Introduction. Spinal aBMD only explains 50–80% of vertebral
As the field of hip arthroscopy continues to develop, functional measures and testing become increasingly important in patient selection, managing patient expectations prior to surgery, and physical readiness for return to athletic participation. The Hip Sport Test (HST) was developed to assess
While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping. The purpose of this study is to compare functional performance and musculotendinous morphology in patients following OM or NOM for acute ATR. Eligible patients were aged 18-65 years old with an ATR who underwent OM or NOM within three weeks of injury and were at least one-year post injury. Gastrocnemius muscle thickness and Achilles tendon length and thickness were assessed with ultrasound. Functional performance was examined with single-leg hop tests and isokinetic plantar
Purpose of study and background. Spinal muscle area (SMA) is often employed to assess muscle functionality and is important for understanding the risk individuals may have of developing back pain or the risk of postural instability and falls.. However, handgrip
Aims. To draw a comparison of the pullout
Aims. Rotational acetabular osteotomy (RAO) is an effective joint-preserving surgical treatment for acetabular dysplasia. The purpose of this study was to investigate changes in muscle
Aims. Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient’s functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Eligible studies of THA patients that conducted at least one type of objective functional assessment both pre- and postoperatively were identified through Embase, Medline/PubMed, and Cochrane Central database-searching from inception to 15 September 2023. The assessments included were subgrouped for analysis: gait analysis, motion analysis, wearables, and
Aims. Orthopaedic surgery requires grafts with sufficient mechanical
Sarcopenia is an age-related geriatric syndrome which is associated with subsequent disability and morbidity. Currently there is no promising therapy approved for the treatment of sarcopenia. The receptor activator of nuclear factor NF-κB ligand (RANKL) and its receptor (RANK) are expressed in bone and skeletal muscle. Activation of the NF-κB pathway mainly inhibits myogenic differentiation, which leads to skeletal muscle dysfunction and loss. LYVE1 and CD206 positive macrophage has been reported to be associated with progressive impairment of skeletal muscle function with aging. The study aims to investigate the effects of an anti-RANKL treatment on sarcopenic skeletal muscle and explore the related mechanisms on muscle inflammation and the polarization status of macrophages. Sarcopenic senescence-accelerated mouse P8 (SAMP8) mice at month 8 were treated intraperitoneally with 5mg/kg anti-RANKL (IK22/5) or isotype control (2A3; Bio X Cell) antibody every 4 weeks and harvested at month 10. Senescence accelerated mouse resistant-1 (SAMR1) were collected at month 10 as the age-matched non-sarcopenic group. Ex-vivo functional assessment, grip
Aims. Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients. Methods. This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10). Results. There were significant improvements in clinical scores, in the range and
Aims. Loosening of the tibial component after total knee arthroplasty (TKA) is a common indication for revision. Increasing the
Purpose. The Purpose of this study was to evaluate hamstring
Recently, a new suture was designed to minimize laxity in order to preserve consistent tissue approximation while improving footprint compression after tendon repair. The aims of this study were: (1) to compare the biomechanical competence of two different high
Aims. Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass,
Injuries to the quadriceps muscle group are common in athletes performing high-speed running and kicking sports. The complex anatomy of the rectus femoris puts it at greatest risk of injury. There is variability in prognosis in the literature, with reinjury rates as high as 67% in the severe graded proximal tear. Studies have highlighted that athletes can reinjure after nonoperative management, and some benefit may be derived from surgical repair to restore function and return to sport (RTS). This injury is potentially career-threatening in the elite-level athlete, and we aim to highlight the key recent literature on interventions to restore
Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane – anterior to the rib cage – is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of
Tendon is a bradytrophic and hypovascular tissue, hence, healing remains a major challenge. The molecular key events involved in successful repair have to be unravelled to develop novel strategies that reduce the risk of unfavourable outcomes such as non-healing, adhesion formation, and scarring. This review will consider the diverse pathophysiological features of tendon-derived cells that lead to failed healing, including misrouted differentiation (e.g. de- or transdifferentiation) and premature cell senescence, as well as the loss of functional progenitors. Many of these features can be attributed to disturbed cell-extracellular matrix (ECM) or unbalanced soluble mediators involving not only resident tendon cells, but also the cross-talk with immigrating immune cell populations. Unrestrained post-traumatic inflammation could hinder successful healing. Pro-angiogenic mediators trigger hypervascularization and lead to persistence of an immature repair tissue, which does not provide sufficient mechano-competence. Tendon repair tissue needs to achieve an ECM composition, structure,
Objectives. Screw plugs have been reported to increase the fatigue
Background. Revision total knee arthroplasties (rTKA) are performed with increasing frequency due to the increasing numbers of primary arthroplasties, but very little is known regarding the influence of muscle
