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Orthopaedics & Traumatology, Surgery &... Feb 2016Various treatments for patellofemoral instability have been proposed, such as lowering or medialization of the tibial tubercle, division of the lateral retinaculum,... (Review)
Review
Various treatments for patellofemoral instability have been proposed, such as lowering or medialization of the tibial tubercle, division of the lateral retinaculum, plication of the medial retinaculum, lowering of the vastus medialis, and trochleoplasty. However, it has been difficult to analyze the outcomes of each technique because they are often performed in combination. Recent anatomical and biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the primary stabilizer of the patella between full extension and 30° flexion. For this reason, reconstructing this ligament is relevant, reinforced by promising early clinical results. MPFL reconstruction techniques differ in the graft used and the fixation method. They will be described here as a function of their fixation method, either into bone or soft tissue. The technical challenges, advantages and disadvantages of these different techniques are reviewed in detail, along with the postoperative rehabilitation protocol. Strict technique is needed to prevent postoperative complications, with flexion contracture due to excessive graft tension being the most common complication. Recurrence of the instability is rare after surgery, proof of the dependable nature of these reconstruction procedures.
Topics: Contracture; Femur; Humans; Joint Instability; Knee Joint; Ligaments, Articular; Patella; Postoperative Complications; Quadriceps Muscle; Range of Motion, Articular; Plastic Surgery Procedures; Recurrence; Tibia
PubMed: 26797001
DOI: 10.1016/j.otsr.2015.06.030 -
Journal of Orthopaedic Research :... Nov 2022As cancer survivorship increases, so does the number of patients that suffer from the late effects of radiation therapy. This includes arthrofibrosis, the development of...
As cancer survivorship increases, so does the number of patients that suffer from the late effects of radiation therapy. This includes arthrofibrosis, the development of stiff joints near the field of radiation. Previous reports have concentrated on skin fibrosis around the joint but largely ignored the deeper tissues of the joint. We hypothesized that fat, muscle, and the joint tissues themselves would play a more significant role in joint contracture after radiation than the skin surrounding the joint. To address this hypothesis, we irradiated the right hind flanks of mice with fractionated and unfractionated dose schedules, then monitored the mice for 3 months postradiotherapy. Mice were euthanized and physiological indications of arthrofibrosis including limb contracture and joint resting position were assessed. Stifle (knee) joints demonstrated significant arthrofibrosis, but none was observed in the hock (ankle) joints. During these studies, we were surprised to find that male and female mice showed a significantly different response to radiation injury. Female mice developed more injuries, had significantly worse contracture, and showed a greater difference in the expression of all markers studied. These results suggest that women undergoing radiation therapy might be at significantly greater risk for developing arthrofibrosis and may require specific adjustments to their care.
Topics: Animals; Ankle Joint; Contracture; Female; Fibrosis; Joint Diseases; Knee Joint; Male; Mice
PubMed: 35148568
DOI: 10.1002/jor.25297 -
Bulletin of the NYU Hospital For Joint... 2007Etiologies of elbow contractures can be classified into intrinsic versus extrinsic causes. Posttraumatic elbow stiffness is the most common intrinsic cause and HO... (Review)
Review
Etiologies of elbow contractures can be classified into intrinsic versus extrinsic causes. Posttraumatic elbow stiffness is the most common intrinsic cause and HO formation is the most common extrinsic cause of elbow contractures. Patients who sustain significant elbow trauma and have one or more risk factors for HO formation should be given prophylaxis against HO formation in the form of either indomethacin or radiation therapy. Early excision of HO has been shown to be safe and effective. Nonoperative measures are most effective if used within 6 months of contracture onset. These measures include physical therapy and an aggressive splinting program. If nonoperative measures are unsuccessful and the patient has functionally limiting elbow ROM, then surgical intervention should be considered. Careful preoperative assessment of the ulnar nerve is mandatory, as it may need to be transposed. Satisfactory results have been reported with arthroscopic elbow contracture releases. However, this procedure is technically challenging, with the potential for serious neurovascular complications. Satisfactory results have been published for open procedures as well. The direction of the greatest limitation of motion, the presence of ulnar nerve dysfunction, and the location of osteophytes all help to dictate which surgical approach should be selected.
Topics: Arthroscopy; Collateral Ligaments; Contracture; Elbow Joint; Humans; Ossification, Heterotopic; Range of Motion, Articular; Risk Factors
PubMed: 17539758
DOI: No ID Found -
Orphanet Journal of Rare Diseases Nov 2023The diagnosis and treatment of fibro-adipose vascular anomaly (FAVA) of the limb remains challenging since this entity is rare and complex. This paper is aimed to...
BACKGROUND
The diagnosis and treatment of fibro-adipose vascular anomaly (FAVA) of the limb remains challenging since this entity is rare and complex. This paper is aimed to describe the clinical and imaging features, staging and management of this underrecognized disease of the limb.
