Background:
Anatomic repair of a torn rotator cuff tendon on the greater tuberosity (GT) is an important surgical goal in rotator cuff repair. However, few studies have investigated whether the ...efforts made to maximize coverage of the GT are associated with the clinical and structural outcomes after rotator cuff repair surgery.
Purpose:
To investigate whether the quality of repair at the time of surgery is associated with clinical and structural outcomes after surgery and to identify factors influencing the quality of repair.
Study design:
Cohort study; Level of evidence, 3.
Methods:
Data were retrospectively collected from 141 patients who underwent arthroscopic rotator cuff repair between 2008 and 2016. All repairs were classified according to the amount of postoperative GT coverage: A, complete coverage of the GT (n = 96); B, incomplete coverage, comprising more than half of GT (n = 27); C, incomplete coverage, comprising less than half of the GT (n = 16); and D, exposure of the glenohumeral joint (n = 2). All patients underwent magnetic resonance imaging 1 year after surgery. Clinical outcomes and structural integrity based on Sugaya classification were assessed 2 years and 1 year after surgery, respectively. Preoperative factors associated with the postoperative GT coverage (measured at the close of surgery) were identified using a multivariable proportional odds cumulative logit model.
Results:
The forward flexion strength in group A (10.3 ± 4.6 lb) was significantly greater than that in group C (6.5 ± 3.7 lb) (P = .003) 2 years after surgery. The postoperative Constant score in group A (76.6 ± 11.5) was greater than that in group C (66.7 ± 15.6) (P = .018). The number of cases that showed retearing of the repaired tendon was as follows: group A (5/96; 5.2%), group B (7/27; 25.9%), and group C (10/16; 62.5%). There was no significant difference in the changes of pain visual analog scale scores among groups 2 years after surgery (all P > .05). Also, there was no significant difference in the changes of range of motion in all directions among groups 2 years after surgery (all P > .05). Patients with preoperative GT coverage B included in the postoperative GT coverage groups through surgery were as follows: group A (23/45; 51.1%), group B (17/45; 37.8%), and group C (5/45; 11.1%). Preoperative GT coverage was the only independent factor that was associated with GT coverage in multivariable analysis.
Conclusion:
Quality of repair, measured as the extent of postoperative GT coverage at the time of surgery, was associated with clinical and structural outcomes after rotator cuff repair surgery.
Bone loss with aging and menopause increases the risk of fragile vertebral fracture, osteoporotic vertebral compression fracture (OVCF). The fracture causes severe pain, impedes respiratory function, ...lower the quality of life, and increases the risk of new fractures and deaths. Various medications have been prescribed to prevent a secondary fracture, but few study summarized their effects. Therefore, we investigated their effects on preventing subsequent OVCF via meta-analyses of randomized controlled trials.
Electronic databases, including MEDLINE, EMBASE, CENTRAL, and Web of Science were searched for published randomized controlled trials from June 2015 to June 2019. The trials that recruited participants with at least one OVCF were included. We assessed the risk of bias of every study, estimated relative risk ratio of secondary OVCF, non-vertebral fracture, gastrointestinal complaints and discontinuation due to adverse events. Finally, we evaluated the quality of evidence.
Forty-one articles were included. Moderate to high quality evidence proved the effectiveness of zoledronate (Relative Risk, RR: 0.34; 95% CI, 0.17-0.69, p = 0.003), alendronate (RR: 0.54; 95% CI: 0.43-0.68; p < 0.0001), risedronate (RR: 0.61; 95% CI: 0.51-0.73; p < 0.0001), etidronate (RR, 0.50; 95% CI, 0.29-0.87, p < 0.01), ibandronate (RR: 0.52; 95% CI: 0.38-0.71; p < 0.0001), parathyroid hormone (RR: 0.31; 95% CI: 0.23-0.41; p < 0.0001), denosumab (RR, 0.41; 95% CI, 0.29-0.57; p < 0.0001) and selective estrogen receptor modulators (Raloxifene, RR: 0.58; 95% CI: 0.44-0.76; p < 0.0001; Bazedoxifene, RR: 0.66; 95% CI: 0.53-0.82; p = 0.0002) in preventing secondary fractures. Moderate quality evidence proved romosozumab had better effect than alendronate (Romosozumab vs. alendronate, RR: 0.64; 95% CI: 0.49-0.84; p = 0.001) and high quality evidence proved that teriparatide had better effect than risedronate (risedronate vs. teriparatide, RR: 1.98; 95% CI: 1.44-2.70; p < 0.0001).
