Soft Tissue Pathology Research Articles

“Exploring The Nexus”: Chronic musculoskeletal pain in diabetic vs non-diabetic population

IntroductionDiabetes-mellitus (DM) has transcended the boundaries and affected populations across globe, it predisposes individual to stiffness and musculoskeletal-pain due to accumulation of glycation-end-products. Musculoskeletal-pain is a common yet frequently neglected complication. Pain mechanisms have been categorized as nociceptive, neuropathic, nociplastic, and idiopathic. Four criteria were put by Kosek-et-al to identify nociplastic pain that affects the musculoskeletal-system. Study aimed to evaluate prevalence of chronic musculoskeletal (cMSK) pain and its association with diabetes and glycaemic control and to evaluate comorbid conditions of cMSK pain. Methods and materialsA prospective case-control study was conducted at a level-1-tertiary-care-facility. Patients with type-2 DM above 30-years-age who visited outpatient department participated in the study (study group). Age-matched equal number of healthy individuals (control-cohort) were recruited in the study. We collected data from 300 participants in each group. Analysis was done based-on HbA1c-levels, random-blood-sugar (RBS),clinical-history, and comorbidities. Information regarding cMSK-pain was gathered using modified version of Nordic standard questionnaire. ResultsOverall prevalence of cMSK pain was 23.3 % (140 out of 600). Among Group-1/Diabetic group, it was 27.7 % and among group-2/Healthy Cohort it was 19 % and the odds ratio was 1.6. Most commonly reported region with cMSK among group-1 and group-2 was shoulder (32.5 %) and knee (36.8 %) respectively. We found a significant association between cMSK-pain and HbA1c levels (p < 0.005). and individuals with HbA1c levels of more than 12 reported involvements in multiple regions. We didn't find significant association between cMSK and DM, HTN, dyslipidemia, or hypothyroidism (P > 0.05). ConclusionStudy highlights higher-prevalence and significant impact of cMSK pain in diabetic patients compared to non-diabetic individuals. Addressing musculoskeletal-pain is crucial for improving overall quality-of-life in diabetic patients. Clinicians should adopt a proactive and comprehensive approach to pain management in diabetics. Using a simple Nordic questionnaire during routine check-ups helps with screening of joint and surrounding soft tissue pathology, preventing future complications that could lead to disability.

Unexpected Encounters: Ossifying Fibromyxoid Tumor Unveiled During Evaluation for Inguinal Hernia

Abstract Introduction/Objective Soft tissue pathology often presents diagnostic surprises, elucidating the intricate nature of disease processes. In this introduction, we discuss the unexpected discoveries that can arise during clinical evaluations and emphasize the importance of thorough evaluation in soft tissue pathology. Methods/Case Report We present the case of a 40-year-old male who underwent evaluation for a right inguinal hernia, during which an ossifying fibromyxoid tumor (OFMT) was incidentally discovered. Imaging modalities intended for hernia assessment revealed a 4.5 cm mass abutting the hernia site. Surgical exploration, initiated for hernia repair, unveiled the unsuspected coexistence of a direct inguinal hernia and an OFMT. Histopathological analysis of the excised mass revealed a complex OFMT architecture, characterized by a plexiform growth pattern, fibrous to fibromyxoid matrix, and distinct cellular features. The neoplastic cells exhibited bland round to ovoid nuclei, occasional multinucleation, and scattered mitotic figures. Immunohistochemistry demonstrated variable positivity for desmin and focal positivity for S-100 protein, while CD34, keratin AE1/AE3, smooth muscle actin, and p63 were consistently negative. Notably, the tumor exhibited areas of hypercellularity and easily identifiable mitotic figures, consistent with morphologic features of malignancy in OFMT. Results (if a Case Study enter NA) N/A Conclusion This case highlights the intricate interplay between primary clinical concerns and incidental pathological findings, underscoring the necessity for comprehensive evaluation in soft tissue pathology. Understanding the nuanced histological and immunohistochemical characteristics of OFMT is pivotal for accurate diagnosis and optimal patient management. The unexpected discovery of OFMT during evaluation for inguinal hernia emphasizes the importance of thorough assessment and consideration of incidental findings in clinical practice.

Can ChatGPT-4 Diagnose and Treat Like an Orthopaedic Surgeon? Testing Clinical Decision Making and Diagnostic Ability in Soft-Tissue Pathologies of the Foot and Ankle.

