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Journal of Orthopaedic Research :... Mar 2022Anterior cruciate ligament (ACL) ruptures significantly impact athletes in terms of return to play and loss of long-term quality of life. Before the onset of this study,... (Review)
Review
Anterior cruciate ligament (ACL) ruptures significantly impact athletes in terms of return to play and loss of long-term quality of life. Before the onset of this study, understanding the mechanism of ACL injury was limited. Thus, the primary focus of this manuscript is to describe our multi-faceted approach to uncovering the mechanism of noncontact ACL injury (NC-ACLI) with the goal of developing preventive strategies. The initial qualitative analysis of ACL injury events revealed most (70%) injuries involve minimal to no contact and occurr during landing or deceleration maneuvers in team sports with a minor perturbation before the injury that may disrupt the neuromuscular system leading to poor body dynamics. A series of quantitative videotape studies demonstrated differences in leg and trunk positions at the time of NC-ACLI in comparison to control subjects. Analysis of the faulty dynamics provoking NC-ACLI, especially the flat-footed landing component, supports the theory that an axial compressive force is the critical factor responsible for NC-ACLI. Our magnetic resonance imaging study demonstrated the NC-ACLI position was associated with a higher tibial slope, and joint contact occurring on the flat, anterior portion of the lateral femoral condyle versus the round, posterior aspect. Both anatomic conditions favor sliding (pivot shift) over rolling in the presence of an axial compressive force. Subsequent cadaveric studies supported axial compressive forces as the primary component of NC-ACLI. Both a strong eccentric quadriceps contraction and knee abduction moments may increase the compressive force at the joint thereby lowering the axial threshold to injury. This manuscript summarizes the NC-ACLI mechanism portion of the 2021 OREF Clinical Research Award.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Awards and Prizes; Humans; Knee Joint; Quality of Life; Tibia
PubMed: 34951064
DOI: 10.1002/jor.25257 -
Radiographics : a Review Publication of... 2020The acromioclavicular joint is an important component of the shoulder girdle; it links the axial skeleton with the upper limb. This joint, a planar diarthrodial... (Review)
Review
The acromioclavicular joint is an important component of the shoulder girdle; it links the axial skeleton with the upper limb. This joint, a planar diarthrodial articulation between the clavicle and the acromion, contains a meniscus-like fibrous disk that is prone to degeneration. The acromioclavicular capsule and ligaments stabilize the joint in the horizontal direction, while the coracoclavicular ligament complex provides vertical stability. Dynamic stability is afforded by the deltoid and trapezius muscles during clavicular and scapular motion. The acromioclavicular joint is susceptible to a broad spectrum of pathologic entities, traumatic and degenerative disorders being the most common. Acromioclavicular joint injury typically affects young adult males and can be categorized by using the Rockwood classification system as one of six types on the basis of the direction and degree of osseous displacement seen on conventional radiographs. MRI enables the radiologist to more accurately assess the regional soft-tissue structures in the setting of high-grade acromioclavicular separation, helping to guide the surgeon's selection of the appropriate management. Involvement of the acromioclavicular joint and its stabilizing ligaments is also important for understanding and classifying distal clavicle fractures. Other pathologic processes encountered at this joint include degenerative disorders; overuse syndromes; and, less commonly, inflammatory arthritides, infection, metabolic disorders, and developmental malformations. Treatment options for acromioclavicular dysfunction include conservative measures, resection arthroplasty for recalcitrant symptoms, and surgical reconstruction techniques for stabilization after major trauma.
Topics: Acromioclavicular Joint; Biomechanical Phenomena; Humans; Joint Diseases
PubMed: 32762593
DOI: 10.1148/rg.2020200039 -
The International Journal of... 2021The axial skeleton of the has undergone an evolutionary reduction of its bone elements. This structural plan is strongly preserved throughout the order and would have... (Review)
Review
The axial skeleton of the has undergone an evolutionary reduction of its bone elements. This structural plan is strongly preserved throughout the order and would have emerged as a highly specialized anatomical adaptation to its locomotor jumping pattern. The development programs that direct the vertebral morphogenesis of the anurans are poorly described and the molecular bases that have caused their pattern to differ from other tetrapods are completely unknown. In this work, we review the ontogeny of the spinal column of the anurans and explore the genetic mechanisms that could explain the morphological difference and the maintenance of the body plan during evolution. Here, we propose that the absence of caudal osseous elements, as a consequence of the inability of sclerotomes to form cartilaginous condensations in frogs, could be due to changes in both pattern and expression levels of , , and genes along the anteroposterior axis. The anteriorised expression of the genes together with the reduction in the expression levels of , and in the posterior somites could explain, at least partly, the loss of caudal vertebrae in the anurans during evolution.