Zoledronate, alendronate, risedronate, etidronate, ibandronate, parathyroid hormone, denosumab and selective estrogen receptor modulators had significant secondary prevention effects on OVCF. Moderate quality evidence proved romosozumab had better effect than alendronate. High quality evidence proved PTH had better effect than risedronate, but with higher risk of adverse events.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on ...the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion.
Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion. Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI).
The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively.
Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.
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•3D porous calcium phosphate scaffolds with fast degrading brushite surface covering a bone-like apatite core was prepared at physiological conditions by 3D printing and calcium ...phosphate cement reaction.•Composite brushite-apatite scaffolds showed high compressive strength even with high porosity.•Highly porous composite scaffolds showed improved bone regeneration and was completely replaced by new bone by the end of the test period.•Compared to conventional bone implants with single composition, brushite-apatite composite scaffolds show promising potential in bone tissue engineering.
Highly porous calcium phosphate (CaP) scaffolds with multiple phases were fabricated through combination of material extrusion type 3D printing process, salt-leaching, and bone cement chemistry under physiological conditions. Scaffolds with nano-sized calcium deficient hydroxy apatite (CDHA) in the core and large crystals of dicalcium phosphate dihydrate (DCPD or brushite) on the outer surface were fabricated by immersing the 3D ceramic scaffold in aqueous ‘cement solution’. In contrast to conventional CaP cement reactions where a single product is obtained, here we could achieve a composite of apatite-brushite. The composite scaffolds showed improved compressive strength without loss of porosity which was suitable for efficient bone tissue regeneration. With 65 % porosity, these scaffolds showed compressive strength of 15 MPa. The porosity of CaP scaffold was increased by applying salt-leaching technique to 3D printing, which greatly influenced the biodegradation of the scaffold in vivo. Composite scaffolds with fast degrading brushite shell showed better and faster scaffold-to-bone integration compared to apatite based scaffold. In vivo studies verified that multi-phase CaP scaffolds with bimodal pore structure induced good new bone formation behavior (85 % of coverage rate on calvaria defect site after 11 weeks of implantation) with good biodegradability (76.6 % of degradation in rabbit subdermal model after 12 weeks of implantation).
Schematic illustration of study design. Bone cement preparation and Study design of in vitro &in vivo model.
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•A novel functional bone cement was prepared according to incorporating ...Tetracalcium phosphate (TTCP) and Whitlockite (WH) bioceramics.•TTCP/WH bone cement exhibits good biocompatibility and osteoconductivity and better histocompatibility with surrounding bone tissue.•TTCP/WH functional bone cement may be a promising alternative to overcome PMMA cement’s limitations in treating osteoporotic vertebralcompression fractures.
PMMA bone cement is commonly used in the field of orthopedics as a filling material. However, due to the lack of biological activity and high elastic modulus, its application scope and efficacy are greatly limited, such as in the treatment of osteoporotic vertebral compression fractures(OVCF). For this reason, new functional bone cement was synthesized and designed to address and improve those shortcomings. In this study, Tetracalcium phosphate (TTCP) and Whitlockite (WH) were incorporated with PMMA cement to prepare a novel bone cement (TTCP/WH) and systemically evaluated its characteristics such as the operational working time and mechanical properties, etc. based on the International Standardization Organization standard (ISO 5833). Also, the biocompatibility and osteogenic activity of TTCP/WH bone cement were analyzed in vitro, and the rabbit ilium bone defect model was also used to evaluate osteoconduction and osseointegration with native bone tissue. Our results showed that TTCP/WH functional bone cement exhibited good osteoconductivity compared with bio-inert PMMA bone cement, facilitated new bone formation, and was histocompatible with surrounding bone tissue while maintaining its original purpose of supporting. So, TTCP/WH functional bone cement may be a promising alternative to overcome PMMA cement’s limitations in treating OVCF.
