Soft Tissue Treatment Research Articles

Effectiveness of Instrument-assisted Soft-tissue Mobilization Versus Dry Cupping on Pain and Cervical Range of Motion in Treatment of Neck Pain

Abstract Background: Neck pain is characterized by symptoms of a nonspecific nature of the pain, which is of mechanical origin.[1,2] Frequently observed manifestations of neck discomfort encompass muscle pain, muscle spasms, headaches, facet joint pain, nerve pain, referred pain, and bone pain.[3] Instrument-assisted soft-tissue mobilization (IASTM) stands as a proficient myofascial intervention used for the treatment of soft tissues. Here, using instruments typically crafted from stainless steel featuring beveled edges and anatomically contoured designs to accommodate various body regions, this technique allows for enhanced depth of penetration.[4] Primarily used for the identification and therapeutic management of soft-tissue disorders, the approach involves the application of these specialized instruments.[5] Dry cupping, alternatively recognized as air cupping or suction cupping, constitutes a therapeutic methodology, wherein a vacuum is generated within cups and subsequently applied to targeted regions of the body. These cups, fabricated from diverse materials such as glass, silicone, or plastic, induce suction effects. Through the application of this suction, dry cupping serves to promote circulation, alleviate muscle tension, and facilitate the energetic flow within the treated areas. Material and Methods: The purpose of the study to effectiveness of instrument-assisted soft-tissue mobilization versus dry cupping on pain and cervical range of motion in treatment of neck pain. The study is comparative in nature, and total subjects were 15 subjects in each group. The assessment of pain and range of motion of cervical flexion and lateral flexion were taken before starting the treatment of both the groups. The patients were randomly assigned by lottery method for both the groups, and assessments were taken on 0 day and at the end of 4th week by VAS and ROM by a goniometer. Results: In IASTM treatment, the P value is 0.031. This suggests that there is a statistically significant difference between the pre-treatment and post-treatment values for the IASTM group. But, in dry cupping, the P value is 0.001. This indicates a highly significant difference between the precupping and postcupping values for this treatment group. The scores of variables VAS and ROM were improved significantly better in the subjects treated with dry cupping as compared to the group variables treated with instrument-assisted soft-tissue mobilization. Conclusion: The study conclude that the dry cupping is more beneficial for the treatment of neck pain and range of motion.

Treatment outcomes and short-term stability in adult anterior openbite patients treated with or without extractions: a National Dental Practice-Based Research Network study.

To investigate whether extractions in adult anterior openbite (AOB) patients lead to improved treatment outcomes and better short-term stability. Records of extraction (EXT) and nonextraction (NE) adult patients were identified from all patients treated with fixed appliances through the National Dental Practice-Based Research Network. Photographic Openbite Severity Index was used to assess treatment success and stability. Skeletal, dental, and soft tissue treatment outcomes were evaluated using cephalometric analysis. Pretreatment and posttreatment records were collected for 115 patients. Thirty-three were treated with extractions; 82 were treated without extractions. The EXT group was younger, more crowded, and had less previous orthodontic treatment. Success rate of AOB correction in the EXT group was slightly higher (97%) than the NE group (92%) but not statistically different. No significant differences were observed in skeletal outcomes. The EXT group exhibited more lingual tipping and posterior movement of maxillary and mandibular incisors and less extrusion of mandibular incisors. Dental changes in the EXT group were associated with increased nasolabial angle and lip retraction. The small number of patients with AOB relapse did not provide enough power to identify differences in stability between the two groups. Orthodontists have high success correcting AOB with or without extractions. The EXT group displayed more retraction and lingual tipping of incisors as well as increased retraction of soft tissues. Stability of AOB closure was more than 90% for both groups after 1 year, with marginal increases in stability after extractions.

Preparation and Characterization of Injectable Augmentation Gels Containing Polycaprolactone and Hyaluronic Acid.

