Overuse Injuries in Teenagers Smithuis, Frank; Maas, Mario
Journal of the Belgian Society of Radiology,
11/2021, Volume:
105, Issue:
1
Journal Article
Peer reviewed
Open access
Overuse injuries in teenagers have increased in incidence in the past decades. Adequately diagnosing these injuries is a challenge ('Figures 1' and '2'), especially when unfamiliar with the specific ...overuse injury patterns and the development steps of the teenager musculoskeletal system. When considering overuse injuries in this population it is helpful to focus on two points or resemblance and dissemblance between teenagers and adults: Teenagers are 'the same' as adults. Increasingly teenagers are exposed to a higher – more professional – level of sport activities. Likewise, the specific activities they have to perform for their specific sport are the same as in adults ('Figures 3' and '4'). Teenagers are 'not the same' as adults. Their intrinsic biomechanics differ greatly from that of adults, with the growing (apo)physis as the most striking difference between both. Thus, the same specific activity result in different injuries ('Figure 5'). In this lecture, we will focus mainly on similarities between overuse injuries in different anatomical regions. How do these injuries relate to each other, considering their similarities in development and different types of stress? Could we use the basics of one type of overuse injury as a guideline for the other injuries?
Background:
Ankle osteoarthritis is debilitating and usually affects relatively young people, often as a result of previous ankle traumas, frequently occurring in sports. Platelet-rich plasma (PRP) ...injections for ankle osteoarthritis have shown no evidence of benefit over the course of 26 weeks. Previous studies on PRP for knee osteoarthritis showed that clinically significant improvements with PRP occurred between 6 to 12 months in the absence of initial benefit. No studies have evaluated the effect of PRP from 6 to 12 months in ankle osteoarthritis.
Purpose:
To assess the efficacy of PRP injections in ankle osteoarthritis over the course of 52 weeks.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
In this 52-week follow-up trial, 100 patients with ankle osteoarthritis were randomized to a PRP group or placebo (saline) group. Patients received 2 intra-articular talocrural injections: at inclusion and after 6 weeks. Patient-reported outcome measures were used to assess pain, function, quality of life, and indirect costs over 52 weeks.
Results:
Two patients (2%) were lost to follow-up. The adjusted between-group difference for the patient-reported American Orthopaedic Foot & Ankle Society score over 52 weeks was −2 points (95% CI, −5 to 2; P = .31) in favor of the placebo group. No significant between-group differences were observed for any of the secondary outcome measures.
Conclusion:
For patients with ankle osteoarthritis, PRP injections did not improve ankle symptoms and function over 52 weeks compared with placebo injections.
Registration:
NTR7261 (Netherlands Trial Register).
Gaucher disease, caused by a deficiency of the lysosomal enzyme glucocerebrosidase, leads to prominent glucosylceramide accumulation in lysosomes of tissue macrophages (Gaucher cells). Here we show ...glucosylsphingosine, the deacylated form of glucosylceramide, to be markedly increased in plasma of symptomatic nonneuronopathic (type 1) Gaucher patients (n = 64, median = 230.7nM, range 15.6-1035.2nM; normal (n = 28): median 1.3nM, range 0.8-2.7nM). The method developed for mass spectrometric quantification of plasma glucosylsphingosine is sensitive and robust. Plasma glucosylsphingosine levels correlate with established plasma markers of Gaucher cells, chitotriosidase (ρ = 0.66) and CCL18 (ρ = 0.40). Treatment of Gaucher disease patients by supplementing macrophages with mannose-receptor targeted recombinant glucocerebrosidase results in glucosylsphingosine reduction, similar to protein markers of Gaucher cells. Since macrophages prominently accumulate the lysoglycosphingolipid on glucocerebrosidase inactivation, Gaucher cells seem a major source of the elevated plasma glucosylsphingosine. Our findings show that plasma glucosylsphingosine can qualify as a biomarker for type 1 Gaucher disease, but that further investigations are warranted regarding its relationship with clinical manifestations of Gaucher disease.
Movement of skin markers with respect to their underlying bone (i.e. soft tissue artifacts (STAs)) might corrupt the accuracy of marker-based movement analyses. This study aims to quantify STAs in 3D ...for foot markers and their effect on multi-segment foot kinematics as calculated by the Oxford and Rizzoli Foot Models (OFM, RFM). Fifteen subjects with asymptomatic feet were seated on a custom-made loading device on a computed tomography (CT) table, with a combined OFM and RFM marker set on their right foot. One unloaded reference CT-scan with neutral foot position was performed, followed by 9 loaded CT-scans at different foot positions. The 3D-displacement (i.e. STA) of each marker in the underlying bone coordinate system between the reference scan and other scans was calculated. Subsequently, segment orientations and joint angles were calculated from the marker positions according to OFM and RFM definitions with and without STAs. The differences in degrees were defined as the errors caused by the marker displacements. Markers on the lateral malleolus and proximally on the posterior aspect of the calcaneus showed the largest STAs. The hindfoot-shank joint angle was most affected by STAs in the most extreme foot position (40° plantar flexion) in the sagittal plane for RFM (mean: 6.7°, max: 11.8°) and the transverse plane for OFM (mean: 3.9°, max: 6.8°). This study showed that STAs introduce clinically relevant errors in multi-segment foot kinematics. Moreover, it identified marker locations that are most affected by STAs, suggesting that their use within multi-segment foot models should be reconsidered.