The screening tools for sarcopenia are measuring calf circumference, SARC-F or SPPB. However, not all of these tools have high sensitivity, specificity, and low margins of error. This research ...investigates potential of 3D anthropometry of the lower extremities on screening of sarcopenia.
From October 2022 to February 2023, we retrospectively analyzed results of 3D body scanner and bio-impedance analysis for patients aged 45 to 85 at risk of sarcopenia. The 3D scanner measured the surface and volume values of both thighs and calves. When skeletal muscle index (SMI) is less than 5.7, patients were classified to Low SMI group, indicative of sarcopenia.
A total six out of 62 patients were classified to Low SMI group, showing significantly lower values of right, left, mean calf volumes and mean calf surface than the other patients (right calf volume 2.62 L vs. 3.34 L,
= 0.033; left calf volume 2.62 L vs. 3.25 L,
= 0.044; mean calf volume 2.62 L vs. 3.29 L,
= 0.029; mean calf surface 0.12 m
vs. 0.13 m
,
= 0.049). There was no statistical difference in thigh volume and surface. Through AUC-ROC analysis, mean calf volume was the most significant cut-off value (right calf volume 2.80 L, AUC = 0.768; left calf volume 2.75 L, AUC = 0.753; mean calf volume 3.06 L, AUC = 0.774; mean calf surface 0.12 m
, AUC = 0.747).
The calf volume and surface values have significant relationship with low SMI, and the mean calf volume was the most significant cut-off screening value for Low SMI. The 3D scanner demonstrated its value as a new means for screening sarcopenia.
Bone substrates like hydroxyapatite and tricalcium phosphate have been widely used for promoting spinal fusion and reducing the complications caused by autograft. Whitlockite has been reported to ...promote better bone formation in rat calvaria models compare with them, but no study investigated its effect on spinal fusion yet. Also, the higher osteoinductivity of whitlockite raised concern of ectopic ossification, which was a complication of spinal fusion surgery that should be avoided. In this study, we compared the osteoinductivity of whitlockite, hydroxyapatite, and tricalcium phosphate porous particles with SD rat spine posterolateral fusion model and investigated whether whitlockite could induce ectopic ossification with SD rat abdominal pouch model. The micro-CT result from the posterolateral fusion model showed whitlockite had slightly but significantly higher percent bone volume than tricalcium phosphate, though none of the materials formed successful fusion with surrounding bone tissue. The histology results showed the bone formed on the cortical surface of the transverse process but did not form a bridge between the processes. The result from the abdominal pouch model showed whitlockite did not induce ectopic bone formation. Whitlockite had a potential of being a better bone substrate hydroxyapatite and tricalcium phosphate in spinal fusion with low risk of inducing ectopic ossification.
A nationwide, observational, and cross-sectional study targeting postmenopausal patients from 62 orthopedic outpatient clinics in Korea between October 2010 and February 2011.
This study was carried ...out to investigate comorbidity, trauma history, and the status of osteoporotic fracture treatment in Korean postmenopausal women.
There has been little reports on the comorbidity, family history, trauma history, and treatment status of osteoporotic fractures in patients visiting the orthopedic outpatient clinics in Korea.
A total of 1,255 postmenopausal women between the ages of 50 and 80 years were enrolled in the study and the population distribution was reflected by region. Comorbidity, familial history of osteoporosis, familial history of osteoporotic fracture, history of falls, and status of osteoporotic fracture management were evaluated using an interview and questionnaire. The relationship between family history of osteoporosis and bone mineral density was analyzed.