Injectable augmentation gels are widely used in the treatment of soft tissue. The composition of these gels has to be continuously improved due to the limitations of the currently available formulations. This study focuses on the development of an innovative injectable gel designed to address current trends and specific needs within the field. The current study utilized a safer hyaluronic acid (HA) gel carrier, created with a less toxic cross-linker, in combination with polycaprolactone (PCL) microspheres at various concentrations. PCL microspheres were prepared using an emulsification-solvent evaporation technique. Six different gel formulations were developed using PCL microspheres and biphasic HA gel structures. The produced microspheres had non-agglomerated, smooth surfaces with an average particle size of approximately 45 ± 0.14 μm. The rheological results of the PCL-HA6 such as storage modulus (G', Pa), loss modulus (G", Pa), complex viscosity (η*), and phase angle (°) at 1 Hz frequency were measured as 553.97 ± 32.48, 368.4 ± 12.24, 105.9 ± 5.27, and 33.65 ± 0.92, respectively, and the injection force was measured as 9.64 ± 1.46. Invitro tests revealed that the PCL-HA6 group showed the highest cell viability compared to the other groups and provided a relative increase in collagen production over time, as demonstrated by the relevant gene expression. The developed PCL/HA gel exhibited biocompatibility and non-toxicity, making it a safe option for soft tissue augmentation. It demonstrated potential for medical applications and exhibited favorable rheological characteristics and injectability.

Manual physical therapy for neck disorders: an umbrella review

ABSTRACT Introduction Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50–85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. Results A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs. Conclusion Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.

Evaluation of Treatment Effects of en Masse Mandibular Arch Distalization Using Skeletal Temporary Anchorage Devices: A Systematic Review.

Mandibular arch distalization using temporary anchorage devices (TADs) is effective in correcting borderline Class lll cases without surgery. This review analysed the existing literature evaluating the dental, skeletal, and soft tissue changes after en masse mandibular arch distalization using TADs. We followed PRISMA guidelines and registered this review in PROSPERO database CRD42023450524. PubMed, Google Scholar, Cochrane, Web of Science, and SCOPUS databases were searched. Orthodontic patients requiring en masse mandibular distalization using TADs were compared with different modalities of distalization. Dental changes were evaluated along with skeletal and soft tissue changes and treatment duration. Randomized controlled trials (RCTs), cohort studies, longitudinal studies, and retrospective studies were eligible to be included. The risk of bias was assessed using ROBINS-I tool ("Risk Of Bias In Non-randomized Studies-of Interventions"). Of 1764 identified records, seven studies (one non-RCT, one prospective clinical trial, and five retrospective cohort studies) were included. One study had a low risk of bias, three had moderate bias, two had serious bias, and one had critical bias. All studies showed molar distalization and distal tipping with significant retraction of the lower lip. Miniplates showed greater distalization compared to miniscrews. Interradicular miniscrews exhibited the least distal tipping. Changes in SNB, ANB, occlusal plane angle, and mandibular plane angle were reported. Retromolar screws and ramal plates reported reduced treatment duration. TADs are effective in en masse distalization of mandibular dentition with intrusive or extrusive effects.

Temporary Circular External Fixation for Spanning the Traumatized Ankle Joint.

