a reference model. The model clustering segmentation algorithm proposed in this study is used for detailed segmentation, and the results are input into Materialise’s interactive medical control system (Mimics) software. According to the process, the 3D CT reconstructed images are derived. Finally, the 3D reconstruction results of knee ligament CT are optimized by using Geomagic Studio 2012 software. The application of 3D CT images and magnetic resonance imaging (MRI) images obtained by the algorithm in this study in the diagnosis and treatment of knee ligament strains are compared. Results: The CT 3D image reconstruction method based on the model clustering algorithm proposed in this study can clearly show the ligament structure of the knee joint. The optimized CT 3D image has a smoother surface and a clearer display, which is more conducive for observing the knee joint ligament structure more clearly. The comparative experiments have found that the diagnostic accuracy of 3D CT images is 95%, and the diagnostic accuracy of MRI images is 85%. The diagnostic accuracy of the 3D reconstructed images proposed in this study is significantly higher than that of MRI images, and the difference is statistically significant (P &lt; 0.05). Conclusion: The proposed algorithm has an excellent effect on the 3D reconstruction of CT images. Also, it has high efficiency and accuracy in the diagnosis and treatment of sports knee ligament strains.

Arthroscopic Trapeziectomy and Suture Button Suspensionplasty: A Review of the Literature and Description of the "Three-Step Arthroscopic Trapeziectomy Technique".

In the last two decades, surgeons have rapidly developed arthroscopic techniques to treat basal joint osteoarthritis. Such techniques spare the joint capsule and ligaments, allow more accurate staging of cartilage degeneration to determine the most appropriate treatment, and decrease the risk of injury to the radial artery and superficial branch of the radial nerve. Arthroscopic resection arthroplasty of the trapezium can be performed as either partial or complete trapeziectomy. Many papers have described partial trapeziectomy but few have discussed complete trapeziectomy. Suture button implants avoid the drawbacks of temporary fixation using Kirschner wire, as well as the drawbacks of ligament reconstruction, which necessitates the sacrifice of a tendon and involves both wide exposure and scar tissue. This paper aimed to review the published data on the arthroscopic treatment of basal thumb osteoarthritis, with a special focus on stabilization using suture button suspensionplasty, and to present a technique that structures this procedure into three steps, allowing it to be performed in an easier, more organized, and faster way.

АДАПТИВНЫЕ ПРЕОБРАЗОВАНИЯ СВЯЗОЧНОГО АППАРАТА КОЛЕННОГО СУСТАВА У ЛИСИЦ В УСЛОВИЯХ ИЗМЕНЕННОЙ ФУНКЦИОНАЛЬНОЙ НАГРУЗКИ

The aim of the research is identification of complex structural changes of the fox’s knee joint ligaments to ensure its high biomechanical potencies. A promising approach for the study of adaptive and compensatory changes of the joint as a multicomponent biomechanical system is to evaluate the structural transformations of its ligaments under conditions of a new functional load. The research was carried out on the basis of the Department of Animal Anato-my and Histology named after Professor A. F. Klimov «Moscow state Academy of Veterinary Medicine and Biotech-nology – MBA named after K. I. Scryabin» and on the basis of JSC «Breeding animal farm «Saltykovsky». The arti-cle presents information about morphological transformations of the lateral and median ligaments of the knee joint that determine its reliable stability. Numerous structural changes of the fox ligaments during cage housing is re-flected, which decrease in the thickness of bundles of collagen fibers and their compositional density compared to the standard structure (in wild individuals). Morphological transformations that can significantly reduce the strength and elasticity resistance of the ligaments and the biomechanical potential of the joint are shown. 23 fox individuals, including 15 individuals of the cage housing and 8 representatives of the natural habitat were studied. The re-search used a comprehensive methodological approach, including anatomical preparation, light microscopy of histological sections, scanning electron microscopy, micromorphometry and statistical analysis of the obtained digi-tal data. According to the results of the study, it was found that fox individuals from natural biocenosis, have colla-gen structures of the lateral ligaments different in waving and packing density from ones of cage housing, which can contribute to ensuring their biomechanical domination.

