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International Journal of Environmental... Apr 2021Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year.... (Review)
Review
Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year. ACL injuries occur via contact and non-contact mechanisms, with the former being more common in males and the later being more common in females. These injuries typically require surgical repair and have relatively high re-rupture rates, resulting in a significant psychological burden for these individuals and long rehabilitation times. Numerous studies have attempted to determine risk factors for ACL rupture, including hormonal, biomechanical, and sport- and gender-specific factors. However, the incidence of ACL injuries continues to rise. Therefore, we performed a systematic review analyzing both ACL injury video analysis studies and studies on athletes who were pre-screened with eventual ACL injury. We investigated biomechanical mechanisms contributing to ACL injury and considered male and female differences. Factors such as hip angle and strength, knee movement, trunk stability, and ankle motion were considered to give a comprehensive, joint by joint analysis of injury risk and possible roles of prevention. Our review demonstrated that poor core stability, landing with heel strike, weak hip abduction strength, and increased knee valgus may contribute to increased ACL injury risk in young athletes.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Athletes; Biomechanical Phenomena; Female; Humans; Knee Joint; Male
PubMed: 33917488
DOI: 10.3390/ijerph18073826 -
Orthopaedics & Traumatology, Surgery &... Feb 2015Post-traumatic knee stiffness and loss of range of motion is a common complication of injuries to the knee area. The causes of post-traumatic knee stiffness can be... (Review)
Review
Post-traumatic knee stiffness and loss of range of motion is a common complication of injuries to the knee area. The causes of post-traumatic knee stiffness can be divided into flexion contractures, extension contractures, and combined contractures. Post-traumatic stiffness can be due to the presence of dense intra-articular adhesions and/or fibrotic transformation of peri-articular structures. Various open and arthroscopic surgical treatments are possible. A precise diagnosis and understanding of the pathology is mandatory prior to any surgical treatment. Failure is imminent if all pathologies are not addressed correctly. From a general point of view, a flexion contracture is due to posterior adhesions and/or anterior impingement. On the other hand, extension contractures are due to anterior adhesions and/or posterior impingement. This overview will describe the different modern surgical techniques for treating post-traumatic knee stiffness. Any bony impingements must be treated before soft tissue release is performed. Intra-articular stiff knees with a loss of flexion can be treated by an anterior arthroscopic arthrolysis. Extra-articular pathology causing a flexion contracture can be treated by open or endoscopic quadriceps release. Extension contractures can be treated by arthroscopic or open posterior arthrolysis. Postoperative care (analgesia, rehabilitation) is essential to maintaining the range of motion obtained intra-operatively.
Topics: Arthroscopy; Contracture; Humans; Knee Injuries; Knee Joint; Orthopedic Procedures; Pain Management; Physical Therapy Modalities; Postoperative Care; Radiography; Range of Motion, Articular; Tissue Adhesions; Treatment Outcome; Wounds and Injuries
PubMed: 25583236
DOI: 10.1016/j.otsr.2014.06.026 -
Sports Health 2015Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower's elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable... (Review)
Review
CONTEXT
Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower's elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common.
EVIDENCE ACQUISITION
Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 5.
RESULTS
All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance.
CONCLUSION
Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result.
Topics: Arthralgia; Athletic Injuries; Biomechanical Phenomena; Collateral Ligaments; Elbow Joint; Humans; Postoperative Complications; Elbow Injuries
PubMed: 26502444
DOI: 10.1177/1941738115607208 -
Psychopharmacology Bulletin Oct 2020Adhesive capsulitis of the shoulder (AC) is characterized by fibrosis and contracture of the glenohumeral joint capsule, resulting in progressive stiffness, pain, and... (Review)
Review
BACKGROUND
Adhesive capsulitis of the shoulder (AC) is characterized by fibrosis and contracture of the glenohumeral joint capsule, resulting in progressive stiffness, pain, and restriction of motion of the shoulder. The prevalence of AC is estimated to be 2-5% of the general population. Patients with AC typically have an insidious onset of pain and can progress to severe limitation of the shoulder leading to significant disability and decreased quality of life.
OBJECTIVES
The objective of this manuscript is to provide a comprehensive review of AC with a focus on clinical presentation, natural history, pathophysiology, and various treatment modalities.
STUDY DESIGN
A review article.
SETTING
A review of literature.
METHODS
A search was made on the Pubmed database using the keywords of adhesive capsulitis, frozen shoulder, shoulder capsulitis, arthrofibrosis, shoulder pain, shoulder stiffness.
RESULTS
Our search identified numerous studies in order to provide a comprehensive review of the current understanding of the treatment and management of AC.
LIMITATIONS
There remains limited evidence in literature about the understanding of AC and optimal treatment.
CONCLUSION
AC is an important cause of chronic pain and disability. There is currently no consensus on treatment. Initial treatment modalities revolve around conservative measures as well as aggressive physical therapy. Further treatment options include intraarticular injections, hydro-dilation, nerve blocks, and for more refractory cases, surgical interventions such as arthroscopic capsulotomy.