Temporary ankle-spanning circular fixation aims to provide osseous stability while (1) allowing access to and recovery of the traumatized soft-tissue envelope and (2) facilitating safe, comfortable, and clinically relevant cross-sectional imaging for surgical planning. It is most commonly utilized in a "span-scan-plan" treatment strategy in cases of peri-articular fractures around the ankle2. Conventional monolateral fixators are prone to morbidity at the half-pin sites in the foot and variation in construct stability. Temporary ankle-spanning circular external fixation of the traumatized ankle joint can mitigate these issues. A circular external fixator construct is assembled beginning with a single tibial ring that is fixed to the tibia by half-pins that are spread on either side of the ring and forming a "virtual ring block." A foot ring is attached via 2 crossed tensioned fine wires in the calcaneum and a single midfoot fine wire in order to prevent an equinus deformity. The tibial virtual ring block and the foot ring are interconnected by 3 polyaxial "rapid-adjust struts" that are evenly distributed around the limb. The fracture is then reduced, and the polyaxial rapid-adjust struts are locked1. Numerous constructs have been proposed to optimally immobilize the ankle joint while also allowing limb elevation and access to the ankle for soft-tissue care3-6. A commonly utilized construct is the monolateral "bar-and-clamp" spanning external fixator, which relies on half-pin fixation in the foot that may induce bone lysis, result in pin-site infections, and prevent weight-bearing. Calcaneal half-pins are particularly troublesome and can lead to adjacent lysis, instability, and potential loss of initial reduction as a result of the cancellous bone quality. The principal objective of temporary joint-spanning external fixation is to realign the traumatized joint and to maintain this reduction until definitive surgery while facilitating soft-tissue treatment and surgical planning7-11. This strategy forms the first step in the "span-scan-plan" approach to pilon fractures described by Sirkin et al.2. Multiple subsequent studies have confirmed the superiority of external fixation over splinting for initial soft-tissue care following distal tibial and ankle trauma12,13. Temporary circular external fixation has been shown to outperform monolateral fixation in terms of both the adequacy of the initial reduction and the maintenance of this reduction1. Harrison et al. demonstrated that temporary circular fixation of the traumatized ankle yielded 100% good or excellent initial reduction compared with 91% for monolateral fixation. This initial reduction was also better maintained by circular fixator constructs compared with monolateral ones (96% versus 78%). Placement and orientation of the rings should take into account the zone of injury, access for orthoplastic procedures, and the maximum length of adjustable struts.Orthogonal frame application allows the best biomechanical environment for stabilization of fracture and/or dislocation of the tibiotalar joint to facilitate soft-tissue care. Care should be taken in the operating room to ensure orthogonal mounting of both the proximal and the distal ring to their respective bone segments.Avoid transverse fine wires in the calcaneus to prevent translation while in the frame; consider the use of tensioned olive wires to further protect against translation.Place the midfoot wire through the base of the metatarsals or along the cuneiforms to maximize fixation.Take care to avoid placing the ankle or forefoot in equinus. CEF = circular external fixatorPAD = pronation adductionPER = pronation external rotationSAD = supination adductionSER = supination external rotation.

Lower extremity degloving soft tissue injuries: Patterns, treatment, and short-term Outcome in Sudan: A Sub-Saharan African setting

BackgroundDegloving soft tissue injury is among the most devastating trauma types, especially when involving the lower extremities. This study aims to identify degloving soft tissue injury (DSTI) Patterns, Treatment, and Short-term Outcomes. MethodsThis is a prospective, cross-sectional, hospital-based study of patients with DSTIs over six months. ResultsFifty-six patients with lower extremity DSTIs were included. The mean age of the patients was. 29.2 years.Males were predominant (71.4 %). The common site for DSTIs is the dorsum of the foot. Fourteen patients with degloving injury to the foot dorsum had open fractures with type 3 A Gustilo classification. Participants with MESS 1 did not have underlying fractures. Patients with higher MESS scores experienced a more severe form of injury. Most of the patients presented late to plastic surgery services. Definitive management offered to the patients includes secondary intention, direct closure, SSG, and loco-regional flap. The loco-regional flaps used were random fascia-cutaneous, sural, saphenous, Lateral gastrocnemius, and medial gastrocnemius. Thirty-nine of the participants had no complications following management. The complications encountered include Surgical site infection, wound dehiscence, and partial graft or flap loss. These complications were managed by local wound care and a local flap. More extended hospital stay was observed in patients with low revised trauma scores. ConclusionLower extremity DSTIs are common injuries in Sudan, and it is management is challenging. DSTIs with underlying fractures are the most common pattern of injury, with the dorsum of the foot being the most commonly affected part. A multidisciplinary approach is essential for management.

Evaluating the Effects of Carriere Motion Appliance and Twin Block Appliances in Class II Correction-A Retrospective Study.

The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy. Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA. The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation.

Open Bankart Repair with Subscapularis Split.