Early and delayed acromioclavicular joint reconstruction provide equivalent outcomes

Some comparative studies have reported improved outcomes for early compared with delayed reconstruction for high-grade acromioclavicular (AC) joint dislocations. However, most are based on older techniques and did not specifically involve reconstruction of both the coracoclavicular (CC) and AC joint ligaments. The purpose of this study was to compare functional outcomes of early vs. delayed surgical intervention of AC joint dislocations managed with combined CC and AC ligament reconstruction. A retrospective comparative study was performed of 53 patients who underwent early (<2 weeks after injury) or delayed (≥2 weeks after injury) open stabilization for AC joint dislocation. All patients were managed with the same surgical technique of combined CC reconstruction and stabilization of the AC joint, except for the addition of a gracilis allograft for biologic CC reconstruction in delayed intervention. Outcome was determined at a minimum follow-up of 12 months, using the Acromioclavicular Joint Instability (ACJI) score, Taft score, Subjective Shoulder Value (SSV), visual analog scale (VAS)for pain, and overall satisfaction (0-10). Multivariable regression analyses were performed to test associations of ACJI and Taft scores with 5 independent variables (early vs. delayed surgery, age, sex, manual worker, and Rockwood type). The cohort comprised 47 men (89%) and 6 women (11%) aged 40.1 ± 11.2 years (range, 22-63 years). The early group (n = 31) underwent surgery 1.1 ± 0.5 weeks after injury, whereas the delayed group (n = 22) underwent surgery 84.3 ± 99.1 weeks after injury. There were no significant differences in ACJI scores (87 ± 14 vs. 89 ± 14, P = .267), Taft scores (10.1 ± 1.3 vs. 10.7 ± 1.3, P=.084), pain on VAS (0.3 ± 0.7 vs. 0.6 ± 1.1, P = .541), SSV (95 ± 7 vs. 93 ± 9, P = .427), or overall satisfaction (9.6 ± 0.9 vs. 9.4 ± 1.1, P = .491). Multivariable analyses revealed no associations between any of the independent variables and ACJI or Taft score. Early and delayed surgical interventions of high-grade AC joint dislocation provide equivalent clinical scores when combined CC and AC joint fixation is used for stabilization. Rapid surgical intervention for high-grade AC joint dislocation may not be necessary, as most patients can still benefit from surgery at a later stage.

Sex Differences in Anatomic Features Linked to Anterior Cruciate Ligament Injuries During Skeletal Growth and Maturation

Background: Several anatomic features of the knee have been shown to affect joint and anterior cruciate ligament (ACL) loading and the risk of subsequent injuries. While several studies have highlighted sex differences between these anatomic features, little is known on how these differences develop during skeletal growth and maturation. Hypotheses: (A) Anatomic features linked to an ACL injury will significantly change during skeletal growth and maturation. (B) The age-related changes in anatomic features linked to an ACL injury are different between male and female patients. Study Design: Cross-sectional study; Level of evidence, 3 Methods: After institutional review board approval, magnetic resonance imaging data from 269 unique knees (patient age 3-18 years; 51% female), free from any injuries, were used to measure femoral notch width, posterior slope of the lateral tibial plateau (lateral tibial slope), medial tibial depth, tibial spine height, and posterior lateral meniscal bone angle. Linear regression was used to test the associations between age and quantified anatomic indices. Patients were then divided into 4 age groups: preschool (3-6 years), prepubertal (7-10 years), early adolescent (11-14 years), and late adolescent (15-18 years). Also, 2-way analysis of variance with the Holm-Sidak post hoc test was used to compare morphology between male and female patients in each age group. Results: The femoral notch width, medial tibial depth, and tibial spine height significantly increased with age (P < .001). The lateral tibial slope decreased with age only in male patients (P < .001). Except for the posterior lateral meniscal bone angle, the age-related changes in anatomy were different between male and female patients (P < .05). On average, early and late adolescent female patients had smaller femoral notches, steeper lateral tibial slopes, flatter medial tibial plateaus, and shorter tibial spines compared with age-matched male patients (P < .01). Conclusion: Overall, the findings supported our hypotheses, showing sex-specific changes in anatomic features linked to an ACL injury during skeletal growth and maturation. These observations help to better explain the reported age and sex differences in the prevalence of ACL injuries. The fact that most of these anatomic features undergo substantial changes during skeletal growth and maturation introduces the hypothesis that prophylactic interventions (ie, activity modification) would have the potential to reshape a maturing knee in a manner that lowers the risk of noncontact ACL injuries.

Prevalence of Knee Joint Dysfunction in Multiparous Pregnant Women

During pregnancy, physiological and hormonal changes lead to increase in ligament laxity and postural changes. Damage to the ligaments of knee joint, and other knee problems which results in increase in the risk of fall in pregnant women. Objective: The study was done to determine the prevalence of knee joint dysfunction in multiparous pregnant women. Method: The study involved 66 multiparous women at KIMSDU. Each of them was assessed for right and left Q angle and also knee joint proprioception was recorded by using goniometer. Signs and symptoms of knee joint dysfunction were graded based on lysholm knee scoring scale. Result: On the basis of this study 29% of women showed signs and symptoms of knee joint dysfunction. 47 subjects had excellent and 19 subjects had poor joint condition. 44 had normal Q angle and 21 had altered Q angle. There are significant changes in knee joint proprioception. Conclusion: The study concluded that there is prevalence of knee joint dysfunction in multiparous pregnant women.

