Vol 1-1 Review Article

Five Key Points on Meniscal Allograft Transplantation

Eric D Haunschild, Ron Gilat, Michael C Fu, Brian J Cole*

Midwest Orthopaedics at Rush, Chicago IL, USA

Meniscus injuries are a common presentation to orthopedic clinics, with hundreds of thousands of meniscectomies and meniscus repairs being performed every year1. As the consequence of osteoarthritis progression has been found to be associated with functional meniscal deficiency, a significant increase in repair surgeries have occurred in recent years2. However, in symptomatic patients with irreparable tears, partial meniscectomy remains the standard of care. Meniscectomy is not harmless and can result in increased contact stress, predisposing the patient to early-onset osteoarthritis1.

In a select group of patients with persistent unicompartmental pain and symptomatic meniscus deficiency, meniscal allograft transplantation (MAT) has emerged as an acceptable surgical procedure aiming to restore function and improve pain. In many patients, MAT can result in long-term improvement, with a recent systematic review demonstrating favorable graft survival and functional outcomes at a minimum ten years after surgery3. These favorable outcomes demonstrate lasting symptomatic improvement and, though unproven at this time, may decrease the progression of osteoarthritis in the knee. The purpose of this article is to review five key points on the indications, pre-operative considerations and surgical preparation, surgical technique, and common concomitant procedures of MAT.

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Vol 1-1 Review Article

Biomechanics of Military Load Carriage and Resulting Musculoskeletal Injury: A Review

Brian D. Fox, Lawrence W. Judge, D. Clark Dickin, Henry Wang*

Biomechanics Laboratory, School of Kinesiology, Ball State University. Muncie, IN, USA

Load carriage is a common activity used in daily tasks for many occupations, so understanding its injury mechanisms, as well as the biomechanical modifications made to gait and posture during load carriage, could reduce injury risk during this activity. The purpose of this review was to compile the most recent literature regarding biomechanical adaptations to load carriage, including its effects on musculoskeletal injury, kinematic, spatiotemporal, and kinetic adaptations, and insights about the future of load carriage research. Researchers found a high degree of injury in personnel who participate in heavy load carriage activities as a part of their job, with lower back and lower extremity injuries being the most common. An observation of several studies that measured kinematic, spatiotemporal, and kinetic adaptations suggest that there may be a threshold in which typical gait kinematics must change to account for the additional load. Not adapting proper mechanisms to deal with increased load carriage forces may lead to lower extremity injury. Future studies should observe how persons untrained in load carriage respond to these loads, and how controlling for variables like speed and cadence affect gait adaptations.

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Vol 1-1 Case Report

Metaphyseal Chondrodysplasia Schmid type - widening the phenotype: Significant variable expression in two familial cases with heterozygous COL10A1 variants

AH Sabir1*, S Mahesh2, RT Freeman3, N Kiely3, A Mageuri4, D Lim5, T Cole5

1Clinical Genetics Registrar, Birmingham Women’s and Children’s Hospital NHS Trust and Birmingham Health Partners, UK

2Foundation Doctor, Royal Wolverhampton Hospital NHS Trust, UK

3Paediatric Orthopaedic Consultant. Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK

4Clinical Genetic Scientist, Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands

5Consultant Clinical Geneticist. Birmingham Women’s and Children’s Hospital NHS Trust and Birmingham Health Partners, UK

Metaphyseal Chondrodysplasia Schmid Type (SMCD) is a rare dominant form of skeletal dysplasia, caused by heterozygous mutations in the COL10A1 (Collagen Type X alpha 1) gene which codes for α1 chains in type X collagen, and typically results in disproportionate short stature. We report two families with the clinical and radiological diagnosis of SMCD seen in our unit over 4 years. In the first family (A), the proband had a possible pathogenic COL10A1 variant (c.133C>T, p.Pro45Ser). However, his father had the same variant without any obvious signs of SMCD, causing uncertainty whether this mutation was pathogenic. In the second family (B), the proband and her affected father had the same variant. Almost at the same time, a large consanguineous family was reported to have segregation of the variant with SMCD phenotypes in that the homozygosity was related to severer phenotypes and the heterozygosity to milder phenotypes. Hence, we were convinced that the variant was pathogenic. The pathogenic variant (p.Pro45Ser) causes a wide phenotypic spectrum of SMCD and even subclinical features. In this report, we highlight attenuated phenotypes of SMCD, and also discuss the latest therapeutic advances in SMCD and its mechanism of action.