Anterior shoulder dislocations are a common injury, especially in the young, active, male population1. Soft-tissue treatment options for shoulder instability include arthroscopic or open Bankart repair, with open Bankart repair historically having lower rates of recurrence and reoperation, faster return to activity2-4, and a similar quality of life compared with arthroscopic repair5. More recent literature has suggested similar recurrence rates between arthroscopic and open procedures6. However, open Bankart repair may be indicated in cases of recurrent instability, especially if the patient participates in high-risk sports, because open repair can provide more capsular shift through the use of extra-capsular knots7. Performing a subscapularis split decreases the likelihood of subscapularis tendon avulsion following subscapularis tendon tenotomy and subsequent repair, as has been described in the literature8. Indications for open Bankart repair include failure of arthroscopic Bankart repair, multiple dislocations, with subcritical bone loss. This surgical technique is performed via the deltopectoral approach. The subscapularis tendon is exposed and "spared" by splitting the fibers with use of a longitudinal incision between the upper 2/3 and lower 1/3 of the subscapularis. We begin the split medially near the myotendinous junction. Because the subscapularis becomes increasingly difficult to separate from the capsule as it tracks laterally, a RAY-TEC sponge is utilized to bluntly dissect. A T-shaped laterally based capsulotomy is made to expose the glenohumeral joint. The vertical aspect is made first, followed by the horizontal aspect from lateral to medial, extending to the labrum. A Fukuda retractor is placed through the split to hold the humeral head laterally. The labrum is elevated, and the glenoid is prepared with rasp. Then labrum is repaired with knotted suture anchors until it is secure. One anchor is utilized for each "hour" of the clock face, with a minimum of 3 anchors. The anchors are placed on the articular margin of the glenoid. Sutures are passed from the anchor through the capsule and tied outside the capsule. The capsulotomy is then repaired with use of a suture. The suture is utilized to pull the inferior portion superiorly. The inferior portion is taken superiorly, and the superior leaflet is imbricated over the top. Finally, an examination is performed to ensure that the humeral head can be translated to but not over the anterior and posterior glenoid rims. No repair of the subscapularis tendon insertion is required. The incision is closed with deep dermal and subcuticular suture. Nonoperative treatment options include rotator cuff and periscapular strengthening or immobilization. Operative treatment options include open Bankart repair with subscapularis tenotomy and repair, arthroscopic Bankart repair, or bone block augmentation procedures. This procedure is different from the alternative treatments in that it is an open procedure, which allows for a more robust repair because the capsule can be shifted and doubled over, leading to the described decreased recurrence and reoperation rates. Open Bankart repair is better suited for large lesions that would be difficult to repair via arthroscopy. This procedure differs from other open Bankart techniques because the subscapularis is split rather than tenotomized, which removes the need to repair the tendon and decreases the rate of avulsion of the subscapularis tendon repair. Finally, this procedure is less invasive than the Latarjet procedure because it does not require osseous osteotomies and fixation. This procedure provides adequate capsular shift and visualization of the Bankart lesion without the increased risk of postoperative subscapularis tendon injury. If the subscapularis split alone does not provide adequate visualization, portions of the subscapularis tendon can be released from the lesser tuberosity.The location and origin of the upper and lower subscapular nerves can have variable courses, which could theoretically put them at risk for iatrogenic injury; however, studies have shown this subscapularis split technique to be safe from and prevent denervation of the muscle. GBL = glenoid bone lossEUA = examination under anesthesiaMRI = magnetic resonance imagingHSL = Hill-Sachs lesionAHCA = anterior humeral circumflex artery.

Real-World Use of Dalbavancin for Treatment of Soft Tissue and Bone Infection in Children: Safe, Effective and Hospital-Time Sparing.

Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents.

Hoffa fractures are associated with concomitant soft tissue injures and a high postoperative complication rate

IntroductionHoffa fractures are a rare and often overlooked entity. The main goal of surgical treatment is to restore the articular surface and maintain knee function. However, current clinical data indicate heterogeneous outcomes. The aim of this multicenter study was to obtain a representative data set of patients with isolated Hoffa fractures with special emphasis on concomitant soft tissue injuries, diagnostic algorithms, treatment strategies and functional outcomes.Materials and methodsParticipating Level I trauma centres were asked to review their internal database for isolated Hoffa fractures treated surgically between 2010 and 2020. Demographics, mechanism of injury, diagnostic and therapeutic algorithm, Letenneur classification, concomitant soft tissue injuries, and postoperative knee function and complications were analysed.ResultsA total of 56 patients from six participating trauma centres were included. The median age at injury was 45 years (15–94) with a median follow-up of 19 months (2–108). The most common mechanism of injury was high-energy trauma, with unicondylar lateral Letenneur type I and II fractures being the most common. Surgical treatment was independent of the type of fracture and included isolated screw fixation, combined plate and screw fixation and isolated plate osteosynthesis. Isolated screw fixation resulted in significantly better range of motion (ROM) values (p = 0.032), but the highest number of postoperative complications (n = 14/20, n.s.) compared to the other fixation techniques. The highest number of fixation failures requiring revision was observed in the plate and screw fixation group (n = 3/8, p = 0.008). Osteochondral flake fractures (n = 12/43, 27%) and lateral meniscus injuries (n = 5/49, 10%) were commonly seen in Hoffa fractures.ConclusionsTreatment of Hoffa fractures with screw fixation resulted in significantly better functional outcomes, probably due to less comminuted fractures. Concomitant cartilage, meniscal and ligamentous injuries are common and warrant preoperative recognition and management.

