Treatment and Prevention of Osteoarthritis through Exercise and Sports

Osteoarthritis (OA) is a degenerative joint disease with a high prevalence among older people. To date, the pathogenesis of the disease and the link between muscle function and OA is not entirely understood. As there is no known cure for OA, current research focuses on prevention and symptomatic treatment of the disorder. Recent research has indicated that muscle weakness precedes the onset of OA symptoms. Furthermore, several studies show a beneficial effect of land-based aerobic and strengthening exercises on pain relief and joint function. Therefore, current research focuses on the possibility to employ exercise and sports in the prevention and treatment of OA

Percutaneous foot joint needle placement using a C-arm flat-panel detector CT

Purpose: Image guidance is valuable for diagnostic injections in foot orthopaedics. Flat-detector computed tomography (FD-CT) was implemented using a C-arm, and the system was tested for needle guidance in foot joint injections. Methods: FD-CT—guided joint infiltration was performed in 6 patients referred from the orthopaedic department for diagnostic foot injections. All interventions were performed utilising a flat-panel fluoroscopy system utilising specialised image guidance and planning software. Successful infiltration was defined by localisation of contrast media depot in the targeted joint. The pre- and post-interventional numeric analogue scale (NAS) pain score was assessed. Results: All injections were technically successful. Contrast media deposit was documented in all targeted joints. Significant relief of symptoms was noted by all 6 participants. Conclusions: FD-CT—guided joint infiltration is a feasible method for diagnostic infiltration of midfoot and hindfoot joints. The FD-CT approach may become an alternative to commonly used 2D-fluoroscopically guidanc

Messung der isometrischen Dorsalextensions- und Plantarflexions- Kraft in den Sprunggelenken

Dieser Artikel beschreibt ein Messgerät zur Bestimmung der isometrischen Kraft in den Sprunggelenken in Dorsalextension und Plantarflexion. Durch die Kombination der Vorrichtung zur Bestimmung der freiwilligen isometrischen Maximalkraft in den Sprunggelenken, des Elektromyogrammes und der genauen Positionskontrolle des zumessenden Beines ist es z.B. möglich, einen objektiven Vergleich der Unterschiede der Muskulatur zwischen dem linken und rechten Bein, wie auch während der Rehabilitation nach einer Operation oder Verletzung zu bekommen. This article describes an easy to use test equipment for measuring the isometric force in the ankle joints in dorsiflexion and plantar flexion. The combination of the test equipment for measuring the voluntary maximal isometric muscle force in the ankle joint, the surface electromyograms and the motion analysis of the measured leg allow an objective comparison of the strength of the muscular force between the left and right leg. It might be also used as a control setup during rehabilitation after surgical treatment or injurie

The biomechanical influence of tibio-talar containment on stability of the ankle joint

Chronic ankle instability (CAI) is a frequent sport orthopaedic entity. Although many risk factors have been studied extensively, little is known how it is influenced by the osseous joint configuration. Based on lateral X-rays, the radius of the talar surface and the tibial coverage of the talus (sector α) were measured on a DICOM/PACS system in 52 patients with CAI and an age- and sex-matched control group. The talar radius was found to be larger in patients with CAI (21.2±2.4mm) than in the control group (17.7±1.9mm; P<0.0001). The tibio-talar sector was smaller in patients with CAI (80°±5.1°) than in the control group (88.4°±7.2°; P<0.0001). The aim of this study is to analyse the biomechanical influence of the clinical data on stability of the ankle joint. A two-dimensional model of the tibio-talar joint in the sagittal plane was developed. The joint configuration was described by the tibio-talar sector (α) and the radius (r) of the talus. The force (F=F BW tan α/2) and energy (E=F BWr [1−cos α/2]) to dislocate the talus out of the tibial plafond were deduced. Ankle stability is a function of the tibio-talar sector: the force necessary to dislocate the joint is decreasing with a smaller sector. The clinical data show that the force needed to dislocate the ankle of CAI patients was 14% weaker than the one needed in the case of healthy subjects (P<0.0001). The energy to dislocate the ankle depends both on the sector and the radius. The clinical data do not show a significant difference between the energy needed to dislocate the joint of CAI patients and the one of healthy subjects. This is because there is a correlation of a small sector and a large radius for CAI ankles. CAI is associated with an unstable osseous joint configuration, which is characterized by a larger radius of the talus and a smaller tibio-talar sector. The findings of the biomechanical model explain the clinical observations and demonstrate how stability of the ankle joint is influenced by the osseous configuration. Surgical ankle ligament stabilization might be more recommended in patients with an unstable osseous configuration as such patients have a disposition for recurrent sprains. Removing anterior osteophytes for anterior impingement should be done carefully in CAI patients because this would decrease the tibial coverage of the talus and thus dispose the talus to dislocate anteriorly. People who have an unstable ankle configuration and who nevertheless engage in activities with high risk of ankle sprains could be asked to wear ankle protecting sports equipmen

Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

Introduction and purpose: Intramedullary screw fixation (ISF) of proximal fifth-metatarsal fractures is known as first treatment option in young, sports active patients. No study analyzed functional and biomechanical outcome before. Hypothetically ISF leads to (1) a high bony union rate within 12weeks, (2) normal hindfoot eversion strength, and (3) normal gait and plantar pressure distribution. Methods: Fourteen out of 22 patients were available for follow-up with an average follow-up of 42months; clinical and radiological follow-up, and biomechanical evaluation by isometric muscular strength measurement (inversion, eversion strength) and dynamic pedobarography, comparing to the non-affected contralateral foot. Level of significance: 0.05. Results: Subjective result: Excellent or good result in 14 patients, none fair or poor. AOFAS midfoot score: 100 points in 13 patients and 87 points in 1 patient. The same sports activity level (0-4) was reached in 13 out of 14 patients. Radiologic examination: consolidation after 6weeks in 9 patients and after 12weeks in another 4 patients, one partial union. Average maximal eversion strength 59N (ratio to the contralateral foot: 0.92, not significant). Dynamic pedobarography showed ratios of 0.99-1.01 to the contralateral side for ground reaction force, ground peak time, peak pressure and contact area (not significant). Interpretation: A very-high patient-satisfaction, a fast bony healing and complete return to sports were documented. Muscular strength measurement and dynamic pedobarography showed complete functional rehabilitation. Therefore, ISF in proximal fifth-metatarsal fractures can be recommended as a secure procedur

Effectiveness of the addition of Lidocaine to a hemostatic, bioresorbable putty in the treatment of iliac crest donor site pain

Background: The harvest of iliac crest bone grafts (ICBG) is associated with relevant donor site pain, but may be lowered by the application of lidocaine loaded on biodegradable, hemostatic putty for sustained local analgesic release. The goal of this double-blind controlled trial was to assess the efficacy of adding lidocaine to a hemostatic putty (Orthostat ™) to treat donor site pain following harvest of ICBG in foot and ankle procedures. Methods: After ICBG harvest during a foot and ankle procedure, the resulting bone defect was either filled with Orthostat™ (n = 7) or with the same hemostatic putty loaded with lidocaine (Orthostat-L™, n = 7). During the first 72 postoperative hours, donor site and surgical site pain were managed by patient controlled morphine delivery and a peripheral nerve block. Donor site pain was periodically quantified on a Visual Analog (VAS) and a Wong Baker FACES scale. Pain scores were plotted over time to calculate the area under the curve (AUC) to quantify the overall pain experienced in specific time intervals. Results: Orthostat-L™ significantly reduced donor site pain over the first 12 hours postoperatively as evidenced by a significant decrease of the AUC in both VAS (p = 0.0366) and Wong Baker FACES pain score plots (p = 0.0024). Cumulated morphine uses were not significantly decreased with Orthostat-L™. Conclusion: The addition of lidocaine to a hemostatic putty offers a significant ICBG donor site pain reduction over the first 12 postoperative hours. Trial registration ClinicalTrials.gov NCT01504035. Registered January 2nd 2012

