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Seminars in Nuclear Medicine May 2024Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce... (Review)
Review
Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce the socioeconomic impact of bone and joint infections. Morphologic imaging such as ultrasound and plain radiographs form the first line investigations, however, in early infections findings may be negative or nonspecific. Nuclear medicine imaging techniques play a complementary role to morphologic imaging in the diagnosis of bone and joint infections. The availability of hybrid systems (SPECT/CT, SPECT/MRI, PET/CT or PET/MRI) offers improved specificity with ability to assess the extent of infection. Bone scans are useful as a gatekeeper wherein negative scans rule out sepsis with a good accuracy, however positive scans are nondiagnostic and more specific tracers should be considered. These include the use of labeled white blood cells and antigranulocyte antibodies. Various qualitative and quantitative interpretation criteria have been suggested to improve the specificity of the scans. PET has better image resolution and F-FDG is the major tracer for PET imaging with applications in oncology and inflammatory/infective disorders. It has demonstrated improved sensitivity over the SPECT based tracers, however, still suffers from lack of specificity. F-FDG PET has been used to monitor therapy in bone and joint infections. Other less studied, noncommercialized SPECT and PET tracers such as In-Biotin, Tc-Ubiquicidin, F-Na-Fluoride, F-labeled white blood cells and I-Fialuridine to name a few have shown great promise, however, their role in various bone and joint infections has not been established. Hybrid imaging with PET or PET/MRI offers huge potential for improving diagnostics in infections of the joints and bones.
Topics: Humans; Positron Emission Tomography Computed Tomography; Single Photon Emission Computed Tomography Computed Tomography; Bone and Bones; Infections; Joints; Bone Diseases
PubMed: 38016897
DOI: 10.1053/j.semnuclmed.2023.10.007 -
Journal of Foot and Ankle Research Jul 2023Kinematic coupling between the first metatarsophalangeal (MTP) and midtarsal joints is evident during gait and other movement tasks, however kinetic foot coupling during... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Kinematic coupling between the first metatarsophalangeal (MTP) and midtarsal joints is evident during gait and other movement tasks, however kinetic foot coupling during walking has not been examined. Furthermore, contributing factors to foot coupling are still unclear. Therefore, the purpose of this study was to investigate kinematic and kinetic coupling within the foot by restricting MTP motion during overground walking. We hypothesized that when the MTP joint was prevented from fully extending, the midtarsal joint would achieve less peak motion and generate less positive work compared to walking with normal MTP motion.
METHODS
Twenty-six individuals participated in this randomized cross-over study. Using motion capture to track motion, participants walked at 1.3 m/s while wearing a brace that restricted MTP motion in a neutral (BR_NT) or extended (BR_EX) position. Additionally, participants walked while wearing the brace in a freely moveable setting (BR_UN) and with no brace (CON). A pressure/shear sensing device was used to capture forces under each foot segment. During stance, peak joint motion and work were calculated for the MTP and midtarsal joints using inverse dynamics. A series of ANOVAs and Holm post hoc tests were performed for all metrics (alpha = 0.05).
RESULTS
The brace successfully decreased peak MTP motion by 19% compared to BR_UN and CON. This was coupled with 9.8% less midtarsal motion. Kinetically, the work absorbed by the MTP joint (26-51%) and generated by the midtarsal joint (30-38%) were both less in BR_EX and BR_NT compared to BR_UN.
CONCLUSION
Implications and sources of coupling between the MTP and midtarsal joints are discussed within the context of center of pressure shifts and changes to segmental foot forces. Our results suggest that interventions aimed at modulating MTP negative work (such as footwear or assistive device design) should not ignore the midtarsal joint.