MATERIAL AND METHOD
Patients diagnosed with FAVA and managed between September 2019 and May 2022 in department of pediatric surgery & vascular anomalies of Xi'an international medical center hospital were retrospectively reviewed. Data extracted include age at presentation, previous diagnosis, affected muscles, symptoms, previous treatment, our management, and follow-up.
RESULTS
Thirty-two patients with FAVA were diagnosed and managed in our center. There was a female sex predominance, with 23 female (72%) and 9 male (28%) in the cohort. Only one lesion was noticed during infancy; the remaining presented at age 1 to 20 years (median, 7 years). The most commonly involved muscles were gastrocnemius (14/32, 44%) and soleus (13/32, 40%). Swelling (mass), pain and contractures were the most common presentations. MRI featured a heterogeneous and ill-defined intramuscular high signal intensity. Diseases were staged according to clinical features: stage I (pain stage, n = 4), stage II (contracture stage, n = 20) and stage III (deformity stage, n = 8). Patients with stage I disease underwent radical resection and obtained a cure. Patients with stage II disease received radical resection and possible Achilles lengthening, having an outcome of cure. Personalized treatment was required in patients with stage III disease, including radical/partial/staged resection, Achilles lengthening/tenotomy, joint capsulotomy, neurolysis/neurectomy, tendon transfer, stretching exercises, and oral sirolimus/alpelisib. Significant improvement of symptoms was achieved in most.
CONCLUSION
The most distinct features of FAVA include enlarging mass, severe pain and contracture. Based on distinct clinical and radiologic features, it is not difficult to make the diagnosis of FAVA. Earlier awareness of this disease can reduce misdiagnoses. Surgery-based comprehensive management can typically improve pain and contracture. Oral sirolimus or alpelisib plays an important role in treatment of unresectable lesions and major nerve involvement. Surgery alone can be curative in early stage FAVA.
Topics: Child; Humans; Male; Female; Infant; Child, Preschool; Adolescent; Young Adult; Adult; Retrospective Studies; Treatment Outcome; Vascular Malformations; Contracture; Pain; Sirolimus; Obesity
PubMed: 37936141
DOI: 10.1186/s13023-023-02961-6 -
Muscle & Nerve Jun 2020Limb contractures are debilitating complications associated with various muscle and nervous system disorders. This report summarizes presentations at a conference at the... (Review)
Review
Limb contractures are debilitating complications associated with various muscle and nervous system disorders. This report summarizes presentations at a conference at the Shirley Ryan AbilityLab in Chicago, Illinois, on April 19-20, 2018, involving researchers and physicians from diverse disciplines who convened to discuss current clinical and preclinical understanding of contractures in Duchenne muscular dystrophy, stroke, cerebral palsy, and other conditions. Presenters described changes in muscle architecture, activation, extracellular matrix, satellite cells, and muscle fiber sarcomeric structure that accompany or predispose muscles to contracture. Participants identified ongoing and future research directions that may lead to understanding of the intersecting factors that trigger contractures. These include additional studies of changes in muscle, tendon, joint, and neuronal tissues during contracture development with imaging, molecular, and physiologic approaches. Participants identified the requirement for improved biomarkers and outcome measures to identify patients likely to develop contractures and to accurately measure efficacy of treatments currently available and under development.
Topics: Cerebral Palsy; Chicago; Contracture; Education; Humans; Muscular Dystrophy, Duchenne; Musculoskeletal Diseases; Nervous System Diseases; Research Report
PubMed: 32108365
DOI: 10.1002/mus.26845 -
Hand Clinics May 2017Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of... (Review)
Review
Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of management for this condition, this is unable to address the chronic sequelae of HO, including chronic pain, joint contractures, nerve dysfunction, and open wounds. Current therapeutic modalities are aimed at excision and the prevention of recurrence using nonsteroidal antiinflammatory drugs (NSAIDs) or radiation therapy. Research is now focused on identifying alternative strategies to prevent the initial occurrence of HO through NSAIDs and novel inhibitors of the bone morphogenetic protein signaling pathway.
Topics: Arm Injuries; Burns; Contracture; Elbow Joint; Humans; Joint Dislocations; Ossification, Heterotopic; Range of Motion, Articular
PubMed: 28363301
DOI: 10.1016/j.hcl.2016.12.013 -
American Family Physician Jul 2007Dupuytren's disease is a progressive condition that causes the fibrous tissue of the palmar fascia to shorten and thicken. The disease is common in men older than 40... (Review)
Review
Dupuytren's disease is a progressive condition that causes the fibrous tissue of the palmar fascia to shorten and thicken. The disease is common in men older than 40 years; in persons of Northern European descent; and in persons who smoke, use alcohol, or have diabetes. Patients present with a small, pitted nodule (or multiple nodules) on the palm, which slowly progresses to contracture of the fingers. The disease initially can be managed with observation and nonsurgical therapy. It will regress without treatment in approximately 10 percent of patients. Steroid injection into the nodule has been shown to reduce the need for surgery. Surgical referral should be made when metacarpophalangeal joint contracture reaches 30 degrees or when proximal interphalangeal joint contracture occurs at any degree. Timing of surgical intervention varies, but surgery is usually performed when the metacarpophalangeal joint contracture exceeds 40 degrees or when the proximal interphalangeal joint contracture exceeds 20 degrees. In-office percutaneous needle aponeurotomy is an alternative to surgery.
