Lesiones del ligamento cruzado anterior en esquiadores: conceptos actuales / Anterior cruciate ligament injuries in skiers: current concepts

El esquí es un deporte individual con una tasa de lesiones de 1,84 por 1.000 días esquiador en la población general. Las roturas del ligamento cruzado anterior (LCA) son algunas de las más comunes, llegando a una tasa de 5 por cada 100 esquiadores por temporada a nivel competitivo, debido a la gran exigencia a la que se encuentran sometidas las rodillas. Lo anterior presenta un desafío para el traumatólogo a la hora de plantear un manejo. Se realizó una revisión de la literatura respecto de los mecanismos de lesión, tratamiento, prevención, rehabilitación y uso de órtesis en el retorno deportivo. Se describen los mecanismos clásicos de lesión en esquiadores amateurs y competitivos. La mayoría de las lesiones de LCA son de resolución quirúrgica, en que la recomendación de reconstrucción debe ser con injerto autólogo de hueso-tendón patelar-hueso, salvo en los pacientes mayores o en pacientes con fisis abierta, en los que se recomienda el uso de injerto autólogo de semitendinoso-gracilis. La prevención y rehabilitación se basan en mejorar la fuerza y el control neuromuscular de los estabilizadores dinámicos de la rodilla implementándose programas específicos, evaluación del gesto deportivo, y pruebas de control neuromuscular. Se recomienda el uso de órtesis funcionales adecuadas en los pacientes sometidos a reconstrucción del LCA. Las lesiones de LCA en esquiadores de nivel competitivo son habituales, de manejo específico y multidisciplinario. La elección del injerto y del tipo de rehabilitación son fundamentales en el retorno deportivo del esquiador. NIVEL DE EVIDENCIA: V.

Skiing is an individual sport with an injury rate of 1.84 per 1,000 skier days among the general population. Anterior cruciate ligament (ACL) tears are among the most common injuries in skiers, with a rate of 5 per 100 skiers per season at a competitive level, because of the great demand placed on the knees. Their treatment is a challenge for orthopedic surgeons. A review of the literature was carried out regarding injury mechanisms, treatment, prevention, rehabilitation, and the use of bracing in the return to sports. The classic injury mechanisms in amateur and competitive skiers are described. Most ACL injuries require surgical resolution, with reconstruction using autologous bone-patellar tendon-bone graft, except in older patients or those with open physis, who must receive an autologous semitendinosusgracilis graft. Prevention and rehabilitation are based on improving strength and neuromuscular control of the dynamic knee stabilizers, implementing specific programs, evaluating the sport movements, and performing neuromuscular control tests. Suitable functional bracings are recommended in patients undergoing ACL reconstruction. ACL injuries in competitive-level skiers are common, and their management is specific and multidisciplinary. The choice of graft and rehabilitation type is critical to resume skiing. LEVEL OF EVIDENCE: V.

Correlation between bracing treatment and depression severity in adolescent idiopathic scoliosis / 第二军医大学学报

Objective To evaluate the mental health status of patients with adolescent idiopathic scoliosis (AIS) after bracing treatment, and to observe the severity of depressive symptoms and analyze the influencing factors. Methods We collected the general data and imaging data of AIS patients who underwent bracing treatment in the outpatient clinic of Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2015. The data included age, gender, body mass index, coronal main curve Cobb angle at the initial treatment and the last follow-up, and duration of bracing treatment. The Center for Epidemiological Studies depression scale for children (CES-DC) and the strengths and difficulties questionnaire (SDQ) were used to assess the severity of depression and the mental health status before bracing treatment and at the last follow-up. Multivariate linear regression model was used to analyze the factors influencing the severity of depression during the bracing treatment. Results A total of 112 patients (16 males and 96 females) were enrolled in our study. We found that the CES-DC score was significantly higher at the last follow-up than that at the beginning (38.4±3.0 vs 26.1±4.2); the scores of the emotional problems (7.7±1.5 vs 5.3±2.2) and peer problems (7.6±1.4 vs 5.0±1.6) in the SDQ were significantly increased and the score of the prosocial behavior was significantly decreased (2.7±0.5 vs 4.2±0.3) at the last follow-up (t＝25.22, －27.22, 9.54 and 12.94; all P0.01). Multivariate linear regression analysis suggested that the depression severity of AIS patients was positively correlated with the pre-treatment coronal main curve Cobb angle, duration of bracing treatment, and pre-treatment SDQ emotional symptom and peer problem scores (all P0.05), but were negatively correlated with the score of the prosocial behavioral subscale of SDQ. Conclusion The mental health status of patients with AIS is changed after bracing treatment, with increased severity of depression. Active psychological intervention shall be given to patients with large pre-treatment coronal main curve Cobb angle, longer treatment time of bracing, and higher pre-treatment SDQ’s emotional symptom scores and peer problem scores, which may improve the post-treatment quality of life of patients.