Topics: Humans; Foot Joints; Walking; Foot; Gait; Metatarsophalangeal Joint; Biomechanical Phenomena; Range of Motion, Articular
PubMed: 37488576
DOI: 10.1186/s13047-023-00643-x -
International Journal of Molecular... Jul 2023Osteoarthritis (OA) is a multifactorial disease in which genetics, aging, obesity, and trauma are well-known risk factors. It is the most prevalent joint disease and the... (Review)
Review
Osteoarthritis (OA) is a multifactorial disease in which genetics, aging, obesity, and trauma are well-known risk factors. It is the most prevalent joint disease and the largest disability problem worldwide. Recent findings have described the role of damage-associated molecular patterns (DAMPs) in the course of the disease. In particular, alarmins such as HMGB1, IL-33, and S100B, appear implicated in enhancing articular inflammation and favouring a catabolic switch in OA chondrocytes. The aims of this review are to clarify the molecular signalling of these three molecules in OA pathogenesis, to identify their possible use as staging biomarkers, and, most importantly, to find out whether they could be possible therapeutic targets. Osteoarthritic cartilage expresses increased levels of all three alarmins. HMGB1, in particular, is the most studied alarmin with increased levels in cartilage, synovium, and synovial fluid of OA patients. High levels of HMGB1 in synovial fluid of OA joints are positively correlated with radiological and clinical severity. Counteracting HMGB1 strategies have revealed improving results in articular cells from OA patients and in OA animal models. Therefore, drugs against this alarmin, such as anti-HMGB1 antibodies, could be new treatment possibilities that can modify the disease course since available medications only alleviate symptoms.
Topics: Animals; Alarmins; Cartilage, Articular; Chondrocytes; HMGB1 Protein; Interleukin-33; Joints; Osteoarthritis; Synovial Membrane
PubMed: 37569519
DOI: 10.3390/ijms241512143 -
Journal of Biomechanics May 2024Semi-recumbent cycling performed from a wheelchair is a popular rehabilitation exercise following spinal cord injury (SCI) and is often paired with functional electrical...
Semi-recumbent cycling performed from a wheelchair is a popular rehabilitation exercise following spinal cord injury (SCI) and is often paired with functional electrical stimulation. However, biomechanical assessment of this cycling modality is lacking, even in unimpaired populations, hindering the development of personalised and safe rehabilitation programs for those with SCI. This study developed a computational pipeline to determine lower limb kinematics, kinetics, and joint contact forces (JCF) in 11 unimpaired participants during voluntary semi-recumbent cycling using a rehabilitation ergometer. Two cadences (40 and 60 revolutions per minute) and three crank powers (15 W, 30 W, and 45 W) were assessed. A rigid body model of a rehabilitation ergometer was combined with a calibrated electromyogram-informed neuromusculoskeletal model to determine JCF at the hip, knee, and ankle. Joint excursions remained consistent across all cadence and powers, but joint moments and JCF differed between 40 and 60 revolutions per minute, with peak JCF force significantly greater at 40 compared to 60 revolutions per minute for all crank powers. Poor correlations were found between mean crank power and peak JCF across all joints. This study provides foundation data and computational methods to enable further evaluation and optimisation of semi-recumbent cycling for application in rehabilitation after SCI and other neurological disorders.
Topics: Humans; Male; Bicycling; Adult; Biomechanical Phenomena; Female; Hip Joint; Spinal Cord Injuries; Knee Joint; Ankle Joint; Models, Biological; Electromyography
PubMed: 38640830
DOI: 10.1016/j.jbiomech.2024.112094 -
Sensors (Basel, Switzerland) Aug 2023The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable...
The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable postures are biomechanical risk factors for developing MSS. Ergonomic devices such as exoskeletons are possible solutions that can reduce muscle and joint load. To design effective exoskeletons for surgeons, one needs to quantify which neck and trunk postures are seen and how much support during actual surgery is required. Hence, this study aimed to establish the biomechanical profile of neck and trunk postures and neck and lumbar joint loads during open surgery (training). Eight surgical trainees volunteered to participate in this research. Neck and trunk segment orientations were recorded using an inertial measurement unit (IMU) system during open surgery (training). Neck and lumbar joint kinematics, joint moments and compression forces were computed using OpenSim modelling software and a musculoskeletal model. Histograms were used to illustrate the joint angle and load distribution of the neck and lumbar joints over time. During open surgery, the neck flexion angle was 71.6% of the total duration in the range of 10~40 degrees, and lumbar flexion was 68.9% of the duration in the range of 10~30 degrees. The normalized neck and lumbar flexion moments were 53.8% and 35.5% of the time in the range of 0.04~0.06 Nm/kg and 0.4~0.6 Nm/kg, respectively. Furthermore, the neck and lumbar compression forces were 32.9% and 38.2% of the time in the range of 2.0~2.5 N/kg and 15~20 N/kg, respectively. In contrast to exoskeletons used for heavy lifting tasks, exoskeletons designed for surgeons exhibit lower support torque requirements while additional degrees of freedom (DOF) are needed to accommodate combinations of neck and trunk postures.
