Association between hip joint impingement and lumbar disc disease in elite rowers

Objectives Lumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers. Methods Cross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured. Results 85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o’clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=−2.60, p=0.018). Conclusions Rowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required

Genetic associations with psychosis and affective disturbance in Alzheimer's disease

Inga Margret Antonsdottir, Constantine Lyketsos, and Robert A. Sweet contributed equally to this study.Highlights: · It has long been known that psychotic and affective symptoms are often comorbid in individuals diagnosed with Alzheimer's disease. Here we examined for the first time the genetic architecture underlying this clinical observation, determining that psychotic and affective phenotypes in Alzheimer's disease are genetically correlated. · Nevertheless, psychotic and affective phenotypes in Alzheimer's disease diverged in their genetic correlations with psychiatric phenotypes assessed in individuals without Alzheimer's disease. Psychosis in Alzheimer's disease was negatively genetically correlated with bipolar disorder and positively with depressive symptoms, whereas the affective phenotypes in · Alzheimer's disease were positively correlated with anxiety disorder and more strongly correlated than psychosis with depressive symptoms. Psychosis in Alzheimer's disease, and the joint psychotic and affective phenotype, had significant estimated heritability, whereas the affective in AD did not. · Examination of the loci most strongly associated with the psychotic, affective, or joint phenotypes revealed overlapping and unique associations.INTRODUCTION: Individuals with Alzheimer's disease (AD) commonly experience neuropsychiatric symptoms of psychosis (AD+P) and/or affective disturbance (depression, anxiety, and/or irritability, AD+A). This study's goal was to identify the genetic architecture of AD+P and AD+A, as well as their genetically correlated phenotypes. METHODS: Genome-wide association meta-analysis of 9988 AD participants from six source studies with participants characterized for AD+P AD+A, and a joint phenotype (AD+A+P). RESULTS: AD+P and AD+A were genetically correlated. However, AD+P and AD+A diverged in their genetic correlations with psychiatric phenotypes in individuals without AD. AD+P was negatively genetically correlated with bipolar disorder and positively with depressive symptoms. AD+A was positively correlated with anxiety disorder and more strongly correlated than AD+P with depressive symptoms. AD+P and AD+A+P had significant estimated heritability, whereas AD+A did not. Examination of the loci most strongly associated with the three phenotypes revealed overlapping and unique associations. DISCUSSION: AD+P, AD+A, and AD+A+P have both shared and divergent genetic associations pointing to the importance of incorporating genetic insights into future treatment development.NIH. Grant Numbers: AG027224, MH116046, AG071169

Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner

This case presents symptom resolution for a long-distance runner with chronic Achilles tendinopathy (AT), following a partial tear of his Achilles tendon. The patient reported a sudden pain during a morning run, with preserved function. Three hours postinjury, he was reviewed in a musculoskeletal clinic. An ultrasound scan confirmed a partial Achilles tear, associated with significant Doppler activity. His index of AT severity The Victorian Institute of Sports Assessment - Achilles Questionnaire (VISA-A) 4 hours postinjury was markedly higher compared with 2 weeks preinjury, indicating reduced symptom severity. A follow-up scan 4 weeks postinjury showed minimal mid-portion swelling and no signs of the tear. His VISA-A score showed continued symptom improvement. This case represents resolution of tendinopathic symptomatology post partial Achilles tear. While the natural histories of AT and Achilles tears remain unknown, this case may indicate that alongside the known role of loading, inflammation may be a secondary mediator central to the successful resolution of AT pain

Suprapatellar synovial hypertrophy and reliability of the novel ultrasound assessment of suprapatellar recess in patients with recent knee injuries or early osteoarthritis