GaitRec, a large-scale ground reaction force dataset of healthy and impaired gait

The quantification of ground reaction forces (GRF) is a standard tool for clinicians to quantify and analyze human locomotion. Such recordings produce a vast amount of complex data and variables which are difficult to comprehend. This makes data interpretation challenging. Machine learning approaches seem to be promising tools to support clinicians in identifying and categorizing specific gait patterns. However, the quality of such approaches strongly depends on the amount of available annotated data to train the underlying models. Therefore, we present GaitRec, a comprehensive and completely annotated large-scale dataset containing bi-lateral GRF walking trials of 2,084 patients with various musculoskeletal impairments and data from 211 healthy controls. The dataset comprises data of patients after joint replacement, fractures, ligament ruptures, and related disorders at the hip, knee, ankle or calcaneus during their entire stay(s) at a rehabilitation center. The data sum up to a total of 75,732 bi-lateral walking trials and enable researchers to classify gait patterns at a large-scale as well as to analyze the entire recovery process of patients.

Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint

Introduction The collateral ligaments of the first metacarpophalangeal (MCP) joint provide stability to the thumb. Injury to these collateral ligaments occurs more commonly in sports accidents leading to joint instability, weakness in pinch and grip strength. Normal morphometric measurements of collateral ligaments are essential for primary repair or reconstruction of the injured ligament. Hence, the objective of the study is to give the detailed morphometric profile of the proper collateral ligaments of the MCP joint of the thumb.Materials and Methods A total of 55 adult cadaveric hands were included in the study taken from 18 male (36 hands) and 10 female (19 hands) cadavers. Out of 55 hands, 28 belonged to the left side, while 27 were of the left side. The MCP joints were dissected to expose the collateral ligament complex. The length and width of the proper ligaments were measured.Results Both the proper collateral ligament attachments and the direction of the fibers were defined. Overall length and the width of both the proper collateral ligaments showed no statistically significant difference of mean between the left and the right sides. However, the length of both the proper collateral ligaments is significantly less in females compared with the males.Conclusion The morphometric details of the proper collateral ligaments obtained from this study would be useful for hand surgeons during surgical correction of the injured collateral ligaments either by primary repair or reconstruction with a tendon graft.

Assisting technical development in closed reduction for distal femoral fractures

Distal femoral fracture is one of the difficult fractures to treat due to the complex types and varies complications after operation. The concept about closed reduction to deal with fracture has been accepted widely with the innovation of surgical technology and internal fixation. Some tissue, including joint capsule, ligaments, muscles and tendons, surround femoral condyle, which indicates they may tract the fractured bone to deformity. In addition, the difficulty of reduction during operation may be increased with combined other injuries. At present, the idea of using different methods to reduce the re-injury before the closed reduction of distal femoral fracture has been recognized and popularized. A kind of appropriate reduction and internal fixation can not only reduce the difficulty of operation but also shorten the operation duration and reduce the incidence of postoperative complications. In addition to the common reduction method of manual reduction, plate can not only be taken as internal fixation, but also achieve reduction reviewing literatures about the methods of reduction in recent years. However, it is not suitable for some complex fractures. The traction table is not widely used at present due to varies complications. Distractors like AO distractor or other kinds of femoral distractors can achieve reduction by providing reverse force. However, it should be noticed that some risk factors such as vascular and nerve injury can occur during the surgery. The present study summarized different ways that were adopted during the closed reduction and internal fixation of distal femoral fractures. The appropriate method chose by surgeons to improve the efficiency and reduce risks should be used based on the need of surgery.

Cross-anatomical, radiographic and computed tomographic study of the stifle joint of donkeys (Equus africanus asinus).

