Patellar Tendinopathy in Athletes

We report the results of nonoperative and operative management of patellar tendinopathy in 42 athletes with Blazina stage 2 (26 patients) or stage 3 (16 patients) patellar tendinopathy. All patients were initially managed nonoperatively with nonsteroidal antiinflammatory drugs, physical therapy, and a progressive rehabilitation program based on isometric exercises, stretching, and eccentric exercises. After 6 months, 33 patients showed symptomatic improvement and were able to resume their sports. In nine patients with Blazina stage 3 tendinopathy, nonoperative measures failed, and surgery was performed. Operative treatment consisted of removal of the degenerated areas of the tendon, multiple longitudinal tenotomies, and drilling of the lower pole of the patella at the site of tendon attachment. Histologic examination of the excised tendon tissue showed areas of necrosis and mucoid degeneration, and alterations of the bone-tendon junction. After a mean follow-up of 4.8 years, clinical results were excellent or good in all patients. In the group treated nonoperatively, results were better in the patients who had stage 2 tendinopathy than in those with stage 3.

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Operative Management of Foot and Ankle Equinovarus Associated with Focal Dystonia

Foot & Ankle International ◽

10.1177/107110079801900408 ◽

1998 ◽

Vol 19 (4) ◽

pp. 229-231 ◽

Cited By ~ 8

Author(s):

Thomas J. Moore ◽

William Evans ◽

Douglas Murray

Keyword(s):

Tendon Transfer ◽

Operative Management ◽

Clinical Results ◽

Focal Dystonia ◽

Functional Improvement ◽

Foot And Ankle ◽

Tendon Transfers ◽

Anterior Tibial ◽

Clinically Significant

Six surgical procedures, consisting of tendon transfers and releases, were performed in five patients with idiopathic focal dystonia involving the lower extremity. All patients were female. Surgical management was performed to correct clinically significant foot abnormalities. The goal of each procedure was functional improvement and obtaining a plantigrade foot. The SPLATT (split anterior tibial tendon transfer) procedure was performed in each foot with a flexible equinovarus foot abnormality. Follow up at a mean of 27.2 months (range, 8–40 months) yielded satisfactory clinical results without significant complications. Clinical equinovarus has not recurred after this procedure. All patients remain brace-free ambulators.

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Agranulocytosis Associated with Etodolac

Annals of Pharmacotherapy ◽

10.1177/106002809402800406 ◽

1994 ◽

Vol 28 (4) ◽

pp. 458-460 ◽

Cited By ~ 6

Author(s):

Richard L. Cramer ◽

Vivian C. Aboko-Cole ◽

Richard J. Gualtieri

Keyword(s):

Hemoglobin Concentration ◽

Nonsteroidal Antiinflammatory Drugs ◽

Blood Cell Count ◽

Patient History ◽

Antiinflammatory Drugs ◽

Intravenous Antibiotic ◽

Drug Induced ◽

Case Summary ◽

Case Assessment

OBJECTIVE: To report a case of probable etodolac-induced agranulocytosis. CASE SUMMARY: A 72-year-old woman who had been taking etodolac 300 mg bid for approximately six weeks presented to the emergency department with symptoms of urosepsis. She was found to be profoundly granulocytopenic. Etodolac was discontinued and broad-spectrum intravenous antibiotic therapy was administered for the next 17 days. Results of bone marrow biopsy revealed marked hypocellularity consistent with drug-induced agranulocytosis. Following etodolac withdrawal, the total white blood cell count reached a low value of 0.9 × 109L and then returned to a preetodolac baseline after 15 days. Her hemoglobin concentration also decreased significantly during hospitalization. DISCUSSION: Agranulocytosis has rarely been reported in association with nonsteroidal antiinflammatory drugs (NSAIDs), and there are no literature reports associating etodolac with agranulocytosis. This case involving etodolac is consistent with the pattern described with other NSAIDs. Factors correlating etodolac as the causative agent are identified. Details of patient history, treatment, follow-up, and assessment are discussed. CONCLUSIONS: Detailed case assessment demonstrated probable etodolac-induced agranulocytosis in our patient. Clinicians should be aware that etodolac, like other NSAIDs, has potential to cause agranulocytosis.

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Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain: interventions and promising long-term outcomes

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04780-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Anna Trulsson Schouenborg ◽

Marcelo Rivano Fischer ◽

Elisabeth Bondesson ◽

Anna Jöud

Keyword(s):

Physical Activity ◽

Musculoskeletal Pain ◽

Clinical Results ◽

Rehabilitation Program ◽

Chronic Musculoskeletal Pain ◽

Sensorimotor Training ◽

Rehabilitation Programs ◽

Pain Disability ◽

Physical Activity Advice

Abstract Background There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed. Aim To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period. Methods All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014–2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured ‘clinical reasoning’ using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients’ medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge. Results In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up. Conclusions A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.

