The efficiency of the Ponseti method in relapsing forms of congenital clubfoot

In the last decade, the Ponseti method has been recognized by most orthopedists around the world as the gold standard for clubfoot treatment. However, the efficiency of the Ponseti method in relapsing forms of congenital clubfoot in children has been under-examined. We analyzed 103 patients with relapsing clubfoot, aged 1 to 9 years, who were treated at the National Center of Rehabilitation and Prosthetics of the Disabled from 2017 to 2019. These patients had a relapse with typical clubfoot contractures without multiplanar deformity of the feet. The treatment process consisted in the application of the method of I. Ponseti for all patients; if indicated, transplantation of the tendon of the anterior tibial muscle was performed.

Bone Formation and Adaptive Morphology of the Anterior Tibial Muscle in 3-mm Daily Lengthening Using High-Fractional Automated Distraction and Osteosynthesis with the Ilizarov Apparatus Combined with Intramedullary Hydroxyapatite-Coated Wire

Purpose. We studied osteogenesis and morphofunctional features of the anterior tibial muscle using 3-mm high-frequency automated lengthening with the Ilizarov apparatus alone and in combination with intramedullary nailing. Material and Methods. Tibia was lengthened with a round-the-clock automated distractor at a 3-mm daily rate for 10 days in 16 mongrel dogs. In group 1 (n = 8), a 1.8-mm intramedullary titanium wire coated with hydroxyapatite was introduced into the tibial canal followed by Ilizarov frame mounting and transverse osteotomy of the diaphysis. Distraction mode was 0.025 mm x 120 increments a day. In group 2 (n = 8), distraction mode was the same but nailing was not used. Bone formation and the anterior tibial muscle were studied at two time points: (1) upon distraction completion; (2) three months after the apparatus removal. Bone formation was studied radiographically. Muscle preparations were examined histologically and stereomicroscopically. Results. There was a threefold reduction in the distraction time in both groups. Consolidation took 13.83±4.02 days in group 1 and 33.7±2.4 days in group 2. Muscle macropreparations of the experimental limb in group 1 at study time points did not show significant differences from intact tissues. Muscle histostructure in both groups was characterized by activation of angiogenesis and myohistogenesis, but the volumetric density of microvessels in the lengthening phase was three times higher in group 1. Conclusion. Combined technology significantly reduces the total lengthening procedure and does not compromise limb functions. Intramedullary HA-coated wires promote faster bone formation. The muscle was able to exhibit structural adaptation and plasticity of a restitution type.

ID: 1022 Acellular muscle scaffolds: Histological and biochemical evaluation

Anterior tibial muscle of C57Bl6/J mice was subjected to decellularization with hypotonic solution, detergents and DNase. Resulting acellular scaffolds were examined to characterize the content of chromatin, cell cytoplasm and extracellular matrix components incl. basal laminas, fibres and glycoproteins. Although the sarcoplasm and cell nuclei were removed, the general skeletal muscle microarchitecture with ECM of stromal components remained well preserved at light and electron microscopic levels. Moreover, basal laminas contouring honeycomb-like structures left after removal of myofibres and vascular endothelium remained intact. Immunostaining of scaffolds for collagen IV and laminin confirmed positivity of basal laminas. Histochemical staining of deparaffinised scaffold sections identified well organized fibres after staining with green trichrome, Sirius red, Weigert’s resorcin fuchsin and Gomori impregnation. Chemical analysis gave evidence of reduced dsDNA and well-preserved collagen according to high hydroxyproline content and laminin as documented by Western blotting. We cultured scaffolds seeded with murine myogenic cells in vitro and confirmed their cytocompatibility as the cells were able to adhere, grow and migrate through the ECM without affecting the scaffold structure. Myogenic cells were able to migrate in the endomysium and start to fuse. Implantation of decellularized scaffolds into an artificial cavity inside of anterior tibial muscle of mice in vivo confirmed the scaffolds were colonized soon by recipient inflammatory cells without formation of foreign body giant cells. Scaffolds were well integrated with recipient skeletal muscle and gradually resorbed within 3 weeks. Our results confirm decellularized muscle scaffold is a promising alternative for rebuilding the skeletal muscle organ as it can preserve basic chemical components and the tissue microstructure and show biocompatibility for myogenic cells as demonstrated in vitro and in vivo.

Accessory anterolateral talar facet impingement with tibialis spastic varus foot

In recent years, some authors have reported accessory anterolateral talar facet impingement with flatfoot including peroneal spastic flatfoot. Conversely, to our knowledge, no case report has been published about accessory anterolateral talar facet impingement with tibialis spastic varus foot. We report the first case in a 22-year-old man with intellectual disability, bilateral cleft hands and type 1 diabetes mellitus. Since spraining his left ankle over a year earlier, he experienced left sinus tarsi pain while standing and walking. Physical examination revealed that his left foot was in the varus position with spasm of the anterior tibial muscle, tenderness in the sinus tarsi and lateral hindfoot pain upon attempted passive hindfoot eversion. He could not stand on his left toes. His pain decreased after lying down and receiving a massage on his anterolateral lower leg at night. Radiographs and computed tomography scans revealed the absence of tarsal coalition and the presence of accessory anterolateral talar facet in both feet. Magnetic resonance imaging demonstrated abutting bone marrow edema between the talus and calcaneus around the accessory anterolateral talar facet. We diagnosed the patient with accessory anterolateral talar facet impingement and tibialis spastic varus foot. After conservative treatment failed, resection of accessory anterolateral talar facet achieved good results with short-term follow-up.

