Orthopedic Therapy Research Articles

Improving translation success of cell-based therapies in orthopaedics.

There is a clear discrepancy between the growth of cell therapy and tissue engineering research in orthopaedics over the last two decades and the number of approved clinical therapies and products available to patients. At the 2015 annual meeting of the Orthopaedic Research Society, a workshop was held to highlight important considerations from the perspectives of an academic scientist, clinical researcher, and industry representative with the aim of helping researchers to successfully translate their ideas into clinical and commercial reality. Survey data acquired from workshop participants indicated an overall positive opinion on the future potential of cell-based therapies to make a significant contribution to orthopaedic medicine. The survey also indicated an agreement on areas requiring improvement in the development of new therapies, specifically; increased support for fundamental research and education and improved transparency of regulatory processes. This perspectives article summarises the content and conclusions of the workshop and puts forward suggestions on how translational success of cell-based therapies in orthopaedics may be achieved.

Redefining Role of Manual Therapy in Orthopedics and Rheumatology

We are probably hearing about this in some form over the past few years, but the reality of the problem is striking when a patient is sitting in your clinic. I evaluated a young software engineer in my office outside of Coimbatore who was suffering from low back pain for past few years which he developed after joining the software industry. The history suggested a sciatic pain radiating to the lower back, who had multiple consultations and did quite a number of MRI’s which showed no red flags with multiple disc bulges and was suggested physical therapy trail of four weeks which fails he may require a surgery. The physical examination confirmed the diagnosis with neural sensitivity (non-disruptive syndrome). Our discussion turned toward the manual therapy, movement impairment and reestablishing motor control of the spine and the rehabilitation process considering the effect of disc pathology and neural sensitivity.

Development of a new assessment rubric for a short-answer test of clinical reasoning in orthopaedic manual physical therapy (OMPT)

Development of a new assessment rubric for a short-answer test of clinical reasoning in orthopaedic manual physical therapy (OMPT)

Promoting evidence-based practice in orthopaedic manual physical therapy education: an approach to developing competence in instructors and learners

Promoting evidence-based practice in orthopaedic manual physical therapy education: an approach to developing competence in instructors and learners

Platelet-rich plasma in orthopedic therapy: a comparative systematic review of clinical and experimental data in equine and human musculoskeletal lesions.

BackgroundThis systematic review aimed to present and critically appraise the available information on the efficacy of platelet rich plasma (PRP) in equine and human orthopedic therapeutics and to verify the influence of study design and methodology on the assumption of PRP’s efficacy. We searched Medline, PubMed, Embase, Bireme and Google Scholar without restrictions until July 2013. Randomized trials, human cohort clinical studies or case series with a control group on the use of PRP in tendons, ligaments or articular lesions were included. Equine clinical studies on the same topics were included independently of their design. Experimental studies relevant to the clarification of PRP’s effects and mechanisms of action in tissues of interest, conducted in any animal species, were selected.ResultsThis review included 123 studies. PRP’s beneficial effects were observed in 46.7% of the clinical studies, while the absence of positive effects was observed in 43.3%. Among experimental studies, 73% yielded positive results, and 7.9% yielded negative results. The most frequent flaws in the clinical trials’ designs were the lack of a true placebo group, poor product characterization, insufficient blinding, small sampling, short follow-up periods, and adoption of poor outcome measures. The methods employed for PRP preparation and administration and the selected outcome measures varied greatly. Poor study design was a common feature of equine clinical trials. From studies in which PRP had beneficial effects, 67.8% had an overall high risk of bias. From the studies in which PRP failed to exhibit beneficial effects, 67.8% had an overall low risk of bias.ConclusionsMost experimental studies revealed positive effects of PRP. Although the majority of equine clinical studies yielded positive results, the human clinical trials’ results failed to corroborate these findings. In both species, beneficial results were more frequently observed in studies with a high risk of bias. The use of PRP in musculoskeletal lesions, although safe and promising, has still not shown strong evidence in clinical scenarios.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-015-0403-z) contains supplementary material, which is available to authorized users.

