Cartilage lesions occur as a result of joint trauma, and progressively degenerate over time leading to osteoarthritis (OA). Early intervention therapies to repair the initial tissue damage have the potential to delay or prevent the onset of OA. We have developed two acellular treatments; 1) an injectable proteoglycan-like self-assembling hydrogel for the repair of ICRS grade 1 lesions, and 2) a decellularised xenogeneic osteochondral scaffold for surgical grafting in grade 2–4 lesions. We produced an in vitro glycosaminoglycan depleted grade 1 lesion model using porcine cartilage. Peptide-chondroitin sulphate mixture was injected and spontaneously gelled in situ. Cartilage resistance to deformation was increased by 50 %. Decellularised porcine osteochondral scaffolds which maintain the native tissue composition and architecture whilst being immunocompatible were successfully developed and are currently undergoing in vivo assessment in an ovine critical size condylar defect model. Incorporation of the subchondral bone in osteochondral scaffolds is intended to improve osseointegration; implanted decellularised bone-only scaffolds in sheep exhibited superb osteoinductive and osteoconductive properties in a proof-of-concept study. We envisage that our early intervention therapies will be employed clinically to maintain or restore functional hyaline-like cartilage across the whole range of early chondral pathologies and prevent the onset of OA

Around 20% of patients who have total knee replacement find that they experience long-term pain afterwards. There is a pressing need for better treatment and management for patients who have this kind of pain but there is little evidence about how to improve care. To address this gap we are developing a complex intervention comprising a clinic to assess potential causes of a patient's long-term pain after knee replacement and onwards referral to appropriate, existing services. The Medical Research Council recommends that development of complex interventions include several stages of development and refinement and involvement of stakeholders. This study comprises the penultimate stage in the comprehensive development of this intervention. Earlier stages included a survey of current practice, focus groups with healthcare professionals, a systematic review of the literature and expert deliberation. Healthcare professionals from diverse clinical backgrounds with experience of caring for patients with long-term pain after knee replacement were sent a study information pack. Professionals who wished to participate were asked to return their signed consent form and completed study questionnaire to the research team. Participants rated the appropriateness of different aspects of the assessment process and care pathway from 1–9 (not appropriate to very appropriate). Data were collated and a document prepared, consisting of anonymised mean appropriateness ratings and summaries of free-text comments. This document was then discussed in 4 facilitated meetings with healthcare professional held at the future trial centres. A summary report and revised care pathway was then prepared and sent to participants for further comments. 28 professionals completed the questionnaire and/or attended a meeting. Participants included surgeons, physiotherapists, nurses, pain specialists and rheumatologists. Mean appropriateness scores ranged from 6.9 to 8.4. Taking a score of 7–9 as agreement, consensus was achieved that the assessment should be performed at 3 months post-operative by an extended scope practitioner/nurse, treatment be guided by a standardised assessment of pain, and treatment individualised. There was also agreement that referrals in the care pathway to surgical review, GP and pain clinics were appropriate. Nurse-led/self-monitoring was rated lower (6.9) because of considerations about the need to ensure that patients receive appropriate support, follow-up and referral to other services. This work demonstrates the research methods that can be used to refine the design of a complex intervention. The process and findings enable refinement of an intervention for patients with long-term pain after knee replacement. The next stage of intervention development will assess the acceptability and reliability of the assessment process, and the usability of the intervention's standard operating procedures. The intervention will then be evaluated by a larger research team in a multi-centre randomised controlled trial, starting in late 2016