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The Serum Level of Agalactosyl IgG in Rheumatoid Arthritis Patients Treated with Methotrexate

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463209600900104 ◽

1996 ◽

Vol 9 (1) ◽

pp. 19-22

Author(s):

J. K. Lacki ◽

U. Mackiewicz ◽

S. Mackiewicz ◽

W. Muller

Keyword(s):

Rheumatoid Arthritis ◽

Serum Level ◽

Nonsteroidal Antiinflammatory Drugs ◽

Healthy Controls ◽

Disease Course ◽

Antiinflammatory Drugs ◽

Significant Difference ◽

One Year ◽

Agalactosyl Igg

To verify the hypothesis that methotrexate may affect the serum level of agalactosyl IgG (IgG[0]) we followed the changes in IgG galactosylation patterns in a cohort of rheumatoid arthritis patients treated with either methotrexate (MTX) or nonsteroidal antiinflammatory drugs (NSAID). The average values of IgG[0] in RA patients at the beginning of the observation were significantly higher as compared to healthy controls (0.45 ± 0.39 vs. −0.03 ± 0.09, p<0.05). The findings of IgG[0] after one-year follow-up were also higher as compared to healthy controls (0.38 ± 0.39 vs. −0.03 ± 0.09, p<0.05). We did not notice any statistically significant difference in IgG[0] between MTX and NSAID treated patients at the beginning of the study (0.49 ± 0.42 vs. 0.42 ± 0.38, NS). However, during one-year MTX treatment IgG[0] significantly dropped (0.49 ± 0.42 vs. 0.25 ± 0.24, p<0.01). We did not establish any fluctuation in IgG[0] in the group of patients treated with NSAID (0.42 ± 0.38 vs. 0.46 ± 0.45, NS). The data thus far obtained suggest that IgG[0] may serve as an indicator for the disease course in patients with RA. Secondly, the clinical improvement and IgG[0] decrease after methotrexate implies, that the immunoregulatory abnormality in RA may be susceptible to correction by immunotherapy.

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Augmentation Strategies following the Microfracture Technique for Repair of Focal Chondral Defects

Cartilage ◽

10.1177/1947603510366718 ◽

2010 ◽

Vol 1 (2) ◽

pp. 145-152 ◽

Cited By ~ 31

Author(s):

Eric J. Strauss ◽

Joseph U. Barker ◽

James S. Kercher ◽

Brian J. Cole ◽

Kai Mithoefer

Keyword(s):

Treatment Options ◽

Operative Management ◽

Biomechanical Properties ◽

Clinical Results ◽

Symptomatic Improvement ◽

Comprehensive Overview ◽

Chondral Lesions ◽

Repair Tissue ◽

Chondral Defects ◽

Augmentation Techniques

The operative management of focal chondral lesions continues to be problematic for the treating orthopedic surgeon secondary to the limited regenerative capacity of articular cartilage. Although many treatment options are currently available, none fulfills the criteria for an ideal repair solution, including a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage. The microfracture technique is an often-utilized, first-line treatment modality for chondral lesions within the knee, resulting in the formation of a fibrocartilaginous repair tissue with inferior biochemical and biomechanical properties compared to normal hyaline cartilage. Although symptomatic improvement has been shown in the short term, concerns about the durability and longevity of the fibrocartilaginous repair have been raised. In response, a number of strategies and techniques for augmentation of the first-generation microfracture procedure have been introduced in an effort to improve repair tissue characteristics and reduce long-term deterioration. Recent experimental approaches utilize modern tissue-engineering technologies including local supplementation of chondrogenic growth factors, hyaluronic acid, or cytokine modulation. Other second-generation microfracture-based techniques use different types of scaffold-guided in situ chondroinduction. The current article presents a comprehensive overview of both the experimental and early clinical results of these developing microfracture augmentation techniques.

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1 Clinical Results After EPI®and Eccentric Exercise in Patellar Tendinopathy at 10 Years Follow-Up

British Journal of Sports Medicine ◽

10.1136/bjsports-2014-094114.1 ◽

2014 ◽

Vol 48 (Suppl 2) ◽

pp. A1.1-A1

Author(s):

Ferran Abat ◽

Pablo-Eduardo Gelber ◽

Fernando Polidori ◽

Joan-Carles Monllau ◽

Jose-Manuel Sánchez

Keyword(s):

Eccentric Exercise ◽

Clinical Results ◽

Patellar Tendinopathy

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Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2014.10.spine14333 ◽

2015 ◽

Vol 22 (5) ◽

pp. 447-453 ◽

Cited By ~ 20

Author(s):

Tsung-Hsi Tu ◽

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

Hsuan-Kan Chang ◽

Chin-Chu Ko ◽

...