A cross-sectional postal survey of musculoskeletal physiotherapists’ opinions towards the published theory of cervical spine manipulation

AbstractPurposeSurvey the opinions of physiotherapists on the published theory of cervical spine manipulation, to assist the physiotherapist in achieving informed consent in advance of planned orthopaedic manual therapy interventions.MethodA self-administered postal survey was validated, and then sent to 325 physiotherapists working in musculoskeletal practices in Dorset and Hampshire, United Kingdom.ResultsFour articles presenting theories of cervical manipulation were found in the search of literature published during 2008–2011. Nine theories from the literature are presented within the survey: four theories are accepted by more than 50% of the sample.ConclusionsWhen a patient asks how manipulation works, before any of the theories are offered to the patient, it can be elucidated that the theoretical base underpinning every aspect of cervical manipulation is still underdeveloped. This study finds popular theory accepted by over 70% of physiotherapists, namely that spinal manipulation activates mechanore...

Efficacy Report of Lumbar Spinal Stenosis of 90 Cases Based on Adjusting the Curvature of the Spine with Hyperextension Traction

Objective: To observe the clinical effect of the treatment of lumbar spinal stenosis disease by adjusting the curvature of the spine based on orthopedic spinal therapy. Method: Curvature adjustments by four-direction, spinal orthopedic manipulation and functional exercise were applied to different patterns of lumbar spinal stenosis. Results: The overall response rate was 98.9%, including a clinical recovery rate of 83.3%, response rate of 13.3%, marked effectiveness rate of 2.2% and failure rate of 1.1%. The spinal curvatures were improved in 81% of the patients. The 3-month follow-up showed that the “excellent” and “very good” rates of the health status and signs & symptoms improvement were 98.8% and 96.4% respectively. Conclusion: The principal objective of curvature adjustment and Chinese orthopedic manipulation is to adjust the lumbar curvature. Functional exercise is positively correlated with restoration and stability of the spinal curvature. The follow-up indicates that regular exercise is essential to facilitate the therapeutic efficacy.

Short-term effects produced by rapid maxillary expansion and facemask therapy in Class III patients with different vertical skeletal relationships

To evaluate the dentoskeletal short-term effects of rapid maxillary expansion and facemask therapy (RME/FM) in a sample of Class III patients showing different vertical skeletal relationships. Seventy-nine patients (35 females and 44 males) having Class III malocclusion were consecutively treated using RME/FM therapy with application of the protraction force in a downward and forward direction and inclination of about 30° to the occlusal plane. All patients were evaluated at the beginning (T1; mean age, 7.7 years) and at the end (T2; mean age, 9.2 years) of orthopedic therapy and divided into three groups according to their vertical skeletal relationships: normal group (NG), hypodivergent group (HypoG), and hyperdivergent group (HyperG). Statistical comparisons between the three groups were performed on the starting forms (T1), the final forms (T2), and the treatment changes (T1-T2) using the ANOVA with Tukey's post hoc tests. Favorable modification in terms of maxillary advancement (changes in SNA ranging from 1.4° to 1.8°) and intermaxillary sagittal skeletal relationships (changes in Wits appraisal ranging from 2.5 mm to 3.5 mm) were recorded in all groups. The three groups showed no statistically significant differences in changes in either sagittal or vertical skeletal variables. The various vertical skeletal features do not influence the short-term outcomes of RME/FM therapy.

3 boyutlu görüntüleme tekniği kullanılarak nazoalveoler şekillendirme ve cerrahi sonrasında tedavi sonuçlarının değerlendirilmesi: olgu sunumu

Cleft lip and palate is the most common congenital anomaly in facial structures. In our country, this anomaly was encountered 1/800 ratio. Pre-operative orthopedic therapy is widely applied to the individuals with cleft lip and palate. The aim of this case report is to evaluate the treatment results of an infant with bilateral cleft lip and palate in terms of changes obtained after preoperative nasoalveolar molding and surgery using three-dimensional imaging technique

Evaluation of Osseointegration around Tibial Implants in Rats by Ibandronate-Treated Nanotubular Ti-32Nb-5Zr Alloy.

