Bone Union Assessment with Computed Tomography (CT) and Statistical Associations with Mechanical or Histological Testing:A Systematic Review of Animal Studies

Objective and accurate assessment of bone union after a fracture, arthrodesis, or osteotomy is relevant for scientific and clinical purposes. Bone union is most accurately imaged with computed tomography (CT), but no consensus exists about objective assessment of bone union from CT images. It is unclear which CT-generated parameters are most suitable for bone union assessment. The aim of this review of animal studies is to find which CT-generated parameters are associated most strongly with actual bone union. Scientific databases were systematically searched. Eligible studies were studies that (1) were animal studies, (2) created a fracture, (3) assessed bone union with CT, (4) performed mechanical or histological testing as measure of actual bone union, and (5) associated CT-generated outcomes to mechanical or histological testing results. Two authors selected eligible studies and performed risk of bias assessment with QUADAS-2 tool. From 2567 studies that were screened, thirteen studies were included. Most common CT parameters that were investigated were bone mineral density, bone volume, and total callus volume. Studies showed conflicting results concerning the associations of these parameters with actual bone union. CT-assessed torsional rigidity (assessed by three studies) and callus density (assessed by two studies) showed best results. The studies investigating these two parameters reported moderate to strong associations with actual bone union. CT-assessed torsional rigidity and callus density seem the most promising parameters to represent actual bone union after a fracture, arthrodesis, or osteotomy. Prospero trial registration number: CRD4202016473

Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy:a randomised clinical trial

Objective To compare the effectiveness of progressive tendon-loading exercises (PTLE) with eccentric exercise therapy (EET) in patients with patellar tendinopathy (PT). Methods In a stratified, investigator-blinded, block-randomised trial, 76 patients with clinically diagnosed and ultrasound-confirmed PT were randomly assigned in a 1:1 ratio to receive either PTLE or EET. The primary end point was clinical outcome after 24 weeks following an intention-to-treat analysis, as assessed with the validated Victorian Institute of Sports Assessment for patellar tendons (VISA-P) questionnaire measuring pain, function and ability to play sports. Secondary outcomes included the return to sports rate, subjective patient satisfaction and exercise adherence. Results Patients were randomised between January 2017 and July 2019. The intention-to-treat population (mean age, 24 years, SD 4); 58 (76%) male) consisted of patients with mostly chronic PT (median symptom duration 2 years). Most patients (82%) underwent prior treatment for PT but failed to recover fully. 38 patients were randomised to the PTLE group and 38 patients to the EET group. The improvement in VISA-P score was significantly better for PTLE than for EET after 24 weeks (28 vs 18 points, adjusted mean between-group difference, 9 (95% CI 1 to 16); p=0.023). There was a trend towards a higher return to sports rate in the PTLE group (43% vs 27%, p=0.13). No significant between-group difference was found for subjective patient satisfaction (81% vs 83%, p=0.54) and exercise adherence between the PTLE group and EET group after 24 weeks (40% vs 49%, p=0.33). Conclusions In patients with PT, PTLE resulted in a significantly better clinical outcome after 24 weeks than EET. PTLE are superior to EET and are therefore recommended as initial conservative treatment for PT

Development of Preoperative Prediction Models for Pain and Functional Outcome After Total Knee Arthroplasty Using The Dutch Arthroplasty Register Data

Background: One of the main determinants of treatment satisfaction after total knee arthroplasty (TKA) is the fulfillment of preoperative expectations. For optimal expectation management, it is useful to accurately predict the treatment result. Multiple patient factors registered in the Dutch Arthroplasty Register (LROI) can potentially be utilized to estimate the most likely treatment result. The aim of the present study is to create and validate models that predict residual symptoms for patients undergoing primary TKA for knee osteoarthritis. Methods: Data were extracted from the LROI of all TKA patients who had preoperative and postoperative patient-reported outcome measures registered. Multivariable logistic regression analyses were performed to construct predictive algorithms for satisfaction, treatment success, and residual symptoms concerning pain at rest and during activity, sit-to-stand movement, stair negotiation, walking, performance of activities of daily living, kneeling, and squatting. We assessed predictive performance by examining measures of calibration and discrimination. Results: Data of 7071 patients could be included for data analysis. Residual complaints on kneeling (female 72%/male 59%) and squatting (female 71%/male 56%) were reported most frequently, and least residual complaints were scored for walking (female 16%/male 12%) and pain at rest (female 18%/male 14%). The predictive algorithms were presented as clinical calculators that present the probability of residual symptoms for an individual patient. The models for residual symptoms concerning sit-to-stand movement, stair negotiation, walking, activities of daily living, and treatment success showed acceptable discriminative values (area under the curve 0.68-0.74). The algorithms for residual complaints regarding kneeling, squatting, pain, and satisfaction showed less favorable results (area under the curve 0.58-0.64). The calibration curves showed adequate calibration for most of the models. Conclusion: A considerable proportion of patients have residual complaints after TKA. The present study showed that demographic and patient-reported outcome measure data collected in the LROI can be used to predict the probability of residual symptoms after TKA. The models developed in the present study predict the chance of residual symptoms for an individual patient on 10 specific items concerning treatment success, functional outcome, and pain relief. This prediction can be useful for individualized expectation management in patients planned for TKA

Bone Degeneration and Recovery after Early and Late Bisphosphonate Treatment of Ovariectomized Wistar Rats Assessed by In Vivo Micro-Computed Tomography

Bisphosphonates are antiresorptive drugs commonly used to treat osteoporosis. It is not clear, however, what the influence of the time point of treatment is. Recently developed in vivo micro-computed tomographic (CT) scanners offer the possibility to study such effects on bone microstructure in rats. The aim of this study was to determine the influence of early and late zoledronic acid treatment on bone in ovariectomized rats, using in vivo micro-CT. Twenty-nine female Wistar rats were divided into the following groups: ovariectomy (OVX, n = 5), OVX and zoledronic acid (ZOL) at week 0 (n = 8), OVX and ZOL at week 8 (n = 7), and sham (n = 9). CT scans were made of the proximal tibia at weeks 0, 2, 4, 8, 12, and 16; and bone structural parameters were determined in the metaphysis. Two fluorescent labels were administered to calculate dynamic histomorphometric parameters. At week 16, all groups were significantly different from each other in bone volume fraction (BV/TV), connectivity density, and trabecular number (Tb.N), except for the early ZOL and control groups which were not significantly different for any structural parameter. After ZOL treatment at week 8, BV/TV, structure model index, Tb.N, and trabecular thickness significantly improved in the late ZOL group. The OVX and ZOL groups showed, respectively, higher and lower bone formation rates than the control group. Early ZOL treatment inhibited all bone microstructural changes seen after OVX. Late ZOL treatment significantly improved bone microstructure, although the structure did not recover to original levels. Early ZOL treatment resulted in a significantly better microstructure than late treatment. However, late treatment was still significantly better than no treatment