Complex regional pain syndrome is a neuropathic pain disorder associated with ongoing pain that persists beyond the usual expected tissue healing time and that is disproportionate to the degree of ...tissue injury present. Complex regional pain syndrome after hip arthroscopy has not been reported before. Hip arthroscopy is a fast-growing domain that could lead to an increasing number of complex regional pain syndrome cases, probably owing to the high traction forces that are necessary.
We report the case of a 30-year-old German female semiprofessional tennis player who presented with complex regional pain syndrome type I in the lower leg 3 weeks after hip arthroscopy for femoroacetabular impingement syndrome with suture anchor labral repair and femoroplasty. After 2 months of immediate multimodal conservative therapy including administration of gabapentin, prompt full weight-bearing, and intensified physiotherapy, complete recovery was achieved.
Complex regional pain syndrome does occur after elective hip arthroscopy. Disproportionate postoperative pain or other symptoms raising suspicion of complex regional pain syndrome should be promptly evaluated and treated through a multimodal approach. Postless hip arthroscopy may be advantageous.
Abstract Introduction Traumatic elbow dislocations are among the most common injuries in sport climbing. They occur most frequently in bouldering (a climbing discipline with strong upward trend often ...performed indoors) due to the typical low-height backward fall into crashpads. There is still no data about the functional outcome and return to sport of this typical bouldering injury. Materials and methods All Patients with elbow dislocations due to a bouldering associated fall between 2011 and 2020 were identified retrospectively in our level I trauma centre. Trauma mechanisms, injury types and therapies were obtained. Follow-up was performed with an online questionnaire including sports-related effects, return to sport and the Elbow Self-Assessment Score (ESAS). Results 30 patients with elbow dislocations after bouldering accidents were identified. In 22 (73.3%) patients the injury was a simple dislocation. The questionnaire was completed by 20 patients. The leading mechanism was a low-height fall into crashpads. Surgical procedures were performed in every second patient. 18 patients (90%) reported return to bouldering after 4.7 ± 2.1 months. 12 patients (66.7%) regained their pre-injury level. Mid-/Long-term follow-up (mean 105 ± 37.5 months) showed excellent results in ESAS score (97.2 ± 3.9 points). Persistent limited range of motion or instability was reported by only 3 patients (15%). Conclusion Most athletes are able to return to bouldering but only two thirds regain their pre-injury performance level in this demanding upper-extremity sport. The unique low-height trauma mechanism may create a false sense of security. Specific awareness and safety features should be placed for climbing athletes to reduce elbow injuries.
Background The aim of this study was to analyze incidences and sport-specific injury patterns among users of a bodyweight-based training method instructed by a smartphone app (Freeletics Bodyweight ...App). Methods An online questionnaire based on current validated epidemiological observation methods was designed using the statistic website Surveymonkey. Subscribers of the Freeletics Bodyweight App were contacted via an online link. Injury incidence, defined as an event leading to a training pause of at least 1 day, was recorded. The type of injury was reported and classified. Furthermore, all participants were asked whether they recognized any positive or negative effects on their subjective health status. The collected data were analyzed using Surveymonkey statistic services. Results A total of 4365 Freeletics users responded to the questionnaire, 3668 completed forms were subject of further investigation. The injury period prevalence reported by users of the Freeletics App was 24% in men and 21% in women. The most frequently reported site of injury was the shoulder (29%) and the knee joint (28%), with strains (28.5%) and other muscle injuries (14.4%) being the most frequently reported types of injuries. An injury incidence rate of 4.57 per 1000 h was calculated, with injuries occurring less frequently in experienced users. Most participants reported a distinct positive effect of the app-based training on their health status. Conclusion In comparison to other sports activities app-based bodyweight training is associated with a comparably low injury period prevalence. The vast majority of injuries were reported to have resolved within one week. Keywords: Bodyweight, Freeletics, Workout, App, International, Training, Injury patterns
In contrast to infection or mechanical issues joint replacement failure following inflammatory adverse reactions is poorly understood.
To assess the association of IL-1β polymorphisms and history of ...allergy with aseptic non-mechanical complications following arthroplasty.
In 102 patients with aseptic non-mechanically caused symptomatic knee or hip arthroplasty (SA) and 93 patients with asymptomatic arthroplasty (AA) questionnaire-based history, patch test with at least standard series, lymphocyte transformation test (LTT) with nickel, cobalt and chromium and interleukin-1 polymorphism analysis were done. Three polymorphisms of the IL1B gene IL-1b -3954 (rs1143634), IL-1b -511 (rs16944) and IL-1b -31 (rs1143627) and one polymorphism of the IL1RN gene IL1RN intron 2, variable number of tandem repeats, VNTR (rs2234663) were assessed by PCR and gel electrophoresis.