The present investigation was conducted to provide a full anatomical description of the stifle joint of donkeys using 3D computed tomography imaging technique, in addition to the classic anatomical methods, such as radiography and cross-anatomical sectioning. The radiography and CT imaging of stifle joint were interpreted in comparison with cross-sectional anatomical sections. Volume-rendering reconstruction techniques (3D-CT) were used to describe the anatomical structure of stifle joint. The used twelve adult healthy donkeys were free from any musculoskeletal disorders. Four donkeys were used for the gross anatomical observations, four for CT and radiography and two live animals for determination the site of injections. The results of this study revealed that the complex stifle joint was formed from three joints: femorotibial, femoropatellar and proximal tibiofibular. The articular surfaces were described for each joint, and the synovial layer of the articular capsule formed three main joint sacs: femoropatellar, medial femorotibial and lateral femorotibial sacs. The ligaments of stifle joint were recorded, and meniscal ligaments included cranial and caudal ligaments of medial and lateral menisci and meniscofemoral ligament of lateral meniscus. The cruciate ligaments were also described and they included the cranial and caudal cruciate ligaments, while the patellar ligament included the medial, middle and lateral patellar ligaments. The arterial supply and the site of injection of the stifle joint were described. In conclusion, the 3D reconstruction CT provided well-defined baseline reference image for the stifle joint of donkeys for anatomist, radiologist, surgeons and researchers.

The intrinsic subtalar ligaments have a consistent presence, location and morphology

BackgroundChronic subtalar instability is a disabling complication after acute ankle sprains. Currently, the literature describing the anatomy of the intrinsic subtalar ligaments is limited and equivocal which causes difficulties in diagnosis and treatment of subtalar instability. The purpose of this study is to assess the anatomical characteristics of the subtalar ligaments and to clarify some points of confusion. MethodsIn 16 cadaveric feet, the dimensions and locations of the subtalar ankle ligaments were assessed and measured. CT-scans before dissection and after indication of the footprints with radio-opaque paint allowed to generate 3D models and assess the footprint characteristics. ResultsThe cervical ligament (CL) had similar dimensions as the lateral ligaments: anterior length 13.9 ± 1.5 mm, posterior length 18.5 ± 2.9 mm, talar width 13.6 ± 2.2 mm, calcaneal width 15.8 ± 3.7 mm. The anterior capsular ligament (ACaL) and interosseous talocalcaneal ligament (ITCL) were found to be smaller structures with consistent dimensions and locations. ConclusionThis study identified consistent characteristics of the intrinsic subtalar ligaments and clarifies the local anatomical situation. The dimensions and footprints of the intrinsic ligaments of the subtalar joint suggest a more important role of the CL and ACaL in the stability of the subtalar joint. The results of this study are relevant to improve diagnostic tools and offer some guidelines when reconstructing the injured ligaments.

Characteristics of Iatrogenic Nerve Injury from Orthopedic Surgery Correlate with Time to Subspecialty Presentation.

Background:There is no current literature examining iatrogenic nerve injury resulting from orthopedic procedures across subspecialties and anatomic areas. This study uses a single peripheral nerve surgeon’s experience to investigate the variable time to presentation of adult patients with iatrogenic nerve injury after orthopedic surgery.Methods:A retrospective review of patients examined in Peripheral Nerve Clinic (PNC) from January 1, 2012, to April 1, 2018, at a single, private, university hospital was performed. Fifty-eight adult patients met inclusion criteria. Charts were reviewed to determine the index orthopedic procedure, peripheral nerve affected, clinical deficits, patient demographics, and time from injury to PNC presentation.Results:The average patient age was 51.2 years, and the average time to PNC referral was 10.9 months after the procedure that resulted in nerve injury. The orthopedic procedures included fracture fixation (13), joint arthroplasty (10) knee arthroscopy and ligament reconstruction (9), mass excision (9), shoulder arthroscopy (7), irrigation and debridement (2), removal of deep hardware (2), tendon procedures (2), trigger digit release (2), nerve decompression (1), and release of exertional compartment syndrome (1). Time from injury to PNC presentation was substantially shorter for patients with upper extremity versus lower extremity deficits (5.9 months vs 19.8 months; P = 0.0173) and for patients with motor nerve involvement versus those with isolated sensory nerve injury (4.5 months vs 24.3 months; P = 0.0164).Conclusions:Iatrogenic nerve injury is a risk across orthopedic subspecialties. Nerve injuries in the lower extremity and those with isolated sensory deficits have significantly delayed time to subspecialty presentation.

Syndesmosis Injury From Diagnosis to Repair: Physical Examination, Diagnosis, and Arthroscopic-assisted Reduction.

Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.

Are There Nationwide Socioeconomic and Demographic Disparities in the Use of Outpatient Orthopaedic Services?