Materials with differing surfaces have been developed for clinical implant therapy in dentistry and orthopedics. This study was designed to evaluate bone response to titanium alloy containing Ti-32Nb-5Zr with nanostructure, anodic oxidation, heat treatment, and ibandronate coating. Rats were randomly assigned to two groups for implantation of titanium alloy (untreated) as the control group and titanium alloy group coated with ibandronate as the experimental group. Then, the implants were inserted in both tibiae of the rats for four weeks. After implantation, bone implant interface, trabecular microstructure, mechanical fixation was evaluated by histology, micro-computed tomography (μCT) and the push-out test, respectively. We found that the anodized, heat-treated and ibandronate-coated titanium alloy triggered pronounced bone implant integration and early bone formation. Ibandronate-coated implants showed elevated values for removal torque and a higher level of BV/TV, trabecular thickness and separation upon analysis with μCT and mechanical testing. Similarly, higher bone contact and a larger percentage bone area were observed via histology compared to untreated alloy. Furthermore, well coating of ibandronate with alloy was observed by vitro releasing experiment. Our study provided evidences that the coating of bisphosphonate onto the anodized and heat-treated nanostructure of titanium alloy had a positive effect on implant fixation.

Occupational therapy in orthopaedics: An alternative to hip precautions?

Occupational therapy in orthopaedics: An alternative to hip precautions?

Application of Computer Digital Technology in Orthopedic Treatment

The application of computer digital technology in orthopedic treatment is studied. In the field of orthopedic therapy, computer digital technology need to be applied to process of collecting the lesion area to provide the basis for clinical diagnosis and treatment. This paper presents an orthopedic lesion region image segmentation method based on linear analysis algorithm, this method can be adopted to segment orthopedic lesion region effectively, precise location and lesion extent of lesion area obtained to provide data to support the clinical diagnosis. Experimental results show that orthopedic lesion area image segmentation method based on​​ linear analysis algorithm applied to the process of orthopedic treatment, can improve the cure rate efficiently.

Strategy of therapy for bone metastases of cancer

Recently, the importance of cancer-induced bone disease has been recognized. Bone metastases of cancer usually do not have major impacts on prognosis of patients, but skeletal-related events (SRE) markedly aggravate QOL of patients. For bone metastases, multi-disciplinary approaches including drug therapy, orthopedic therapy, radiation therapy, or intervention therapy are necessary. As drug therapy, bone-specific drugs that inhibit osteoclasts such as bisphosphonates, anti-RANKL antibody denosumab have been developed and have shown to decrease SRE and improve QOL. Further development of new bone-specific drugs is ongoing.

Caracterización de los estadios de maduración esquelética y la maduración sexual en niños entre 8-13 años

Introducción: el objetivo de esta investigación fue estudiar las características de los estadios de maduración sexual y esquelética en un grupo de niños de Medellín. Métodos: estudio descriptivo longitudinal prospectivo. Se observaron 33 pacientes, 18 hombresy 15 mujeres, entre los 8 y 13 años; sanos, evaluados con parámetros de maduración esquelética, según Hägg y Taranger; de maduración sexual, según Tanner, y medidas antropométricas de talla y peso. Se realizaron mediciones cada seis meses durante treinta meses. Resultados: se encontraron asociaciones estadísticamente significativas entre la maduración esquelética y la sexual, con la edad, el peso la talla; dimorfismo sexual con respecto a la edad de iniciación de la pubertad. Los incrementos de talla y peso del periodo inmediatamente anterior al inicio de la pubertad fueron iguales o mayores a los registrados en algunas etapas del periodo puberal evaluado. Conclusiones: el desarrollo esquelético, representado por los incrementos en talla y peso en el periodo prepuberal, es semejante a los del periodo puberal evaluado. Estas observaciones sustentan la pertinencia de instaurar la terapia ortopédica en un periodo anterior al puberal. Sin embargo, dadas las características de la muestra, se recomienda validar estos resultados con una muestra más representativaDOI: http://dx.doi.org/10.16925/od.v10i18.719

The evidence-based principles of negative pressure wound therapy in trauma & orthopedics.

Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.

