-
In Vivo (Athens, Greece) 2024The styloid process (SP) becomes clinically relevant when it shows enlargement (>30 mm) in the sense of an elongated SP (ESP) and/or increasing calcification leading to... (Comparative Study)
Comparative Study
BACKGROUND/AIM
The styloid process (SP) becomes clinically relevant when it shows enlargement (>30 mm) in the sense of an elongated SP (ESP) and/or increasing calcification leading to Eagle Syndrome (ES). Panoramic radiograph (PR) or computed tomography (CT) are part of the routine diagnostics in ES. Currently, CT is considered the gold standard. The aim of this study was to investigate the accuracy in the diagnostics/measurements of SP/ESP throughout a comparative study between PR and CT. Furthermore, in addition to measuring established parameters, this study aimed to determine the currently unexamined width in the base and tip of the SP.
PATIENTS AND METHODS
The present study examined the radiological findings of bilateral SP in 100 patients who received both PR and CT on the same day. Measurements of the length of the SP and width at the basis and tip were performed. Furthermore, calcification patterns, Langlais classification and the prevalence of ESP were analyzed.
RESULTS
There was a highly significant correlation between PR and CT measuring SP for every parameter. Males showed significantly longer SP than females among the age group between 18-75 years. The results of the length measurements of the SP (male: right SP=32.98 mm; left SP=35.21 mm; female: right SP=30.31 mm; left SP=30.92 mm) significantly exceeded the values of comparable studies.
CONCLUSION
Consequently, it can be concluded that PR provides accurate measurements when compared to CT for measuring and diagnosing SP/ESP/Eagle syndrome. This study was one of the first to examine the width of the SP in the base and tip, thus these measurements can serve as a baseline for further studies. Since the mean lengths of SP exceeded 30.0 mm in the present study, these findings raise the question of whether the cut-off of 30.0 mm is adequate for the diagnosis of ESP.
Topics: Humans; Male; Female; Middle Aged; Adult; Temporal Bone; Tomography, X-Ray Computed; Aged; Radiography, Panoramic; Adolescent; Young Adult; Ossification, Heterotopic
PubMed: 38688622
DOI: 10.21873/invivo.13580 -
Journal of Shoulder and Elbow Surgery Apr 2024Distal biceps tendon repair is usually performed via a double-incision or single-incision bicortical drilling technique. However, these techniques are associated with...
INTRODUCTION
Distal biceps tendon repair is usually performed via a double-incision or single-incision bicortical drilling technique. However, these techniques are associated with specific complications and usually do not allow for anatomical footprint restoration. It was the aim of this study to report the clinical results of a double intracortical button anatomical footprint repair technique for distal biceps tendon tears. We hypothesized that this technique would result in supination strength comparable to the uninjured side with a low re-rupture rate and minimal bony or neurological complications.
MATERIAL AND METHODS
This was a retrospective, single-surgeon cohort study of a consecutive series of 22 patients with a mean (SD) age of 50.7 (9.4) years and at least 1-year follow-up after distal biceps tendon repair. At final follow-up, complications, range of motion (ROM), the Patient-rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS) for pain, patient satisfaction and supination strength in neutral as well as 60° of supination were analyzed. Radiographic evaluation was performed on a CT scan.
RESULTS
One patient (4.5%) experienced slight paresthesia in the area of the lateral antebrachial cutaneous nerve. Heterotopic ossification was seen in one patient (4.5%). All patients recovered full ROM except for one who had 10° of loss of flexion and extension. Median PREE score was 4.6 (0-39.6), median MEP was 100 (70-100) and median DASH was 1.4 (0-16.7). All but one patient were very satisfied with the outcome. The affected arm had a mean of 98% (± 13) of neutral supination strength (p=0.633) and 94% (± 12) of supination strength in 60° (p=0.054) compared to the contralateral, unaffected side. There were four cases (18.2%) of cortical thinning due to at least one button and one case of button pull-out (4.5%).
CONCLUSIONS
The double intracortical button anatomical footprint repair technique seems to provide reliable restoration of supination strength, excellent patient satisfaction while minimizing complications, particularly nerve damage and heterotopic ossification.
PubMed: 38688419
DOI: 10.1016/j.jse.2024.03.028 -
Journal of Cellular and Molecular... May 2024The pathogenesis of trauma-induced heterotopic ossification (HO) in the tendon remains unclear, posing a challenging hurdle in treatment. Recognizing inflammation as the...
