Progressive Degenerative Changes Research Articles

Factors associated with subjective knee joint stiffness in people with knee osteoarthritis: A systematic review.

Subjective knee stiffness is a common symptom in patients with knee osteoarthritis treated conservatively. However, the influencing factors or effects of knee joint stiffness are unknown. The aim of this study was to explore the factors associated with subjective knee stiffness in patients with knee osteoarthritis. The MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PEDro databases were searched in November 2021. Prospective or retrospective cohort studies were included. The methodological quality of the selected articles was assessed using the Scottish Intercollegiate Guidelines Network checklist. Twenty out of 1943 screened articles were included in this systematic review. Eighteen and two studies were rated as having acceptable and low quality, respectively. All the included studies measured subjective knee stiffness using the Western Ontario and McMaster Universities Osteoarthritis Index. The main findings were that worse preoperative subjective knee stiffness was associated with worse pain, subjective knee stiffness, and patient satisfaction at 1year after total knee arthroplasty. In addition, worse subjective knee stiffness was associated with future degenerative changes in the knee joint, such as joint space narrowing and osteophyte growth progression. Subjective knee stiffness may be associated with the prognosis after total knee arthroplasty and degenerative changes in the knee joint. Early detection and treatment of knee stiffness could lead to a good prognosis after total knee arthroplasty and prevent the progression of degenerative changes in the knee joint.

Cytomorphology of Human Bone Marrow Subjected to Prolonged Standing That Mimic Features of Myelodysplasia

Examination of bone marrow (BM) aspirate smears plays an important role in the diagnosis of patients with various hematological disorders particularly patients with myelodysplastic syndromes (MDS). In current practice, bone marrow samples are often collected by the clinical staff and sent to the laboratory after a variable period of delay. As a result bone marrow aspirate smears prepared from such samples are prone to show morphological changes which may mimic changes observed in MDS. To ascertain the type and extent of morphological changes that may occur due to prolonged standing we have studied BM aspirate specimens from patients diagnosed with various hematological disorders which have been left standing for 30 minutes to 24 hours. Bone marrow aspirate samples were obtained from the right or left posterior iliac crest from ten patients (seven men and three women, age range 50-70 years) presenting with various hematological disorders who underwent BM aspiration and BM trephine biopsy procedures as part of their diagnostic work-up. Clinical indications included pancytopenia (n=3), leukopenia (n=2), thrombocytopenia (n=2), thrombocytosis (n=1), lymphocytosis (n=2). The first draw of 2.0 ml of BM aspirate sample was obtained using a conventional BM aspiration needle and placed in a tube containing appropriate concentrations of dipotassium ethylenediamine tetraacetic acid (EDTA). A drop of marrow was then placed on each of the three glass slides and smears were made. The subsequent smears (three slides from each patient) were made from the collected samples at intervals of 30 minutes, one hour, two hours, four hours, eight hours, 12 hours, 18 hours, and 24 hours. The slides were stained with Romanowsky stain and examined under a light microscope. Five hundred consecutive cells in each slide were assessed and the number of cells exhibiting dysplastic changes was recorded. Striking morphological changes were observed between the smears made of fresh marrow as compared to marrows left standing for a "lengthy" period. No noticeable changes in the morphology of hematopoietic cells were observed in the films made from the marrow which was left standing for not more than an hour at room temperature and were not easily distinguishable from the films made immediately after its collection (fresh marrow). By two hours changes were discernible and by 18-24 hours they became striking, affecting the morphology of all the hematopoietic cells. Myeloid cells were affected uniformly; their nuclei stained more homogeneously than in the fresh marrow, the nuclear lobes became separated and the cytoplasmic margins appeared ragged or less well defined. Small vacuoles appeared in the cytoplasm and they became more prominent and more numerous and the quantity of cytoplasmic granules decreased the longer the samples stood. Nuclear hypolobulation (pseudo-Pelger-Huet anomaly) and bizarre nuclear shapes were also observed. Erythroid precursors were also affected by prolonged standing which led to progressive degenerative changes such as nuclear lobulation and budding, nuclear-cytoplasmic asynchrony, karyorrhexis, cytoplasmic vacuolation, and cytoplasmic blebs. Megakaryocytes were also adversely affected and showed morphological changes in the form of multi-nuclearity and less granulation. Some of the lymphocytes also showed similar changes, including cytoplasmic vacuolation. Some of the nuclei showed major budding giving the appearance of a nucleus with two or three lobes (clover leaf shape). Examination of a BM aspirate smear is a highly informative hematological tool at the hematologist's disposal. However, the preparation of a good quality BM aspirate smear and the aberrations in the morphology of hematopoietic cells caused by a delay in smear preparation have not been reported. Our findings demonstrate that the morphology of hematopoietic cells in the BM aspirate deteriorates considerably during prolonged standing. Some of the changes that were noted were akin to the alterations seen in patients with MDS. We recommend that whenever possible the smears should be made immediately after the sample is withdrawn from the patient. This approach helps ensure the ideal morphology of hematopoietic cells and their accurate analysis for hematological diagnosis and may even prevent misdiagnosis of conditions such as myelodysplastic syndromes.