Effect of Ultrasound Combined with Conventional Therapy on Neck Pain, Function, and Disability in Patients with Cervical Spondylosis: A Randomized Placebo-Controlled Trial

AbstractObjective: The purpose of this study was to evaluate the effect of continuous ultrasound [US] compared with placebo US combined with conventional physiotherapy program for patients with cervical spondylosis.Methods: This was a randomized placebo-controlled trial. Patients, diagnosed with cervical spondylosis, were randomly assigned to one of two groups in an orthopedic physical therapy clinic: a group that received electrotherapy, exercise, hot packs, and therapeutic US [True US group] and a group that received electrotherapy, exercise, hot packs, and sham US [Sham US group]. Patients were treated, on average, three times per week for 4 weeks. Outcome measurements were collected at baseline and after 4 weeks using the Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index.Results: Analysis of variance showed that both groups had improved regarding Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index [p < 0.05]. There was no signif...

Manual therapy in the treatment of ankle hemophilic arthropathy. A randomized pilot study

Purpose: Although physiotherapy has demonstrated effectiveness in preventing ankle arthropathy compared to prophylaxis treatment from early ages, there have been no conclusive studies examining physiotherapy intervention once hemophilic arthropathy of the ankle has been established. The aim of this study was to evaluate the effectiveness of two physiotherapy interventions, in patients with hemophilic arthropathy of the ankle that had not been operated on previously. Method: Nine patients with hemophilia (mean age of 35.7 SD 11.9 years) were randomized to a mobilization group (n = 5) and manual therapy group (n = 4). The two physiotherapy interventions were: (1) passive mobilization and stretching; and (2) manual orthopaedic therapy, both with proprioception training. The study lasted for six weeks, with two sessions a week. Ankle mobility and pain perception, lower limb proprioception and quality of life were the outcome measures. Results: Both treatments improved all ankle movements (p < 0.05). The treatment with passive mobilizations also improved the perception of pain and quality of life. Six months later, both groups still had improved articular movement with the exception of plantar flexion and continued to perceive less pain. Conclusions: Both physiotherapy interventions improved the range of movement and lessened pain in patients with ankle arthropathy. No haemarthrosis was recorded during treatment or during the follow-up period.

Oxygen is a critical parameter for chondrogenic differentiation of human umbilical cord blood mesenchymal stem cell in 3D-cultures

Oxygen is a critical parameter for chondrogenic differentiation of human umbilical cord blood mesenchymal stem cell in 3D-cultures

Regeneration of Periosteum by Human Bone Marrow Stromal Cell Sheets

The presence of a functional periosteum accelerates healing in bone defects by providing a source of progenitor cells that aid in repair. We hypothesized that bone marrow stromal cell (BMSC) sheets could be used to engineer functional periosteal tissues. BMSCs were cultured to hyperconfluence and produced sufficient extracellular matrix to form robust tissue sheets. The sheets were wrapped around calcium phosphate pellets and implanted subcutaneously in mice for 8 weeks. Histologic comparisons were made between calcium phosphate samples with and without BMSC sheet wraps. Bone and periosteum formation were analyzed through tissue morphology and tissue-specific protein expression. Calcium phosphate pellets wrapped in BMSC sheets regenerated a bone-like tissue, but pellets lacking the cell sheet wrap did not. The bone-like tissue seen on the calcium phosphate scaffolds wrapped with the BMSC sheets was enclosed within a periosteum-like tissue characterized morphologically and through expression of periostin. These data indicate that cell sheet technology has potential for regenerating a functional periosteum-like tissue that could aid in future orthopedic therapy.

Vertebral body erosion in a 27-year old female 12 years after thoracic endovascular aortic repair

Introduction: Twelve years after severe blunt chest trauma a 27-year old female presented with persisting, medically refractory back pain. The patient had been one of the first adolescents to be treated by thoracic endovascular aortic repair (TEVAR) for acute rupture of the aortic isthmus-covering the distal aortic arch down to the thoracic level of Th7. First symptoms of back pain occurred 5 years after TEVAR and became progressively severe and she required medical and orthopedic therapy.