Topics: Animals; Anura; Bone and Bones; Gene Expression Regulation, Developmental; Genes, Homeobox; Skeleton; Somites
PubMed: 32930370
DOI: 10.1387/ijdb.200230ss -
Current Osteoporosis Reports Dec 2023This review aims to provide a review of the multidisciplinary management of infants with osteogenesis imperfecta (OI) during the first year of life, focusing on those... (Review)
Review
PURPOSE OF REVIEW
This review aims to provide a review of the multidisciplinary management of infants with osteogenesis imperfecta (OI) during the first year of life, focusing on those with severe disease. The authors draw on published literature and direct experience of working in a large paediatric centre specialising in the management of rare bone disease.
RECENT FINDINGS
Whilst understanding of the pathophysiology of OI has grown over the past decade, the evidence base for management of infants remains limited. There has been a greater recognition of certain subjects of concern including pain management, cervical spine deformity, and neurocognitive development. Both international consensus guidelines on rehabilitation and disease-specific growth charts have been welcomed by clinical teams. The early involvement of multidisciplinary specialist care is critical in ensuring optimal care for the infant with severe OI. A long-term perspective which focuses on the axial, craniofacial, and peripheral skeleton as well as on development more generally provides a framework which can guide the management of infants with severe OI.
Topics: Child; Infant; Humans; Osteogenesis Imperfecta; Diphosphonates; Bone and Bones
PubMed: 37752354
DOI: 10.1007/s11914-023-00823-5 -
Neurosurgery Clinics of North America Apr 2020Chordomas are rare tumors of the axial skeleton whose slow growth belies a relentless tumor with a propensity for recurrence and late metastasis. Local control remains... (Review)
Review
Chordomas are rare tumors of the axial skeleton whose slow growth belies a relentless tumor with a propensity for recurrence and late metastasis. Local control remains an issue with chordoma in spite of aggressive operative management. High local failure rates have led to the exploration of alternative methods of treatment. Radiation continues to gain acceptance as an adjuvant to surgery and, in some cases, as a standalone treatment. However, the use of radiation remains controversial, and operative management remains the standard of care in spite of relatively high morbidity.
Topics: Chordoma; Humans; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Skeleton; Spinal Neoplasms; Treatment Outcome
PubMed: 32147016
DOI: 10.1016/j.nec.2019.11.007 -
Seminars in Cell & Developmental Biology Jul 2022A critical stage in the development of all vertebrate embryos is the generation of the body plan and its subsequent patterning and regionalisation along the main... (Review)
Review
A critical stage in the development of all vertebrate embryos is the generation of the body plan and its subsequent patterning and regionalisation along the main anterior-posterior axis. This includes the formation of the vertebral axial skeleton. Its organisation begins during early embryonic development with the periodic formation of paired blocks of mesoderm tissue called somites. Here, we review axial patterning of somites, with a focus on studies using amniote model systems - avian and mouse. We summarise the molecular and cellular mechanisms that generate paraxial mesoderm and review how the different anatomical regions of the vertebral column acquire their specific identity and thus shape the body plan. We also discuss the generation of organoids and embryo-like structures from embryonic stem cells, which provide insights regarding axis formation and promise to be useful for disease modelling.
Topics: Animals; Body Patterning; Embryonic Development; Gene Expression Regulation, Developmental; Mesoderm; Mice; Somites; Spine; Vertebrates
PubMed: 34690064
DOI: 10.1016/j.semcdb.2021.10.003 -
The Orthopedic Clinics of North America Oct 2021Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in... (Review)
Review
Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in automobile technology, resuscitation techniques, and diagnostic modalities. The leading injury mechanisms are motor vehicle crashes, falls from height, and sports-related events. Current treatment with urgent rigid posterior fixation of the occiput to the cervical spine has resulted in a substantial reduction in management delays expedites treatment of CCJ injuries. Within CCJ injuries, there is a spectrum of instability, ranging from isolated nondisplaced occipital condyle fractures treated nonoperatively to highly unstable injuries with severely distracted craniocervical dissociation. Despite the evolution of understanding and improvement in the management of cases regarding catastrophic failure to diagnose, subsequent neurologic deterioration still occurs even in experienced trauma centers. The purpose of this article is to review the injuries that occur at the CCJ with the accompanying anatomy, presentation, imaging, classification, management, and outcomes.