Abstract

Background. Inpatient physiotherapy is routinely provided after total knee replacement (TKR) surgery to enhance recovery prior to discharge. However, the provision of outpatient physiotherapy is variable in the UK, and the longer-term benefits of outpatient physiotherapy are unclear. This study aimed to evaluate the feasibility of conducting a randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of group-based outpatient physiotherapy after TKR. Methods. Patients listed for primary TKR were recruited prior to surgery. Patients who decided not to participate were asked about their reasons for non-participation. Patients were randomised to attend a newly developed post-operative physiotherapy class plus usual care or usual care alone. Patients allocated to the intervention group were invited to attend a weekly one-hour physiotherapy class, starting at 6 weeks after surgery and running over 6 consecutive weeks. The group classes were run by two physiotherapists within an outpatient gym, and involved task-orientated and individualised exercises. Classes ran on a rolling system, allowing new patients to join each week. Participants completed an evaluation questionnaire after the final class. Outcomes assessment was by questionnaire prior to surgery and 2 weeks, 3 months and 6 months after surgery. Outcomes related to function, pain, balance, self-efficacy, participation, quality of life and resource use. Results. 46/124 patients consented to participate (37% recruitment rate). Frequent reasons for non-participation were related to travelling distance, transportation, and time commitments. 17/23 patients randomised to the intervention group attended the exercise classes. Most (15) patients were very satisfied with the range of exercises on offer. The task-orientated and individual exercises were given average usefulness ratings of 9.6/10 and 9.5/10, respectively. Retention of participants was acceptable; 2 patients were withdrawn from the intervention group and 2 patients from the usual care group. Questionnaire return rates were high in the intervention group (91% at 6 months post-operative) but lower in the usual care group (65% at 6 months post-operative). Conclusion. This study highlights the importance of conducting feasibility work for a RCT. Collecting data on reasons for non-participation provided valuable information on barriers to participation in a trial with this population. The intervention was well attended, and feedback was positive. Questionnaire completion was lower in the usual care group, highlighting the need for additional strategies to improve data collection. Findings from this feasibility study have informed the design of a multi-centre RCT to evaluate the clinical and cost-effectiveness of a group-based outpatient physiotherapy intervention following TKR

Introduction. Lateral epicondylitis, also known as “tennis elbow,” is a degenerative disorder of the common extensor origin of the lateral humeral epicondyle. The mainstay of treatment is non-operative and includes physiotherapy, activity modification, bracing, nonsteroidal anti-inflammatory drugs, and injections. There is a subgroup of patients however who do not respond to non-operative measures and require operative intervention. Methods. We conducted a retrospective review of prospectively collected data to assess whether the introduction of PRP injections for lateral epicondylitis led to a reduction in patients subsequently undergoing surgical release. Results. Prior to the introduction of PRP injections, a mean of 12.75 patients a year underwent arthroscopic release for tennis elbow. Since PRP introduction this reduced to a mean of 4.25 patients a year. Using a Pearsons chi squared test this is a significant fall in the number of releases required, P<0.001. This significant reduction in patients requiring surgery since PRP introduction leads to an absolute risk reduction of 0.773 and number needed to treat on “as-treated” basis of only 1.3. Conclusion. In conclusion we consider PRP injection, for intractable lateral epicondylitis of the elbow, not only a safe but also very effective tool in reducing symptoms and have shown it has reduced the need for surgical intervention in this difficult cohort of patients