Aims. Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the
Aims. The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells. Methods. HIPGEN is a multicentre, multinational, randomized, double-blind, placebo-controlled trial. A total of 240 patients aged 60 to 90 years with low-energy femoral neck fractures (FNF) will be allocated to two arms and receive an intramuscular injection of either 150 × 10. 6. PLX-PAD cells or placebo into the medial gluteal muscle after direct lateral implantation of total or hemi hip arthroplasty. Patients will be followed for two years. The primary endpoint is the Short Physical Performance Battery (SPPB) at week 26. Secondary and exploratory endpoints include morphological parameters (lean body mass), functional parameters (abduction and handgrip
Objectives. Bisphosphonates (BP) are the first-line treatment for preventing fragility fractures. However, concern regarding their efficacy is growing because bisphosphonate is associated with over-suppression of remodelling and accumulation of microcracks. While dual-energy X-ray absorptiometry (DXA) scanning may show a gain in bone density, the impact of this class of drug on mechanical properties remains unclear. We therefore sought to quantify the mechanical
Aims. Arthroplasty is being increasingly used for the management of distal humeral fractures (DHFs) in elderly patients. Arthroplasty options include total elbow arthroplasty (TEA) and hemiarthroplasty (HA); both have unique complications and there is not yet a consensus on which implant is superior. This systematic review asked: in patients aged over 65 years with unreconstructable DHFs, what differences are there in outcomes, as measured by patient-reported outcome measures (PROMs), range of motion (ROM), and complications, between distal humeral HA and TEA?. Methods. A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on PROMs, ROM, and complications. PROMs and ROM results were reported descriptively and a meta-analysis of complications was conducted. Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42021228329). Results. A total of 29 studies met the inclusion and exclusion criteria. The mean Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) score was 19.6 (SD 7.5) for HA and 38 (SD 11.9) for TEA and the mean abbreviated version of DASH was 17.2 (SD 13.2) for HA and 24.9 (SD 4.8) for TEA. The Mayo Elbow Performance Score was the most commonly reported PROM across included studies, with a mean of 87 (SD 5.3) in HA and 88.3 (SD 5) in TEA. High complication rates were seen in both HA (22% (95% confidence interval (CI) 5 to 44)) and TEA (21% (95% CI 13 to 30), but no statistically significant difference identified. Conclusion. This systematic review has indicated PROMs and ROM mostly favouring HA, but with a similarly high complication rate in the two procedures. However, due to the small sample size and heterogeneity between studies,
Introduction. During revision surgery, the active electrode of an electrocautery device may get close to the implant, potentially provoking a flashover. Incidents have been reported, where in situ retained hip stems failed after isolated cup revision. Different sizes of discoloured areas, probably induced by electrocautery contact, were found at the starting point of the fracture. The effect of the flashover on the implant material is yet not fully understood. The aim of this study was to investigate the fatigue
Compressive fracture of osteoporotic vertebrae has been one of the most important health problems in aged societies because severely injured spin might be a reason of bedridden for elderly people. Osteoporosis has been widely assessed by averaged bone mineral density of vertebrae measured using DEXA, however, BMD sometimes does not reflect the
Background. Trunk muscles play an important role in supporting the spinal column. A decline in trunk muscle mass, as measured by bioelectrical impedance analysis (TMM–BIA), is associated with low back pain and poor quality of life. Purpose. The purpose of this study was to determine whether TMM–BIA correlates with quantitative and functional assessments traditionally used for the trunk muscles. Methods. We included 380 participants (aged ≥ 65 years; 152 males, 228 females) from the Shiraniwa Elderly Cohort (Shiraniwa) study, for whom the following data were available: TMM–BIA, lumbar magnetic resonance imaging (MRI), and back muscle
Aims. Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure. Methods. OVID, MEDLINE, and Embase database searches were performed independently by two authors who subsequently completed title, abstract, and full-text screening for inclusion against set criteria. Clinical outcomes and complication data were extracted, and a narrative synthesis presented. Results. Six studies (three randomized controlled trials and three non-randomized observational studies; 443 patients) were included in the final review. The aggregate data support the efficacy of CTFESI in excess of the likely minimal clinically important difference. No major complications were described. Conclusion. There is increasing evidence supporting the efficacy of CTFESI. Concerns regarding the occurrence of catastrophic complications, widely shared in the case report and anecdotal literature, were not found when reviewing the best available evidence. However, the
Introduction. Taper corrosion and fretting has been identified to be a major problem in total hip replacement during the past years. Taper design and manufacturing are not been standardised, and therefore it can be assumed that the tapers vary among different implant manufacturers. This can lead to variable contact situations and stresses in the taper junction depending on the combination. It can be assumed that the taper