ChatGPT-4, a chatbot with an ability to carry human-like conversation, has attracted attention after demonstrating aptitude to pass professional licensure examinations. The purpose of this study was to explore the diagnostic and decision-making capacities of ChatGPT-4 in clinical management specifically assessing for accuracy in the identification and treatment of soft-tissue foot and ankle pathologies. This study presented eight soft-tissue-related foot and ankle cases to ChatGPT-4, with each case assessed by three fellowship-trained foot and ankle orthopaedic surgeons. The evaluation system included five criteria within a Likert scale, scoring from 5 (lowest) to 25 (highest possible). The average sum score of all cases was 22.0. The Morton neuroma case received the highest score (24.7), and the peroneal tendon tear case received the lowest score (16.3). Subgroup analyses of each of the 5 criterion using showed no notable differences in surgeon grading. Criteria 3 (provide alternative treatments) and 4 (provide comprehensive information) were graded markedly lower than criteria 1 (diagnose), 2 (treat), and 5 (provide accurate information) (for both criteria 3 and 4: P = 0.007; P = 0.032; P < 0.0001). Criteria 5 was graded markedly higher than criteria 2, 3, and 4 (P = 0.02; P < 0.0001; P < 0.0001). This study demonstrates that ChatGPT-4 effectively diagnosed and provided reliable treatment options for most soft-tissue foot and ankle cases presented, noting consistency among surgeon evaluators. Individual criterion assessment revealed that ChatGPT-4 was most effective in diagnosing and suggesting appropriate treatment, but limitations were seen in the chatbot's ability to provide comprehensive information and alternative treatment options. In addition, the chatbot successfully did not suggest fabricated treatment options, a common concern in prior literature. This resource could be useful for clinicians seeking reliable patient education materials without the fear of inconsistencies, although comprehensive information beyond treatment may be limited.

7217 Impact of INZ-701 on Bone and Mineral Metabolism Biomarkers and Clinical Outcomes in Adults with ENPP1 Deficiency - Results from 48-week Phase 1/2 Open Label Study

Abstract Disclosure: K. Gunter: Employee; Self; Inozyme Pharma. Stock Owner; Self; Inozyme Pharma. R.A. Wermers: Research Investigator; Self; Inozyme Pharma. R. Fuhr: Employee; Self; Parexel GmbH. Research Investigator; Self; Inozyme Pharma. D. Schnabel: Research Investigator; Self; Inozyme Pharma. A. Besancon: Research Investigator; Self; Inozyme Pharma. M.A. Nour: Research Investigator; Self; Inozyme Pharma. D. Wenkert: Stock Owner; Self; Inozyme Pharma. Y. Sabbagh: Employee; Self; Inozyme Pharma. Stock Owner; Self; Inozyme Pharma. Background: ENPP1 Deficiency is a rare disorder due to inactivating mutations in the ENPP1 gene that result in low levels of inorganic pyrophosphate (PPi), a critical regulator of mineralization. Subsequent pathologic soft tissue calcification results in severe vascular calcification and ∼50% infant mortality. By early adolescence the majority of survivors develop FGF-23 mediated hypophosphatemic rickets, characterized by bone deformities, short stature, joint/ligament calcification and musculoskeletal pain. No targeted therapy exists for this disease. INZ-701 is a recombinant ENPP1-Fc investigational product. Purpose: To describe the safety, tolerability, immunogenicity, and exploratory efficacy (bone and mineral metabolism biomarkers and clinical outcomes) of INZ-701 in adults with ENPP1 Deficiency through the end of the phase 2 study period (week 48). Methods: Phase 1/2, multicenter, open-label, multiple ascending dose study including three adults in each of three dose cohorts (0.2, 0.6 and 1.8 mg/kg, total N=9) with genetic variants in ENPP1 and PPi &amp;lt;1300 nM (NCT04686175). Participants were dosed subcutaneously on Day 1, then twice weekly from Day 8 to end of study. Data through wk 48 as of July 6, 2023 are included; topline wk 48 data will be presented. Per protocol, participants may continue to receive INZ-701 beyond wk 48. Results: Rapid increase in mean PPi from baseline of 426±407 nM was noted in all patients, reaching the healthy volunteer range within 6 hrs of the first dose with sustained elevation through wk 48. Mean PPi across the 0.2, 0.6 and 1.8 mg/kg dose cohorts from day 32 to wk 48 was 1299±131 nM, 1356±136 nM, and 1282±81 nM, respectively. There were improvements from baseline to wk 48 in mean pooled FGF-23 (-22 pg/mL) and serum phosphate (+0.18 mg/dL), with dose-dependent changes in bone specific alkaline phosphatase consistent with bone healing. DEXA revealed improvements in spine BMD and BMC. There were trends towards improvement in mean % predicted change in 6MWT from baseline to wk 48: cohort 1, 76.7% (SE 10.5) to 85.0% (SE 3.0); cohort 2, 52.2% (SE 10.9 ) to 79.0% (SE 2.9); cohort 3, wk 48 data not available. Improvements were also observed in physician and patient global impression of change score (with no patients deteriorating) and PROMIS pain intensity score. INZ-701 was well tolerated with no drug-related serious or severe (&amp;gt; grade 2) adverse events. Low titers of non-neutralizing anti-drug antibodies (≤160) were observed in 7/9 patients. Long half-life of approximately 126 hours suggests the potential for once-weekly dosing. Conclusions: In adults with ENPP1 Deficiency, INZ-701 was well tolerated with no related serious or severe adverse events. INZ-701 demonstrated a rapid and sustained increase in PPi levels from baseline to week 48 with corresponding improvements in bone mineral biomarkers, functional performance, and patient and physician-reported outcomes. Presentation: 6/3/2024