Total hip replacement (THR) is a common elective surgical procedure and can be effective for reducing chronic pain. However, waiting times for THR can be considerable, and patients often experience significant pain during this time. A pain self-management intervention may provide patients with the skills to enable them to manage their pain and its impact more effectively before surgery. However, studies of arthritis self-management programmes have faced challenges because of low recruitment rates, poor intervention uptake, and high attrition rates. This study aimed to evaluate the feasibility of a randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of a group-based pain self-management course for patients undergoing THR. Specific objectives were to assess trial design, ascertain recruitment and retention rates, identify barriers to participation, refine data collection methods, and evaluate uptake and patient satisfaction with the course. Patients listed for THR in an elective orthopaedic centre Bristol, UK were sent a postal invitation about the study. Participants were randomised to attend a pain self-management course plus standard care or standard care only using a computer-generated randomisation system. The pain self-management course was delivered by Arthritis Care and consisted of two half-day group sessions prior to surgery and one full-day group session 2–4 months after surgery. A structured course evaluation questionnaire was completed by participants. Outcomes assessment was by postal questionnaire prior to surgery and 1-month, 3-months and 6-months after surgery. Self-report resource use data were collected using a diary prior to surgery and inclusion of resource use questions in the 3-month and 6-month post-operative questionnaires. Brief telephone interviews were conducted with non-participants to explore barriers to participation. Postal invitations were sent to 385 eligible patients and 88 patients consented to participate (23% recruitment rate). Participants had a mean age of 66 years and 65% were female. Brief interviews with 57 non-participants revealed the most common reasons for non-participation were perceptions about the intervention and difficulties in getting to the hospital for the course. Of the 43 patients randomised to the intervention group, 28 attended the pre-operative pain self-management sessions and 11 attended the post-operative sessions. Participant satisfaction with the course was high, and patients enjoyed the group format. Retention of participants was acceptable, with 83% completing follow-up. Questionnaire return rates were high (76–93%), with the exception of the pre-operative resource use diary (35%). Completion rates for the resource use questions varied by category and allowed for an economic perspective from the health and social care payer to be taken. Undertaking feasibility work for a RCT is labour-intensive; however this study highlights the importance of conducting such work. Postal recruitment resulted in a low recruitment rate and brief interviews with non-participants provided valuable information on barriers to participation. Embedding collection of resource use data within questionnaires resulted in higher completion rates than using resource use diaries. While patients who attended the course gave positive feedback, attendance was low. Findings from this feasibility study enable us to design successful definitive group-based RCTs in the future

Background. Epidural steroid injections can provide temporary relief of symptoms in the treatment of lumbar spinal stenosis. Surgery is indicated when conservative measures fail. We hypothesise that patients who gain temporary relief of symptoms from the administration of epidural steroid injections are more likely to result in an improvement in symptoms following surgical intervention compared to patients who do not respond to injection therapy. Method. The records of patients who had received both an epidural injection and surgical intervention for lumbar spinal stenosis between July 2008 and July 2010 were identified and retrospectively reviewed. Relief of symptoms following epidural injection was noted at 6 weeks post procedure and the patients symptoms following surgical intervention was noted and classified according to MacNab's criteria at 3 months post-surgery. Results. 60 patients who received both an epidural injection and surgical intervention for lumbar spinal stenosis were identified. 76% of patients who gained relief of symptoms from epidural injection scored good or excellent according to MacNab's criteria following surgery (n=34). Only 30% of patients who did not respond to injection therapy scored good or excellent according to MacNab's criteria following surgical intervention (n=5). Conclusion. Patients who gained temporary relief of symptoms from epidural injection were more likely to benefit from surgical intervention in the treatment for lumbar spinal stenosis. No conflicts of interest. No funding obtained. We confirm that this abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

During OA the homeostasis of healthy articular chondrocytes is dysregulated, which leads to a phenotypical transition of the cells, further influenced by external stimuli. Chondrocytes sense those stimuli, integrate them at the intracellular level and respond by modifying their secretory and molecular state. This process is controlled by a complex interplay of intracellular factors. Each factor is influenced by a myriad of feedback mechanisms, making the prediction of what will happen in case of external perturbation challenging. Hampering the hypertrophic phenotype has emerged as a potential therapeutic strategy to help OA patients (Ripmeester et al. 2018). Therefore, we developed a computational model of the chondrocyte's underlying regulatory network (RN) to identify key regulators as potential drug targets

A mechanistic mathematical model of articular chondrocyte differentiation was implemented with a semi-quantitative formalism. It is composed of a protein RN and a gene RN(GRN) and developed by combining two strategies. First, we established a mechanistic network based on accumulation of decades of biological knowledge. Second, we combined that mechanistic network with data-driven modelling by inferring an OA-GRN using an ensemble of machine learning methods. This required a large gene expression dataset, provided by distinct public microarrays merged through an in-house pipeline for cross-platform integration.

