Extracorporeal Shock Wave Therapy (ESWT) as a treatment for recurrent Neurogenic Heterotopic Ossification (NHO)

“This is an Accepted Manuscript of an article published by Taylor & Francis in Brain Injury on 5 Feb 2013, available online: http://www.tandfonline.com/10.3109/02699052.2012.729293." © 2013 Informa UK Ltd.Primary objective: To describe the effects of extracorporeal shock wave therapy (ESWT) on neurogenic heterotopic ossification (NHO). Research design: A single case study was considered the most appropriate methodology in this situation. Methods and procedures: The subject was a 43 year old female 10 years post-traumatic brain injury with recurring NHO around the hip joint. Baseline assessments of pain using a 10-point VAS, range of motion of the hip using a goniometer and walking ability (number of steps over a standard distance) were conducted. Four applications of ESWT using a Minispec™ Extracorporeal Shock Wave Lithotripsy machine (Medispec Int. USA) administered over 6 weeks to the anterolateral aspect of the right hip. Follow-up assessments were conducted weekly over the period of intervention and then monthly for 5 months. Main outcomes and results: Immediately following treatment, pain was reduced to 0 on the VAS scale; hip range of motion increased and the number of steps over a standard distance reduced, indicating increased step length. At 5-month follow-up, without further ESWT intervention, these results were maintained. Conclusion: This case study suggests that ESWT may be a non-invasive, low risk intervention for the management of NHO

Bioabsorbable versus titanium screws in anterior cruciate ligament reconstruction using hamstring autograft: a prospective, blinded, randomized controlled trial with 5-year follow-up

Background: Longer term studies of bioabsorbable screws for ACL reconstruction are reported, but results are specific to the exact screw material and design. Titanium and PLLA-HA screw outcomes have been compared only to 2 years. Purpose: The aim of this study was to compare the clinical and radiological outcomes of PLLAHA screw (BS) versus a titanium screw (TS), for hamstring tendon anterior cruciate ligament reconstruction over 5 years. We hypothesized that there are no differences in clinical scores, and tunnel widening, between the BS and the TS groups, and that the PLLA-HA screw as seen on MRI should show high grade resorption and ossification response over 5 years. Methods: 40 patients undergoing ACLR were randomized to receive either a PLLA-HA screw (BS group) or a Titanium screw (TS group) for ACL fixation. Blinded evaluation was performed at 2 & 5 years with IKDC & Lysholm knee score, KT-1000 arthrometer, single legged hop test, and MRI to evaluate tunnel and screw volumes, peri-screw ossification, graft integration and cyst formation. Results: There was no difference in any clinical outcome measure at 2 or 5 years between the 2 groups. At 2 years, the BS femoral tunnel was smaller than the TS tunnel (p=0.02) and at 5 years, there was no difference. At 2 years the femoral BS screw was a mean 76% of its original volume and by 5 years, 36%. At 2 years the tibial BS screw mean volume was 68% of its original volume and by 5 years, 46%. At 5 years BS group 88% of femoral tunnels and 56% of tibial tunnels demonstrated a significant ossification response. There was no increase in cyst formation in the BS group and no screw breakages. Conclusion: Our study has shown equivalent clinical results between BS and TS groups at 2 and 5 years. This PLLA-HA screw was not associated with increased tunnel widening or cyst formation when compared with the titanium screw. The PLLA-HA screw demonstrated progressive screw resorption and gradual, but incomplete ossification over 5 years