Topics: Bursitis; Humans; Joint Capsule; Quality of Life; Shoulder Joint; Shoulder Pain
PubMed: 33633420
DOI: No ID Found -
Haemophilia : the Official Journal of... Feb 2021Joint bleeds cause major morbidity in haemophilia patients. The synovial tissue is responsible for removal of blood remnants from the joint cavity. But blood components,... (Review)
Review
Joint bleeds cause major morbidity in haemophilia patients. The synovial tissue is responsible for removal of blood remnants from the joint cavity. But blood components, especially iron, lead to a series of changes in the synovial tissue: inflammation, proliferation and neovascularization. These changes make the synovium vulnerable to subsequent bleeding and as such a vicious cycle of bleeding-synovitis-bleeding may develop leading to chronic synovitis. The initial step in the treatment is adequate clotting factor supplementation and immediate physiotherapeutic involvement. If these measures fail, synovectomy may be indicated. Non-surgical options are chemical and radioactive synovectomy. This is a relatively non-invasive procedure to do synovectomy, leading to a reduction in pain and joint bleeds. Radioactive synovectomy seems more effective than chemical synovectomy in larger joints. Surgical options are open and arthroscopic synovectomy. Open synovectomy has been found to decrease the incidence of breakthrough bleeds but at the cost of loss of joint motion. Use of arthroscopic synovectomy has been advocated to reduce bleeding episodes with less morbidity to extra-articular tissue and preservation of joint motion. Use of a continuous passive motion (CPM) machine and early mobilization can decrease the postoperative stiffness and promote early recovery. This review addresses the current understanding of synovitis and its treatment options with specific emphasis on chemical and radioactive synovectomy and surgical options.
Topics: Arthroscopy; Hemophilia A; Humans; Knee Joint; Recurrence; Synovectomy; Synovitis
PubMed: 32490595
DOI: 10.1111/hae.14025 -
Journal of Applied Physiology... Sep 2020Joint stiffness is often measured to make inferences about the stiffness of muscle groups, but little can be gleaned about individual muscles. Decomposing the muscular...
Joint stiffness is often measured to make inferences about the stiffness of muscle groups, but little can be gleaned about individual muscles. Decomposing the muscular origins of joint stiffness may inform treatment targets for conditions like spasticity. To complement joint stiffness, shear wave ultrasound elastography has been used to estimate the material properties of individual muscles. If shear wave measures are to be used to assess the muscular origins of joint stiffness, then changes in shear wave velocity should strongly relate to changes in joint stiffness. Here, we estimated the relationships between shear wave velocity in the primary plantar flexors [soleus (SOL) and medial gastrocnemius (MG)] and ankle joint stiffness. Participants performed isometric plantar flexion tasks at a range of activations (0-40%), while joint stiffness and muscle shear wave velocities were obtained. We observed a strong, linear relationship between plantar flexor shear wave velocities and joint stiffness. Remarkably, the parameter estimates of this stiffness-shear wave relationship strongly agreed with theoretical and literature-based estimates [SOL:MG parameter ratios = 2.83 (observed) vs. 2.85 (expected from theoretical stiffness ratio)]. Finally, a musculoskeletal model of the plantar flexors was able to accurately reproduce joint stiffness estimates, and shear wave velocities could explain 80-95% of the variance in modeled muscle stiffness. These findings suggest that shear wave velocity may be used to infer the muscular origins of changes in joint stiffness. Shear wave velocity is commonly assessed to infer the muscular origins of changes in joint stiffness, but the exact relationship between shear wave velocity changes in muscle and joint stiffness changes remains unknown. Here, we systematically evaluated and quantified this relationship in the plantar flexors. Our results provide evidence for the ability of shear wave velocity to elucidate the muscular origins of joint stiffness changes.
Topics: Ankle; Ankle Joint; Elasticity Imaging Techniques; Humans; Muscle, Skeletal; Ultrasonography
PubMed: 32644909
DOI: 10.1152/japplphysiol.00133.2020 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be... (Review)
Review
Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be overlooked, due to young age and the cartilaginous nature of the joint. There is little bone remodeling in the elbow and displacement fracture, and especially supracondylar or lateral condyle fracture, has to be corrected rigorously, notably in older children. In case of lateral tilt in fracture of the neck of the radial head, on the other hand, remodeling is effective. Deformity in cubitus varus and cubitus valgus leads to neurological lesions and instability. Treatment should be early, with adapted surgery in expert hands. Post-traumatic stiffness is rare. Early intensive physiotherapy is unsuited to children and could worsen the stiffness due to inflammation. Lateral condyle non-union is a classic complication of fracture. Simple percutaneous screwing is a useful option. The equivalent in the medial epicondyle is well-tolerated, and simple monitoring now suffices. Late posterolateral rotational instability is a poorly known complication. It should be considered in case of cubitus varus that becomes painful after a long asymptomatic course. Radiocapitellar subluxation is seen on X-ray. Residual radial head dislocation after primary treatment (Monteggia lesion) responds well to the Bouyala technique of ulnar flexion osteotomy associated to annular ligament repair, without requiring ligament reconstruction.