Although disparities in the use of healthcare services in the United States have been well-documented, information examining sociodemographic disparities in the use of healthcare services (for example, office-based and emergency department [ED] care) for nonemergent musculoskeletal conditions is limited. This study was designed to answer two important questions: (1) Are there identifiable nationwide sociodemographic disparities in the use of either office-based orthopaedic care or ED care for common, nonemergent musculoskeletal conditions? (2) Is there a meaningful difference in expenditures associated with these same conditions when care is provided in the office rather than the ED? This study analyzed data from the 2007 to 2015 Medical Expenditure Panel Survey (MEPS). The MEPS is a nationally representative database administered by the Agency for Healthcare Research and Quality that tracks patient interactions with the healthcare system and expenditures associated with each visit, making it an ideal data source for our study. Differences in the use of office-based and ED care were assessed across different socioeconomic and demographic groups. Healthcare expenditures associated with office-based and ED care were tabulated for each of the musculoskeletal conditions included in this study. The MEPS database defines expenditures as direct payments, including out-of-pocket payments and payments from insurances. In all, 63,514 participants were included in our study. Fifty-one percent (32,177 of 63,514) of patients were aged 35 to 64 years and 29% were older than 65 years (18,445 of 63,514). Women comprised 58% (37,031 of 63,514) of our population, while men comprised 42% (26,483 of 63,514). Our study was limited to the following eight categories of common, nonemergent musculoskeletal conditions: osteoarthritis (40%, 25,200 of 63,514), joint derangement (0.5%, 285 of 63,514), other joint conditions (43%, 27,499 of 63,514), muscle or ligament conditions (6%, 3726 of 63,514), bone or cartilage conditions (8%, 5035 of 63,514), foot conditions (1%, 585 of 63,514), fractures (7%, 4189 of 63,514), and sprains or strains (18%, 11,387 of 63,514). Multivariable logistic regression was used to ascertain which demographic, socioeconomic, and health-related factors were independently associated with differences in the use of office-based orthopaedic services and ED care for musculoskeletal conditions. Furthermore, expenditures over the course of our study period for each of our musculoskeletal categories were calculated per visit in both the outpatient and the ED settings, and adjusted for inflation. After controlling for covariates like age, gender, region, insurance status, income, education level, and self-reported health status, we found substantially lower use of outpatient musculoskeletal care among patients who were Hispanic (odds ratio 0.79 [95% confidence interval 0.72 to 0.86]; p < 0.001), non-Hispanic black (OR 0.77 [95% CI 0.70 to 0.84]; p < 0.001), lesser-educated (OR 0.72 [95% CI 0.65 to 0.81]; p < 0.001), lower-income (OR 0.80 [95% CI 0.73 to 0.88]; p < 0.001), and nonprivately-insured (OR 0.85 [95% CI 0.79 to 0.91]; p < 0.001). Public insurance status (OR 1.30 [95% CI 1.17 to 1.44]; p < 0.001), lower income (OR 1.53 [95% CI 1.28 to 1.82]; p < 0.001), and lesser education status (OR 1.35 [95% CI 1.14 to 1.60]; p = 0.001) were also associated with greater use of musculoskeletal care in the ED. Healthcare expenditures associated with care for musculoskeletal conditions was substantially greater in the ED than in the office-based orthopaedic setting. There are substantial sociodemographic disparities in the use of office-based orthopaedic care and ED care for common, nonemergent musculoskeletal conditions. Because of the lower expenditures associated with office-based orthopaedic care, orthopaedic surgeons should make a concerted effort to improve access to outpatient care for these populations. This may be achieved through collaboration with policymakers, greater initiatives to provide care specific to minority populations, and targeted efforts to improve healthcare literacy. Level III, therapeutic study.

Stem cell-directed therapies for osteoarthritis: The promise and the practice.

Osteoarthritis (OA) is a disease of an entire synovial joint characterized by clinical symptoms and distortion of joint tissues, including cartilage, muscles, ligaments, and bone. Although OA is a disease of all joint tissues, it is a defined accessible compartment and is thus amenable to topical surgical and regenerative therapies, including stem cells. All tissues arise from stem progenitor cells, and the relative capacity of different cellular compartments, and different individuals, to renew tissues into adulthood may be important in the onset of many different degenerative diseases. OA is driven by both mechanical and inflammatory factors, but how these factors affect the proliferation and differentiation of cells into cartilage in vivo is largely unknown. Indeed, our very basic understanding of the physiological cellular kinetics and biology of the stem-progenitor cell unit of the articular cartilage, and how this is influenced by mechano-inflammatory injury, is largely unknown. OA seems, rather deceptively, to be the low-hanging fruit for stem cell therapy. Without the basic understanding of the stem cell and progenitor unit that generate and maintain articular cartilage in vivo, we will continue to waste opportunities to both prevent and manage this disease. In this review, we discuss the biology of chondrogenesis, the stem cell populations that support articular cartilage in health and disease, and future opportunities afforded through the translation of basic articular chondrocyte stem cell biology into new clinical therapies.