Topics: Lumbar Vertebrae; Joints; Posture; Lumbosacral Region; Neck; Biomechanical Phenomena
PubMed: 37571757
DOI: 10.3390/s23156974 -
Journal of Orthopaedic Surgery and... Oct 2023Musculoskeletal spine disorders, especially low back pain, induce enormous amounts of stress and financial burden on individuals and healthcare systems throughout the... (Review)
Review
Musculoskeletal spine disorders, especially low back pain, induce enormous amounts of stress and financial burden on individuals and healthcare systems throughout the world. Disorders of the facet joints in the lumbar spine are the most predominant cause of back pain, resulting in facet joint syndrome (FJS). Conventional treatments for FJS are short-lived and have limitations and side effects. Thus, safer and more effective alternatives that can reduce pain and improve patient-reported outcomes are needed. Recently, the utilization of biologics, including the ones derived from perinatal tissue such as amniotic membrane (AM) and umbilical cord (UC), has significantly increased for regenerative medicine applications. This manuscript summarizes the outcomes of preclinical and clinical studies utilizing AM and/or UC for FJS. We identified no preclinical studies and 3 retrospective studies utilizing the search terms "amniotic membrane" and/or "umbilical cord" and "facet joint syndrome". The administration of AM + UC is safe and potentially efficacious for patients with FJS. However, more preclinical studies and appropriately powered, multi-center, prospective non-randomized and randomized controlled studies with longer follow-up are warranted to further evaluate the efficacy of AM + UC to justify its clinical use.
Topics: Humans; Zygapophyseal Joint; Amnion; Retrospective Studies; Prospective Studies; Musculoskeletal Diseases; Bone Diseases; Umbilical Cord
PubMed: 37784162
DOI: 10.1186/s13018-023-04241-2 -
Scientific Reports Oct 2023Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of...
Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of diverse factors and conditions. The joints most often affected by traumatic osteoarthritis in dromedaries are the metacarpophalangeal and metatarsophalangeal joints. A comprehensive understanding of joint anatomy and topography of the dromedary is required to perform arthrocentesis correctly on affected joints. Forty-two distal limbs were taken from 28 camels and studied by gross dissection, casting, ultrasonography, and computed tomography (CT). Representative three-dimensional models of the joint cavities, recesses, and pouches were obtained using different casting agents. This study provides a detailed description of dorsally, axially, and abaxially positioned joint recesses, as well as palmar/plantar positioned joint pouches. The safety and feasibility of the different arthrocentesis approaches were evaluated. The traditional dorsal arthrocentesis approach of the metacarpophalangeal, metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints, has limitations due to the risk of damaging the tendon structures and articular cartilage, which can lead to joint degeneration. A lateral arthrocentesis approach via the proximal palmar/plantar pouches of the metacarpophalangeal/metatarsophalangeal and proximal interphalangeal joints is recommended. This approach eliminates the potential needle injury to the articulating joint cartilage and other surrounding joint structures, such as tendons, blood vessels, and nerves.
Topics: Animals; Camelus; Arthrocentesis; Forelimb; Joints; Cartilage, Articular; Metatarsophalangeal Joint
PubMed: 37833397
DOI: 10.1038/s41598-023-44391-1 -
BMC Oral Health Sep 2023Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and dentofacial deformities combined with and without postoperative occlusal splints (POS) has not been well studied.
OBJECTIVE
This study was to evaluate and compare the effects of OSu with and without POS in the treatment of TMJ anterior disc displacement without reduction (ADDwoR) in adolescent skeletal Class II malocclusion.
METHODS
A total of 60 adolescents with bilateral ADDwoR were enrolled in this study. They were randomly allocated into two groups: OSu with and without POS. Magnetic resonance imaging (MRI) and lateral cephalometric radiographs were used to measure changes in condylar height and the degree of skeletal Class II malocclusion from before operation and at 12 months postoperatively. Changes in these indicators were compared within and between the two groups.
RESULTS
After OSu, both groups exhibited significant improvements in condylar height and occlusion at the end of 12 months follow-up (P < 0.05). The group of OSu with POS had significantly more new bone formation (2.83 ± 0.75 mm vs. 1.42 ± 0.81 mm, P < 0.001) and improvement in dentofacial deformity than the group of OSu only (P < 0.05). The new bone height was significantly correlated with POS (P < 0.001), the changes of SNB (P = 0.018), overjet (P = 0.012), and Wits appraisal (P < 0.001).
CONCLUSION
These findings indicated that OSu can effectively stimulate condylar regeneration and improve skeletal Class II malocclusion in adolescents with bilateral ADDwoR. The results are better when combined with POS.
