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The Cure That Lies Within: The Mind-Body Connection in Orthopaedics.

The mind and the body are clearly intertwined in ways that are only now being discovered. In the orthopaedic world, injuries and diseases are often classified and described in a very organized, discrete fashion-The radius is fractured, the ACL or meniscus or rotator cuff is torn, the ankle is sprained, and/or the lumbar spine has a disc herniation. Although it is, in many ways, almost comforting to think about injuries or orthopaedic issues in this manner, what about the many patients who fail to fall into this classification? What about the thousands of patients with severe unexplained chroni…

In vivo measurement of localized tibiofemoral cartilage strains in response to dynamic activity.

BACKGROUND: Altered local mechanical loading may disrupt normal cartilage homeostasis and play a role in the progression of osteoarthritis. … odology and data could be used to evaluate the effects of soft tissue injuries (such as ligament or meniscus tears) on cartilage strains in response to dynamic activities of daily living.

Temporomandibular joint disorders: artificial joint replacements and future research needs.

Temporomandibular disorders (TMD) affect a significant section of the American population. According to the National Institutes of Health (N … mately may lead to the use of either a partial or a total joint reconstruction. Degeneration of the meniscus and the actual bony portions of the joint is often seen in cases of true TMJ pathology. The use of custom made or predesigned partial and/or total artificial TMJ replacement remains one of the surgical alternatives for treating various TMJ diseases …

Synovial plicae of the knee. Controversies and review.

Plicae are some of the normal synovial structures of the knee joint cavity. They are remnants of the mesenchymal tissue that occupies the sp … ping, or effusion related to patellofemoral joint motion. The clinical picture mimics a torn medial meniscus or a maltracking patella. Clinical examination is extremely helpful if the snapping plica is palpated at the medial edge of the patella, reproducing the patient's symptoms. If chronic, these symptoms may be treated with nonsteroidal anti-inflammator …

No Effects of Early Viscosupplementation After Arthroscopic Partial Meniscectomy: A Randomized Controlled Trial.

BACKGROUND: The management of the postoperative period after knee arthroscopic surgery may be challenging because surgical trauma deeply alters the joint microenvironment, causing the release of several catabolic molecules and proinflammatory factors that might slow down functional recovery. The possibility of using hyaluronic acid (HA) to promote postoperative pain relief and expedite functional improvement seems attractive, considering its biological properties. PURPOSE: The aim of the present double-blind randomized controlled trial was to evaluate the effects, in terms of pain control and

Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery.

BACKGROUND: The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal surgery. METHODS: This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, includ

Clinical, MRI and arthroscopic correlation in internal derangement of knee.

BACKGROUND: The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. OBJECTIVE: The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. METHODS: Forty one patients with suspected interna

[Paragliding-associated bilateral partial rupture of the rectus femoris muscle].

Pain in the thigh or groin due to a rupture of the rectus femoris muscle is rather uncommon. We report on a patient with a bilateral rupture of the rectus femoris muscle that occurred due to a landing maneuver while para-gliding. The diagnosis was confirmed by ultrasound and MRI. Additionally, an old unilateral anterior cruciate ligament rupture was present. As a functional deficit of the quadriceps muscle could not be observed, a primarily conservative treatment seems to be appropriate.

Diagnostic value of ultrasound in calcium pyrophosphate deposition disease of the knee joint.

OBJECTIVE: To assess the diagnostic performance of ultrasound (US) for calcium pyrophosphate deposition (CPPD) at the level of menisci, hyaline cartilage (HC), tendons, and synovial fluid (SF) of the knee, and to examine inter- and intra-observer reliability. DESIGN: We consecutively included patients with knee effusion over a 2-year period (43 patients with CPPD and 131 controls). All patients underwent SF analysis, conventional radiography (CR), and US examination using the Outcome Measures in Rheumatology (OMERACT) definition of the US characteristics of CPPD. Two independent operators per

A study of acute and chronic tissue changes in surgical and traumatically-induced experimental models of knee joint injury using magnetic resonance imaging and micro-computed tomography.

OBJECTIVE: The objective of this study was to monitor the progression of joint damage in two animal models of knee joint trauma using two non-invasive, clinically available imaging modalities. METHODS: A 3-T clinical magnet and micro-computed tomography (μCT) was used to document changes immediately following injury (acute) and post-injury (chronic) at time points of 4, 8, or 12 weeks. Joint damage was recorded at dissection and compared to the chronic magnetic resonance imaging (MRI) record. Fifteen Flemish Giant rabbits were subjected to a single tibiofemoral compressive impact (ACLF), and

Transphyseal anterior cruciate ligament reconstruction in patients with open physes.