Keyword(s):

Heterotopic Ossification ◽

Clinical Outcomes ◽

Nonsteroidal Antiinflammatory Drugs ◽

Antiinflammatory Drugs ◽

Cervical Arthroplasty ◽

Arm Pain ◽

Nsaid Group ◽

Number Of Patients ◽

Cox 2

OBJECT Heterotopic ossification (HO) after cervical arthroplasty is not uncommon and may cause immobility of the disc. To prevent HO formation, study protocols of clinical trials for cervical arthroplasty undertaken by the US FDA included perioperative use of nonsteroidal antiinflammatory drugs (NSAIDs). However, there are few data supporting the use of NSAIDs to prevent HO after cervical arthroplasty. Therefore, this study aimed to evaluate the efficacy of NSAIDs in HO formation and clinical outcomes. METHODS Consecutive patients who underwent 1- or 2-level cervical arthroplasty with a minimum follow-up of 24 months were retrospectively reviewed. All patients were grouped into 1 of 2 groups, an NSAID group (those patients who had used NSAIDs postoperatively) and a non-NSAID group (those patients who had not used NSAIDs postoperatively). The formation of HO was detected and classified using CT in every patient. The incidence of HO formation, disc mobility, and clinical outcomes, including visual analog scale (VAS) scores of neck and arm pain, neck disability index (NDI) scores, and complications were compared between the two groups. Furthermore, a subgroup analysis of the patients in the NSAID group, comparing the selective cyclooxygenase (COX)-2 to nonselective COX-2 NSAID users, was also conducted for each of the above-mentioned parameters. RESULTS A total of 75 patients (mean age [± SD] 46.71 ± 9.94 years) with 107 operated levels were analyzed. The mean follow-up duration was 38.71 ± 9.55 months. There were no significant differences in age, sex, and levels of arthroplasty between the NSAID and non-NSAID groups. There was a nonsignificantly lower rate of HO formation in the NSAID group than the non-NSAID group (47.2% vs. 68.2%, respectively; p = 0.129). During follow-up, most of the arthroplasty levels remained mobile, with similar rates of immobile discs in the NSAID and non-NSAID groups (13.2% and 22.7%, respectively; p = 0.318). Furthermore, there was a nonsignificantly lower rate of HO formation in the selective COX-2 group than the nonselective COX-2 group (30.8% vs 52.5%, respectively; p = 0.213). The clinical outcomes, including VAS neck, VAS arm, and NDI scores at 24 months postoperatively, were all similar in the NSAID and non-NSAID groups, as well as the selective and nonselective COX-2 groups (all p > 0.05). CONCLUSIONS In this study there was a trend toward less HO formation and fewer immobile discs in patients who used postoperative NSAIDs after cervical arthroplasty than those who did not, but this trend did not reach statistical significance. Patients who used selective COX-2 NSAIDs had nonsignificantly less HO than those who used nonselective COX-2 NSAIDs. The clinical outcomes were not affected by the use of NSAIDs or the kinds of NSAIDs used (selective vs nonselective COX-2). However, the study was limited by the number of patients included, and the efficacy of NSAIDs in the prevention of HO after cervical arthroplasty may need further investigation to confirm these results.

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Use of Platelet-Rich Plasma (PRP) for the Treatment of Chronic Persistent Jumper’s Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00267 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0026

Author(s):

Müjdat Enginsu ◽

Recep Lokmaoğlu ◽

Şafak Selimoğlu ◽

Erol Korkmaz

Keyword(s):

Patient Satisfaction ◽

Clinical Outcome ◽

Platelet Rich Plasma ◽

Clinical Results ◽

Activity Level ◽

Patellar Tendinopathy ◽

Pain Level ◽

Jumper’S Knee ◽

Sports Activity

Objectives: The aim of this study was to evaluate the efficacy of multiple PRP injections on the healing of chronic persistent patellar tendinopathy, after previous classical treatment have failed. Methods: We treated 30 patients affected by chronic jumper’s knee, who had failed previous nonsurgical treatments, with multiple PRP injections and physiotherapy. We also compared the clinical outcome with a homogeneous group of 15 patients primarily treated with the physiotherapy approach. Tegner, VAS, and pain level were used for clinical evaluation before, at the end of the treatment and 3-6 month follow up. Complications, functional recovery and patient satisfaction were also recorded. A statistically significant improvement in all scores was observed at the end of the PRP injections in patients with chronic persistent patellar tendinopathy and a further improvement was noted at 6 month, after physiotherapy was added. Results: Moreover, comparable results were obtained with respect to the less severe cases in the VAS score and pain level evaluation, as in the time to recover and patient satisfaction, with an ever higher improvement in the sports activity level achieved in the PRP group Conclusion: The clinical results are encouraging, indicating that PRP injections have the potential to promote the achievement of a satisfactory clinical outcome, even in difficult cases with chronic persistent tendinopathy after previous classical treatments have failed.

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