Minimally invasive Oxford medial unicompartmental knee replacement in patients 50 years of age or younger

IntroductionThe aim of the present study was to assess clinical outcome and mid-term survivorship of mobile-bearing unicompartmental knee arthroplasty in patients 50 years of age or younger.MethodsThis study reports the results of 119 patients (130 knees) following mobile-bearing medial UKA. Primary indication was advanced osteoarthritis or avascular necrosis of the femoral condyle. The anterior cruciate ligament (ACL) as well as the collateral ligaments were functionally intact, the varus deformity was manually correctable and there was no evidence of osteoarthritis in the lateral compartment. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), American Knee Society Score and Functional Score (AKSS-O, AKSS-F), range of motion (ROM), Tegner activity score, University of California Los Angeles score (UCLA) and visual analogue scale for pain (VAS).ResultsThe survival rate was 96.6% at 6.5 years (95% CI 98.7–91.3%; number at risk: 56) and 91.7% (95% CI 96.7–80%; number at risk: 22) at 10 years for the endpoint device related revisions and 91.5% at 6.5 years (95% CI 95.4–84.5%; number at risk: 56) and 86.8% (95% CI 93–76.2%; number at risk: 22) at 10 years for the endpoint revision for any reason. Outcome scores, VAS and ROM showed significant improvements (p < 0.001). The mean OKS increased from 26.7 (standard deviation (sd): 7.2) preoperatively to 40.9 (sd: 7.6) at final follow-up, the mean AKSS-O from 48.3 (sd: 13.3) to 87.8 (sd: 14.4) and the mean ROM from 118° (sd: 16.7) to 125° (sd: 11.4). The radiological analysis revealed progression of degenerative changes in the lateral compartment in 39.6% of patients without affecting the functional outcome.ConclusionsMedial mobile-bearing UKA is a viable surgical treatment option in young patients with significant improvements in knee function and pain. Further follow-up is necessary to evaluate the long-term efficacy.Level of evidenceRetrospective cohort study, Level III.

Contrast-enhanced micro-computed tomography of compartment and time-dependent changes in femoral cartilage and subchondral plate in a murine model of osteoarthritis.

A lack of understanding of the mechanisms underlying osteoarthritis (OA) progression limits the development of effective long-term treatments. Quantitatively tracking spatiotemporal patterns of cartilage and bone degeneration is critical for assessment of more appropriately targeted OA therapies. In this study, we use contrast-enhanced micro-computed tomography (μCT) to establish a timeline of subchondral plate (SCP) and cartilage changes in the murine femur after destabilization of the medial meniscus (DMM). We performed DMM or sham surgery in 10-12-week-old male C57Bl/6J mice. Femora were imaged using μCT after 0, 2, 4, or 8 weeks. Cartilage-optimized scans were performed after immersion in contrast agent CA4+. Bone mineral density distribution (BMDD), cartilage attenuation, SCP, and cartilage thickness and volume were measured, including lateral and medial femoral condyle and patellar groove compartments. As early as 2 weeks post-DMM, cartilage thickness significantly increased and cartilage attenuation, SCP volume, and BMDD mean significantly decreased. Trends in cartilage and SCP metrics within each joint compartment reflected those seen in global measurements, and both BMDD and SCP thickness were consistently greater in the lateral and medial condyles than the patellar groove. Sham surgery also resulted in significant changes to SCP and cartilage metrics, highlighting a potential limitation of using surgical models to study tissue morphology or composition changes during OA progression. Contrast-enhanced μCT analysis is an effective tool to monitor changes in morphology and composition of cartilage, and when combined with bone-optimized μCT, can be used to assess the progression of degenerative changes after joint injury.

MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure.

Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above the fused spine have higher mobility and they are especially prone to accelerated disc degeneration. The purpose of our study is to investigate early disc degenerative changes two levels above a surgically fused lumbar spine segment and to compare MRI analyses after unilateral and bilateral TLIF procedures. Methods: A total of 117 patients were included in this cross-sectional retrospective single center study (after bilateral TLIF surgery: n = 91, and after unilateral TLIF: n = 26). In both groups, the average patient age was similar: 62.84 years (SD = 12.53) in the unilateral TLIF group and 60.67 years (SD = 11.89) in the bilateral TLIF group. On average, MRI was performed 2.5 years after surgery (SD = 2.09). The modified eight-level Pfirrmann grading system was used for the assessment of disc degeneration severity. Descriptive statistics and the Mann–Whitney test were used to show differences in the Pfirrmann grades regarding the after-surgery period and the patient age. The Wilcoxon signed-rank test results were used to display differences in the Pfirrmann grades before and after surgery. Results: The comparison of mean values, regardless of the type of surgery, shows that this mean value is on average higher in the first segment adjacent to the fused spine segment. The assessment of the intervertebral disc structure in BIL TLIF is higher in both the first and the second segment. Early disc degeneration progression is subtle yet detectable (UNI TLIF 9.28% vs. BIL TLIF 16.74%). The assessment of the intervertebral disc structure is on average lower in patients aged less than 50 years at time of surgery compared with patients aged more than 50 years in UNI TLIF, and higher in the BIL TLIF group, for both the first and the second segment. Conclusion: Patients who had undergone unilateral TLIF fusion surgery have a lower rate of early disc degenerative changes. Considering a significantly higher rate of progressive disc degenerative changes in the elderly with bilateral fusion surgery, extra caution is required in the selection of appropriate surgical technique.

Ocular manifestations of Hutchinson-Gilford-Progeria syndrome: A rare presentation

The Hutchinson-Gilford Progeria (HGP) syndrome is an exceptionally rare genetic condition characterized by premature and accelerated aging in children. It is demonstrated by developmental delay along with progressive degenerative changes of the integumentary, musculoskeletal, cardiac, and vascular systems. In this case report, we describe the ocular manifestations of Hutchinson-Gilford Progeria (HGP) syndrome of a 20-year-old Bangladeshi boy. The patient had the classic triad of prominent eyes, loss of eyebrows or madarosis and lagophthalmos, which are the most common ocular manifestations.He also developed dry eye, keratinized ocular surface, Meibomian gland dysfunction, vascularized cornea, symblepharon, corneal opacification, and cataract. He had several systemic manifeastations that included senile facies, prominent scalp veins, generalized alopecia with plucked bird appearance, and sclerodermatous changes.

Оценка микроциркуляции сетчатки методом окт-ангиографии в сравнительном анализе течения хориоидальной неоваскуляризации при патологической миопии и влажной возрастной макулярной дегенерации на фоне осевой миопии

Background. Optical coherence tomography angiography (OCTA) is a relevant modern method for visualizing choroidal neovascularization and may be promising in assessing retinal microcirculation in various fundus diseases. Aim. To conduct a comparative analysis of retinal microcirculation using OCTA in assessing the course of choroidal neovascularization (CNV) in pathological myopia (PM) and in wet age-related macular degeneration in combination with axial myopia (AMD + M) against the background of antiangiogenic therapy. Methods. The prospective study included 70 people (107 eyes, 70 of them with new-onset CNV). The patients were divided into 2 groups: the first group with pathological myopia (PM) – 47 people (47 eyes), the second group – with wet age-related macular degeneration in combination with medium and high axial myopia (AMD + M) with axial eyes length over 25.00 mm – 23 people (23 eyes). Results. In the PM group, in eyes with CNV, the values of the axial length of the eyes are significantly greater than in AMD + M (29.00 (27.98–29.66) and 25.42 (24.25–27.55) mm, respectively). Initial values of retinal microcirculation in the fovea did not differ between the groups. By the end of the observation period, the area and perimeter of the foveal avascular zone (FAZ) in PM increased significantly due to the progression of degenerative changes in the retina (FAZ area from 0.231 (0.214; 0.260) to 0.302 (0.247; 0.396) mm²; FAZ perimeter from 1.970 (1.897; 2.095) to 2.315 (1.997; 2.645) mm). In AMD + M these indicators significantly decreased due to a decrease in exudative changes in the retina (FAZ area from 0.268 (0.216; 0.398) to 0.191 (0.1345; 0.231) mm² , FAZ perimeter from 2.169 (1.879; 2.574) to 1.478 (1.437; 1.773) mm). Degenerative changes in the fovea and the periphery of the retina with a history of laser coagulation showed a strong direct correlation. Conclusion. OCTA reflects the distinctive features of retinal microcirculation in eyes with CNV in patients with PM and AMD + M at baseline and over time during antiangiogenic therapy. Key words: optical coherence tomography-angiography; OCTA; pathological myopia; age-related macular degeneration; choroidal neovascularization; anti-VEGF therapy; anti-angiogenic therapy.