Methods for evaluating effects of unloader knee braces on joint health: a review

The paper aims to provide a state-of-the-art review of methods for evaluating the effectiveness and effect of unloader knee braces on the knee joint and discuss their limitations and future directions. Unloader braces are prescribed as a non-pharmacological conservative treatment option for patients with medial knee osteoarthritis to provide relief in terms of pain reduction, returning to regular physical activities, and enhancing the quality of life. Methods used to evaluate and monitor the effectiveness of these devices on patients' health are categorized into three broad categories (perception-, biochemical-, and morphology-based), depending upon the process and tools used. The main focus of these methods is on the short-term clinical outcome (pain or unloading efficiency). There is a significant technical, research, and clinical literature gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments. Future research directions may complement existing methods with advanced quantitative imaging (morphological, biochemical, and molecular) and numerical simulation are discussed as they offer potential in assessing long-term and post-bracing effects on the knee joint.

Correlation analysis between interleukin 6 polymorphism and adolescent idiopathic scoliosis susceptibility and bracing effectiveness / 中国修复重建外科杂志

Objective: To analyze the correlation between the polymorphism on interleukin 6 (IL-6) gene promoter region-174 locus and adolescent idiopathic scoliosis (AIS), including the susceptibility, the bracing effectiveness, and the possible mechanism. Methods: The 182 AIS patients and 210 healthy controls who met the inclusion criteria between January 2013 and January 2016 were collected as research objects. The genotype of IL-6 gene promoter region-174 locus, the serum IL-6, the bone mineral density (BMD) of femoral neck and vertebrae (L 1-4), and the bone metabolism parameters, including bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate resistant acid phosphatase 5b (TRACP-5b), urine Ca, and urine Ca/Cr, were detected. All research objects were divided into the AIS group and the control group according to whether they had AIS, the GG, CG, CC groups according to their genotype, and progression-free group and progression group according to the therapeutic effectiveness of 1-year bracing treatment. Statistical analysis for the indexes were conducted respectively. Results: There were significant differences in AIS history, BMD of femoral neck and lumbar vertebrae between the AIS group and control group ( P<0.05). According to the therapeutic effecitveness of 1-year bracing treatment, 182 AIS patients were divided into progression-free group in 110 cases and progression group in 72 cases. The results of single factor analysis showed that there were significant differences in the genotype and allele distribution of IL-6 gene promoter region-174 locus, BMD of femoral neck and lumbar vertebrae, IL-6, TRACP-5b, urine Ca, and urine Ca/Cr between the progression-free group and progression group ( P<0.05). The results of multivariable analysis showed that the BMD of lumbar vertebrae, TRACP-5b, and urine Ca were the influencing factors of bracing efficacy ( P<0.05). According to the results of genotype detection, all research objects were divided into GG group in 264 cases, CG group in 104 cases, and CC group in 24 cases. The IL-6, TRACP-5b, urine Ca, and urine Ca/Cr of GG type carriers were higher and BMD of femoral neck and lumbar vertebrae were lower when compared with the CG and CC type carriers ( P<0.05). The BMD of lumbar vertebrae of CG type carriers was lower than that of CC type carriers ( P<0.05). Conclusion: The polymorphism of IL-6 genepromoter region-174 locus wasn't correlated with the AIS susceptibility, but it was correlated (not independently correlated) with the scoliosis progression under bracing treatment, and the risk for G-carried patients was higher. The mechanism may be that the polymorphism affected the IL-6 expression level and eventually affected the BMD of AIS patients through the bone metabolism.