Aims. The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps
Introduction. Ceramic ball heads are well known in hip arthroplasty for their superior tribology performance and high burst
Objectives. The aim of this study was to systematically review the literature on measurement of muscle
Objectives. Our objective was to predict the knee extension
Our study is still in progress. The results mentioned in the abstract are preliminary results. The final results will be provided at the time of presentation. Over the past decade, the widespread availability of high-resolution ultrasonography coupled with advances in regional anaesthesia have popularised peripheral nerve blocks for anterior cruciate ligament reconstructions (ACLRs). The aim of this study is to investigate whether the femoral nerve block (FNB) administered at the time of ACLR has any long-term impact on the quadriceps
Objectives. The most prevalent disorders of the shoulder are related to the
muscles of rotator cuff. In order to develop a mechanical method
for the evaluation of the rotator cuff muscles, we created a database
of isometric force generation by the rotator cuff muscles in normal
adult population. We hypothesised the existence of variations according
to age, gender and dominancy of limb. Methods. A total of 400 healthy adult volunteers were tested, classified
into groups of 50 men and women for each decade of life. Maximal
isometric force was measured at standardised positions for supraspinatus,
infraspinatus and subscapularis muscles in both shoulders in every
person. Torque of the force was calculated and normalised to lean body
mass. The profiles of mean torque-time curves for each age and gender
group were compared. Results. Our data showed that men gradually gained maximal
Background. More and more patients with end-stage knee OA are treated with total knee replacements (TKR). A modern TKR (Persona PS system, Zimmer Inc.) was designed with the hope to improve fit by providing additional sizing options on the femur and tibia. To date, there is very little information regarding the knee
Achieving normal
This is largest collection of outcomes of distal biceps reconstruction in the literature. 8 subjects prospectively measured pre and post reconstruction
Purpose. Investigating the effects of femoral stem length on hip and knee muscle
Concerns have been raised that deformation of
acetabular shells may disrupt the assembly process of modular prostheses.
In this study we aimed to examine the effect that the
We have compared the time to recovery of isokinetic
quadriceps
Musculoskeletal modeling techniques simulate reverse total shoulder arthroplasty (RTSA) shoulders and how implant placement affects muscle moment arms. Yet, studies have not taken into account how muscle-length changes affect force-generating capacity postoperatively. We develop a patient-specific model for RTSA patients to predict muscle activation. Patient-specific muscle parameters were estimated using an optimization scheme calibrating the model to isometric arm abduction data at 0°, 45°, and 90°. We compared predicted muscle activation to experimental electromyography recordings. A twelve-degree of freedom model with experimental measurements created patient-specific data estimating muscle parameters corresponding to
Introduction. Closed suction intraarticular drain (CSD) use after total knee arthroplasty (TKA) has been studied with regards to wound healing and range of motion, however, no data exist on how CSD use impacts knee joint effusion and quadriceps
Introduction. Current modeling techniques have been used to model the Reverse Total Shoulder Arthroplasty (RTSA) to account for the geometric changes implemented after RTSA [2,3]. Though these models have provided insight into the effects of geometric changes from RTSA these is still a limitation of understanding muscle function after RTSA on a patient-specific basis. The goal of this study sought to overcome this limitation by developing an approach to calibrate patient-specific muscle
Current modeling techniques have been used to model the Reverse Total Shoulder Arthroplasty (RTSA) to account for the geometric changes implemented after RTSA. Though these models have provided insight into the effects of geometric changes from RTSA these is still a limitation of understanding muscle function after RTSA on a patient-specific basis. The goal of this study sought to overcome this limitation by developing an approach to calibrate patient-specific muscle
This work uses a mathematical method to correlate the forces calculated to push-on and pull off a femoral head from a stem and correlate the results of in vitro testing. This work aimed to mathematically model the force needed to disassemble the THR unit for a given assembly load. This work then compared these results with the results of an in vitro experiment. The research presented aimed to determine the assembly forces necessary to prevent movement of the head on the stem through friction. By assessing the forces necessary to push the head onto the stem securely enough to prevent any movement of the head through friction, it is likely that the fretting and corrosion of the head taper interface will be reduced.Summary
Introduction
The disadvantage of removing a well-fixed femoral stem are multiple (operating time, risk of fracture, bone and blood loss, recovery time and post-op complications. Ceramic heads with titanium adapter sleeves (e.g. BIOLOX®OPTION, Ceramtec) are a possibility for putting a new ceramic head on slightly damaged used tapers. ‘Intolerable’ taper damages even for this solution are qualitatively specified by the manufacturers. The aim of this study was to determine the fracture
Purpose: It is known from previous studies that reduced grip
Bone
Purpose The tensile
Questions/purposes:. What factors influence tibial tray-cement interface bond