THEORETICAL JUSTIFICATION OF MEANS OF PHYSICAL THERAPY OF PATIENTS WITH OSTEOCHONDROS OF THE LUMBAR SPINE

Osteochondrosis incidence statistics worldwide indicates that more people suffer from this disease 80% of the population. And more than half of these people unaware of his pathological condition because of the disease is in a latent period of its development. Due to the frequent duration of the disease in therapeutic, as well as a variety of therapeutic options, the treatment of lumbar vertebrae is a special challenge. Today, lumbar osteochondrosis is considered a serious disease that occurs in people of all ages and has a steady tendency to youth, more and more often the disease is diagnosed in people under 20 years of age. The basic treatment and the most widespread diseases on an osteochondrosis on department of a backbone are listed. Yes, according to the data statistics of the Ministry of Health of Ukraine, already in 2001 osteochondrosis spine was 2.91% of disability in diseases and injuries of the musculoskeletal system, and primary disability was 1.5 per 100 thousand population. Diagnosis and treatment of this severe form many scientific works are devoted to spinal lesions clinical, neurological and radiological orientation. The article analyzes the issue of the beneficial effects of physical therapy for patients with osteochondrosis of the lumbar spine. Osteochondrosis is a degenerative-dystrophic disease of the spinal discs of multifactorial origin, which subsequently provokes a change in the structure of the vertebrae and intervertebral discs, limiting their natural functionality. The vertebrae become less durable and more prone to injury, and the intervertebral discs lose some of their elasticity. This disease is characterized by dystrophy in the intervertebral discs. As you know, disks are designed to provide flexibility and mobility to our spine. When the disc becomes flat, depleted, then the vertebrae converge, compressing the vessels and nerve roots. Hence arise pain and swelling. This condition is accompanied by metabolic disorders in the soft tissues surrounding the spine. As a result of osteochondrosis, the risk of injuries and the emergence of serious diseases of the spine, in particular, protrusions and hernias of the intervertebral discs, Schmorl's hernia, scoliosis and others. Despite the fact that there are a huge number of methods for the treatment and rehabilitation of osteochondrosis of the spine, the spread of the disease both in Ukraine and in the world is constantly growing. Currently, the problem of prevention and treatment of these patients is one of the leaders in traumatology. Treatment of osteochondrosis is mainly carried out using conservative methods, which are aimed at eliminating pain, dysfunction of the spinal roots and preventing the progression of degenerative changes in the structure of the spine. Comprehensive conservative therapy includes: a regime of reducing the physical load on the spine, prosthetic and orthopedic devices, physiotherapy procedures and drugs aimed at muscle relaxation, elimination of edema and pain, as well as reflexology. Therapeutic exercise and massage also play an important role in complex treatment.

Neck pain: diagnostic and therapeutic features

Neck pain is a fairly common complaint when visiting a doctor, its occurrence frequency is 10–21% per year, and neck pain takes the 4th place among the causes of disability; almost 50% of patients continue to experience unpleasant sensations or repeated pain episodes. The elderly people are the most prone to the neck pain, this is associated with the progressive degenerative changes in the facet joints and intervertebral discs. However, reasons of this symptom can be of different kinds. Cervicalgia diagnosis is directed primarily to eliminate symptomatic pains associated with severe somatic pathology, immune diseases, infections and oncology. Comorbid diseases and risk factors can combine with each other causing the polyetiologic pain syndrome. Main steps of the cervicalgia diagnostic algorithm are the following: collection of complaints and anamnesis in detail, physical and neurological examination, and also use of visualization methods. Visualization and electrodiagnostic methods are not always informative for patients with chronic cervicalgia and in the degenerative etiology of the syndrome. MRI and the surgeon consultation must be recommended to patients with deteriorating neurological symptoms or with long-term constant pain. Conservative therapy of cervicalgia implies a combination of non-drug methods (compliance with regime, orthopedic treatment, leaf, physiotherapy, etc.) and pharmacotherapy. The last depends on the presence of a neuropathic component of pain and the duration of pain syndrome. The pain therapy with a nociceptive nature is usually implies a combination of non-steroidal anti-inflammatory remedies, non-opioid analgesics and muscle relaxants. Whereas neuropathic pains first-line preparations are tricyclic antidepressants, duloxetine, venlafaxine, pregabalin, gabapentine. The therapy success depends on the proper individual estimation of the pain factors, pain chronization and possible treatment complications. The therapeutic forecast of the acute nonspecific cervicalgia is usually good, but it becomes less predictable if the pain acquires chronic character.

