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Novel approach to determine components size in a total ankle replacement

Tue, 31 Dec 2024 15:00:00 GMT

Title: Novel approach to determine components size in a total ankle replacement Author(s): Jung-Min Lee; Si-Wook Lee Abstract: As a total ankle replacement (TAR) prosthesis has been developed and improved in terms of design and surgical technique, it could be expected to lead to a successful functional outcome in the ankle joint. However, several complications of the TAR procedure may be often caused by an incomplete understanding of the abnormal biomechanics of the ankle joint and the prosthesis design of the TAR. This study was performed to suggest a novel approach to determine the TAR prosthesis size by using an orthopedic digital templating software based on a comparison between X-ray and CT images. This study was examined in a novel approach to determine the prosthesis size by using an orthopedic digital templating software (Orthoview™, Florida, USA) based on the comparison between X-ray and CT images. A total 6 types of clinical foot and ankle images were obtained from x-ray and CT of 55 subjects in the coronal and sagittal plane. The x-ray images magnified as 100% and 115% based on the CT images. All subjects were diagnosed to the ankle osteoarthritis with stage 2–4 according to Takakura’s ankle OA classification. To predict the appropriate component sizes of the TAR prosthesis, the same TAR prosthesis (HINTEGRA, Newdeal, France) was chosen, and the tibial and the the talar component sizes were selected until by adapting to the osteotomized range of the tibia and talus. The unskilled surgeons predicted the sizes of the TAR components before procedure by using the orthopedic digital templating software. These predicted sizes were then compared with the selected sizes by the specialist surgeon during the procedure. The Cohen’s Kappa correlation coefficient was applied to statistically analyze the agreement between the predicted and selected sizes of the TAR components for unskilled and specialist surgeons, respectively. On the CT images, the average agreement rate was relatively higher than on the x-ray images at over 77%. Especially, highest agreement rate was shown at the tibial component in the coronal plane with almost 80%, followed by over 75% in the sagittal plane. In the talar part, the agreement rate was shown to be over 76% in the coronal and sagittal plane, respectively. Overall, the predicted size from the CT image was more consistent with the size selected by the specialist surgeon than the X-ray image. In conclusion, the application of the orthopedic digital templating software based on CT images may expect to provide more complete and detailed visualization to predict the appropriate size of the TAR components than conventional X-ray images which would be limited by relatively lower sensitivity and specificity as well as overlapping the adjacent bones.

Current Narrative Review-Application of Blood Flow Restriction Exercise in Clinical Knee Problems

Tue, 31 Dec 2024 15:00:00 GMT

Title: Current Narrative Review-Application of Blood Flow Restriction Exercise in Clinical Knee Problems Author(s): Saehim Kwon; Ki-Cheor Bae; Chang-Jin Yon; Du-Han Kim Abstract: Quadricep weakness is frequently observed in patients following anterior cruciate ligament (ACL) injury or in those with knee osteoarthritis, often contributing to functional impairments and persistent symptoms. While high-intensity resistance training has been shown to effectively improve muscle strength, its application may be limited in certain populations due to pain or the risk of surgical complications. In recent years, blood flow restriction (BFR) training has emerged as a promising alternative. Growing evidence indicates that low-load BFR exercise can significantly improve muscle strength, induce hypertrophy, and enhance knee function, with outcomes comparable to those of high-intensity resistance training. When implemented using appropriate protocols, BFR training appears to be a safe and efficacious rehabilitation strategy for individuals with knee pathology.

Acromial and scapular spine fractures following reverse total shoulder arthroplasty: treatment dilemma and radiographic prognosticators for enhanced clinical outcomes: a multicenter study