We successfully merged various micro-array experiments into one single dataset where the biological variance was predominant over the batch effect from the different technical platforms. The gain of information provided by this merge enabled us to reconstruct an OA-GRN which subsequently served to complete our mechanistic model. With this model, we studied the system's multi-stability, equating the model's stable states to chondrocyte phenotypes. The network structure explained the occurrence of two biologically relevant phenotypes: a hypertrophic-like and a healthy-like phenotype, recognized based on known cell state markers. Second, we tested several hypotheses that could trigger the onset of OA to validate the model with relevant biological phenomena. For instance, forced inflammation pushed the chondrocyte towards hypertrophy but this was partly rescued by higher levels of TGF-β. However, we could annihilate this rescue by concomitantly mimicking an increase in the ALK1/ALK5 balance. Finally, we performed a screening of in-silico (combinatorial) perturbations (inhibitions and/or over-activations) to identify key molecular factors involved in the stability of the chondrocyte state. More precisely, we looked for the most potent conditions for decreasing hypertrophy. Preliminary validation experiments have confirmed that PKA activation could decrease the hypertrophic phenotype in primary chondrocytes. Importantly the in-silico results highlighted that targeting two factors at the same time would greatly help reducing hypertrophic changes.

A priori testing of conditions with in-silico models may cut time and cost of experiments via target prioritization and opens new routes for OA combinatorial therapies.

Background. Patients presenting to fracture clinic who have had initial management of a fracture performed by Accident and Emergency (A+E) often require further intervention to correct unacceptable position. This usually takes the form of booking a patient for a general anaesthetic to have manipulation under anaesthesia (MUA) or open surgery. Methods. Prospective data collection over a 6-month period. Included subjects were those that had initial management of a fracture performed by A+E, who went on to require re-manipulation in fracture-clinic. Manipulations were performed by trained plaster technicians using entonox analgesia followed by application of moulded cast. Radiographs were reviewed immediately post-manipulation by treating surgeon and patient managed accordingly. A retrospective review of radiograph images was performed by two doctors independently to grade the outcomes following manipulation. Results. 38 patients with 39 fractures included in study. Sites of fracture included 32 distal radius, 2 ankle, 1 spiral distal tibia and fibula, 3 metacarpal and 1 proximal phalanx of finger. 22 patients had anatomical/near-to anatomical reduction at post fracture-clinic manipulation of fracture and was the as well as definitive management (satisfactory outcome). 13 patients had a outcome 2 (minimally displaced but and satisfactory reduction of the fracture) at post fracture-clinic reduction. 12 of these were deemed acceptable went onto outcome 1 for definitive management with 1 going to outcome 2 (requiringed further manipulation). 4 patients had unsatisfactory reduction of fracture outcome 3 at post fracture-clinic reduction and all of these patients went onto outcome 3 (required surgery). Conclusions. This study supports the practice of possible primary reduction and if required, re-manipulation and cast moulding using only entonox analgesia, of selected patient cases fractures by trained plaster technicians. Without this intervention, almost all of these cases will have required an MUA or additionally Kirscher wire or open fixation. There is potential to utilise a plaster technician in A+E, reducing the need for further fracture clinic appointments, being more acceptable to patients and having a resultant cost-saving implication. Level of Evidence. Level 3

Introduction. The treatment osteonecrosis of the femoral head remains uncertain. Core decompression is the standard technique for the early stages (ARCO I and II). A new alternative is core decompression combined with the insertion of an osteonecrosis rod. This implant is supposed to reduce the intraosseous pressure and to give additional structural support. The aim of this study was to evaluate the clinical and radiological outcome via magnetic resonance imaging (MRI) of this new technique. Methods. Twenty-three patients were included in this study. All patients underwent a core decompression combined with the insertion of an osteonecrosis rod. Results. A survival rate of 44 % (10 of 23 patients) was found. The conversion to a total hip arthroplasty was performed after a mean interval of 529 days (range, 120 to 1348 days) because of persistence of pain or destruction of the joint. In five cases, a conversion to a long-stem hip arthroplasty, in seven cases to a short-stem arthroplasty, and in one case in an external hospital, to a hip resurfacing was performed. The majority of patients within the surviving group revealed an almost unchanged stage (mean follow-up of 477 days). In two cases, a radiological regression was obvious. A follow-up MRI of one of those patients showed complete regression. Conclusion. The outcome after core decompression combined with the insertion of a tantalum osteonecrosis intervention implant did not show superior results compared to core decompression. This is in contrast to prior studies. In addition, the surgical procedure and rehabilitation was prolonged and the costs higher than for isolated core decompression. An advantage is low risk of fracture post-operatively. In the case of conversion to total hip arthroplasty, no problems appeared during explantation of the tantalum implant

Background

In the adolescent population, operative management of hallux-valgus is controversial. Operations may be less successful than in adults and post-operative recurrence is more common before full skeletal maturity. This study assesses the radiographic, functional and qualitative outcomes of surgical Hallux Valgus correction in adolescents.

