Rib Cage Measurement Reproducibility Using Biplanar Stereoradiographic 3D Reconstructions in Adolescent Idiopathic Scoliosis

Study design: A reproducibility study of preoperative rib cage 3D measurements was conducted for patients with Adolescent Idiopathic Scoliosis (AIS). Objective: to assess the reliability of rib cage 3D reconstructions using biplanar stereoradiography in patients with AIS before surgery. Summary: no prior reliability study has been performed for preoperative 3D reconstructions of the rib cage by using stereoradiography in patients with preoperative AIS. Materials: this series includes 21 patients with Lenke 1 or 2 scoliosis (74°+ - 20). All patients underwent low-dose standing biplanar radiographs. Two operators performed reconstructions twice each. Intraoperator repeatability, interoperator reproducibility and Intraclass coefficients (ICC) were calculated and compared between groups. Results: The average rib cage volume was 4.7l L (SD ± 0.75 L). SDr was 0.19 L with a coefficient of variation of 4.1% ; ICC was 0.968. The thoracic index was 0.6 (SD ± 0.1). SDr was 0.03 with a coefficient of variation of 4.7 % and a ICC of 0.820. As for the Spinal Penetration Index (6.4% ; SD ± 2.4), SDr was 0.9 % with a coefficient of variation of 14.3 % and a ICC of 0.901. The 3D rib hump SDr (average 27° ± 8°) was 1.4°. The coefficient of variation and ICC were respectively 5.1% and 0.991. Conclusion: 3D reconstruction of the rib cage using biplanar stereoradiography is a reliable method to estimate preoperative thoracic parameters in patients with AIS

Validity of Sit-And-Reach with Plantar Flexion Test in Children Aged 10-12 Years

El principal objetivo del presente estudio fue examinar la validez de criterio de los tests sit-and-reach clásico (SRC) y sit-and-reach con flexión plantar (SRF) para estimar la extensibilidad de la musculatura isquiosural en niños. Un total de 72 escolares (40 niños y 32 niñas) de 10-12 años de edad realizaron los tests lineales SRC y SRF, y el test criterio de medida elevación pasiva de la pierna recta. Los resultados de la correlación de Pearson (r) mostraron moderados valores de asociación de los tests SRC y SRF con la extensibilidad isquiosural (r = 0,71 y r = 0,74, ps < 0,01, respectivamente). Los valores de validez de criterio encontrados para el SRF fueron mayores que para el SRC, excepto para las niñas en el que fueron similares. Los hallazgos del presente estudio sugieren que la evaluación de la extensibilidad de la musculatura isquiosural mediante el test sit-and-reach debería realizarse permitiendo la flexión plantar.The main purpose of this study was to examine the criterion-related validity of classic sit-and-reach (CSR) and sit-and-reach with plantar flexion (SRF) tests for estimating hamstring extensibility in children. A total of 72 students (40 boys and 32 girls) aged 10-12 years performed the lineal tests CSR and SRF, and the criteria measure passive straight-leg raise test. Pearson´s correlation (r) results showed moderate values ​​of association between CSR and SRF with hamstring extensibility (r = 0.71 and r = 0.74, ps < 0.01, respectively). Criterion-related validity ​​values found for SRF were greater than for the CSR, except for the girls where the values were similar. The findings of this study suggest that the assessment of hamstring flexibility by sit-and-reach test should be performed allowing plantar flexion.El primer autor recibe una ayuda del programa de Formación del Profesorado Universitario (FPU) del Ministerio de Educación, Cultura y Deporte (AP2010-5905)