Purpose: Early through to late stage knee osteoarthritis (KOA) has been linked with effusion-synovitis in the suprapatellar pouch and chronic inflammation has been particularly associated with pain. Recent studies also suggest that synovial hypertrophy (SH), especially when seen in the suprapatellar pouch or Hoffa's fat pad, is an independent predictor for development of radiographic KOA. Persistent SH has been reported in post-traumatic knees. Ultrasound (US) assessment has great potential value as a non-invasive, practical method of measuring chronic inflammation and monitoring response to treatment, both clinically and in future trials. The US technique is an operator-dependent technique and reliability of a standardised US protocol in measuring SH and suprapatellar effusion (SE) has not been investigated in populations at risk of KOA.Methods: Aim: to investigate differences between degree of SH in affected and contralateral knees, and examine the intra- and inter-rater reliability of the novel US assessment of suprapatellar SH and SE in a population at risk of KOA.Participants: 57 patients with unilateral knee injuries or post-surgery on ligaments, cartilage and/or tendons were recruited from a single centre over a 6-month period. The exclusion criteria included: joint replacement, known inflammatory arthritis or known radiographic KOA defined as Kellgren and Lawrence of 2 or more in the affected knee.Protocol: each participant had US assessments of both knees performed on the same day by two physicians trained in performing musculoskeletal US and/or two US assessments performed by the same physician 3 days apart. Participants were examined in the supine position, the neutral knee position (preferably 0°), with maximum comfortable quadriceps contraction for the participant. The US probe was applied above the patella in the midline position to visualise in each knee all main structures on long-axis plane in the suprapatellar region: quadriceps tendon, pre-femoral and suprapatellar fat pads as well as shadows of patella and femur. A minimum of 6 images of each suprapatellar pouch in pre-defined region-of-interest (ROI) were recorded.Quantitative and semi-quantiative scoring was performed on the largest area of SH and SE defined using the OMERACT definitions. During each image analysis, a straight line at right angles to the reflexion shadow of the femur (long axis) was used for defining vertical axis for measurement of both synovium and effusion. The highest values for SH and SE in mm, from any imaging obtained during the analysis, were used as results for each scan.Results: 266 knee scans were performed. The study population consisted of otherwise healthy, predominantly young Caucasian males (59% were 34 years or younger, 81% were Caucasian and 74% of participants were males). 35% were smokers or ex-smokers. Affected knees had significantly higher values of SH (p[less than]0.001, mean±SD of affected knees: 3.5±2.8 mm, contralateral knees: 1.4±1.1 mm). Intra- and Inter-rater reliability of the semiquantitive scores were excellent when assessed by Cohen's kappa statistics with kappa values between 0.89 (for inter-rated SH) to 0.95 (for intra-rated SH). Inter- and intra-rater agreements for the quantitative method also showed very strong agreements (the Intra-Class Correlation from 0.83 to 0.98).Conclusions: Significantly increased SH has been demonstrated in symptomatic knees compared with contralateral unaffected knees. The study demonstrated very high reproducibility of a new standardised US method of measuring SH and SE in the suprapatellar pouch. External validation of our findings assessing practicality and reproducibility of this protocol is needed. Further correlation between sonographic findings, macroscopic and microscopic features of synovial membrane inflammation in populations at risk of developing KOA will allow us to establish a diagnostic role for this protocol in the future

Tibial cartilage volume of the back leg versus the higher loaded front leg in elite male and female English cricket fast bowlers

The aim of this study was to determine if the fast bowling action in cricket, during which the front leg experiences about twice the loading of the back leg, causes a clinically significant difference in the normalized medial or lateral tibial cartilage volume of the higher loaded front versus the back leg

Association between hip joint impingement and lumbar disc disease in elite rowers

Objectives: Lumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers. Methods: Cross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured. Results: 85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o’clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=−2.60, p=0.018). Conclusions: Rowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required.</p

A longitudinal cohort study of adolescent elite footballers and controls investigating the development of cam morphology

Cam morphology describes an asphericity of the femoral head that develops during adolescence, is highly prevalent in athletes, and predisposes individuals to future osteoarthritis. However, it’s aetiology remains poorly understood. The aim of this study was to perform 3-year longitudinal follow-up of a control population and football club academy cohort to compare the change in hip and growth plate anatomy between athletes and controls. MRI and questionnaires were used to characterise change in hip and growth plate anatomy and quantify activity levels. 121 male academy footballers and 107 male and female controls participated at baseline. Footballers experienced significantly greater increases in femoral head asphericity (4.83 degrees (95% CI: 2.84 to 6.82), p < 0.001) than controls. A positive correlation existed between activity levels and change in femoral head morphology (coefficient 0.79, p  ≤  0.001). Greatest morphological change occurred in individuals aged 11–12 years at baseline, with no significant change in individuals aged 14 years and older at baseline. Cam morphology development was secondary to soft tissue hypertrophy and lateral growth plate extension. In conclusion, excessive loading of the hip joint through exercise prior to 14 years of age may result in growth plate adaptations causing cam morphology. Potential interventions may include training type and load modification in young adolescent football players

Measuring 3D growth plate shape: Methodology and application to cam morphology

Physeal changes corresponding to cam morphology are currently measured using two-dimensional (2D) methods. These methods are limited by definitions of the femoral neck axis and head center that are dependent on the radiographic plane of view. To address these limitations, we developed three-dimensional (3D) methods for analyzing continuous growth plate shape using magnetic resonance imaging scans. These new methods rely on a single definition of the femoral neck axis and head center that are both nondependent on the radiographic plane of view and allow for analysis of growth plate shape across the growth plate surface (performed using statistical parametric mapping). Using our 3D method, we analyzed the position of the growth plate in the femoral head (relative to a plane tangent to the femoral head) and the curvature of the growth plate (relative to a plane through the center of the growth plate) in 9–16-year-old males at risk for cam morphology and their recreationally active peers (n = 17/cohort). These two measurements provide an avenue to separately analyze the effects of these variables in the overall growth plate shape. We detected differences in growth plate shape with age in recreationally active adolescents but did not detect differences between at risk and recreationally adolescents