Widespread Pressure Pain Hyperalgesia in Chronic Nonspecific Neck Pain with Neuropathic Features: A Descriptive Cross-Sectional Study

Background: Neck pain has an elevated prevalence worldwide. Most people with neck pain are diagnosed as nonspecific neck pain patients. Poor recovery in neck disorders, as well as high levels of pain and disability, are associated with widespread sensory hypersensitivity. Nevertheless, there is controversy regarding the presence of widespread hyperalgesia in chronic nonspecific neck pain (CNSNP); this lack of agreement could be due to the presence of different pathophysiological mechanisms in CNSNP. Objectives: To determinate differences in pressure pain thresholds (PPTs) over extracervical and cervical regions, and differences in cervical range of motion (ROM) between patients with CNSNP with and without neuropathic features (NF and No-NF, respectively). In addition, this study expected to observe correlations in these 2 types of CNSNP of psychosocial factors with PPTs and with cervical ROM separately. Study Design: Descriptive, cross-sectional study. Setting: A hospital physiotherapy outpatient department. Methods: This research involved 53 patients with CNSNP that had obtained a Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) score ≥ 12 (pain with NF, NF group); 54 that had obtained a S-LANSS score < 12 (pain with No-NF, No-NF group), and 53 healthy controls (control group, CG). Measures included: PPTs (suboccipital muscle, upper fibers trapezius muscle, lateral epicondyle, and anterior tibial muscle), cervical ROM (flexion, extension, rotation, and latero-flexion), pain intensity (Visual Analog Scale [VAS]), neck disability index (NDI), kinesiophobia (Tampa Scale of Kinesiophobia-11 [TSK-11]), and Pain Catastrophizing Scale (PCS). Results: A statistically significant effect was observed for the group factor in all assessed measures (P < 0.01). Both CNSNP groups showed statistically significant differences compared to the CG for PPTs in the cervical region (suboccipital and upper fibers trapezius muscles), but only the NF group demonstrated statistically significant differences for PPTs in the lateral epincondyle and anterior tibial muscle when compared to the CG or No-NF group. The largest statistically significant correlation found in the NF group was between PPT in the anterior tibial muscle and TSK-11 (r = -0.372; P < 0.01), while in the No-NF group it was between PPT in the suboccipital muscle and NDI (r = -0.288; P < 0.05). Statistically significant differences were found between the 2 CNSNP groups and CG in all cervical ROMs, but not between both CNSNP groups. The largest statistically significant correlation observed in the NF group was between cervical total rotation and TSK-11 (r = -0.473; P < 0.01), while in the No-NF group it was between cervical total latero-flexion and PCS (r = -0.532; P < 0.01). Limitations: Although the S-LANSS scale has been validated as a screening tool for pain with NF, currently there is no “gold standard,” so these findings should be interpreted with caution. Conclusions: Widespread pressure pain hyperalgesia was detected in patients with CNSNP with NF, but not in patients with CNSNP with No-NF. Patients with CNSNP presented bilateral pressure pain hyperalgesia over the cervical region and a decreased cervical ROM compared to healthy controls. However, no differences were found between the 2 CNSNP groups. These findings suggest differences in the mechanism of pain processing between patients with CNSNP with NF and No-NF. Key words: Neck pain, chronic pain, neuropathic pain, pain threshold, mechanical hyperalgesia, range of motion, pain catastrophizing

Nerve Transfers for Persistent Traumatic Peroneal Nerve Palsy

BACKGROUND: Patients in whom conventional peroneal nerve repair surgery failed to reconstitute useful foot lift need to be evaluated for their suitability to undergo a concomitant tendon transfer procedure or nerve transfers. OBJECTIVE: To report our first clinical experience with nerve transfers for persistent traumatic peroneal nerve palsy. METHODS: Between 2007 and 2013, 8 patients were operated on for foot drop after unsuccessful nerve surgery. Six patients without fatty degeneration of the anterior tibial muscle and proximal lesion of the peroneal nerve were oriented for tibial to peroneal nerve transfer. In the other 2 cases where the anterior and lateral compartments were destructed, the anterior tibial muscle function was reconstructed with a neurotized lateral gastrocnemius transfer. For each patient, we graded postoperative results using the British Medical Research Council scheme and the Ninkovic assessment scale. RESULTS: Of the 6 patients who underwent nerve transfer of the anterior tibial muscle, 2 patients had excellent results, 1 patient had good results, 1 patient had fair results, and 2 patients had poor results. Of the 2 patients that underwent neurotized lateral gastrocnemius transfer, 1 patient achieved excellent results after tenolysis, whereas 1 patient achieved poor results. After the nerve transfer, 5 patients did not wear an ankle-foot orthosis. Four patients did not limp. Four patients were able to walk barefoot, navigate stairs, and participate in activities. CONCLUSION: Early clinical results after tibial to peroneal nerve transfer and neurotized lateral gastrocnemius transfer appear mixed. The results of nerve transfer seem, on the whole, less reliable than the literature reports on tendon transfer.