Differential evolution and cost-maps for needle path planning in Baker’s cyst aspiration

Purpose: The Baker’s cysts appear within the popliteal fossa along with the progression of degenerative changes. Removal of its contents through aspiration is often a necessary complement to treatment at various stages of the development of gonarthritis. Methods: The paper presented a procedure for needle automatic needle path planning in cyst aspiration in transverse plane. The method was based on optimization and used a custom objective function, which utilized cost maps obtained from preprocessed, segmented images of the knee. The optimization was carried out with Differential Evolution. Furthermore, a preliminary sensitivity analysis was carried out. The obtained paths were compared to the reference paths proposed by an experienced surgeon. Results: The procedure was tested on 165 numerical simulations. In all of the obtained paths, the needle successfully avoided crucial objects, such as veins, arteries and nerves. Furthermore, the overall travel distance in the joint was also minimized. When compared to the reference from the surgeon, 90% of the paths were almost the same or only slightly different. Furthermore, the remaining 10% of the generated paths were viable but different. Conclusion: Based on the obtained results, the proposed solution could be a viable solution for planning the aspiration of Baker’s cyst.

Caecal Ligation and Puncture Develops Time Dependent Progression of Sepsis with Multiple Organs Damage and Vascular Dysfunctions in Mice

Sepsis is a dysregulated systemic inflammatory response syndrome that affects multiple organs. However, its effect on vital organs during different phases of sepsis is lacking. Present study was carried out to establish the time dependent changes in the vital organs during different phases of sepsis. Sepsis was induced by caecal ligation and puncture in mice. Sepsis significantly reduced RBC, Hb and WBC counts during both the phases whereas neutrophil count was increased during early phase. There was also a marked fall in lymphocyte count during late phase of sepsis which is an indicative of immunosuppressive state. Significant rise in the plasma ALT, AST, BUN and creatinine levels during early and late phases of sepsis were suggestive of liver and kidney dysfunctions which were further substantiated by histopathological examinations of these vital organs. Sepsis also produced a state of hypoproteinaemia with significant reduction in plasma albumin level. Significant progressive attenuation of vascular reactivity to nor-adrenaline and endothelial relaxation to acetylcholine were also observed in early to late phases of sepsis. However, sodium-nitroprusside-induced endothelium-independent relaxation was unaltered in both early ‘as well as late phase of sepsis. Histopathological examination of lungs, heart and intestine showed progressive degenerative changes which were more prominent with progression from early to late phase of sepsis. Based on the findings of the present study, it may be inferred that caecal ligation and puncture produces time-dependent progression of sepsis in mice affecting multiple organs.

Біомеханічні особливості ходьби хворих на коксартроз за даними системи GAITRite Частина 1. Геометричні параметри ходьби

Мета роботи: оцінити динаміку та особливості геометричних параметрів ходьби пацієнтів до тотального протезування кульшового суглоба та після нього при збереженні та зменшенні довжини плеча дії абдукторів (ДПДА) стегна після протезування у віддаленому періоді спостереження. Матеріали та методи. Аналізували геометричні параметри ходьби: довжина кроку (Step Length) або короткий крок; довжина довгого кроку (Stride Length); ширина опори (H-H Base Support) та величини кута розвороту стопи (Toe In/Toe Out), що були отримані за допомогою системи GAITRite. Було проаналізовано параметри ходьби 46 хворих на коксартроз. До І групи увійшло 26 хворих, у яких рентгенометрично після протезування кульшового суглоба довжина плеча дії абдукторів стегна не змінилася або різниця не перевищувала 10 мм у бік зменшення. До ІІ групи потрапили хворі (20 пацієнтів), у яких після протезування рентгенометрично було виявлено зменшення ДПДА стегна більше ніж на 10 мм. Обстеження проводили до протезування та у віддалені періоди спостереження — через 1–1,5 та 5–7 років після протезування. Результати. До протезування групи за параметрами ходьби були однаковими. Протезування у більшості хворих приводило до відновлення параметрів ходьби, хоча у більшості випадків нормалізація параметрів і не досягала середньостатистичної референтної норми, але практично відновлювало симетричність ходьби. Через 5–7 років у хворих спостерігали погіршення параметрів ходьби, а у деяких хворих погіршення показників досягало значень до ендопротезування. Особливо це було помітно у хворих зі зменшеною довжиною дії плеча абдукторів стегна. У цих хворих відбувалося постійне перенапруження означених м’язів, що у віддаленому періоді призводить до розвитку чи прогресування дегенеративних змін в інших суглобах нижньої кінцівки — колінному суглобі, гомілково-ступневому суглобі та поперековому відділі хребта, що й обумовлює погіршення ходьби у віддаленому періоді спостереження. Висновки. Проведений аналіз показав, що у хворих зі зменшенням довжини плеча дії абдукторів стегна внаслідок тривалого однобічного перенапруження м’язів протезованої кінцівки у віддаленому періоді спостерігається втрата опорності та надбаних після протезування навичок ходьби.

Comparison of Gait Symmetry and Joint Moments in Unilateral and Bilateral Hip Osteoarthritis Patients and Healthy Controls.