Knee orthoses for treating patellofemoral pain syndrome

Background: Patellofemoral pain syndrome (PFPS) is a painful musculoskeletal condition, which is characterised by knee pain located in the anterior aspect (front) and retropatellar region (behind) of the knee joint. Various non-operative interventions are suggested for the treatment of this condition. Knee orthoses (knee braces, sleeves, straps or bandages) are worn over the knee and are thought to help reduce knee pain. They can be used in isolation or in addition to other treatments such as exercise or non-steroidal anti-inflammatory medications. Objectives: To assess the effects (benefits and harms) of knee orthoses (knee braces, sleeves, straps or bandages) for treating PFPS. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (11 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015 Issue 5), MEDLINE (1946 to 8 May 2015), EMBASE (1980 to 2015 Week 18), SPORTDiscus (1985 to 11 May 2015), AMED (1985 to 8 May 2015), CINAHL (1937 to 11 May 2015), PEDro (1929 to June 2015), trial registries and conference proceedings. Selection criteria: Randomised and quasi-randomised controlled clinical trials evaluating knee orthoses for treating people with PFPS. Our primary outcomes were pain and function. Data collection and analysis: Two review authors independently assessed studies for eligibility, assessed study risk of bias and extracted data. We calculated mean differences (MD) or, where pooling data from different scales, standardised mean differences (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% CIs for binary outcomes. We pooled data using the fixed-effect model. Main results: We included five trials (one of which was quasi-randomised) that reported results for 368 people who had PFPS. Participants were recruited from health clinics in three trials and were military recruits undergoing training in the other two trials. Although no trials recruited participants who were categorised as elite or professional athletes, military training does comprise intensive exercise regimens. All five trials were at high risk of bias, including performance bias reflecting the logistical problems in these trials of blinding of participants and care providers. As assessed using the GRADE approach, the available evidence for all reported outcomes is 'very low' quality. This means that we are very uncertain about the results. The trials covered three different types of comparison: knee orthosis and exercises versus exercises alone; one type of orthosis versus another; and knee orthosis versus exercises. No trials assessed the mode of knee orthosis use, such as whether the orthosis was worn all day or only during physical activity. Two trials had two groups; two trials had three groups; and one trial had four groups. All five trials compared a knee orthosis (knee sleeve, knee brace, or patellar strap) versus a 'no treatment' control group, with all participants receiving exercises, either through a military training programme or a home-based exercise programme. There is very low quality evidence of no clinically important differences between the two groups in short-term (2 to 12 weeks follow-up) knee pain based on the visual analogue scale (0 to 10 points; higher scores mean worse pain): MD -0.46 favouring knee orthoses, 95% CI -1.16 to 0.24; P = 0.19; 234 participants, 3 trials). A similar lack of clinically important difference was found for knee function (183 participants, 2 trials). None of the trials reported on quality of life measures, resource use or participant satisfaction. Although two trials reported on the impact on sporting or occupational participation, one trial (35 participants) did not provide data split by treatment group on the resumption of sport activity and the other reported only on abandonment of military training due to knee pain (both cases were allocated a knee orthosis). One trial (59 participants, 84 affected knees) recording only adverse events in the two knee orthoses (both were knee sleeves) groups, reported 16 knees (36% of 44 knees) had discomfort or skin abrasion. Three trials provided very low quality evidence on single comparisons of different types of knee orthoses: a knee brace versus a knee sleeve (63 participants), a patella strap with a knee sleeve (31 participants), and a knee sleeve with a patellar ring versus a knee sleeve only (44 knees). None of three trials found an important difference between the two types of knee orthosis in pain. One trial found no clinically important difference in function between a knee brace and a knee sleeve. None of the three trials reported on quality of life, resource use or participant satisfaction. One trial comparing a patella strap with a knee sleeve reported that both participants quitting military training due to knee pain were allocated a knee sleeve. One poorly reported trial found three times as many knees with adverse effects (discomfort or skin abrasion) in those given knee sleeves with a patella ring than those given knee sleeves only. One trial compared a knee orthosis (knee brace) with exercise (66 participants). It found very low quality evidence of no clinically important difference between the two intervention groups in pain or knee function. The trial did not report on quality of life, impact on sporting or occupational participation, resource use, participant satisfaction or complications. Authors' conclusions: Overall, this review has found a lack of evidence to inform on the use of knee orthoses for treating PFPS. There is, however, very low quality evidence from clinically heterogeneous trials using different types of knee orthoses (knee brace, sleeve and strap) that using a knee orthosis did not reduce knee pain or improve knee function in the short term (under three months) in adults who were also undergoing an exercise programme for treating PFPS. This points to the need for good-quality clinically-relevant research to inform on the use of commonly-available knee orthoses for treating PFPS

Pseudoacromegaly

© 2018 Elsevier Inc. Individuals with acromegaloid physical appearance or tall stature may be referred to endocrinologists to exclude growth hormone (GH) excess. While some of these subjects could be healthy individuals with normal variants of growth or physical traits, others will have acromegaly or pituitary gigantism, which are, in general, straightforward diagnoses upon assessment of the GH/IGF-1 axis. However, some patients with physical features resembling acromegaly – usually affecting the face and extremities –, or gigantism – accelerated growth/tall stature – will have no abnormalities in the GH axis. This scenario is termed pseudoacromegaly, and its correct diagnosis can be challenging due to the rarity and variability of these conditions, as well as due to significant overlap in their characteristics. In this review we aim to provide a comprehensive overview of pseudoacromegaly conditions, highlighting their similarities and differences with acromegaly and pituitary gigantism, to aid physicians with the diagnosis of patients with pseudoacromegaly.PM is supported by a clinical fellowship by Barts and the London Charity. Our studies on pituitary adenomas and related conditions received support from the Medical Research Council, Rosetrees Trust and the Wellcome Trust

Lateral shelf acetabuloplasty in the treatment of Legg-Calvé -Perthes disease

Although head containment is extremely important for the development of the acetabulum and femoral head, there are debates about conservative and surgical treatment. Shelf acetabuloplasty is an effective means of treatment as regards the coverage of the femoral head within the acetabulum, which is the most important issue for the normal development of the hip joint. Nineteen hips of 18 patients were evaluated radiographically using the acetabulum-head index of Heyman and Herndon and the center-edge angle for containment. It was shown that postoperatively both indices improve to increase the containment, thus demonstrating the effectiveness of shelf acetabuloplasty

Lateral shelf acetabuloplasty Legg-Calve-Perthes disease

Although head containment is extremely important for the development of the acetabulum and femoral head, there are debates about conservative and surgical treatment. Shelf acetabuloplasty is an effective means of treatment as regards the coverage of the femoral head within the acetabulum, which is the most important issue for the normal development of the hip joint. Nineteen hips of 18 patients were evaluated radiographically using the acetabulum-head index of Heyman and Herndon and the center-edge angle for containment. It was shown that postoperatively both indices improve to increase the containment, thus demonstrating the effectiveness of shelf acetabuloplasty. (c) 2004 Lippincott Williams & Wilkins

False profile radiography for the evaluation of Legg-Celvé-Perthes disease

False profile radiography (FPR), as proposed by Lequesne and de Sèze, depicts the pathology on the anterolateral acetabular wall and femoral head. A study was conducted to find out the differences between normal anteroposterior radiography and FPR. Twenty-seven patients with Legg-Calvé-Perthes disease who had not been operated on previously and 50 recruits without any pathology were studied for the acetabulum-head index of Heyman-Herndon (HHI) and center-edge angles (CEs) in anteroposterior radiographs and VCA angles in FPR. The VCA angle is most useful to detect anterolateral coverage of the femoral head in lateral pillar C hips. FPR is an easy, reliable and cheap technique to evaluate the anterolateral parts of the femoral head, and the acetabulum. © 2004 Lippincott Williams & Wilkins

Rib deformity in scoliosis.

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level