Tumeurs mésenchymateuses utérines associées à translocation : du nouveau sans oublier l’ancien. Une approche diagnostique intégrée

This review focuses on uterine mesenchymal tumors that are defined on a molecular level by a single and unique genetic alteration, that is somehow necessary and sufficient to allow tumor growth and progression. Although diverse from a clinical, morphological and immunohistochemical point of view, the different entities we are going to talk about share both a simple genomic profile with a low number of chromosomal alterations observed by CGH Array (few deletions, gains or amplifications...) and a low mutational burden observed by sequencing technics. Some of these entities are already well known and described in the literature when found outside of the uterus and gynecological tract. It remains intriguing that uterine mesenchymal pathology has been lagging behind when compared to its extrauterine counterpart. How can we explain that when it comes to inflammatory myofibroblastic tumors, abundant numbers of articles have been published since the 70's, but it was only in the early 2000s that the first relevant descriptions of this tumor in the uterus emerged? Certainly, the increased accuracy, availability, and use of molecular biology technics and in particular RNA sequencing in the area of uterine pathology can partly explain the reduction of the gap between soft tissue and uterine pathology we currently observe. Other reasons explaining this gap may be the high prevalence of smooth muscle tumors in the uterus and the abounding diversity of their morphological aspects, which may have partly eclipsed the array of differential diagnoses. Last but not least, one can hypothesize that the relative "simplicity" of hysterectomy procedures, referring to their safety and accessibility, has cured most of the lesions and partly clouded our knowledge regarding the biological potential and natural history of these newly described entities. As a consequence of this situation, our reader will often encounter the wording "uncertain malignant potential", as for some of these rare entities, evidence to establish reliable prognostic variables is still insufficient. We hope this review to be a useful tool to guide pathologists through the diversity and complexity of uterine mesenchymal tumors. As a scientific and medical community, sharing this knowledge will help us to collectively raise our vigilance and awareness by expanding the array of our differential diagnoses. We hope this will lead to more cases being accurately diagnosed, and ultimately, to a deeper knowledge regarding the biological potential and clinical evolution of these tumors. From a therapeutical point of view, the consequences of an accurate diagnosis for the patient are already appreciable through the use of targeted therapy. Examples include: ALK inhibitors in inflammatory myofibroblastic tumor, tyrosine-kinase inhibitors in COL1A::PDGFB rearranged sarcomas or mTOR inhibitors in PEComa.

Aberrant positivity for BCOR immunohistochemistry in merkel cell carcinoma - a potential diagnostic pitfall