The purpose of this study was to develop a DTI-based method to quantitatively assess fiber angles and changes therein in leg muscles in order to facilitate longitudinal studies on muscle fiber ...architectural adaptations in healthy subjects.
The upper legs of five volunteers were scanned twice on the same day. The right lower legs of five volunteers were scanned twice with the ankle in three positions, i.e. -15° dorsiflexion, 0° neutral position, and 30° plantarflexion. The MRI protocols consisted of a noise scan, a 3-point mDixon scan and a DTI scan. Fiber-angle color maps were generated for four muscles in the upper legs and two muscles in the lower leg. Voxel-wise fiber angles (θ) were calculated from the angle between the principal eigenvector of the diffusion tensor and a reference line defined between the origo and insertion points of each muscle. Bland-Altman analysis, intraclass correlation coefficient (ICC), coefficient of variation (CV%), minimal detectable change (MDC), standard error (SE) and Friedman test were used for assessing the feasibility of this method and in order to have an indication of the repeatability and the sensitivity.
Bland-Altman analysis showed good repeatability (CV%<10 and 0.7≤ICC≤0.9) with exception of the Tibialis Anterior (TA) muscle in dorsiflexion position(CV%: 12.2) and the Semitendinosus (ST) muscle (left leg) (CV%: 11.4). The best repeatability metrics were found for the SOL muscle in neutral position (CV%: 2.6). Changes in average θ in TA and SOL with ankle positions were observed in accordance with expected agonist and antagonist functions of both muscles. For example, for the anterior left compartment the change in fiber angle Δθ with respect to the neutral position Δθ = -1.6° ± 0.8° and 2.2° ± 2.8° (p = 0.008), for dorsiflexion and plantarflexion, respectively.
Our method facilitates fast inspection and quantification of muscle fiber angles in the lower and upper leg muscles in rest and detection of changes in lower-leg muscle fiber angles with varying ankle angles.
Background
To evaluate the inter-observer and inter-vendor reliability of diffusion tensor imaging parameters in the musculoskeletal system.
Methods
This prospective study included six healthy ...volunteers three men (mean age: 42; range: 31–52 years) and three women (mean age: 36; range: 30–44 years).
Each subject was scanned using different 3 Tesla magnetic resonance scanners from three different vendors at three different sites bilaterally. First, the intra-class correlation coefficient was used to determine between-observers agreement for overall measurements and clinical sites. Next, between-group comparisons were made through the nonparametric Friedman’s test. Finally, the Bland–Altman method was used to determine agreement among the three scanner measurements, comparing them two by two.
Results
A total of 792 measurement were calculated. ICC reported high levels of agreement between the two observers. ICC related to MD, FA, and RD measurements ranged from 0.88 (95% CI 0.85–0.90) to 0.95 (95% CI 0.94–0.96), from 0.85 (95% CI 0.81–0.88) to 0.95 (95% CI 0.93–0.96), and from 0.89 (0.85–0.90) to 0.92 (0.90–0.94).
No statistically significant inter-vendor differences were observed. The Bland–Altmann method confirmed a high correlation between parameter values.
Conclusion
An excellent inter-observer and inter-vendor reliability was found in our study.
Key points
Diffusion tensor imaging shows excellent inter-observer reliability.
Diffusion tensor imaging shows excellent inter-vendor reliability.
Quantitative results in musculoskeletal application of diffusion tensor imaging are reproducible in all the three magnetic resonance scanners.
DTI, as a reproducible magnetic resonance sequence, can be used for a quantitative evaluation of muscle microstructures during daily practice.
Previous studies have shown that MRI of fresh hamstring injuries have diagnostic and prognostic value. The clinical relevance of MRI at return to play (RTP) has not been clarified yet. The aim of ...this study is to describe MRI findings of clinically recovered hamstring injuries in amateur, elite and professional athletes that were cleared for RTP.
We obtained MRI of 53 consecutive athletes with hamstring injuries within 5 days of injury and within 3 days of RTP. We assessed the following parameters: injured muscle, grading of injury, presence and extent of intramuscular signal abnormality. We recorded reinjuries within 2 months of RTP.
MRIs of the initial injury showed 27 (51%) grade 1 and 26 (49%) grade 2 injuries. Median time to RTP was 28 days (range 12-76). On MRI at RTP 47 athletes (89%) had intramuscular increased signal intensity on fluid-sensitive sequences with a mean longitudinal length of 77 mm (±53) and a median cross-sectional area of 8% (range 0-90%) of the total muscle area. In 22 athletes (42%) there was abnormal intramuscular low-signal intensity. We recorded five reinjuries.
89% of the clinically recovered hamstring injuries showed intramuscular increased signal intensity on fluid-sensitive sequences on MRI. Normalisation of this increased signal intensity seems not required for a successful RTP. Low-signal intensity suggestive of newly developed fibrous tissues is observed in one-third of the clinically recovered hamstring injuries on MRI at RTP, but its clinical relevance and possible association with increased reinjury risk has to be determined.
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