Tue, 31 Dec 2024 15:00:00 GMT

Title: Acromial and scapular spine fractures following reverse total shoulder arthroplasty: treatment dilemma and radiographic prognosticators for enhanced clinical outcomes: a multicenter study Author(s): Sung Min Rhee; Radhakrishna Kantanavar; Chang Woo Woo; Jin Jung; Joo Han Oh; Yang-Soo Kim; Sang-Jin Shin; Jae Chul Yoo; Hyun Seok Song; Chul Hyun Cho; Yong Girl Rhee Abstract: Background: The management of acromial and scapular spine fractures (ASFs) after reverse total shoulder arthroplasty (rTSA) remains challenging, often prompting surgeons to opt nonoperative treatment. The reported outcomes vary due to multiple influencing factors. This study aimed to analyze prognostic factors affecting outcomes of nonoperatively treated ASFs following rTSA. Methods: Among 2,837 cases, 78 patients (2.7%) with ASFs following rTSA from 8 regional hospitals were retrospectively reviewed, including 10 surgical and 68 nonoperatively managed cases. The study focused on the 68 nonoperatively managed patients (56 females, 12 males, median age 74 years). The median ASF onset post-rTSA was 5 months (interquartile range: 3-9.8), with a mean follow-up after the diagnosis of ASFs of 30 months (range, 24-56). Fractures were classified using the Levy classification. The patient-acceptable symptom state for the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) score after rTSA (76 and 1.5, respectively) were used to group patients and assess demographic, clinical, and radiological prognostic factors, including fracture location, angulation, displacement, and union status. Results: In predicting below-acceptable VAS score (VAS score > 1.5), the absence of prior surgery had an odds ratio of 0.19 (95% confidence interval [CI], 0.04-0.79; P value: .023), while fracture angulation had an odds ratio of 1.11 (95% CI, 1.03-1.21; P value: .008). A fracture angulation ≥ 36° (specificity 90%, sensitivity 62.5%) and displacement ≥ 9 mm (specificity 90%, sensitivity 33.3%) were significant predictors of below-acceptable VAS score. For predicting below-acceptable ASES score (ASES score < 76), fracture angulation had an odds ratio of 1.13 (95% CI, 1.04-1.22; P value: .004). A fracture angulation ≥ 37° (specificity 90%, sensitivity of 62.8%) and displacement ≥ 10 mm (specificity 90%, sensitivity 34.9%) were significant predictors of a below-acceptable ASES score. Fracture location and nonunion status did not significantly impact outcomes. Conclusion Fracture angulation was the most critical prognostic factor, negatively influencing nonoperatively managed ASF outcomes. Fracture location, nonunion status, and lateralization of rTSA did not affect clinical results. These findings will aid in patient counseling and guide decisions between nonoperative and surgical management.

High-Dose Statins Preserve Tendon-Bone Interface Healing Without Adversely Affecting Fatty Infiltration in a Rotator Cuff Repair Rat Model

Tue, 31 Dec 2024 15:00:00 GMT

Title: High-Dose Statins Preserve Tendon-Bone Interface Healing Without Adversely Affecting Fatty Infiltration in a Rotator Cuff Repair Rat Model Author(s): Jong Pil Yoon; Sung-Jin Park; Dong-Hyun Kim; Jun-Young Kim; Chul-Hyun Cho; Hyun Joo Lee; Seok Won Chung Abstract: Purpose: To evaluate the effects of high-dose atorvastatin (hATZ) on histologic and biomechanical tendon-bone interface (TBI) healing and fatty infiltration following rotator cuff (RC) repair in a rat model. Methods: Twenty Sprague-Dawley rats underwent RC repair surgery on both shoulders, after which hATZ was administered orally for 4 weeks postoperatively. The effects of hATZ on TBI healing were assessed macroscopically, histologically, and biomechanically. Fatty infiltration was evaluated using Oil-Red-O staining and immunohistochemical analysis of gene marker expressions. Expression levels of muscle RING-finger protein 1 (MuRF-1) and muscle atrophy F-box protein, markers of muscle atrophy, and peroxisome proliferator-activated receptor γ and CCAAT/enhancer-binding protein α, transcription factors involved in adipogenesis, were assessed by quantitative real-time polymerase chain reaction to evaluate molecular changes related to muscle degeneration. Biomechanical tendon healing was measured using a universal testing machine, and histologic analysis was performed using hematoxylin and eosin and Masson’s trichrome staining. Results: At 4 weeks postoperatively, systemic administration of hATZ did not negatively affect TBI healing following RC repair. Fatty infiltration analysis showed no significant difference between the hATZ group (3,322.16 ± 1,117.59 μm2) and the control group (3,946.94 ± 1,843.96 μm2) (P = .415). However, immunohistochemical analysis revealed that hATZ significantly inhibited the expression of MuRF-1 (P < .001), a key regulator of muscle atrophy, while the expression levels of muscle atrophy F-box protein (P = .803), peroxisome proliferator-activated receptor γ (P = .200), and CCAAT/enhancer-binding protein α (P = .909) remained unchanged. Histologic analysis confirmed no significant differences in collagen density (P = .142) or arrangement (P = .164) between the groups, and biomechanical testing showed comparable ultimate strength (P = .398) and load to failure (P = .464). Conclusions: High-dose atorvastatin did not impair histologic and biomechanical healing of the TBI in a rat model of RC repair. It also did not accelerate fatty infiltration of the muscle and led to a significant downregulation of the muscle atrophy–related marker MuRF-1. Clinical Relevance: This study shows that hATZ does not negatively affect TBI healing or muscle recovery following RC repair, supporting its continued use in patients requiring long-term statin therapy.