BackrgoundMerkel cell carcinoma (MCC) is a rare, aggressive primary cutaneous neuroendocrine carcinoma, frequently associated with clonal Merkel cell polyomavirus integration. MCC can pose significant diagnostic challenges due to its diverse clinical presentation and its broad histological differential diagnosis. Histologically, MCC presents as a small-round-blue cell neoplasm, where the differential diagnosis includes basal cell carcinoma, melanoma, hematologic malignancies, round cell sarcoma and metastatic small cell carcinoma of any site. We here report strong aberrant immunoreactivity for BCOR in MCC, a marker commonly used to identify round cell sarcomas and other neoplasms with BCOR alterations.MethodsBased on strong BCOR expression in three index cases of MCC, clinically mistaken as sarcoma, a retrospective analysis of three patient cohorts, comprising 31 MCC, 19 small cell lung carcinoma (SCLC) and 5 cases of neoplasms with molecularly confirmed BCOR alteration was conducted. Immunohistochemical staining intensity and localization for BCOR was semi-quantitatively analyzed.ResultsThree cases, clinically and radiologically mimicking a sarcoma were analyzed in our soft tissue and bone pathology service. Histologically, the cases showed sheets of a small round blue cell neoplasm. A broad panel of immunohistochemistry was used for lineage classification. Positivity for synaptophysin, CK20 and Merkel cell polyoma virus large T-antigen lead to the diagnosis of a MCC. Interestingly, all cases showed strong positive nuclear staining for BCOR, which was included for the initial work-up with the clinical differential of a round cell sarcoma. We analyzed a larger retrospective MCC cohort and found aberrant weak to strong BCOR positivity (nuclear and/or cytoplasmic) in up to 90% of the cases. As a positive control, we compared the expression to a small group of BCOR-altered neoplasms. Furthermore, we investigated a cohort of SCLC as another neuroendocrine neoplasm and found in all cases a diffuse moderate to strong BCOR positivity.ConclusionsThis study demonstrates that neuroendocrine neoplasms, such as MCC and SCLC can express strong aberrant BCOR. This might represent a diagnostic challenge or pitfall, in particular when MCC is clinically mistaken as a soft tissue or a bone sarcoma.

Report of the German Society of Pathology Working Group on Bone, Joint, and Soft Tissue Pathology

Report of the German Society of Pathology Working Group on Bone, Joint, and Soft Tissue Pathology

Effectiveness of Single, Double or Triple Platelets-Rich Plasma Injection in Foot and Ankle Soft Tissue Pathology

Effectiveness of Single, Double or Triple Platelets-Rich Plasma Injection in Foot and Ankle Soft Tissue Pathology

Imaging and Preoperative Planning of Athletic Hip Pathology

Proper imaging is essential for treatment planning of athletic hip pathology. Plain radiographs are a valuable imaging modality, as they can provide useful information regarding patient native anatomy and hip pathoanatomy. Both acetabular- and femoral-sided pathology can be examined using a variety of radiographic views including the AP pelvis, cross table lateral, modified Dunn, and false profile views. Computed tomography can be utilized to further characterize the hip in the coronal and sagittal planes with the added information of axial imaging. This can aid in assessment of hip dysplasia and femoroacetabular impingement. Magnetic resonance imaging can be useful in evaluation soft tissue pathology of the hip, as well as in assessment of the cartilage. Ultrasound offers a non-invasive method of imaging the hip and can be useful in dynamic studies.

“In My Experience…15 Data Points To Better Evaluate Platelet Rich Plasma Kits And Protocols”

Introduction Platelet rich plasma (PRP) use in orthopedics is growing. Clinical research documenting effective outcomes for various conditions is fueling interest in PRP as a safe intervention for many soft tissue and joint pathologies in orthopedics. However, clinicians do not have a consistent means to evaluate PRP as a biologic drug and as a result interpreting clinical reports can be challenging. Additionally, clinicians often do not have the necessary information to fully evaluate PRP kits and protocols when deciding on how to best integrate this therapy into their practice. Purpose This paper defines 15 different metrics that can be used to quantify PRP and to compare PRP kits and protocols. Our goal is to provide a comprehensive framework that allows for the unbiased evaluation of PRP regardless of the kit or protocol used. By using these PRP metrics routinely, we can improve characterization PRP for research and clinical purposes.

Prevalence of Dental Abnormalities, Soft Tissue Pathologies and Occlusion Disorders in Patients with High BMI: A Cross-sectional Study.

The relationship between body mass index (BMI) and oral disorders remains unclear. This study examined the prevalence and types of dental abnormalities and oral mucosal lesions among female students with obesity attending a Taif University sports centre. This non-interventional cross-sectional study enrolled female students with high BMI from a university sports facility using a convivence sampling method. The participants were divided into three BMI groups. Data were collected using an interview and by clinical oral examination. Prevalence and oral disorder types and possible mechanisms linking BMI and dental development were evaluated. Ultimately, 86 female students with obesity were analysed. The mean BMI was 42.8 kg/m2, indicating high obesity levels. A weak although statistically significant correlation was observed between age and BMI (r=0.27), indicating that older students had higher BMI. A statistically significant association was observed between BMI and dental abnormalities (p0.05). The dental abnormality prevalence increased with BMI, ranging from 37.5% to 40.7% in the ≤40 and >45 kg/m2 groups, respectively. Most participants (66.3%) had oral mucosal lesions, with the highest prevalence among participants in the 40-45 kg/m2 group (71.4%). A statistically significant relationship was observed between BMI and dental abnormalities; obesity may negatively affect oral health.