The pathogenesis of trauma-induced heterotopic ossification (HO) in the tendon remains unclear, posing a challenging hurdle in treatment. Recognizing inflammation as the root cause of HO, anti-inflammatory agents hold promise for its management. Malvidin (MA), possessing anti-inflammatory properties, emerges as a potential agent to impede HO progression. This study aimed to investigate the effect of MA in treating trauma-induced HO and unravel its underlying mechanisms. Herein, the effectiveness of MA in preventing HO formation was assessed through local injection in a rat model. The potential mechanism underlying MA's treatment was investigated in the tendon-resident progenitor cells of tendon-derived stem cells (TDSCs), exploring its pathway in HO formation. The findings demonstrated that MA effectively hindered the osteogenic differentiation of TDSCs by inhibiting the mTORC1 signalling pathway, consequently impeding the progression of trauma-induced HO of Achilles tendon in rats. Specifically, MA facilitated the degradation of Rheb through the K48-linked ubiquitination-proteasome pathway by modulating USP4 and intercepted the interaction between Rheb and the mTORC1 complex, thus inhibiting the mTORC1 signalling pathway. Hence, MA presents itself as a promising candidate for treating trauma-induced HO in the Achilles tendon, acting by targeting Rheb for degradation through the ubiquitin-proteasome pathway.
Topics: Animals; Rats; Proteasome Endopeptidase Complex; Ossification, Heterotopic; Signal Transduction; Ras Homolog Enriched in Brain Protein; Ubiquitin; Male; Osteogenesis; Tendons; Rats, Sprague-Dawley; Tendon Injuries; Proteolysis; Cell Differentiation; Achilles Tendon; Disease Models, Animal; Ubiquitination; Mechanistic Target of Rapamycin Complex 1; Stem Cells
PubMed: 38686493
DOI: 10.1111/jcmm.18349 -
Journal of Orthopaedic Case Reports Apr 2024Introduction: Pellegrini-Stieda syndrome, characterized by medial collateral ligament (MCL) calcification or ossification, often follows a history of trauma. While rare,...
INTRODUCTION
Introduction: Pellegrini-Stieda syndrome, characterized by medial collateral ligament (MCL) calcification or ossification, often follows a history of trauma. While rare, its distinct radiographic features pose diagnostic challenges. Conservative treatments are effective for many, but surgical intervention is necessary when they fail.
CASE REPORT
A 31-year-old male with knee pain and stiffness, an inability to extend his knee, and a fixed flexion deformity. Radiological examinations confirmed heterotopic ossification along the MCL, indicating post-traumatic Pellegrini-Stieda syndrome. Despite 3 months of conservative treatment, the patient's pain persisted, leading to surgical excision. The surgical approach involved diagnostic arthroscopy, revealing arthritic changes and adhesions. Arthroscopic adhesiolysis and open excision of the ossified mass significantly improved the patient's range of motion. Histopathological examination confirmed heterotopic bone formation. Follow-up appointments at 1, 3, and 6 months showed a pain-free and mobile knee joint, with the Pellegrini-Stieda lesion disappearing from radiographs.
CONCLUSION
This case underscores the effectiveness of surgical intervention for refractory Pellegrini-Stieda syndrome, offering hope for improved patient outcomes and highlighting the importance of early diagnosis and tailored treatment in managing this rare condition.
PubMed: 38681929
DOI: 10.13107/jocr.2024.v14.i04.4342 -
Journal of Orthopaedic Case Reports Apr 2024A patient presented for recalcitrant right hip pain secondary to femoroacetabular impingement (FAI) after blunt motor vehicle trauma and following the development of a...
INTRODUCTION
A patient presented for recalcitrant right hip pain secondary to femoroacetabular impingement (FAI) after blunt motor vehicle trauma and following the development of a 12 cm heterotopic ossification (HO). FAI is an increasingly recognized diagnosis where the hip joint is exposed to repeated femoral microtrauma from high-level physical activity or trauma, often causing labral ossification, and perhaps underlying a similar biological mechanism to HO.
CASE REPORT
In this case report, we have an otherwise healthy 49-year-old male who was involved in a high-speed motor vehicle collision who was diagnosed with right hip FAI secondary to HO (Brooker's Class IV) and indicated for surgical excision of the HO anterior to the right proximal femur. The care team and patient initially trialed non-operative conservative treatment with non-steroidal anti-inflammatories drugs (NSAIDs) and hypothesized therapeutic success using a non-surgical approach. Surgical resection was pursued with the patient after a failure of conservative measures. The patient reported a zero out of ten on a ten-point numerical rating scale for pain, he also stated improved quality of life, satisfaction with the procedure, and subsequent rehabilitation at 1-month post-operative follow-up.