Patients with unilateral hip osteoarthritis show a characteristic gait pattern in which they unload the affected leg and overload the unaffected leg. Information on the gait characteristics of patients with bilateral hip osteoarthritis is very limited. The main purposes of this study were to investigate whether the gait pattern of both legs of patients with bilateral hip osteoarthritis deviates from healthy controls and whether bilateral hip osteoarthritis patients show a more symmetrical joint load compared to unilateral hip osteoarthritis patients. In this prospective study, 26 patients with bilateral hip osteoarthritis, 26 patients with unilateral hip osteoarthritis and 26 healthy controls were included. The three groups were matched for gender, age and walking speed. Patients were scheduled for a unilateral total hip arthroplasty on the more affected/more painful side. All participants underwent a three-dimensional gait analysis. Gait kinematics and gait kinetics of patients and controls were compared using Statistical Parametric Mapping. Corrected for speed, the gait kinematics and kinetics of both legs of patients with bilateral hip osteoarthritis differed from healthy controls. Bilateral patients had symmetrical knee joint loading, in contrast to the asymmetrical knee joint loading in unilateral hip osteoarthritis patients. The ipsilateral leg of the bilateral patients could be included in studies in addition to unilateral hip osteoarthritis patients as no differences were found. Although patients with bilateral hip osteoarthritis show more symmetrical frontal plane knee joint moments, a pathological external knee adduction moment in the second half of stance was present in the ipsilateral leg in patients with unilateral and bilateral hip osteoarthritis. The lateral adjustment of the knee adduction moment may initiate or accelerate progression of degenerative changes in the lateral compartment of the knee.

A Review on Diagnosis and Management of Cervical Spondylosis

Cervical spondylosis is a term that encompasses a wide range of progressive degenerative changes that affect all components of the cervical spine (i.e., intervertebral discs, facet joints, Luschka joints, flava ligaments, and laminae). It is a natural aging process and occurs in most people after the age of five. Most people with radiographic spondylotic changes in the cervical spine remain asymptomatic, and 25% of those under 40, 50% of those over 40, and 85% of those over 60 show some evidence of degenerative changes , including changes in the environment. Uncovertebral joints, facet joints, posterior longitudinal ligament (PLL) and yellow ligament lead to narrowing of the spinal canal and intervertebral foramina. As a result, the spinal cord, spinal vasculature, and nerve roots can become compressed, leading to the three clinical syndromes that occur with cervical spondylosis: axial neck pain, cervical myelopathy, and cervical radiculopathy. Cervical spondylosis is usually diagnosed for clinical reasons only, but imaging is also required. Treatment for cervical spondylosis can be medical or surgical, depending on whether the patient has symptoms of myelopathy, radicular pain, or neck pain.