Introduction. Approximately 20-25% of patients having joint replacement in the UK have moderate-severe frailty. Frailty is associated with poorer outcomes after joint replacement. Targeting frailty pre-operatively with exercise and protein supplementation could improve post-operative outcomes. Prior to conducting a randomised controlled trial (RCT), a feasibility study was necessary to inform trial design and delivery. Method. We conducted a randomised feasibility study with embedded qualitative work. Patients aged ≥65 years, frail and undergoing THR or TKR were recruited from three UK hospitals. Participants were randomly allocated on a 1:1 ratio to the intervention or usual care group. The intervention group had a 1:1 appointment with a physiotherapist and were provided with a home-based, tailored daily exercise programme and a daily protein supplement for 12 weeks before their operation, supported by six telephone calls from a physiotherapist. Questionnaires were administered at baseline and 12 weeks after randomisation. Interviews were conducted with 19 patients. Feasibility outcomes were eligibility and recruitment rates, intervention adherence, and acceptability of the trial and the intervention. Result. 411 patients were sent a screening pack. Of the 168 patients who returned a screening questionnaire, 79 were eligible and consented to participate, and 64 were randomised. Of the 33 participants randomised to the intervention, 26 attended the intervention appointment. Eighteen participants (69%) received all six intervention follow-up telephone calls. Nineteen participants completed an intervention adherence log; 13 (68%) adhered to the exercise programme and 11 (58%) adhered to the protein supplementation. The overall retention rate was 86% at 12 weeks. The 12-week follow-up questionnaire was returned by 84% of participants who were sent a questionnaire. Interviews found that the trial and intervention were generally acceptable, but areas of potential improvements were identified. Conclusion. This study demonstrated that a larger study is possible and has identified improvements to optimise the design of a RCT

This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic, and long bone fractures; interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews; and pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including osteoarthritis (OA). Synovial fluid (SF) biomarker measurement is a potential method to predict treatment response and effectiveness. However, the significance of different biomarkers and their correlation to clinical outcomes remains unclear. This systematic review evaluated current SF biomarkers used in investigation of cartilage degeneration or regeneration in the knee joint and correlated these biomarkers with clinical outcomes following cartilage repair or regeneration interventions. PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. Studies evaluating SF biomarkers and clinical outcomes following cartilage repair intervention were included. Two researchers independently performed data extraction and QUADAS-2 analysis. Biomarker inclusion, change following intervention and correlation with clinical outcome was compared. 9 studies were included. Study heterogeneity precluded meta-analysis. There was significant variation in sampling and analysis. 33 biomarkers were evaluated in addition to microRNA and catabolic/anabolic ratios. Five studies reported on correlation of biomarkers with six biomarkers significantly correlated with clinical outcomes following intervention. However, correlation was only demonstrated in isolated studies. This review demonstrates significant difficulties in drawing conclusions regarding the importance of SF biomarkers based on the available literature. Improved standardisation for collection and analysis of SF samples is required. Future publications should also focus on clinical outcome scores and seek to correlate biomarkers with progression to further understand the significance of identified markers in a clinical context

Introduction. Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). Interestingly, content and dose of exercise interventions seem to be important for the effect of exercise interventions, but the optimal content and dose is unknown. This warrants randomized controlled trials providing evidence for the optimal exercise program in Hip OA. The aim of this trial was to investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance, hip pain and hip-related quality of life in patients with hip OA. Method. This was a multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. 160 participants with clinically diagnosed hip OA were recruited from hospitals and physiotherapy clinics and randomly assigned to twelve weeks of PRT or NEMEX. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability. The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS). Result. The mean changes from baseline to 12-week follow-up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, 0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX. For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX. Conclusion. In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL

The National Hip Fracture Database (NHFD) is a clinically led web based audit used to inform national policy guidelines. The aim of this audit was to establish the accuracy of completion of NHFD v13.0 theatre collection sheets, identify common pitfalls and areas of good practice, whilst raising awareness of the importance of accuracy of this data and the manner in which it reflects performance of CAH Trauma & Orthopaedic unit in relation to national guidelines. Our aim was to improve completion up to >80% by the operating surgeon and improve overall accuracy. The methodology within both cycles of the audit were identical. It involved reviewing the NHFD V13.0 completed by the operating surgeon and cross-checking their accuracy against clinical notes, operation notes, imaging, anaesthetic charts and A&E admission assessment. Following completion of cycle 1 these results were presented, and education surrounding V13.0 was provided, at the monthly trust audit meeting. At this point we introduced a sticker onto the pre-operative checklist for Hip fractures. This included time of admission and reason for delay. We then completed a re-audit. Cycle-1 included 25 operations, 56% (n=14) had a completed V13.0 form. Of these 21% (n=3) were deemed to be 100% accurate. Cycle-2 included 31 operations (between April – June 21) 81% (n=25) had a completed intra-operative from and showed an increase in accuracy to 56% (n=14). Through raising awareness, education and our interventions we have seen a significant improvement in the completion and accuracy of v13.0. Although 100% accuracy was not achieved its clear that education and intervention will improve compliance over time. Through the interventions that we have implemented we have shown that it is possible to improve completion and accuracy of the NHFD V13.0 theatre collection sheet locally and feel this could be implemented nationally

Obesity is associated with poor outcomes and increased risk of failure after rotator cuff (RC) repair surgery. The effect of diet-induced obesity (DIO) on enthesis healing has not been well characterised and whether its effects can be reversed with dietary intervention is unknown. We hypothesised that DIO would result in inferior enthesis healing in a rat model of RC repair and that dietary intervention in the peri-operative period would improve enthesis healing. A total of 78 male Sprague-Dawley rats were divided into three weight-matched groups from weaning and fed either: control diet (CD), high-fat diet (HFD), or HFD until surgery, then CD thereafter (HF-CD). After 12 weeks the left supraspinatus tendon was detached, followed by immediate surgical repair. At 2 and 12 weeks post-surgery, animals were cullers and RCs harvested for biomechanical and histological evaluation. Body composition and metabolic markers were assessed via DEXA and plasma analyses, respectively. DIO was established in the HFD and HF-CD groups prior to surgery, and subsequently reversed in the HF-CD group after surgery. At 12 weeks post-surgery, plasma leptin concentrations were higher in the HFD group compared to the CD group (5.28 vs. 2.91ng/ml, P=0.003). Histologically, the appearance of the repaired entheses was poorer in both the HFD and HF-CD compared to the CD group at 12 weeks (overall histological score 6.20 (P=0.008), 4.98 (P=0.001) and 8.68 out of 15, respectively). The repaired entheses in the HF-CD group had significantly lower (26.4 N, P=0.028) load-at-failure 12 weeks post-surgery compared to the CD group (34.4 N); while the HFD group was low, but not significantly different (28.1 N, P=0.096). Body mass at the time of surgery, plasma leptin and body fat percentage were negatively correlated with histological scores and plasma leptin with load-at-failure 12 weeks post-surgery. DIO impaired enthesis healing in this rat RC repair model, with inferior biomechanical and histological outcomes. Restoring normal weight with dietary change after surgery did not improve healing outcomes. Exploring interventions that improve the metabolic state of obese patients and counselling patients appropriately about their modest expectations after repair should be considered