Topics: Adrenal Cortex Hormones; Diagnosis, Differential; Dupuytren Contracture; Humans; Orthopedic Procedures; Risk Factors
PubMed: 17668844
DOI: No ID Found -
Journal of Orthopaedic Research :... Dec 2022Stiff joints formed after trauma, surgery or immobilization are frustrating for surgeons, therapists and patients alike. Unfortunately, the study of contracture is...
Stiff joints formed after trauma, surgery or immobilization are frustrating for surgeons, therapists and patients alike. Unfortunately, the study of contracture is limited by available animal model systems, which focus on the utilization of larger mammals and joint trauma. Here we describe a novel mouse-based model system for the generation of joint contracture using 3D-printed clamshell casts. With this model system we are able to generate both reversible and irreversible contractures of the knee and ankle. Four- or 8-month-old female mice were casted for either 2 or 3 weeks before liberation. All groups formed measurable contractures of the knee and ankle. Younger mice immobilized for less time formed reversible contractures of the knee and ankle. We were able to generate irreversible contracture with either longer immobilization time or the utilization of older mice. The contracture formation translated into differences in gait, which were detectable using the DigiGait® analysis system. This novel model system provides a higher throughput, lower cost and more powerful tool in studying the molecular and cellular mechanisms considering the large existing pool of transgenic/knockout murine strains.
Topics: Female; Mice; Animals; Contracture; Ankle Joint; Gait; Knee Joint; Hindlimb; Joint Diseases; Disease Models, Animal; Joint Dislocations; Printing, Three-Dimensional; Range of Motion, Articular; Mammals
PubMed: 35266583
DOI: 10.1002/jor.25313 -
Journal of Orthopaedic Surgery (Hong... 2020We intend to assess the efficacies and limitations of collagenase clostridium histolyticum (CCH) and fasciectomy in treating Dupuytren's contracture, and the associated... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We intend to assess the efficacies and limitations of collagenase clostridium histolyticum (CCH) and fasciectomy in treating Dupuytren's contracture, and the associated complications and rate of recurrences aiming to present a treatment algorithm.
METHODS
A literature search within the PubMed, Web of Sciences, Cochrane Library, and EMBASE databases was performed using the combined key words 'Dupuytren, palmar aponeurosis contracture, collagenase clostridium histolyticum and fasciectomy', including all possible studies with a set of predefined inclusion and exclusion criteria.
RESULTS
Thirty studies were assessed for eligibility from 215 identified records. Seventeen publications satisfied the inclusion criteria including 2142 joints in 1784 patients. The mean follow-up time was 18.0 months (3-60).
CONCLUSION
Acceptable contractures release was obtained in both techniques. Severe complications associated with fasciectomy outrank those of CCH, whereas the low rate of recurrence favors the fasciectomy technique.
Topics: Clostridium; Dupuytren Contracture; Fasciotomy; Humans; Microbial Collagenase; Treatment Outcome
PubMed: 32484064
DOI: 10.1177/2309499020921747 -
BioMed Research International 2015Joint contractures, defined as the limitation in the passive range of motion of a mobile joint, can be classified as noninflammatory diseases of the musculoskeletal... (Review)
Review
Joint contractures, defined as the limitation in the passive range of motion of a mobile joint, can be classified as noninflammatory diseases of the musculoskeletal system. The pathophysiology is not well understood; limited information is available on causal factors, progression, the pathophysiology involved, and prediction of response to treatment. The clinical heterogeneity of joint contractures combined with the heterogeneous contribution of joint connective tissues to joint mobility presents challenges to the study of joint contractures. Furthermore, contractures are often a symptom of a wide variety of heterogeneous disorders that are in many cases multifactorial. Extended immobility has been identified as a causal factor and evidence is provided from both experimental and epidemiology studies. Of interest is the involvement of the joint capsule in the pathophysiology of joint contractures and lack of response to remobilization. While molecular pathways involved in the development of joint contractures are being investigated, current treatments focus on physiotherapy, which is ineffective on irreversible contractures. Future treatments may include early diagnosis and prevention.
Topics: Animals; Arthritis; Contracture; Disease Models, Animal; Forecasting; Humans; Immobilization; Joints; Motor Activity; Range of Motion, Articular
PubMed: 26247029
DOI: 10.1155/2015/848290