MRI Evaluation of Traumatic and Non-traumatic Pathologies of the Ankle Joint and Hindfoot: A Single-Center Observational Study.

Background Pathologies affecting the ankle joint and hindfoot can present with a variety of clinical symptoms and etiologies, necessitating accurate diagnostic tools for effective management. Magnetic resonance imaging (MRI) is a valuable imaging modality for assessing these pathologies, providing detailed visualization of bone, joint, tendon, and other soft tissue abnormalities. Objectives To evaluate MRI findings in a diverse cohort of 105 participants with pathologies affecting the ankle joint and hindfoot, focusing on the prevalence and types of bone, joint, tendon, and soft tissue abnormalities. Materials and methods A single-center observational descriptive study was conducted at Dr. D. Y. Patil Medical College and Hospital and Research Centre, Pune, India, over a period from August 2022 to July 2024, involving 105 participants (54.3% male, 45.7% female) with a mean age of 39.04 years. MRI scans were analyzed to assess the prevalence of bone, joint, tendon, and soft tissue pathologies. Clinical profiles, symptom duration, and etiological classifications were documented. Results Analysis of the results obtained from 105 (N = 105) study participants revealed that pain (94.3%, or 99 cases) was the most common symptom, followed by restricted movement (86.7%, or 91 cases), trauma history (75.2%, or 79 cases), and swelling (73.3%, or 77 cases). Traumatic causes (76.2%, or 80 cases) predominated, while inflammatory (48.3%, or 14 cases) and infective (34.5%, or 10 cases) causes were also significant. MRI findings showed marrow edema in 41.9%, or 44 cases, subchondral cysts in 22.9% (24 cases), fractures in 17.1% (18 cases), and erosions in 10.5% of participants (11 cases). Joint involvement was most frequent in the tibiotalar (76.2%, or 80 cases) and subtalar joints (58.1%, or 61 cases). Tendon pathologies included peritendonitis (55.2%, or 58 cases) and tendinosis (23.8%, or 25 cases), with the Achilles tendon being the most frequently affected (39%, or 41 cases). Ligament injuries were predominantly sprains (46.7%, or 49 cases), with less frequent partial (18.1%, or 19 cases) and complete tears (7.6%, or eight cases). Soft tissue findings included subcutaneous edema (76.2%, or 80 cases) and bursitis (24.8%, or 26 cases). Among the study participants who presented with non-traumatic pathologies, inflammatory pathologies (48.3%, or 14 cases) were the most common, followed by infective (34.5%, or 10 cases) and neoplastic (17.2%, or five cases) pathologies. Conclusion MRI effectively identifies a wide range of pathologies in the ankle and hindfoot, with marrow edema, joint effusion, and tendon pathologies being prevalent. The study underscores the utility of MRI in diagnosing and assessing various conditions in the ankle joint complex and highlights the need for accurate imaging to guide treatment decisions. Future research should focus on correlating MRI findings with clinical outcomes to enhance diagnostic accuracy and management strategies.

EWSR1::ATF1 fusions characterize a group of extra-abdominal epithelioid and round cell mesenchymal neoplasms, phenotypically overlapping with sclerosing epithelioid fibrosarcomas, and intra-abdominal FET::CREB fusion neoplasms.

With the increasing use of next generation sequencing in soft tissue pathology, particularly in neoplasms not fitting any World Health Organization (WHO) category, the spectrum of EWSR1 fusion-associated soft tissue neoplasms has been expanding significantly. Although recurrent EWSR1::ATF1 fusions were initially limited to a triad of mesenchymal neoplasms including clear cell sarcoma of soft tissue, angiomatoid fibrous histiocytoma and malignant gastrointestinal neuroectodermal tumor (MGNET), this family has been expanding. We herein describe 4 unclassified extra-abdominal soft tissue (n = 3) and bone (n = 1) neoplasms displaying epithelioid and round cell morphology and carrying an EWSR1::ATF1 fusion. Affected were 3 males and 1 female aged 20-56years. All primary tumors were extra-abdominal and deep-seated (chest wall, mediastinum, deltoid, and parapharyngeal soft tissue). Their size ranged 4.4-7.5cm (median, 6.2). One patient presented with constitutional symptoms. Surgery with (2) or without (1) neo/adjuvant therapy was the treatment. At last follow-up (8-21months), 2 patients developed progressive disease (1 recurrence; 1 distant metastasis). The immunophenotype of these tumors is potentially misleading with variable expression of EMA (2 of 3), pankeratin (2 of 4), synaptophysin (2 of 3), MUC4 (1 of 3), and ALK (1 of 3). All tumors were negative for S100 and SOX10. These observations point to the existence of heretofore under-recognized group of epithelioid and round cell neoplasms of soft tissue and bone, driven by EWSR1::ATF1 fusions, but distinct from established EWSR1::ATF1-associated soft tissue entities. Their overall morphology and immunophenotype recapitulate that of the emerging EWSR1/FUS::CREB fusion associated intra-abdominal epithelioid/round cell neoplasms. Our cases point to a potentially aggressive clinical behavior. Recognizing this tumor type is mandatory to delineate any inherent biological and/or therapeutic distinctness from other, better-known sarcomas in the differential diagnosis including sclerosing epithelioid fibrosarcoma.