Topics: Child; Humans; Elbow Fractures; Fractures, Bone; Elbow Joint; Ulna; Joint Dislocations
PubMed: 36302449
DOI: 10.1016/j.otsr.2022.103454 -
Journal of Orthopaedic Trauma Dec 2015Osteoarthritis affects millions of people worldwide, is associated with joint stiffness and pain, and often causes significant disability and loss of productivity.... (Review)
Review
Osteoarthritis affects millions of people worldwide, is associated with joint stiffness and pain, and often causes significant disability and loss of productivity. Osteoarthritis is believed to occur as a result of ordinary "wear and tear" on joints during the course of normal activities of daily living. Posttraumatic osteoarthritis is a particular subset of osteoarthritis that occurs after a joint injury. Developing clinically relevant animal models will allow investigators to delineate the causes of posttraumatic osteoarthritis and develop means to slow or prevent its development after joint injury. Chondroprotectant compounds, which attack the degenerative pathways at a variety of steps, are being developed in an effort to prevent posttraumatic osteoarthritis and offer great promise. Often times, cartilage degradation after joint injury occurs despite our best efforts. When this happens, there are several evolving techniques that offer at least short-term relief from the effects of posttraumatic osteoarthritis. Occasionally, these traumatic lesions are so large that dramatic steps must be taken in an attempt to restore articular congruity and joint stability. Fresh osteochondral allografts have been used in these settings and offer the possibility of joint preservation. For patients presenting with neglected displaced intra-articular fractures that have healed, intra-articular osteotomy techniques are being developed in an effort to restore joint congruity and function. This article reviews the results of a newly developed animal model of posttraumatic osteoarthritis, several promising chondroprotectant compounds, and also cartilage techniques that are used when degenerative cartilage lesions develop after joint injury.
Topics: Anti-Inflammatory Agents; Cartilage, Articular; Combined Modality Therapy; Fractures, Cartilage; Humans; Osteoarthritis; Osteotomy; Plastic Surgery Procedures
PubMed: 26584267
DOI: 10.1097/BOT.0000000000000462 -
PloS One 2022Even though running enjoys growing popularity, the effects of fatigue on the running kinematics of novices have rarely been studied. This is surprising, given the risk...
Even though running enjoys growing popularity, the effects of fatigue on the running kinematics of novices have rarely been studied. This is surprising, given the risk of running-related injuries when detrimental movement patterns are adopted. Therefore, the goal of the present study was to characterize the effects of fatigue induced by a high-intensity running protocol on spatiotemporal and stiffness parameters as well as on joint kinematics and center of mass (CoM) motion in novice runners. 14 participants performed a standardized treadmill familiarization and ran at 13 km/h until voluntary exhaustion. Kinematics were captured using a 3D motion capture system. Spatiotemporal and stiffness parameters as well as the range of motion (RoM) of the joints and CoM were compared by use of paired t-tests. Time series of the joint angles and CoM motion were analyzed by the statistical parametric mapping method. The results revealed that novice runners did not change spatiotemporal or stiffness parameters, but showed adaptations in joint kinematics, e.g. decreased dorsiflexion and increased pronation in the ankle joint during the swing phase. The findings of this study underline the importance of strengthening the ankle joint to prevent excessive pronation and increase its stability in novice runners.
Topics: Ankle Joint; Biomechanical Phenomena; Humans; Leg; Pronation; Range of Motion, Articular
PubMed: 35363776
DOI: 10.1371/journal.pone.0265550 -
Acta Biochimica Et Biophysica Sinica Jan 2022The pericellular matrix stiffness is strongly associated with its biochemical and structural changes during the aging and osteoarthritis progress of articular cartilage....
The pericellular matrix stiffness is strongly associated with its biochemical and structural changes during the aging and osteoarthritis progress of articular cartilage. However, how substrate stiffness modulates the chondrocyte regulatory volume decrease (RVD) and calcium signaling in chondrocytes remains unknown. This study aims to investigate the effects of substrate stiffness on the chondrocyte RVD and calcium signaling by recapitulating the physiologically relevant substrate stiffness. Our results showed that substrate stiffness induces completely different dynamical deformations between the cell swelling and recovering progresses. Chondrocytes swell faster on the soft substrate but recovers slower than the stiff substrate during the RVD response induced by the hypo-osmotic challenge. We found that stiff substrate enhances the cytosolic Ca oscillation of chondrocytes in the iso-osmotic medium. Furthermore, chondrocytes exhibit a distinctive cytosolic Ca oscillation during the RVD response. Soft substrate significantly improves the Ca oscillation in the cell swelling process whereas stiff substrate enhances the cytosolic Ca oscillation in the cell recovering process. Our work also suggests that the TRPV4 channel is involved in the chondrocyte sensing substrate stiffness by mediating Ca signaling in a stiffness-dependent manner. This helps to understand a previously unidentified relationship between substrate stiffness and RVD response under the hypo-osmotic challenge. A better understanding of substrate stiffness regulating chondrocyte volume and calcium signaling will aid the development of novel cell-instructive biomaterial to restore cellular functions.
Topics: Calcium; Calcium Signaling; Cartilage, Articular; Chondrocytes; Humans; Osmosis; Osteoarthritis
PubMed: 35130619
DOI: 10.3724/abbs.2021008