CONCLUSION
HO with near complete ankylosis of the hip joint may be causative of FAI when untreated. Although this case demonstrates a rarely studied traumatic etiology of impingement secondary to HO, initial standard conservative anti-inflammatory treatment can still be pursued. By analyzing the periarticular impact of HO secondary to non-surgical trauma, we can utilize and make inferential correlations from the literature, studying HO and impingement in the setting of prior hip surgery to guide treatment and prognosis in those presenting with FAI symptoms secondary to blunt force trauma.
PubMed: 38681919
DOI: 10.13107/jocr.2024.v14.i04.4362 -
Biomolecules Apr 2024The formation of bone outside the normal skeleton, or heterotopic ossification (HO), occurs through genetic and acquired mechanisms. Fibrodysplasia ossificans... (Review)
Review
The formation of bone outside the normal skeleton, or heterotopic ossification (HO), occurs through genetic and acquired mechanisms. Fibrodysplasia ossificans progressiva (FOP), the most devastating genetic condition of HO, is due to mutations in the gene and is relentlessly progressive. Acquired HO is mostly precipitated by injury or orthopedic surgical procedures but can also be associated with certain conditions related to aging. Cellular senescence is a hallmark of aging and thought to be a tumor-suppressive mechanism with characteristic features such as irreversible growth arrest, apoptosis resistance, and an inflammatory senescence-associated secretory phenotype (SASP). Here, we review possible roles for cellular senescence in HO and how targeting senescent cells may provide new therapeutic approaches to both FOP and acquired forms of HO.
Topics: Humans; Ossification, Heterotopic; Cellular Senescence; Myositis Ossificans; Animals; Activin Receptors, Type I
PubMed: 38672501
DOI: 10.3390/biom14040485 -
Biomedicines Apr 2024Fibrodysplasia ossificans progressiva (FOP) is a debilitating genetic disorder characterized by recurrent episodes of heterotopic ossification (HO) formation in muscles,... (Review)
Review
Fibrodysplasia ossificans progressiva (FOP) is a debilitating genetic disorder characterized by recurrent episodes of heterotopic ossification (HO) formation in muscles, tendons, and ligaments. FOP is caused by a missense mutation in the gene (activin A receptor type I), an important signaling receptor involved in endochondral ossification. The mutation induces increased downstream canonical SMAD-signaling and drives tissue-resident progenitor cells with osteogenic potential to participate in endochondral HO formation. In this article, we review aberrant ACVR1 signaling and the cells that give rise to HO in FOP. FOP mouse models and lineage tracing analyses have been used to provide strong evidence for tissue-resident mesenchymal cells as cellular contributors to HO. We assess how the underlying mutation in FOP disrupts muscle-specific dynamics during homeostasis and repair, with a focus on muscle-resident mesenchymal cells known as fibro-adipogenic progenitors (FAPs). Accumulating research points to FAPs as a prominent HO progenitor population, with FAPs not only aberrantly differentiating into chondro-osteogenic lineages but creating a permissive environment for bone formation at the expense of muscle regeneration. We will further discuss the emerging role of FAPs in muscle regeneration and therapeutic targeting of these cells to reduce HO formation in FOP.
PubMed: 38672135
DOI: 10.3390/biomedicines12040779 -
Bioengineering (Basel, Switzerland) Apr 2024Traumatic heterotopic ossification (HO) is frequently observed in Service Members following combat-related trauma. Estimates suggest that ~65% of wounded warriors who...
Traumatic heterotopic ossification (HO) is frequently observed in Service Members following combat-related trauma. Estimates suggest that ~65% of wounded warriors who suffer limb loss or major extremity trauma will experience some type of HO formation. The development of HO delays rehabilitation and can prevent the use of a prosthetic. To date there are limited data to suggest a standard mechanism for preventing HO. This may be due to inadequate animal models not producing a similar bone structure as human HO. We recently showed that traumatic HO growth is possible in an ovine model. Within that study, we demonstrated that 65% of sheep developed a human-relevant hybrid traumatic HO bone structure after being exposed to a combination of seven combat-relevant factors. Although HO formed, we did not determine which traumatic factor contributed most. Therefore, in this study, we performed individual and various combinations of surgical/traumatic factors to determine their individual contribution to HO growth. Outcomes showed that the presence of mature biofilm stimulated a large region of bone growth, while bone trauma resulted in a localized bone response as indicated by jagged bone at the linea aspera. However, it was not until the combinatory factors were included that an HO structure similar to that of humans formed more readily in 60% of the sheep. In conclusion, data suggested that traumatic HO growth can develop following various traumatic factors, but a combination of known instigators yields higher frequency size and consistency of ectopic bone.