We found no significant difference in smoking history and atopy but 25% versus 10% of self-reported metal allergy in SA versus AA; the patch test (respective, LTT) for metal sensitivity was more often positive in SA patients. The allele 498 bp of the IL1RN polymorphism occurred significantly more often in the SA group (37% versus 11%; p < 0.0001). Upon additional presence of atopy, the difference was even greater (60% vs 10%) (p < 0.000001). There was no association of IL-1 polymorphisms with metal allergy.
The IL1RN VNTR allele 498 bp was strongly associated with SA. In patients with a history of atopy, presence of the IL1RN VNTR allele 498 bp led to a four-fold higher SA prevalence compared to patients without this allele.
Summary Objective To evaluate morphological and quantitative MR findings 9 years after autograft transfer of the posterior femoral condyle (Mega-OATS) and to correlate these findings with clinical ...outcomes. Quantitative MR measurements were also obtained of the contralateral knee and the utility as reference standard was investigated. Design Both knees of 20 patients with Mega-OATS osteochondral repair at the medial femoral condyle (MFC) were studied using 3T MRI 9 years after the procedure. MR-sequences included morphological sequences and a 2D multislice multiecho (MSME) spin echo (SE) sequence for quantitative cartilage T2 mapping. Cartilage segmentation was performed at the cartilage repair site and six additional knee compartments. Semi-quantitative MR observation of cartilage repair tissue (MOCART) scores and clinical Lysholm scores were obtained. Paired t -tests and Spearman correlations were used for statistical analysis. Results Global T2-values were significantly higher at ipsilateral knees compared to contralateral knees (42.1 ± 3.0 ms vs 40.4 ± 2.6 ms, P = 0.018). T2-values of the Mega-OATS site correlated significantly with MOCART scores ( R = −0.64, P = 0.006). The correlations between MOCART and Lysholm scores and between absolute T2-values and Lysholm scores were not significant ( P > 0.05). However, higher T2 side-to-side differences at the femoral condyles correlated significantly with more severe clinical symptoms (medial, R = −0.53, P = 0.030; lateral, R = −0.51, P = 0.038). Conclusions Despite long-term survival, 9 years after Mega-OATS procedures, T2-values of the grafts were increased compared to contralateral knees. Clinical scores correlated best with T2 side-to-side differences of the femoral condyles, indicating that intraindividual adjustment may be beneficial for outcome evaluation.
Introduction
Avulsions of the lesser femoral trochanter are rare injuries in the adolescent population. An acute avulsion causes severe functional impairment with compromised hip flexion. Recent ...literature reports the superiority of surgical treatment for apophyseal avulsion fractures of the pelvis in adolescents. Unfortunately, there are no guidelines for an evidence-based treatment of lesser trochanter avulsions established. We present the cases of two adolescent athletes treated operatively.
Materials and methods
Two adolescent males, 12 and 16 years old, suffered an avulsion of the lesser trochanter during soccer. They reported immobilizing groin pain with subjective impairment in daily activities and inability to perform sports. Surgical treatment with a new retrograde technique by applying an adapted mini-open anterior approach was performed. Intraoperatively, both cases showed an intact musculo-tendinous unit attached to the avulsed fragment.
Results
Both patients showed excellent postoperative results and were satisfied with the clinical outcome. In the postoperative follow-up an adequate consolidation of the lesser trochanter was visible. No complications were postoperatively reported at final follow-up.
Conclusions
The retrograde fixation technique has led to an excellent outcome without complications in two adolescents with acute lesser trochanter apophyseal avulsions. Further clinical use may support the value of this new surgical technique.
Intramuscular oil injections generating slowly degrading oil-based depots represent a controversial subject in bodybuilding and fitness. However they seem to be commonly reported in a large number of ...non-medical reports, movies and application protocols for 'site-injections'. Surprisingly the impact of long-term (ab)use on the musculature as well as potential side-effects compromising health and sports ability are lacking in the medical literature. We present the case of a 40 year old male semi-professional bodybuilder with systemic infection and painful reddened swellings of the right upper arm forcing him to discontinue weightlifting. Over the last 8 years he daily self-injected sterilized sesame seed oil at numerous intramuscular locations for the purpose of massive muscle building. Whole body MRI showed more than 100 intramuscular rather than subcutaneous oil cysts and loss of normal muscle anatomy. 2-step septic surgery of the right upper arm revealed pus-filled cystic scar tissue with the near-complete absence of normal muscle. MRI 1 year later revealed the absence of relevant muscle regeneration. Persistent pain and inability to perform normal weight training were evident for at least 3 years post-surgery. This alarming finding indicating irreversible muscle mutilation may hopefully discourage people interested in bodybuilding and fitness from oil-injections. The impact of such chronic tissue stress on other diseases like malignancy remains to be determined.