Topics: Atlanto-Axial Joint; Atlanto-Occipital Joint; Axis, Cervical Vertebra; Cervical Atlas; Cervical Vertebrae; Humans; Joint Dislocations; Occipital Bone; Spinal Fractures; Spinal Injuries; Trauma, Nervous System
PubMed: 34538354
DOI: 10.1016/j.ocl.2021.05.013 -
Skeletal Radiology Jun 2021The spine is the main stabilizer and load bearer of the axial skeleton. It is also important for the protection of neural structures, such as the spinal cord, nerve... (Review)
Review
The spine is the main stabilizer and load bearer of the axial skeleton. It is also important for the protection of neural structures, such as the spinal cord, nerve roots, and cauda equina. In the healthy skeleton, most injuries are a consequence of high-energy trauma and can lead to severe dysfunction, such as tetraplegia or paraplegia. In order to avoid such disabilities, it is important to recognize details that will guide treatment, and that will determine the necessity or not to have surgery. Familiarity with radiography, CT, and MRI in evaluating spine trauma is necessary, as, in some cases, all three methods will be useful in determining management and surgical planning. The most important factor in determining management in the thoracolumbar spine is the posterior ligamentous complex (PLC). Therefore, familiarity with its anatomy, primary and secondary signs of its injuries, is essential for radiologists in the emergency setting. Spine fractures are a very heterogeneous group of disorders. Management can be both conservative and surgical. It is important for radiologists to be aware of classifications and patterns for these injuries.
Topics: Humans; Lumbar Vertebrae; Radiography; Spinal Fractures; Spinal Injuries; Thoracic Vertebrae
PubMed: 33165712
DOI: 10.1007/s00256-020-03668-6 -
Drugs Apr 2023Axial symptoms (i.e., back pain) are common in the general population. At the same time 25-70% of patients with psoriatic arthritis (PsA) exhibit signs of inflammatory...
Axial symptoms (i.e., back pain) are common in the general population. At the same time 25-70% of patients with psoriatic arthritis (PsA) exhibit signs of inflammatory axial involvement (axial PsA). The presence of unexplained chronic (duration ≥ 3 months) back pain in a patient with psoriasis or PsA should trigger evaluation of the presence of axial involvement. Evaluation of axial involvement normally involves imaging of the axial skeleton (sacroiliac joints and/or spine) in addition to clinical and laboratory evaluation. Symptomatic patients with confirmed axial PsA are treated with a combination of non-pharmacologic and pharmacologic methods including the use of non-steroidal anti-inflammatory drugs, tumour necrosis factor, interleukin 17, and Janus kinase inhibitors. Interleukin 23 blockade might also be effective in the axial domain of PsA; a dedicated clinical study is ongoing at present. Safety considerations, patient preference, as well as the presence of other disease manifestations (especially of extra-musculoskeletal manifestations-clinically relevant psoriasis, acute anterior uveitis, inflammatory bowel disease), define the choice of a specific drug or drug class.
Topics: Humans; Arthritis, Psoriatic; Psoriasis; Spine; Sacroiliac Joint; Back Pain
PubMed: 36976477
DOI: 10.1007/s40265-023-01857-w -
Proceedings of the National Academy of... Apr 2024The axial columns of the earliest limbed vertebrates show distinct patterns of regionalization as compared to early tetrapodomorphs. Included among their novel features...
The axial columns of the earliest limbed vertebrates show distinct patterns of regionalization as compared to early tetrapodomorphs. Included among their novel features are sacral ribs, which provide linkage between the vertebral column and pelvis, contributing to body support and propulsion by the hindlimb. Data on the axial skeletons of the closest relatives of limbed vertebrates are sparce, with key features of specimens potentially covered by matrix. Therefore, it is unclear in what sequence and under what functional context specializations in the axial skeletons of tetrapods arose. Here, we describe the axial skeleton of the elpistostegalian and show that transformations to the axial column for head mobility, body support, and pelvic fin buttressing evolved in finned vertebrates prior to the origin of limbs. No atlas-axis complex is observed; however, an independent basioccipital-exoccipital complex suggests increased mobility at the occipital vertebral junction. While the construction of vertebrae in is similar to early tetrapodomorphs, its ribs possess a specialized sacral domain. Sacral ribs are expanded and ventrally curved, indicating likely attachment to the expanded iliac blade of the pelvis by ligamentous connection. Thus, the origin of novel rib types preceded major alterations to trunk vertebrae, and linkage between pelvic fins and axial column preceded the origin of limbs. These data reveal an unexpected combination of post-cranial skeletal characters, informing hypotheses of body posture and movement in the closest relatives of limbed vertebrates.
Topics: Animals; Biological Evolution; Fossils; Vertebrates; Bone and Bones; Lower Extremity
PubMed: 38564638
DOI: 10.1073/pnas.2316106121