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Vol 1-2 Commentary

Commentary: Postoperative Pain Management Strategies in Hip Arthroscopy

Collin LaPorte2, Michael D. Rahl2, Olufemi R. Ayeni3, Travis J. Menge1,2*

1Spectrum Health Medical Group Orthopedics & Sports Medicine, Grand Rapids, MI, USA

2Michigan State University College of Human Medicine, Grand Rapids, MI, USA

3Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada

Hip arthroscopy is a rapidly growing field due to its significant diagnostic and therapeutic value in treating a variety of hip disorders. Due to the lack of standardized protocol for pain management in these patients, adequate control of postoperative pain continues to be challenging. Several techniques have been employed to find a regimen that is effective at reducing postoperative pain, narcotic consumption and cost to the patient and healthcare system. The purpose of this article is to provide a review of important conclusions from the previous paper “Postoperative Pain Management Strategies in Hip Arthroscopy” and report on possible implications of the article.

Recent literature supports the use of a multi-modal approach to managing postoperative pain in patients undergoing hip arthroscopy. When a pre-and postoperative analgesic regimen is used in combination with peripheral nerve block or intraoperative anesthetic injection, patients experience less pain and postoperative narcotic consumption. Postoperative pain scores and opioid consumption are similar between the different techniques. However, postoperative complications are less in those receiving intra-articular (IA) injection or local anesthetic infiltration (LAI) compared to peripheral nerve blocks.

Recent studies suggest that intraoperative techniques such as IA injection or LAI used in conjunction with a pre-and postoperative analgesic regimen may be the safest and most effective multi-modal strategy for reducing postoperative pain in these patients. In addition, omitting the use of peripheral nerve block may lead to decreased anesthesia procedural fees and operating room turnover time, resulting in decreased cost to the patient and increased efficiency of the facility.

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Vol 1-2 Research Article

The Relationship between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine Syndrome Pattern of Osteoarthritis in the Knee

Gu Yu-guo, Jiang Hong*

Department of Orthopaedics and Traumatology, Suzhou TCM Hospital, in affiliation with Nanjing University of Chinese Medicine, Suzhou, China

Purpose: The aim of this study was to guide the quantitative analysis of Traditional Chinese Medicine (TCM) syndromes by the measurement of magnetic resonance.

Methods: A total of 213 patients with knee osteoarthritis were selected for TCM dialectical classification, and their MRI images were scored on Whole-Organ Magnetic Resonance Imaging Score (WORMS) to evaluate the correlation between severity of synovitis and TCM syndrome types in the scores.

Results: Among the 213 patients, 25 were Anemofrigid-damp arthralgia syndrome (accounting for 11.7%), 84 were Pyretic arthralgia syndrome (39.4%), 43 were Blood stasis syndrome (20.2%), and 61 were Liver and kidney vitality deficiency syndrome (28.6%). In the WORMS score, 12 (5.6%) had a synovitis score of 0, 60 (28.2%) had a synovitis score of 1, 50 (23.5%) had a synovitis score of 2, and 91 (42.7%) had a synovitis score of 3. There was a statistically significant difference in the correlation analysis. The group with a synovitis score of 3 in WORMS was more likely to occur in the Pyretic arthralgia syndrome (X2 = 194.424, P = 0.000).

Conclusion: In this study, Pyretic arthralgia syndrome (39.4%) was found to be the main clinical manifestation in patients with knee osteoarthritis synovitis. This finding has certain guiding significance for relevant treatment.

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Vol 1-2 Mini Review

Injuries to the Stomatognathic System during the Practice of Brazilian jiu-jitsu and the Importance of using Mouthguard: A Mini-Review

Robeci Alves Macedo-Filho, Tiago Ribeiro Leal, Andreia Medeiros Rodrigues Cardoso, Sandra Aparecida Marinho*

Dentistry Course, State University of Paraiba (Universidade Estadual da Paraíba-UEPB), Campus VIII, R. Coronel Pedro Targino, s/n. CEP: 58.233-000. Araruna, PB, Brazil

The practice of sports has become increasingly commonplace in the daily lives of individuals and sports-related injuries vary depending on the sport practiced. Oral and facial injuries are very common in many sports. Brazilian jiu-jitsu is a contact sport in which the stomatognathic system is exposed to injuries, and the most prevalent are soft tissue injuries, such as facial abrasions and lacerations and dental injuries, such as tooth fractures. Although not mandatory in Brazil for the practice of Brazilian jiu-jitsu, a mouthguard is an essential form of protection from orofacial injuries. When a blow is applied to the face, the mouthguard provides absorption and dissipation of force and also reduces of impact to the temporomandibular joint, by redistributing the force. For that, it is therefore of the utmost importance for athletes to visit a dentist periodically for examinations. Such protective devices (mouthguards) may be individualized and crafted by a dentist for better adaptation and less discomfort for the user.