Achilles Tendon and Athletes

Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pathologies vary from tendinopathy to frank rupture. Diagnosis is made clinically. Imaging modalities are used adjunctively. Management of AT rupture in athletes is challenging to surgeons due to worldwide growing popularity of sports and potential social and financial impact of AT injury to an athlete. Hence, new surgical techniques aim at attaining quick recovery with good outcome, finding similar results with both open and percutaneous techniques when accompanying these with functional rehabilitation protocols. Non-operative strategies include shoe wear modification, physiotherapy and extracorporeal shock wave therapy. Surgical interventions vary based on the AT pathology nature and extent. Direct repair can work for small-sized defects. V-Y gastrocnemius advancement could approximate the tendon edges for repair within 2–8 cm original gap. Gastrocnemius turndown can bridge tendon loss > 8 cm. Autogenous, allogeneous or synthetic tendon grafts were used for AT reconstruction purposes. In AT tendinopathies with no tendon tissue loss, surgical procedures revolve around induction of tissue repair through lesion incision or debridement to full detachment followed by reattachment. Extra-precautions are exercised for prevention of AT disorders especially among susceptible athletes participating in sports involving excessive AT strain

Substitutes of Structural and Non-Structural Autologous Bone Grafts in Hindfoot Arthrodeses and Osteotomies: A Systematic Review

Background: Structural and non-structural substitutes of autologous bone grafts are frequently used in hindfoot arthrodeses and osteotomies. However, their efficacy is unclear. The primary goal of this systematic review was to compare autologous bone grafts with structural and non-structural substitutes regarding the odds of union in hindfoot arthrodeses and osteotomies. Methods: The Medline and EMBASE and Cochrane databases were searched for relevant randomized and non-randomized prospective studies as well as retrospective comparative chart reviews. Results: 10 studies which comprised 928 hindfoot arthrodeses and osteotomies met the inclusion criteria for this systematic review. The quality of the retrieved studies was low due to small samples sizes and confounding variables. The pooled random effect odds for union were 12.8 (95% CI 12.7 to 12.9) for structural allografts, 5.7 (95% CI 5.5 to 6.0) for cortical autologous grafts, 7.3 (95% CI 6.0 to 8.6) for cancellous allografts and 6.0 (95% CI 5.7 to 6.4) for cancellous autologous grafts. In individual studies, the odds of union in hindfoot arthrodeses achieved with cancellous autologous grafts was similar to those achieved with demineralised bone matrix or platelet derived growth factor augmented ceramic granules. Conclusion: Our results suggest an equivalent incorporation of structural allografts as compared to autologous grafts in hindfoot arthrodeses and osteotomies. There is a need for prospective randomized trials to further clarify the role of substitutes of autologous bone grafts in hindfoot surgery

Engineering human cell-based, functionally integrated osteochondral grafts by biological bonding of engineered cartilage tissues to bony scaffolds

In this study, we aimed at developing and validating a technique for the engineering of osteochondral grafts based on the biological bonding of a chondral layer with a bony scaffold by cell-laid extracellular matrix. Osteochondral composites were generated by combining collagen-based matrices (Chondro-Gide) containing human chondrocytes with devitalized spongiosa cylinders (Tutobone) using a fibrin gel (Tisseel). We demonstrate that separate pre-culture of the chondral layer for 3 days prior to the generation of the composite allows for (i) more efficient cartilaginous matrix accumulation than no pre-culture, as assessed histologically and biochemically, and (ii) superior biological bonding to the bony scaffold than 14 days of pre-culture, as assessed using a peel-off mechanical test, developed to measure integration of bilayered materials. The presence of the bony scaffold induced an upregulation in the infiltrated cells of the osteoblast-related gene bone sialoprotein, indicative of the establishment of a gradient of cell phenotypes, but did not affect per se the quality of the cartilaginous matrix in the chondral layer. The described strategy to generate osteochondral plugs is simple to be implemented and--since it is based on clinically compliant cells and materials--is amenable to be readily tested in the clinic