Poster 225: Assessing Hip-RSI in Patients that Undergo Hip Arthroscopy for Femoroacetabular Impingement

Objectives: Femoroacetabular impingement (FAI) is a condition that affects young athletes who participate in high impact activities. Patients often experience gradually worsening hip and/or groin pain, and thus have months to years of symptoms before choosing to undergo hip arthroscopy to correct the bony and soft tissue pathology. Patients undergoing surgery usually report that they are pursuing surgery for pain relief and expect to be able to return to their previous level of activity. An athlete’s ability to return to their previous level of sport depends not only on their physical ability, but their psychological ability as well. Because patients often experience months to years of symptoms before surgery, this group is particularly vulnerable to kinesiophobia, pain catastrophizing, and other psychological factors that may influence recovery and overall return to physical activity. The Hip-Return to Sport after Injury (Hip-RSI) scale is a validated tool used to assess an athlete’s psychological readiness to return to sport and specifically looks at emotions, confidence, and risk appraisal in relation to a patient’s perception of hip function and is positively associated with return to sport (RTS). Recovery and RTS is not a linear process, as an athlete’s psychological readiness likely changes over time. However, this potential change in readiness throughout the recovery process has not yet been described. This study primarily aimed to describe the change in Hip-RSI in patients who undergo hip arthroscopy for FAI. A secondary objective was to examine the relationship between Hip- RSI and patient satisfaction with hip function, patient expectations of recovery timeline, patient expectations to return to sport, and history of anxiety/depression. Methods: A single surgeon’s prospectively collected Hip Database was used to obtain a comprehensive patient list. This study was conducted under the IRB approval of the Hip Database. Patients were included if they underwent a hip arthroscopy and completed the Hip-Return to Sport after Injury questionnaire (Hip-RSI) at minimum one of four postoperative timepoints: 3 months, 6 months, 1 year and 2 years. One hundred and fifty patients had a completed Hip-RSI score at at least one of these timepoints. Additional variables included BMI, diagnosis codes, patient satisfaction and expectations, history or presence of anxiety/depression, and other patient reported outcomes (PROs), including iHOT-12, HOS-ADL and HOS-SSS. There were four patient satisfaction and expectations questions patients answered in their questionnaire, three of which were yes/no questions, and one was a slider scale from 0-10 that pertained to hip function satisfaction. A chart review was performed to determine the BMI, diagnosis codes, and history/presence of history of anxiety/depression for patients who did not have this data in the Hip Database. A Mann Whitney U test and Pearson correlation tests were performed to determine averages and correlations between Hip-RSI and the history/presence of anxiety/depression and satisfaction and expectations. Results: The average age of this population was 30 ± 13 years, with an average BMI of 25.8 ± 5.7, and an average duration of symptoms for 24.7± 22.6 months. Hip-RSI scores were determined for each of the four timepoints, which showed that there was an increase in Hip-RSI scores from 3 months to 1 year postoperatively, and an almost a 10-point decrease at 2 years postoperatively, as shown in Table 1. There was no significant difference in Hip-RSI in patients with a history of anxiety and/or depression at any of the four timepoints. There were no significant correlations between Hip-RSI and any other variables or outcome measures at two years postoperatively. At 3 months, 6 months, and 12 months postoperatively, Hip-RSI had a strong, positive correlation with a patient’s self-reported satisfaction level of their current hip function (p&lt;0.001). The averages of Hip-RSI and this patient satisfaction question are shown in Table 2. Two other patient expectation questions were also positively correlated with Hip-RSI at various timepoints, as shown in Figure 1. Hip-RSI had a strong correlation with three other PROs: iHOT-12, HOS-ADL, and HOS-SSS at all three timepoints (p&lt;0.001). The only exceptions were two moderative, positive correlations between Hip-RSI and HOS-ADL, as well as between Hip-RSI and HOS-SSS, at 3 months postoperatively. Conclusions: Based on our findings, a patient’s psychological readiness for return to sport changes over time, with an increase in readiness up to 1 year postoperatively, and a decrease in readiness at two years postoperatively. While history or presence of anxiety and/or depression does not influence Hip-RSI scores, patient satisfaction and expectations after a hip arthroscopy appears to influence it, however further investigation is required.