Análise da visão e forma de colocação de órtese tornozelo-pé pelos pais ou cuidadores de pacientes com paralisia cerebral / Vision and ankle-foot orthosis by parents or caregives palsy patients

JUSTIFICATIVA E OBJETIVOS: Para pacientes portadores de paralisia cerebral (PC) podem ser prescritas diferentes tipos de órteses que auxiliarão, dentre outras atividades, a qualidade da deambulação. Diversos estudos têm avaliado a função motora de crianças com PC, porém pouco se sabe sobre a importância desses aditamentos na visão dos cuidadores e seu correto modo de colocação. O objetivo deste estudo foi verificar o modo de colocação das órteses tornozelo-pé (AFO) pelos pais ou cuidadores e a visão deles sobre esses aditamentos. MÉTODO: Realizou-se um questionário em nove pais de crianças com PC para obter informações sobre a importância e a boa colocação da órtese. RESULTADOS: Todos os pais acharam fundamental a utilização da órtese e relataram terem sido orientados, entretanto apenas cinco realizaram de forma correta. CONCLUSÃO: Pôde-se verificar a boa conscientização em relação aos benefícios e importância do aditamento, porém nem todos os pais são bem orientados quanto à colocação adequada.

BACKGROUND AND OBJECTIVES: For patients with cerebral palsy (CP) may be prescribed different types of bracing that will help the quality of walking. Several studies have measured the motor function of children with cerebral palsy, but little it is known about the important of the correctly placement of those bracing in the vision of the caregivers. The objective of the study was check the placement of AFO's by parents or caregivers and their opinion about those bracing.METHOD: A questionnaire was conducted in nine cerebral palsy parents or caregivers to obtain their information about the importance and correctly placement of the bracing.RESULTS: All parents found essential the use of bracing and all of them said that have learned how to use it before. Just five made the placement correctly. CONCLUSION: So, we could see good awareness of the benefits and the importance of the bracing, in other way, not of them were informed about the correctly placement.

Nonoperative Treatment of Thoracolumbar Fractures without Neurological Deficit / 中国康复理论与实践

@#Objective To evaluate the clinical effect of postural reduction and bracing on thoracolumbar fractures without neurological deficit.Methods21 patients with thoracolumbar fractures(T11～L2

Research advance in effectiveness of bracing for adolescent idiopathic scoliosis / 上海第二医科大学学报

The role of bracing for adolescent idiopathic scoliosis,which came into application in 1960's,has long been controversial.There are various brace instrument with different reported effectiveness.In this paper,we summarize the research findings and main views in the effectiveness of bracing for adolescent idiopathic scoliosis in the past ten years,and explore the possible causes leading to the different results.Besides,we are trying to point out the research trend,in hope of drawing a scientific conclusion on the effectiveness of bracing treatment in the near future.

Functional cast bracing as a treatment for humeral shaft fractures

Sixty-eight fractures of the shaft of the humerus were treated with a function cast brace consisting of a plaster of Paris individually-molded. A good alignment of fracture fragments is maintained and permitted rapid and uninterrupted osteogenesis. The early presumption of functional activity to the entire extremity resulted in condition conclusive to fracture healing and the prevention of contractures and joint stiffness secondary to prolonged immobilization which is fairly common in other forms of treatmentThere are no non-unions encountered, and morbidity is minimum.(Summary)

Lower extremity bracing in paraplegia-A follow-up study.

The use of bracing was studied in 76 patients with spinal injuries by a questionnaire survey. A total of 37 responses were deemed to be complete and acceptable. The responses included 35 males and 2 females, whose ages ranged from 19 to 56 years (mean = 30.6 years, SD = 9.7). Only 11 of the whole group (29.7 percent) were still using braces at the time of the study. All the spinal injury patients in this group used braces for exercise, while the cauda equine cases also used braces for ambulating. Inconvenience was the main reason for discontinuing the use of braces by the spinal injury patients. However, some of the cauda equine injury patients were able to ambulate without braces, while the others considered braces to be cumbersome and useless. The results of the resent study indicate that bracing should be prescribed at a later stage, after patients had returned home and require it for use in their home environments. This would make brace prescription more effective and appropriate for each patient.