JAMES LIND ALLIANCE FIRST TIME SOFT TISSUE KNEE INJURIES PRIORITY SETTING PARTNERSHIP: TOP TEN RESEARCH PRIORITIES

IntroductionThe knee is the most commonly injured joint in sporting accidents, leading to substantial disability, time off work and morbidity (1). Treatment and assessment vary around the UK (2), whilst there remains a limited number of high-quality randomised controlled trials assessing first time, acute soft tissue knee injuries (3,4). As the clinical and financial burden rises (5), vital answers are required to improve prevention, diagnosis, treatment, rehabilitation, and delivery of care. In association with the James Lind Alliance, this BASK, BOSTAA and BOA supported prioritising exercise was undertaken over a year.MethodsThe James Lind Alliance methodology was followed; a modified nominal group technique was used in the final workshop. An initial survey invited patients and healthcare professionals to submit their uncertainties regarding soft tissue knee injury prevention, diagnosis, treatment, rehabilitation, and delivery of care. Seventy-four questions were formulated to encompass common concerns. These were checked against best available evidence. Following the interim survey, 27 questions were taken forward to the final workshop in January 2023, where they were discussed, ranked, and scored in multiple rounds of prioritisation by groups of healthcare professionals, patients, and carers.ResultsOver 1000 questions were submitted initially. Twenty-seven were taken forward to the final workshop following the surveys. Nearly half of the responses were from patients/carers. The Top 10 (Figure 1) includes prevention, diagnosis, treatment, and rehabilitation questions, reflecting the concerns of patients, carers, and a wider multidisciplinary team.ConclusionThis validated process has generated an important, wide- ranging Top 10 priorities for future soft tissue knee injury research. These have been submitted to the National Institute for Health and Care Research and are now available for researchers to investigate. The final 27 questions which were taken to the final workshop have also been published on the James Lind Alliance website. Research into these questions will lead to future high-quality research, thus improving patient care & outcomes.For any figures or tables, please contact authors directly.

LASERS IN PROSTHODONTICS

Laser treatment in periodontal and oral surgery and in other disciplines in dentistry has replaced many traditional electrosurgical and scalpel procedures and is beginning to replace the dental handpiece. The successful construction of removable full and partial dentures mainly depends on the preoperative evaluation of the supporting hard and soft tissue structures and their proper preparation. Lasers may now be used to perform most preprosthetic surgeries. These procedures include hard and soft tissue tuberosity reduction, torus removal, treatment of unsuitable residual ridges including undercut and irregularly resorbed ridges, treatment of unsupported soft tissues, and other hard and soft tissue abnormalities. Stability, retention, function, and esthetics of removable prostheses may be enhanced by proper laser manipulation of the soft tissues and underlying osseous structure.

Effect of Active Release Technique and Cyriax approach on pain, grip strength and functional performance in individuals with lateral epicondylitis: a randomized clinical trial protocol

Background: Tennis elbow, also known as lateral epicondylitis, is a painful condition characterized by irritation of the tendons that link the forearm muscles on the outside of the elbow, which can result from using the elbow too much. Active Release Technique (ART) is defined as a hands-on approach that manages cases to enable the identification and treatment of soft tissue injuries. Through the removal of fibrosis and adhesions that can develop in tissues as a result of overload from frequent use, the aim of ART, a soft tissue treatment, is to lessen tissue stress. Deep transverse friction (DTF) and Mill's manipulation, which are used shortly after DTF, have been used by Cyriax and Cyriax to successfully treat tennis elbow. ART and Cyriax techniques have shown promise for lateral epicondylitis sufferers. There hasn't yet been any research comparing these two approaches for participants with lateral epicondylitis. The aim is to examine the efficiency of ART with the Cyriax technique on lateral epicondylitis pain, strength, and function. Methods: A total number of 60 participants will be included as per the inclusion criteria and then they will be further divided into 30 in each group. The physiotherapy intervention will be given to Groups A (ART) and Group B (Cyriax technique) along with conventional 12 sessions spread across four weeks, three times per week. Each patient will be evaluated during and after treatment on the baseline and after four weeks using the Visual Analogue Scale (VAS), hand grip strength dynamometer, and Patient-rated Tennis Elbow Evaluation (PRTEE) scale. Conclusions: This physiotherapy intervention could be used in the treatment of lateral epicondylitis if our study's hypothesis is found to be accurate. Registration: CTRI (CTRI/2023/06/053660; 08/06/2023).