TRIAL REGISTRATION
This trial was prospectively registered on the chictr.org.cn registry with ID: ChiCTR1900021821 on 11/03/2019.
Topics: Adolescent; Humans; Dental Occlusion; Joint Dislocations; Magnetic Resonance Imaging; Malocclusion, Angle Class II; Occlusal Splints; Temporomandibular Joint; Temporomandibular Joint Disc; Temporomandibular Joint Disorders
PubMed: 37759222
DOI: 10.1186/s12903-023-03402-3 -
Journal of ISAKOS : Joint Disorders &... Aug 2023Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material.... (Review)
Review
IMPORTANCE
Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material. During the last decade, LATs have increased in prevalence in clinical practice and academic literature. Observing the trends in LAT publications can be used to identify clusters of strong evidence for clinical practice and to highlight areas of the literature which need further development.
OBJECTIVE
This article aims to define ligament augmentation as a technique category, observe anatomical, procedural, and temporal trends in LAT publication, and report on the state of current research in this field.
EVIDENCE REVIEW
Primary literature in the English language, which describes ligament augmentation and reports on human, cadaveric, or biomechanical models, and published prior to May 24th, 2022, was targeted for analysis. PubMed, Embase, and Cochrane CENTRAL databases were explored using a focused keyword search strategy, and the resulting publications were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected and analysed using descriptive statistics.
FINDINGS
Two hundred eighty-three publications reporting ligament augmentation techniques, published from May 1989 to May 2022, were included for final analysis. A wide technical and anatomical variety of procedures are reported. 36.8% of LAT publications describe knee ligaments, among which the anterior cruciate ligamenthas the highest focus in ligament augmentation publications (31.8% of articles). LAT literature has recently expanded in anatomical scope, with many contemporary articles describing the usage of a LAT in the ankle syndesmosis and coracoclavicular ligaments. 60.4% of LAT literature has been published since 2017. There has been an 11% average increase in the rate of LAT publication reports since 2015. Novel fixation devices-suture buttons and suture anchors-have gained wide popularity in the literature.
CONCLUSIONS AND RELEVANCE
In this review, we define LATs and quantitatively describe the expansion of LAT use reported in the literature. This data will provide physicians an overview of the history of these methods, as well as illustrate the broad range of applications available for the use of LATs.
Topics: Humans; Knee Joint; Ankle Joint; Ligaments, Articular; Suture Anchors
PubMed: 37105381
DOI: 10.1016/j.jisako.2023.04.003 -
Archives of Orthopaedic and Trauma... Feb 2024Surgical treatment options for acromioclavicular joint separations are varied. Frequently, suspension devices (SD) are inserted for stabilization under arthroscopic...
INTRODUCTION
Surgical treatment options for acromioclavicular joint separations are varied. Frequently, suspension devices (SD) are inserted for stabilization under arthroscopic view. This study investigates the feasibility and accuracy of three-dimensional (3D) digital-volume-tomography (DVT) C-arm navigated implantation with regard to the general trend toward increasingly minimally invasive procedures.
MATERIALS AND METHODS
The implantation of a TightRope suture button system (SD) via a navigated vertical drill channel through the clavicle and coracoid was investigated in 10 synthetic shoulder models with a mobile isocentric C-arm image intensifier setup in the usual parasagittal position. Thereby, in addition the placement of an additive horizontal suture cerclage via a navigated drill channel through the acromion was assessed.
RESULTS
All vertical drill channels in the Coracoclavicular (CC) direction could be placed in a line centrally through the clavicle and the coracoid base. The horizontal drill channels in the Acromioclavicular (AC) direction ran strictly in the acromion, without affecting the AC joint or lateral clavicle. All SD could be well inserted and anchored. After tensioning and knotting of the system, the application of the horizontal AC cerclage was easily possible. The image quality was good and all relevant structures could be assessed well.
CONCLUSION
Intraoperative 3D DVT imaging of the shoulder joint using a mobile isocentric C-arm in the usual parasagittal position to the patient is possible. Likewise, DVT navigated SD implantation at the AC joint in CC and AC direction on a synthetic shoulder model. By combining both methods, the application in vivo could be possible. Further clinical studies on feasibility and comparison with established methods should be performed.
Topics: Humans; Acromioclavicular Joint; Radiography; Clavicle; Acromion; Upper Extremity; Joint Dislocations
PubMed: 37938379
DOI: 10.1007/s00402-023-05112-5