Локальная терапия при остеоартрите и патологиях околосуставных мягких тканей: фокус на гиалуроновую кислоту

Локальная терапия при остеоартрите и патологиях околосуставных мягких тканей: фокус на гиалуроновую кислоту

Efficacy of low molecular weight hyaluronic acid (500–730 kDa) in post-traumatic pathology of periarticular soft tissues at different sites: data from an open-label pilot clinical study

Local injection therapy (LIT) with hyaluronic acid (HA) medications is one of the most promising methods for the treatment of periarticular soft tissue pathology (PASTP) caused by injury or overuse. Objective: to evaluate the efficacy and safety of LIT with HA medication with a molecular weight of 500–730 kDa in patients with various post-traumatic PASTP. Material and methods. The study included 30 patients with rotator cuff syndrome (RCS), lateral epicondylitis (LE) and plantar fasciitis (PF) after trauma. Inclusion criteria were the presence of moderate/severe pain (≥40 mm on a visual analogue scale (VAS)) over a 3-month period and the absence of effect of LIT with glucocorticoids. All patients were administered HA peritendinously three times (7 days apart) under ultrasound guidance. Treatment results were evaluated after 1 and 3 months based on the dynamics of pain intensity (VAS) and functional indicators using the ASES (American Shoulder and Elbow Surgical Evaluation), MES (Mayo Elbow Score) and FFI (Foot Functional Index) questionnaires. Results and discussion. In the general group, there was a statistically significant decrease in pain intensity after 1 and 3 months from a mean of 57.6 ± 14.7 to 37.0 ± 14.8 and 35.0 ± 14.3 mm according to VAS respectively (p &lt; 0.05). In the patient groups with different PASTP, the average assessment of pain intensity and functional impairment at baseline and after 1 and 3 months was: for RCS (n = 11) 59.0 ± 15.1, 39.0 ± 15.7, 36.3 ± 16.2 mm according to VAS and 49.1 ± 14.3, 60.1 ± 13.7, 61.7 ± 3.8 according to ASES, respectively; with LE (n = 10) 54.0 ± 13.4, 35.0 ± 9.7, 34.0 ± 11.7 mm according to VAS and 71.5 ± 11.1, 78.3 ± 9.0, 81.5 ± 8.3 according to MES; with PF (n = 9) 61.0 ± 16.5, 36.6 ± 19.3, 34.4 ± 15.8 mm according to VAS and 47.2 ± 22.8, 39.6 ± 39.7, 39.0 ± 29.9 according to FFI. None of the patients experienced any adverse events during treatment. Conclusion. HA medication with a molecular weight of 500–730 kDa showed good efficacy and safety in LIT of PASTP of the shoulder, elbow joint and foot. Further studies are needed to evaluate the possibility of a broad use of the drug for the treatment of PASTP in real clinical practice.

Pediatric Patients Who Underwent Elbow Arthroscopy Had an 86% Return-to-Sport Rate, a 12% Reoperation Rate, and a 3.7% Complication Rate

PurposeThe purpose of this study was to assess the applicability and safety of elbow arthroscopy in the pediatric population at our institution by analyzing the indications and complications in a large pediatric patient series. MethodsAll patients who underwent elbow arthroscopy at 18 years of age or younger from 2006 to 2017 by a single fellowship-trained surgeon were retrospectively identified. Exclusion criteria were a follow-up shorter than eight weeks and open surgeries (not fully arthroscopic). Medical records were reviewed for baseline characteristics, indications for elbow arthroscopy, range of motion, complications, and reoperations. Results191 patients (64 boys and 127 girls) were included with a median age of 15.5 years (IQR 14.0-16.7). Indications for arthroscopic surgery were grouped into treatment of osteochondritis dissecans (60%), debridement for bony or soft tissue pathology (35%), contracture release (3%), and diagnostic arthroscopy (3%). The complication rate was 3.7%, including 4 minor complications (3 superficial wound problems, 1 transient ulnar neuropathy) and 3 major complications (1 manipulation under anesthesia for stiffness, 1deep infection, 1 (unplanned) reoperation for persistent locking within 1 year of the index procedure). 23 patients (12%) needed subsequent surgery because of newly developed, persisting or recurring elbow problems. 86% were able to return to sports. ConclusionsPediatric elbow arthroscopy performed by an experienced surgeon using a standardized technique for a wide variety of elbow conditions has an acceptable complication rate that is similar to previously published literature on elbow arthroscopy in the pediatric and adult populations; however, a significant proportion of patients needed subsequent surgery in the following years.