A number of patients (23%) had a family history of osteoporosis and 16.5% had a family history of fractures. Most (64.7%) of the patients had one or more comorbidities, including 58.8% exhibiting a chronic disease and 16.4% suffering from diseases that restrict exercise or walking. The results of the questionnaire indicated that 21.8% of these fracture patients had experienced a fracture previously and that the most common type of fracture was that of the spine. Lumbar spine bone mineral density was found to be lower in the presence of family history of osteoporosis.
Postmenopausal women are liable to have osteoporotic fractures due to the high prevalence of osteoporosis, a history of falling, and the comorbidity with diseases that restrict ambulation. A better understanding of postmenopausal women in the orthopedic outpatient settings is important to the management of osteoporotic fractures.
Spinal balance analysis is critical to the diagnosis and treatment of ASD, and radiography is the current gold standard. Radiation-free 3D full body scanner has been developed to overcome drawbacks ...of X-ray such as radiation exposure and limited reflection of actual daily activity.
This study aims to develop a spinal balance analysis system based on the 3D full body scanner and compare it to X-ray parameters. This study aims to develop a spinal balance analysis system based on the 3D full body scanner and compare it to X-ray parameters.
This study is a prospective observational study.
Ninety-seven participants recruited from our hospital patient clinic and underwent both 3D body scanning and whole spine X-rays. The participants completed the clinical questionnaire and body composition analyses.
The 3D scanner spinal balance parameters were defined as the angles between two points relative to the plumb line, the horizontal distances between two points, the angle between three points, and shoulder gradient. The X-ray spinal balance parameters were C2-7 sagittal vertical axis (SVA), T1 slope, sagittal vertical axis (SVA), odontoid hip axis angle (ODHA), clavicle angle, T1 coronal tilt, lumbar lordosis, sacral slope, and pelvic incidence-lumbar lordosis (PI-LL) mismatch. Body composition scores were body mass index (BMI), percentage body fat (PBF), and skeletal muscle index (SMI). Patient-reported clinical symptoms included the visual analog scale (VAS, 0-10) score of low back pain and the modified Oswestry Disability Index (mODI, 0-45).
Five inflection points were automatically labeled by AI from the 3D scanner data and spinal balance parameters were subsequently calculated. Correlation analysis was conducted to compare spinal balance parameters obtained from a 3D full-body scanner and X-ray imaging. The same analysis was also conducted to identify correlation between spinal parameters and clinical symptoms. Partial correlation analysis and multiple regression analysis were conducted to determine the impact of body composition on spinal balance.
The study indicated statistically significant correlations between sagittal parameters of X-ray and 3D body scanner. The correlation coefficient of dAB_hor (horizontal distance between ear and shoulder in the sagittal plane) and C2-C7 SVA was 0.478 (p-value <0.001). The correlation coefficient between aAC_sag (sagittal angle of ear-hip from the plumb line) and ODHA was 0.336 (p <0.001). For coronal spinal balance, the shoulder gradient calculated by AI was compared to the clavicle angle from the X-ray, resulting in a correlation coefficient of 0.373 (p <0.001). In contrast, the differences between 3D scanning and radiography were unaffected by body composition. Additionally, there was correlation between clinical symptoms and spinal parameters. The ODI score had a statistically significant correlation with both aBCD(shoulder-hip-knee angle) and aCDE(hip-knee-ankle angle) with correlation coefficients of -0.205 (p-value 0.044) and 0.245 (p-value 0.015), respectively. The correlation between the cervical spinal parameters was found to be stronger than the thoracolumbar parameters due to the differences in posture, time, and landmarks in the two exams conducted. The clinical symptoms were correlated with aBCD and aCDE due to the compensatory knee flexion for the thoracolumbar kyphosis.
Our study highlights that the spinal balance analysis, based on 3D full-body scanner, has a statistical correlation with X-ray. Furthermore, clinical symptoms were correlated with hip flexion and knee flexion parameters obtained from the 3D scanner attributed to the compensatory motion. This preliminary study sets the foundation for the application of radiation-free 3D body scanner in the spinal balance analysis.
This abstract does not discuss or include any applicable devices or drugs.
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