Imaging can provide valuable information about the function of tissues and organs. The capacity for detecting and measuring imaging biomarkers of biological activities, allows for a better understanding of the pathophysiology of any process in the human body, including the musculoskeletal system. This is of particular importance in oncologic, metabolic and rheumatologic diseases, but not limited to these. In the domain of the musculoskeletal system, functional imaging also means to be able to address biomechanical evaluations. Weight-bearing imaging and dynamic studies have a prominent role. All imaging techniques (X-rays, CT, MR, ultrasound) are in demand, and offer different applications, specific equipment and novel methods for addressing this. Functional imaging is also essential to drive minimally invasive treatments – i.e. interventional radiology, and new treatment approaches move together with the advances on imaging guidance methods. On both the diagnostic and the interventional side, the increasing availability of dedicated equipment and the development of specific imaging methods and protocols greatly helps the transition from research to clinical practice

The principal of “function priority, early rehabilitation, and return to sports” is now the goal for sports injury rehabilitation. Neuromuscular electrical stimulation for anterior cruciate ligament (ACL) reconstruction is a rising procedure for early rehabilitation. This paper systematically assessed the effects of neuromuscular electrical stimulation on postoperative ACL reconstruction to provide guidance for physiotherapist and patient when designing a suitable rehabilitation protocol. To evaluate the interventional outcomes of neuromuscular electrical stimulation following ACL reconstruction, we searched PubMed, EMbase, the Cochrane Library, Web of Science and CNKI to collect all randomized controlled trials (RCTs) comparing the effects with neuromuscular electrical stimulation and without intervention on rehabilitation after ACL reconstruction up to January 30, 2022. Two investigators independently performed literature screening, data extraction, bias assessment of risk, and used RevMan 5.3 software to conduct a meta-analysis. A total of six RCTs were included, and the results showed that the use of neuromuscular electrical stimulation after anterior cruciate ligament reconstruction significantly improved the International Knee Documentation Committee (IKDC) scores (MD 6.33, 95% CI [-0.43, 12.22]; I2 = 66%; p = 0.040), the Lysholm score (MD 7.94, 95% CI [6.49, 9.39]; I2 = 89%; p < 0.001), and the range of motion (ROM) (MD 9.99, 95% CI [7.97, 12.02]; I2 = 81%; p < 0.001) in the knees when compared to the control group without using neuromuscular electrical stimulation. Existing evidence show that neuromuscular electrical stimulation is beneficial for early rehabilitation after ACL reconstruction. The use of neuromuscular electrical stimulation is encouraged in the design of rehabilitation protocol. However, due to the limited number of RCT studies and the small sample size, further multi-center RCTs with more participants are needed for a higher-level evidence

Biplane video X-ray (BVX) – with models segmented from magnetic resonance imaging (MRI) – is used to directly track bones during dynamic activities. Investigating tibiofemoral kinematics helps to understand effects of disease, injury, and possible interventions. Develop a protocol and compare in-vivo kinematics during loaded dynamic activities using BVX and MRI. BVX (60 FPS) was captured whilst three healthy volunteers performed three repeats of lunge, stair ascent and gait. MRI scans were performed (Magnetom 3T Prisma, Siemens). 3D bone models of the tibia and femur were segmented (Simpleware Scan IP, Synopsis). Bone poses were obtained by manually matching bone models to X-rays (DSX Suite, C-Motion Inc.). Mean range of motion (ROM) of the contact points on the medial and lateral tibial plateau were calculated using custom MATLAB code (MathWorks). Results were filtered using an adaptive low pass Butterworth filter (Frequency range: 5-29Hz). Gait and Stair ascent activities from one participant's data showed increased ROM for medial-lateral (ML) translation in the medial compartment but decreased ROM in anterior-posterior (AP) translation when comparing against the same translations on the lateral compartment of the tibial plateau. Lunge activity showed increased ROM for both ML and AP translation in the medial compartment when compared with the lateral compartment. These results highlight the variability in condylar translations between different activities. Understanding healthy in-vivo kinematics across different activities allows the determination of suitable activities to best investigate the kinematic changes due to disease or injury and assess the efficacy of different interventions. Acknowledgements: This research was supported by the Engineering and Physical Sciences Research Council (EPSRC) doctoral training grant (EP/T517951/1)