Biophysical Stimulation in Athletes’ Joint Degeneration: A Narrative Review

Osteoarthritis (OA) is the most prevalent degenerative joint disease and the main cause of pain and disability in elderly people. OA currently represents a significant social health problem, since it affects 250 million individuals worldwide, mainly adults aged over 65. Although OA is a multifactorial disease, depending on both genetic and environmental factors, it is reported that joint degeneration has a higher prevalence in former athletes. Repetitive impact and loading, joint overuse and recurrent injuries followed by a rapid return to the sport might explain athletes’ predisposition to joint articular degeneration. In recent years, however, big efforts have been made to improve the prevention and management of sports injuries and to speed up the athletes’ return-to-sport. Biophysics is the study of biological processes and systems using physics-based methods or based on physical principles. Clinical biophysics has recently evolved as a medical branch that investigates the relationship between the human body and non-ionizing physical energy. A physical stimulus triggers a biological response by regulating specific intracellular pathways, thus acting as a drug. Preclinical and clinical trials have shown positive effects of biophysical stimulation on articular cartilage, subchondral bone and synovia. This review aims to assess the role of pulsed electromagnetic fields (PEMFs) and extracorporeal shockwave therapy (ESWT) in the prevention and treatment of joint degeneration in athletes.

Open MRI assessment of anterior femoroacetabular clearance in active and passive impingement-provoking postures

Aims Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.

Low grade of osteoarthritis development after Latarjet procedure with a minimum 5 years of follow-up: a systematic review and pooled analysis

Purpose The purpose of this systematic review and pooled analysis was to evaluate incidence and risk factors for glenohumeral osteoarthritis (OA) in patients who underwent Latarjet procedure with a minimum of 5-year follow-up. Methods The PRISMA guidelines were followed to perform this systematic review. PubMed and EMBASE were searched up to February 29, 2020 for English, human in vivo studies that evaluated glenohumeral OA in patients undergoing Latarjet procedure at least 5 years after surgery. A pooled analysis on the included databases sent by authors was performed to evaluate the risk factors influencing the development or progression of dislocation arthropathy after the Latarjet procedure. Results Four studies, including a total of 280 patients (213 males and 67 females), were analysed. In our study population, the median age at surgery was 25.0 years (range 20.8–32.6 years). and 92.1% were athletes. In 90% of the cases, the number of dislocations before surgery were fewer than 5. The recurrence of instability after Latarjet procedure was observed only in seven patients (2.5%). The position of the bone graft resulted flush to the anterior glenoid rim in 238 cases (85.3%), medial in 8 (2.9%) and overhanging in 33 (11.8%). Radiological signs of development or progression of shoulder OA were observed in 25.8% of the patients, of which 88.6% presented a grade 1 of OA according to Samilson and Prieto classification. The overhanging position of the bone graft resulted statistically significant for onset or worsening of OA. The age at surgery, the number of dislocations before surgery and the Hill–Sachs lesion were not significantly associated with joint degeneration. Instead, hyperlaxity showed a prevention role in the development of OA after open Latarjet procedure. Conclusion The Latarjet procedure is a valid and safe surgical treatment in recurrent anterior shoulder instability with a low risk of developing moderate or severe OA also at long-term follow-up. The overhanging position of the bone graft represents the principal risk factor of joint degeneration, whereas the hyperlaxity seems to be protective. Finally, age, gender, time between first dislocation and surgery, and number of dislocations do not seem to affect the onset of OA after Latarjet procedure. Therefore, an accurate execution of the Latarjet procedure can be considered a valid treatment even in young and athletes thanks to the low recurrence rates and the low development of major long-term complications. Level of evidence IV.

Complex Tibial Plateau Fractures Treated with a Hybrid External Fixator – Long Term Results

Introduction: High energy tibial plateau fractures represent a challenge because of the combined bone and soft tissue injury. The iatrogenic impact can further increase the likelihood for crippling complications. Less invasive treatment protocols have been developed to improve the results. Objective: We present the long-term results of limited internal fixation combined with a small wire external fixator. Patients and Methods: Fourteen patients were followed for at least 10 years. Initial and final functional results, complications and presence of joint degeneration were registered according to validated rating scores. Results: Of all patients included in the study, thirteen showed an excellent initial rating and one had an average result at baseline. 10 years later, eight patients still showed excellent grading results, four – good ones, one – average and one – poor results. Ten knees (71%) had osteoarthritis. Postphlebitic syndrome was diagnosed in two cases. Three knees showed medio-lateral instability, one showed a varus and one – a valgus deformity. Knee arthroplasty was performed in one case. Conclusion: The limited internal fixation combined with a hybrid ex fix can be considered as an alternative to the ORIF, especially when the soft tissues are severely compromised. Despite the inevitable joint degeneration, the associated overall morbidity is low and the long term function is quite satisfactory.

The influence of Electroacupuncture on a dog diagnosed with osteoarthritis: A case report

Electroacupuncture is a specific branch of acupuncture that uses electrical stimulation through the selected acupoints. Osteoarthritis is considered a complex condition associated with painful joints and locomotor dysfunction. The aim of this case report was to bring scientific support regarding the effect of electroacupuncture in a dog with chronic joint degeneration. An 11-year-old male German shepherd referred to the University of Agricultural Sciences and Veterinary Medicine of Cluj with severe pain in his hind limbs and around his back. Diagnosis based on a western examination, neurological assessment and radiographs indicated chronic osteoarthritis with hip dysplasia. From Traditional Chinese Veterinary Medicine based diagnosis was Kidney Qi Deficiency leading to Bony Bi Syndrome. For the last two years, the treated dog with Mavacoxib (single dose every month) did not show any significant improvement. A combination of a fine needle with dry acupuncture, electroacupuncture (30-40Hz alternated with 80-100 Hz) and aqua-acupuncture using Zeel (AP) was performed. During the winter, weekly treatment was planned, after that, every two weeks treatment with electroacupuncture and dry needle, for five months until the present. Since we started the acupuncture treatment, the dog is more active and enjoys playing again. We have managed to stop the administration of NSAID’s and improve his life quality. In the present study, we evaluated the effect of complementary medicine on a dog with chronic pain and joint degeneration. Electroacupuncture is a complex technique that requires special training; if used wisely, it can be an excellent complementary therapy for veterinary patients’ pain control.

PROGRESS AND PRECLUSION OF KNEE OSTEOARTHRITIS: A STUDY

There is a need for better medical and preclinical instruments to diagnose knee OA in its initial phases owing to the increase occurrence of knee osteoarthritis (OA), a devastating knee joint degeneration. Osteoarthritis commonly affects patients who are obese and those above the age of 60. This mainly happens to age down and over-weighted people. The goal is to provide practical methods for assessing the seriousness of knee OA quickly and with human consistency. We also present Changes that affect your chances of getting sick of knee osteoarthritis, Treatment of knee osteoarthritis and the Prevention methods of knee osteoarthritis.

Risk-Factor Analysis of Disc and Facet Joint Degeneration After Inter-Segmental Pedicle Screw Fixation for Lumbar Spondylolysis

Background: To assess the effects of inter-segment pedicle screw fixation for the treatment of lumbar spondylolysis, and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation.Methods: The study included 54 male L5 spondylolysis patients who underwent pars repair and inter-segment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes including the disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration.Results: Bony union was achieved in all cases. Logistic regression analysis revealed that duration of instrumentation of more than 15.5 months and 21.0 months were significant risk factor of the incidence of L4/5 and L5S1 facet degeneration, respectively. Conclusions: Inter-segmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor of facet joint degeneration. Once bony union is achieved, remove of the instruments should be recommended.