Zusammenfassung
Dem Trochanterschmerzsyndrom liegt, entgegen früherer Lehrmeinungen, in der Mehrzahl der Fälle eine chronische Insertionstendinopathie oder Partialruptur der Glutealmuskulatur am ...Trochanter major zu Grunde. Eine laterale Schmerzangabe mit Punctum maximum am Trochanter major mit schmerzhaften Alltagsaktivitäten wie Treppensteigen, Einbeinstand und Schlafen auf der Seite sind typische Symptome. Eine gründliche Anamnese und die klinische Untersuchung unter Anwendung diverser Testverfahren sind wegweisend für die Diagnose. Zudem wird in der Regel eine Röntgenaufnahme angefertigt und ggf. ergänzend eine Sonographie und/oder Magnetresonanztomographie (MRT) durchgeführt. Primär erfolgt zunächst eine konservative Behandlung schrittweise über 3 Monate mit isometrischer und exzentrischer Kräftigung der Hüftabduktoren und anschließend eine schmerzadaptierte Rückkehr zu täglichen Aktivitäten.
Lateralizing, derotating intertrochanteric varus osteotomy to increase the ischiofemoral space to counter painful impingement of the lesser trochanter and the os ischium with resulting entrapment of ...quadratus femoris muscle.
Symptomatic ischiofemoral impingement (IFI) caused by Coxa valga et antetorta, Coxa valga or Coxa antetorta, or a short femoral neck.
Anatomic configuration suggestive of IFI in asymptomatic patients. Symptomatic IFI caused by another underlying pathology. Valgus deformity of the knee.
Measurement of femoral antetorsion. Planning of the osteotomy, lateralization, varus angle for correction, rotation and offset correction, leg length change, and osteosynthesis plate. General or spinal anesthesia in supine or lateral position. Skin incision (15 cm) beginning lateral of the greater trochanter tip, distally along the axis of the femur. Preparation onto the femur by L‑shaped dissection of the vastus lateralis from the bone. A Kirschner(K-)wire is then positioned along the anterior femoral neck to designate the femoral neck antetorsion. A triangle set on the lateral femoral cortexis is used to determine the osteotomy angle. In the thus determined angle, a second K‑wire is shot centrally along the femoral neck axis just inferior to its cranial cortex. About 5 mm distal to the second wire, the entry for the blade is prepared using a drill. Using the blade setting instrument, the blade is introduced into the femoral neck, then slightly pulled back. The rotation is then marked on the anterior femoral cortex proximal and distal to the planned osteotomy and the osteotomy is performed. A blade plate without displacement is impacted. The osteotomy is then reduced, the distal fragment pulled laterally onto the plate, and the screws inserted after compression of the osteotomy with a tension device.
Touch-toe bearing for 6 weeks, then radiological assessment of osteotomy healing before an increase in weight bearing (15 kg/week). Hip flexion limited to 90° for 6 weeks. Elective implant removal after 12-18 months.
Studies of this lateralizing varus osteotomy have not been published. The 25-year results of the conventional derotating intertrochanteric varus osteotomy technique show good functional results and low complication rates, with non-union being the most common. Arthroscopic resection of the lesser trochanter has been reported as a surgical alternative in the treatment of IFI in case reports and small series. Advantages of the osteotomy are the restoration of biomechanics and preservation of iliopsoas tendon insertion.
The serine protease urokinase-type plasminogen activator (uPA) interacts with a specific receptor (uPAR) on the surface of various cell types, including tumor cells, and plays a crucial role in ...pericellular proteolysis. High levels of uPA and uPAR often correlate with poor prognosis of cancer patients. Therefore, the specific inhibition of uPA with small molecule active-site inhibitors is one strategy to decrease the invasive and metastatic activity of tumor cells. We have developed a series of highly potent and selective uPA inhibitors with a C-terminal 4-amidinobenzylamide residue. Optimization was directed toward reducing the fast elimination from circulation that was observed with initial analogues. The x-ray structures of three inhibitor/uPA complexes have been solved and were used to improve the inhibition efficacy. One of the most potent and selective derivatives, benzylsulfonyl-d-Ser-Ser-4-amidinobenzylamide (inhibitor 26), inhibits uPA with a Ki of 20 nm. This inhibitor was used in a fibrosarcoma model in nude mice using lacZ-tagged human HT1080 cells, to prevent experimental lung metastasis formation. Compared with control (100%), an inhibitor dose of 2 × 1.5 mg/kg/day reduced the number of experimental metastases to 4.6 ± 1%. Under these conditions inhibitor 26 also significantly prolonged survival. All mice from the control group died within 43 days after tumor cell inoculation, whereas 50% of mice from the inhibitor-treated group survived more than 117 days. This study demonstrates that the specific inhibition of uPA by these inhibitors may be a useful strategy for the treatment of cancer to prevent metastasis.