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Vol 1-2 Review Article

Subtalar and Chopart Dislocations in Children and Adolescents

N. K. Sferopoulos

Department of Pediatric Orthopaedics, “G. Gennimatas” Hospital, Thessaloniki, Greece

Subtalar and Chopart dislocations are extremely rare in childhood but become slightly more common in older children and adolescents. Subtalar dislocation involves dislocation of the subtalar and talonavicular joints, with intact tibiotalar and calcaneocuboid joints, in the absence of a talar neck fracture. It should be differentiated from the Chopart dislocation and from traumatic entities presenting radiographically as isolated talonavicular dislocations. Chopart joint injury involves the talonavicular and calcaneocuboid joints of the foot. The injury may appear as sprain, fracture, subluxation or dislocation. Diagnosis is made on plain radiographs; although initial views may not reveal the severity of the lesion, since spontaneous reduction may occur. The radiographic detection of an isolated talonavicular dislocation is probably indicative of a Chopart joint injury, in which a momentary subluxation or dislocation of the calcaneocuboid joint has occurred. The differential diagnosis of a radiographically detected isolated talonavicular dislocation should also include traumatic entities associated with intact calcaneocuboid joint, such as the swivel talonavicular dislocation and the isolated displacement of only the medial part of the Chopart joint. The swivel talonavicular dislocation is a subtype of the Chopart joint injury, in which the foot with the calcaneus is rotated beneath the talus, producing subtalar subluxation but not dislocation. In the isolated displacement of only the medial part of the Chopart joint the subtalar joint is not injured. The injury is usually associated with a fracture of the body of the tarsal navicular and it is believed to be the result of severe abduction or adduction of the forefoot.

Subtalar dislocations and Chopart joint injuries in children and adolescents seem to be comparable with their adult counterparts in the mechanism of injury, classification, treatment, complications and outcome. The challenges in treating these injuries are to achieve adequate diagnosis and prompt treatment. It appears mandatory that obtaining and maintaining an early anatomic reduction remains the key factor in achieving good outcomes. However, a high incidence of complications, such as compartment syndrome, soft tissue compromise, avascular necrosis of bone, bone growth deformities and debilitating early post-traumatic arthritis, have been reported.

The purpose of this report is to review the relevant publications on subtalar and Chopart dislocations in children and adolescents and to present illustrative cases treated at our institution.

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Vol 1-2 Research Article

Comparing Training Load and Intensity Perceptions between Female Distance Runners and Their Coach

Lawrence W. Judge1, David Bellar2, Beau Links3, Andrew Mullally3, Mark King3, Zachry Waterson3, Brian Fox1,4, Makenzie Schoeff1, Nicholas Nordmann1, Henry Wang1*

1School of Kinesiology, Ball State University, Muncie IN, USA

2University of North Carolina at Charlotte, Charlotte, NC, USA

3Fort Wayne Medical Education Program, Fort Wayne, USA

4Denotes graduate student author

Coaches are trusted to create effective training plans based on the abilities of their athletes. However, there can exist a discrepancy between the coaches’ intended training intensity and the intensity perceived by their athletes. Thus, the purpose of this study was to evaluate athletes’ perceptions of training intensity and how they compared to their coach’s intended training intensity. Six female collegiate track and field athletes who ran >800 meter events were recruited for this study (Mean [SD]: 21.3 [1.2] years). Training duration, rate of perceived exertion (RPE), average heart rate for each training session and hours slept nightly were recorded for the next 14 weeks. Easy training days showed a discernible difference with actual session RPE rating higher than the target value (mean [SD] perception 3.25 [.847], target 1.51 [.692], p<.001), while hard training days were perceived as easier than intended (mean [SD] perception 6.26 [1.24], target 8.16 [.646], p<.001). Similarly, average training load (defined as the product of Session RPE and exercise duration) was higher than coach’s intentions on easy days (actual load mean [SD] 117.28 [19.15] p=.046), and lower than the coach’s intentions on hard days (p=.029). Workouts that are more intense than intended may lead to overtraining syndrome in athletes, and workouts that are less intense than intended may lead to undertraining, and athletes not achieving their full potential. Appropriate monitoring of training load can provide important information to athletes and coaches. Training load needs to be accurately determined to establish other recovery factors.

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