An Examination of Personalized Approaches in the Management of Ankle Fractures: A Thorough Evaluation of Soft Tissue Factors, Treatment Methods, and Patient Adherence.

This study offers a thorough analysis of tibial pilon fractures, accounting for patient compliance, diverse treatment options, and soft tissue implications. The article discusses varied treatment pathways, ranging from single-stage interventions to two-stage methods for open fractures by presenting seven clinical cases. The emphasis is on the intricate interplay of trauma intensity, bone damage, and adjacent soft tissue in dictating treatment plans and patient outcomes. The challenges posed by non-compliant patients rejecting advised treatments are underscored, illuminating the inherent risks. Drawing from varied patient demographics, comorbidities, and fracture types, a comprehensive guide for clinicians emerges. The findings underscore the importance of a tailored, patient-centric approach, considering the multifaceted nature of ankle fractures, local soft tissue health, patient's overall well-being, and their adherence to the proposed treatment regimen.

JAMES LIND ALLIANCE FIRST-TIME SOFT-TISSUE KNEE INJURIES PRIORITY-SETTING PARTNERSHIP: TOP TEN

AbstractIntroductionThe knee is the most commonly injured joint in sporting accidents. They cause substantial disability, time off work and long-term problems. There remains a limited number of high-quality randomised controlled trials assessing first time, acute soft tissue knee injuries. Key areas requiring answers include prevention, diagnosis, treatment, rehabilitation and delivery of care. In association with the James Lind Alliance, this BASK, BOSTAA and BOA supported prioritising exercise was undertaken over a year.MethodologyThe James Lind Alliance methodology was followed. An initial survey invited patients and healthcare professionals to submit their uncertainties regarding soft tissue knee injury prevention, diagnosis, treatment, rehabilitation and delivery of care. Over 1000 questions were submitted. Seventy-four questions were formulated to encompass common concerns. These were checked against best available evidence. Following the interim survey, 27 questions were taken forward to the final workshop in January 2023, where they were discussed, ranked and scored in multiple rounds of prioritisation by groups of healthcare professionals, patients and carers.ResultsThe Top 10 includes prevention, diagnosis, treatment and rehabilitation questions, reflecting the concerns of patients, carers and a wider multidisciplinary team. These will be presented and explained.ConclusionThis validated process has generated an important Top 10, which has been submitted to the National Institute for Health and Care Research. All 27 questions will be published, thus being available for researchers to investigate. The questions in the Top 10 will lead to future high quality research, thus improving patient outcomes.

Hip Arthroscopy for Femoroacetabular Impingement

Background: Femoroacetabular impingement (FAI) is pain due to shape mismatch at the hip joint commonly affecting young athletes, and there are 2 main types depending on which bone has the underlying deformity: cam (femoral) and pincer (acetabular). Hip arthroscopy is an invaluable technique in the sports surgeon repertoire, and there is a need for a comprehensive tutorial that elucidates the best practices and nuances. Indications: Pain with evidence of FAI and labral tear on imaging, and failing conservative treatment, warrants arthroscopy. Technique Description: FAI surgery requires anatomical labral repair, thorough osteoplasty to correct the underlying deformity and prevent labral retearing, and careful treatment of soft tissues and capsular closure. Results: Reduced pain and improved hip function are the goals of treatment, with approximately 90% of patients returning to sport at 6 to 8 months postoperatively. Discussion/Conclusion: Hip arthroscopy is a safe and effective treatment for patients with FAI who failed conservative therapy. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Three-dimensional cultures of gingival fibroblasts on fibrin-based scaffolds for gingival augmentation: A proof-of-concept study