PubMed: 38671772
DOI: 10.3390/bioengineering11040350 -
BMC Musculoskeletal Disorders Apr 2024This study aimed to compare cervical sagittal parameters and clinical outcomes between patients undergoing cervical laminoplasty(CL) and those undergoing lateral mass... (Comparative Study)
Comparative Study
Comparison of radiological and clinical outcomes of cervical laminoplasty versus lateral mass screw fixation in patients with ossification of the posterior longitudinal ligament.
PURPOSE
This study aimed to compare cervical sagittal parameters and clinical outcomes between patients undergoing cervical laminoplasty(CL) and those undergoing lateral mass screw fixation(LMS).
METHODS
We retrospectively studied 67 patients with multilevel ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent lateral mass screw fixation (LMS = 36) and cervical laminoplasty (CL = 31). We analyzed cervical sagittal parameters (C2-7 sagittal vertical axis (C2-7 SVA), C0-2 Cobb angle, C2-7 Cobb angle, C7 slope (C7s), T1 slope (T1s), and spino-cranial angle (SCA)) and clinical outcomes (visual analog scale [VAS], neck disability index [NDI], Japanese Orthopaedic Association [JOA] scores, recovery rate (RR), and minimum clinically significant difference [MCID]). The cervical sagittal parameters at the last follow-up were analyzed by binary logistic regression. Finally, we analyzed the correlation between the cervical sagittal parameters and each clinical outcome at the last follow-up after surgery in both groups.
RESULTS
At the follow-up after posterior decompression in both groups, the mean values of C2-C7 SVA, C7s, and T1s in the LMS group were more significant than those in the CL group (P ≤ 0.05). Compared with the preoperative period, C2-C7 SVA, T1s, and SCA gradually increased, and the C2-C7 Cobb angle gradually decreased after surgery (P < 0.05). The improvement in the JOA score and the recovery rate was similar between the two groups, while the improvement in the VAS-N score and NDI score was more significant in the CL group (P = 0.001; P = 0.043). More patients reached MCID in the CL group than in the LMS group (P = 0.036). Binary logistic regression analysis showed that SCA was independently associated with whether patients reached MCID at NDI postoperatively. SCA was positively correlated with cervical NDI and negatively correlated with cervical JOA score at postoperative follow-up in both groups (P < 0.05); C2-7 Cobb angle was negatively correlated with cervical JOA score at postoperative follow-up (P < 0.05).
CONCLUSION
CL may be superior to LMS in treating cervical spondylotic myelopathy caused by OPLL. In addition, smaller cervical SCA after posterior decompression may suggest better postoperative outcomes.
Topics: Humans; Ossification of Posterior Longitudinal Ligament; Laminoplasty; Female; Male; Cervical Vertebrae; Retrospective Studies; Middle Aged; Aged; Treatment Outcome; Bone Screws; Decompression, Surgical; Follow-Up Studies
PubMed: 38671386
DOI: 10.1186/s12891-024-07385-2 -
Cureus Mar 2024A woman in her 20s with a past medical history of surgical debulking of a right neck mass presented to the hospital for persistent and worsening right shoulder pain. The...
A woman in her 20s with a past medical history of surgical debulking of a right neck mass presented to the hospital for persistent and worsening right shoulder pain. The shoulder pain was associated with trismus and back and neck pain. A CT scan of the neck with contrast revealed post-surgical changes with increased heterotopic ossification throughout the surgical site extending to the supraclavicular soft tissues and the left sternocleidomastoid muscle, suggesting muscle ossification. A biopsy was performed, and the patient was diagnosed with myositis ossificans (MO). Initial treatment began with the administration of steroids and analgesics. She was scheduled for a follow-up with orthopedics, rheumatology, and genetics, but she was lost for follow-up. MO is a very rare medical condition usually associated with trauma, and in our patient, the symptoms started after a chiropractic adjustment.
PubMed: 38665716
DOI: 10.7759/cureus.56931