Oral health in systemic sclerosis: A scoping review

Background: Limited research on oral health in systematic sclerosis poses a significant challenge for people with systematic sclerosis and health care professionals. We conducted a scoping review to map existing research on oral health–related quality of life in systematic sclerosis across domains including (1) oral manifestations or symptoms, (2) functional consequences, (3) psychosocial aspects, (4) associated patient factors and (5) self-care and management considerations. Methods: We searched MEDLINE, EMBASE, SCOPUS and CINAHL databases to 10 March 2023 for studies on oral health in people with systematic sclerosis. Study data were mapped into pre-specified domains of oral health–related quality of life, subtopics and types of research and reported in tabular form. Results: Of 1460 unique studies reviewed, 91 were eligible and included in the scoping review; of these, 69 (76%) were published as full-text versions, 72 (79%) were from Europe or North America, and 63 (69%) included ⩽50 participants. Only 1 study had &gt;200 participants (N = 382). By domains, 85 (93%) studies reported aspects of oral manifestations or symptoms, with the most common subtopics being oral opening and mandibular function, sicca, periodontitis and soft tissue changes and pathology; 36 (40%) studies provided information on associated patient factors, 23 (25%) on self-care and management, 19 (21%) on psychosocial aspects and 6 (7%) on functional consequences. No studies related to interventions included &gt;50 participants. Conclusion: Most studies on oral health in systematic sclerosis report on manifestations or symptoms, and there are relatively few studies on other important domains. Most studies have been conducted with small samples. Updated systematic reviews should evaluate the quality of existing evidence in domains where enough studies have been done. Large, well-conducted primary studies are needed to address knowledge gaps across domains, including studies that test approaches for supporting oral self-care, improving routine professional care and addressing major disability-causing manifestations.

Navicular bone oedema and sclerosis: current concepts on best management

Pathology associated with the navicular bone remains a common cause of forelimb lameness in horses. Since the introduction of advanced imaging modalities (particularly magnetic resonance imaging) it is now recognised that pathology of the navicular bone rarely occurs in isolation; concurrent abnormalities of the structures of the podotrochlear apparatus are often present. Different pathological processes of the navicular bone can have the same radiological appearance. Identifying the underlying disease process, as well as concurrent injuries, is essential for implementing the most appropriate management strategies in horses with navicular bone pathology. Horses with acute onset lameness or soft tissue injuries will often require a period of rest initially, whereas horses with chronic insidious lameness and no soft tissue pathology may be able to continue in work following treatment. Management should be focused on reduction of pain and inflammation which is often achieved with systemic non-steroidal anti-inflammatories, and intra-articular or intra-bursal medication in combination with reducing concussive forces acting on the navicular bone through alterations in shoeing and modification of exercise.

Postoperative Benefits of Soft Tissue Wrist Arthroscopy: Retro- and Prospective Analyses of Outcome Measures.

Background: Elective soft-tissue-only wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist pain. A number of pathologies can be treated arthroscopically, with the aim of pain reduction and improved wrist mobility. A postinterventional evaluation of the treatment using objective and patient-reported outcome measures (PROMs) allows for an evidence-based statement about the benefits of soft-tissue-only wrist arthroscopy. Methods: A dual-center study combining retro- and prospective clinical analyses of patient outcomes after soft-tissue-only wrist arthroscopies was performed. The data were collected at two hospitals with departments specializing in hand surgery. The outcome was measured by assessing the range of motion of the wrist and its manual strength, as well as PROMs, including Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: A total of 154 soft interventions met the study criteria and could be included. Seven months after the elective soft-tissue-only wrist arthroscopies, mobility improved significantly for active extension and flexion, as well as the ulnar and radial abduction of the wrist. The grip strength also improved significantly, by an average of 6 kg, during this period. The DASH score improved significantly, from 35 points to 14 points. Additionally, wrist pain at rest was reduced significantly. Conclusions: After elective soft-tissue-only wrist arthroscopy, patients showed an overall functional improvement in their wrist, with a significant reduction in pain and improvement of mobility and grip strength. This study emphasizes the importance of wrist arthroscopy as a successful treatment option for soft tissue pathologies of the wrist.