P11 Multiple insufficiency fractures in rheumatoid arthritis

Abstract Case report - Introduction Rheumatoid arthritis (RA) is an autoimmune inflammatory arthropathy with systemic manifestations. It is 4-times more common in females. RA is recognised to induce bone loss and decrease in bone mineral density (BMD). Management may include corticosteroids (CS) for new presentations, acute flares, and more rarely longer-term management, which increases bone fragility. Patients are at 30—50% increased risk of developing osteoporosis with a 30% increase in fracture risk. This risk rises with the level of persistent disease inflammation. We present a case of a lady with longstanding RA, who sustained multiple bone fractures without significant osteoporosis on bone density scanning. Case report - Case description Our patient is a 64-year-old headteacher who took early retirement due to reduced mobility after 20 years of seropositive RA. She had received multiple disease modifying drugs (DMARDs) and biologics therapies, requiring repeated alterations primarily due to treatment failure. She was commenced on alendronic acid due to osteopaenia of the hip but 2 years later sustained a fractured neck of femur and was switched to risedronate. A year later she presented with acutely painful and swollen right foot and ankle without history of trauma. X-rays showed progressive degenerative change whilst inflammatory markers were normal. Ultrasound demonstrated sub-clinical synovitis. Her medication was optimised but the ankle swelling persisted, rendering her wheelchair-reliant. MRI revealed multiple stress fractures involving calcaneum, talus and 5th proximal phalanx. She was treated with 16 weeks of an Aircast boot. An old right upper medial tibial fracture was also identified. Repeat dual energy X-ray absorptiometry (DEXA) scan showed osteopaenia but with improvement from the previous scan (T score of -2.1 total hip and -1.6 lumbar vertebra). She smoked 1 cigarette a day, did not drink alcohol and there was no parental history of fractures. No evidence of malabsorption or endocrine disorder was identified. Unusually, she had received tamoxifen in her late 20s for cancer prevention based on breast fibroadenosis and she experienced early menopause aged 36 years. Inflammatory markers, calcium, parathyroid hormone, and immunoglobulins were normal. Vitamin D3 levels were insufficient at 40.3 nmol/l and replacement was initiated, following which she was switched to intravenous zoledronic acid. After one infusion of zolendronate, she twisted her right ankle and sustained a new malleolar fracture. She was converted to 6-monthly denosumab injections along with calcium and vitamin D, which has been continued. Her RA remains active, and she has recently commenced JAK2 inhibitors. Case report - Discussion Inflammatory arthropathies such as RA predispose to significant morbidity and disability. An earlier age of diagnosis poses a longer inflammatory response in body, with a higher incidence of bone health complications. A treat-to-target strategy in RA aids optimal disease management and reduces fracture risk. Studies have shown the risk of osteoporosis in RA is not just disease dependent but also affected by certain medications. Treatment challenges arise when a patient sustains fracture despite a BMD above osteoporosis risk criteria, leading us to consider other variables. She was further investigated for secondary causes of osteoporosis, including endocrine causes, and was found to be vitamin D insufficient, which was replaced prior to further antiresorptive treatment. Our case also highlights a diagnostic dilemma given that our patient presented with a single swollen joint assumed to be due to active RA. Multiple insufficiency fractures were only identified after MRI was performed. As per EULAR criteria, our patient had difficult to treat RA with a long disease duration. She showed intolerance to a several DMARDs and treatment failure with multiple biologic therapies. She had required local joint injections and repeated short courses of oral steroids. These factors are likely to have played a considerable role in her fracture development. RA is an independent risk factor for fracture in both men and women with disease duration and CS use being important clinical variables. Bisphosphonates are considered vital in fracture risk reduction. The compliance is an important factor for both primary and secondary prevention of fracture. They are associated with decreased bone remodelling and have been well studied for atypical femoral fractures; however, whether there is any link with stress fractures in the feet requires further studies. Long-term use (&amp;gt;5years) hasn’t shown to be beneficial in preventing hip fractures. Case report - Key learning points

ACL reconstruction, medial meniscus repair and high tibial osteotomy done as a single stage procedure in a case of neglected ACL and partial medial meniscus tear with a subsequent varus knee: A case report

A long standing anterior cruciate ligament (ACL) tear causes progressive degenerative changes in the knee. This leads to secondary meniscal lesions, cartilage degenerative changes and subsequent varus angulation.A 27 year old male footballer presented to us with a traumatic right knee pain and swelling with recurrent instability, since 8 years. On examination there was knee laxity with an obvious varus deformity of the right leg. Radiographs showed medical compartment osteoarthritis and MRI was suggestive of a chronic ACL and medial meniscus tear. A single step salvage procedure of ACL reconstruction, medial meniscus repair and valgus producing high tibial osteotomy (HTO) was done for this patient. Post operatively there was no knee laxity and instability. At one year follow up, the patient had a satisfactory outcome with a painless and complete knee range of motion and had full weight bearing.In this case report we have shown how a single step salvage procedures with biological reconstructions can be done for patients with chronic ACL and medial meniscus tear patients with varus angulation, with a good outcome. Hence, simultaneous reconstructions of the ACL and medial meniscus with HTO can be used as a novel management technique to delay arthroplasty in young patients with unstable arthritic knees.

Validity of Skeletal Muscle Ultrasound in Assessment of Suspected Limb Girdle Muscular Dystrophy Patients

Abstract Background Limb-girdle muscular dystrophies (LGMDs) are a clinically and genetically heterogeneous group of disorders characterized by progressive muscle weakness and degenerative muscle changes. Studies have shown that ultrasound can be useful both for diagnosis and follow-up of LGMDs patients. Objectives This study aims to measure the sensitivity and the specificity of muscle ultrasound in assessment of suspected limb girdle muscular dystrophy patients. Subjects and Methods This cross-sectional descriptive study was conducted on Fifty-five patients with suspected LGMD from neuromuscular unit, myology clinic, Ain Shams University hospitals and eight healthy subjects. Age was above 2 years. Both sexes were included in the study. They underwent real-time B-mode ultrasonography performed with using Logiq p9 General Electric ultrasound machine and General Electric 7-11.5 MHZ linear array ultrasound probe. All ultrasound images have been obtained and scored by a single examiner and muscle echo intensity was visually graded semiquantitative according to Heckmatt's scale. The examiner was blinded to the muscle biopsy results and clinical evaluations. Results Statistical analysis revealed that the diagnostic performance of muscle US (Heckmatt’s score) in LGMD is most sensitive when calculated in all examined upper limb and lower limb muscles, followed by lower limb muscles alone. US of upper limb was found to be the least sensitive. Conclusions Muscle ultrasound is a practical and reproducible and valid tool that can be used in assessment of suspected LGMD patients.