ObjectiveGingival tissue regeneration is associated with several challenges. Tissue engineering regenerates the different components of the tissues, providing three major elements: living cells, appropriate scaffolds, and tissue-inducing substances. This study aimed to regenerate the gingival connective tissue in vitro, using human gingival fibroblasts cultured in three-dimensional fibrin gel scaffolds. DesignHuman gingival fibroblasts were seeded in a novel three-dimensional fibrin gel scaffold and maintained in two media types: platelet lysate media (control) and collagen-stimulating media (test). Cellular viability and proliferation were assessed, and the production of collagen and other extracellular matrix components in these constructs was investigated and compared. ResultsHuman gingival fibroblasts cultured in three-dimensional cultures were metabolically active and proliferated in both media. Furthermore, histologic sections, scanning electron microscopy, and quantitative polymerase chain reaction confirmed the production of higher levels of collagen and other extracellular matrix fibers in three-dimensional constructs cultured in collagen-stimulating media. ConclusionsCulturing human gingival fibroblasts in a novel three-dimensional fibrin gel scaffold containing collagen-stimulating media resulted in a tissue-equivalent construct that mimics human gingival connective tissue. The impact of these results should be considered for further investigations, which may help to develop a compatible scaffold for gingival soft tissue regeneration and treatment of mucogingival deformities.

Progress in Application of Concentrated Growth Factor in Oral Tissue Regeneration

Tissue regeneration is an important engineering method for the treatment of oral soft and hard tissue defects.Growth factors,as one of the three elements of tissue regeneration,are a necessary condition for tissue regeneration.Concentrated growth factor(CGF)is a new generation of blood extract prepared by changing the centrifugal speed on the basis of the preparation of platelet-rich plasma(PRP)and platelet-rich fibrin(PRF).It contains abundant growth factors and a fibrin matrix with a three-dimensional network structure,being capable of activating angiogenesis and promoting tissue regeneration and healing.CGF has been widely used in the repair and regeneration of oral soft and hard tissues.This paper introduces the preparation and composition of CGF and reviews the application of CGF in oral implantation and the regeneration of oral bone tissue,periodontal tissue,and dental pulp tissue.

Building liquid-liquid perfusion interface (LLPI) –based patient-derived tumoroids (PDTs) model system as clinical research tools for testing cancer therapeutics.

e15192 Background: Current in vitro cancer model systems are inadequate in their representation and application of an actual tumor. Use of three-dimensional PDTs that consists of stroma and the microenvironment vastly addresses these shortcomings. However, a complete picture of the intratumoral interactions and functions requires optimal supply of oxygen to address problems associated with poor cellular oxygenation. Soft tissue sarcomas are malignant tumors that develop in the tissues that surround and support bones and organs. For non-resectable soft tissue sarcomas, model systems and treatment options are either limited or not available. We are establishing our Matrigel-based PDTs on a Liquid-Liquid Perfusion Interface (LLPI) using a synthetic hemoglobin as a blood substitute to build a comprehensive model system that is an amalgamation of an in vitro-in vivo system. Our objective is to replicate tumor complexity and use our model to serve as an effective and reliable platform to test and investigate therapeutic options. Methods: Soft tissue sarcoma PDT models with LLPI were built and used for testing under the following groups: Drug treatments with Doxorubicin (10nM), HSP90 inhibitor (1)10 nM, (2) 100 nM and (3) 1 mM) and combination (Doxorubicin + HSP90) for 10 days was compared on Sarcoma PDT models with and without oxygenation to test the impact of oxygen on tumor volume. Currently we are pursuing downstream analysis using apoptosis, proliferation and cytokine profiling and dynamic oxygen analysis of the TME. Results: We compared the effect of Doxorubicin with HSP90 inhibitor on a Sarcoma PDT model with and without oxygenation to observe the impact of oxygen on tumor growth. We observed similar rate of cell growth in the untreated samples in both model systems. In the non-oxygenated PDTs Doxorubicin-HSP90 combination was effective in reducing tumor volume. In the oxygenated PDTs the efficacy of the combination therapy (Doxorubicin+HSP90) was no longer observed. Conclusions: The oxygenation status impacts the effect of Doxorubicin, HSP90 combination, a critical influence that would not have been observable without the use of oxygenated PDT model system. The impact of intratumoral variations on oxygenation levels warrants testing other existing and novel therapeutics on oxygenated PDT model systems to investigate the extent of the influence of oxygenation on the tumor biology. [Table: see text]