PURPOSE: The purpose of this study was to evaluate the clinical outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes. METHODS: Transphyseal ACL reconstruction was performed in 26 patients with open tibial and femoral physes (physis >2 mm) by use of autogenous quadrupled hamstrings as grafts. Meniscal tearing was found in 65.3% of the patients. Partial chondral defect injury on the medial femoral condyle was found 6 months after injury in only 2 patients (7.69% of all patients). The mean follow-up period was 45 +/- 18.3 months. Clinical outcomes

Indirect MR arthrography: optimization and clinical applications.

PURPOSE: To evaluate and optimize a method for producing magnetic resonance (MR) images similar to MR arthrograms of multiple synovial joints with intravenous gadopentetate dimeglumine injection. MATERIALS AND METHODS: The authors examined the effects of joint motion, dose of gadopentetate dimeglumine (0.1, 0.2, and 0.4 mmol/kg), and fat saturation on the enhancement rate of the joint cavity and the degree of image contrast generated among articular structures on MR images in 14 healthy volunteers. Shoulder, elbow, wrist, hip, knee, and ankle joints of 10 volunteers were imaged with optimized

Dual-energy CT virtual non-calcium: an accurate method for detection of knee osteoarthritis-related edema-like marrow signal intensity.

ObjectivesTo evaluate the performance of a dual-energy computed tomography (DECT) virtual non-calcium (VNCa) technique in the detection of edema-like marrow signal intensity (ELMSI) in patients with knee joint osteoarthritis (OA) compared to magnetic resonance imaging (MRI).MethodsThe study received local ethics board approval, and written informed consent was obtained. DECT and MRI were used to examine 28 knees in 24 patients with OA. VNCa images were generated by dual-energy subtraction of calcium. The knee joint was divided into 15 regions for ELMSI grading, performed independently by two m

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… of the posterior horn of the meniscus; and (3) posterior, extending from the posterior capsule accessory of the posterior horn of the meniscus to the posterior superior and posterior junction of bone and cartilage. … Region C of the tibial surface corresponds to the uncovered portion between the anterior and posterior horns of the meniscus centrally and the portion covered by the body of the meniscus peripherally Fig. 2 Regional subdivision of the articular surfaces. …

Continuous suture all-inside meniscal repair technique produces excellent functional outcomes and return to play rates with a low rate of failure.

BACKGROUND: The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. METHODS: We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5 year period. We recorded demographic details, injury ty

ACL reconstruction in over-50 year-olds: Comparative study between prospective series of over-50 year-old and under-40 year-old patients.

INTRODUCTION: ACL reconstruction is increasingly proposed for over-50 year-olds, although surgery had a poor reputation in this age-group, mainly due to postoperative stiffness. ACL reconstruction results were compared between two prospective series of, respectively, over-50 year-old (group 1) and under-40 year-old patients (group 2). The main study hypothesis was that ACL surgery provides the same functional results after 50 as before 40 years of age, and the secondary hypothesis was that the rate of complications does not differ. METHODS: A multicenter prospective non-randomized follow-up s

Quadriceps weakness associates with greater T1ρ relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction.

PURPOSE: Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial an

Post-traumatic knee MRI findings and associations with patient, trauma, and clinical characteristics: a subgroup analysis in primary care in the Netherlands.

BACKGROUND: The added value of magnetic resonance imaging (MRI) in primary care is still being debated. A high diagnostic yield can be expected in young and active patients with post-traumatic knee complaints. AIM: To determine the frequency of MRI abnormalities in young and active patients (aged 18-45 years) and the associations with patient, trauma, and clinical characteristics. DESIGN AND SETTING: A subgroup analysis of 174 patients, aged 18-45 years with knee trauma of <6 months, allocated to MRI in a randomised controlled trial on the yield of MRI in primary care. Patients were recruite

Anterior cruciate ligament injuries in adolescents with open physis: effect of recurrent injury and surgical delay on meniscal and cartilage injuries.

BACKGROUND: Treatment choices for skeletally immature patients sustaining anterior cruciate ligament (ACL) injuries have been controversial. The main dilemma is whether surgical treatment should be provided before patients reach skeletal maturity or whether nonoperative treatment should be provided until the physis has closed. Surgical reconstruction risks physeal damage, while delaying surgery may increase menisci and cartilage damage. PURPOSE: To identify patients at the onset of ACL injury and follow them longitudinally to surgery or final follow-up to describe differences between nonopera

[Chronic knee pain and specific heat phobia. A case report].

This case report presents the medical history of a patient suffering from chronic knee pain with specific heat phobia who had a long history of sick certificates. Using multimodal pain therapy and biofeedback therapy the acquired anxiety disorder could be solved. Long-term working ability could be achieved.