VALUE OF MUSCLE MAGNETIC RESONANCE IMAGING IN COMPARISON WITH MUSCLE BIOPSY FOR DIFFERENTIATING VARIOUS TYPES OF LGMD

Abstract Background Limb Girdle Muscular Dystrophies (LGMD) are a clinically and genetically heterogeneous group of disorders which share progressive muscle weakness and degenerative muscle changes involving the shoulder and pelvic girdle muscles. The diagnostic approach is based on a comprehensive clinical history, a thorough physical examination, laboratory data, electrophysiological investigations, and particularly the histologic and immunoanalysis of a muscle biopsy, followed by a genetic confirmation of the diagnosis. Magnetic Resonance Imaging (MRI) complements clinical examination by delineating characteristic disease specific patterns of muscle involvement which helps in differentiation of individual LGMD subtypes. It is used to demonstrate the severity and distinguish between dystrophic and non-dystrophic diseases. Objective Identification of the value, sensitivity of Muscle MRI to be used as a tool for diagnosis and differentiation of patients with LGMD and as a guidance for the needed immunological and genetic studies to confirm their diagnosis. Patients and methods This study was conducted on 71 patients with clinical criteria of LGMD diagnosed by clinical, laboratory and dystrophic muscle biopsy from Myology Clinic and Neuromuscular Unit, Ain Shams University Hospitals, Muscle MRI was done blind from the results of muscle biopsy, immunohistochemistry and genetic studies. MRI muscles was done at mid-thigh, mid-leg levels. MRI Equipment was 1.5 Tesla in the Radiology department, Ain Shams University Hospitals (T1, Fat subtraction). MRI T1 images were obtained and muscle fatty infiltration in every single muscle was graded on a 5 point rating scale. Results The results showed that the diagnostic performance of muscle MRI in LGMD is most sensitive when calculated in examined Thigh muscles, followed by Leg muscles in comparison with muscle biopsy. Conclusion Muscle MRI is a practical, reproducible and valid tool that can be used in assessment of suspected LGMD patients.

Reproductive Aging in Caenorhabditis elegans: From Molecules to Ecology

Aging animals display a broad range of progressive degenerative changes, and one of the most fascinating is the decline of female reproductive function. In the model organism Caenorhabditis elegans, hermaphrodites reach a peak of progeny production on day 2 of adulthood and then display a rapid decline; progeny production typically ends by day 8 of adulthood. Since animals typically survive until day 15 of adulthood, there is a substantial post reproductive lifespan. Here we review the molecular and cellular changes that occur during reproductive aging, including reductions in stem cell number and activity, slowing meiotic progression, diminished Notch signaling, and deterioration of germ line and oocyte morphology. Several interventions have been identified that delay reproductive aging, including mutations, drugs and environmental factors such as temperature. The detailed description of reproductive aging coupled with interventions that delay this process have made C. elegans a leading model system to understand the mechanisms that drive reproductive aging. While reproductive aging has dramatic consequences for individual fertility, it also has consequences for the ecology of the population. Population dynamics are driven by birth and death, and reproductive aging is one important factor that influences birth rate. A variety of theories have been advanced to explain why reproductive aging occurs and how it has been sculpted during evolution. Here we summarize these theories and discuss the utility of C. elegans for testing mechanistic and evolutionary models of reproductive aging.

The Use of Infrapatellar Fat Pad-Derived Mesenchymal Stem Cells in Articular Cartilage Regeneration: A Review.

Cartilage is frequently damaged with a limited capacity for repair. Current treatment strategies are insufficient as they form fibrocartilage as opposed to hyaline cartilage, and do not prevent the progression of degenerative changes. There is increasing interest in the use of autologous mesenchymal stem cells (MSC) for tissue regeneration. MSCs that are used to treat articular cartilage defects must not only present a robust cartilaginous production capacity, but they also must not cause morbidity at the harvest site. In addition, they should be easy to isolate from the tissue and expand in culture without terminal differentiation. The source of MSCs is one of the most important factors that may affect treatment. The infrapatellar fat pad (IPFP) acts as an important reservoir for MSC and is located in the anterior compartment of the knee joint in the extra-synovial area. The IPFP is a rich source of MSCs, and in this review, we discuss studies that demonstrate that these cells have shown many advantages over other tissues in terms of ease of isolation, expansion, and chondrogenic differentiation. Future studies in articular cartilage repair strategies and suitable extraction as well as cell culture methods will extend the therapeutical application of IPFP-derived MSCs into additional orthopedic fields, such as osteoarthritis. This review provides the latest research concerning the use of IPFP-derived MSCs in the treatment of articular cartilage damage, providing critical information for the field to grow.