A Comparison of Imaging Outcomes From 2 Weightbearing CT Modalities.

BACKGROUND: The use of weightbearing images to diagnose foot and ankle injuries continues to offer hope for improved insight into pathologies, but weightbearing CT imaging has been limited by availability. The ability to apply force to the lower limb in a horizontal bore CT system may offer an adaptation to currently available imaging systems that provides access to weightbearing images without the acquisition of additional expensive imaging space or equipment. METHODS: In order to determine whether a horizontal CT system could produce the same results as a standing CT, 3 images of one foot from 10 subjects was obtained and standard measures were calculated. Each subject underwent a standing CT scan, a scan in a horizontal bore CT machine while the subject pressed against a pedal with spring resistance and a finally a scan with the foot placed on the pedal but without any pressure. RESULTS: No statistically significant difference between the standing and pedal-based CTs resulted. Navicular height and Meary angle (axial) were statistically different from nonweightbearing for both standing and horizontal systems. The horizontal results were statistically different from nonweightbearing in IM angle, talocalcaneal angle, and talonavicular coverage. No differences from nonweightbearing were found for either system in talar tilt, talocrural angle, or the lateral Meary angle. CONCLUSION: The results in this initial study of normal control subjects suggest that a pedal-based loading mechanism may adapt a horizontal-bore CT system for the acquisition of weightbearing images. CLINICAL RELEVANCE: The ability to acquire a weightbearing CT from a horizontal bore CT machine can make these images more available.

Tamarindus indica Seed Extract-Based Botanical Compositions Alleviate Knee Pain and Improve Joint Function in Mild-to-Moderate Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Clinical Study.

OBJECTIVE: Knee pain and reduced joint function affect the quality of life of subjects suffering from knee osteoarthritis (KOA). The present randomized, double-blind, placebo-controlled study aimed to assess the clinical efficacy of two botanical compositions, NXT15906F6 and NXT19185, in pain relief and improvement in the musculoskeletal function of knee osteoarthritis (KOA) subjects. NXT15906F6 contains ethanol/aqueous extract of Tamarindus indica seeds and aqueous ethanol extract of Curcuma longa rhizome, and NXT19185 is a combination of NXT15906F6 and an aqueous ethanol extract of Garcinia mangostana fruit rind. METHODS: The present trial recruited ninety subjects with mild-to-moderate KOA, using a radiographic Kellgren-Lawrence (KL) grading system. The participants were randomized into one of three groups (n = 30) to receive either placebo, NXT15906F6 (250 mg/day), or NXT19185 (300 mg/day) for 56 days. The change in Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was the primary efficacy measure of the study. Improvements in the functional scores, serum proinflammatory modulators, and cartilage degradation product in the urine samples were the secondary efficacy measures. Twenty-seven subjects in each group completed the trial. RESULTS: After the trial, NXT15906F6 and NXT19185 significantly improved (P < 0.05) the WOMAC scores from baseline compared with placebo. In the subgroup analyses, the knee pain and functional scores were significantly improved in the KL-II and KL-III grade KOA subjects. At the end of the study, the NXT15906F6- and NXT19185-supplemented participants showed significant (P < 0.05) improvement in the functional scores, inflammatory status, and collagen breakdown product in the urine samples. Summary. The present study demonstrates that NXT15906F6 and NXT19185 supplementations reduce knee pain and improve the musculoskeletal function of KOA subjects. Moreover, these herbal compositions helped reduce inflammation and inflammation-induced cartilage degeneration in the participants. NXT15906F6 and NXT19185 supplementations are further documented to be tolerable and safe to the participants.

A Combination of Tamarindus indica seeds and Curcuma longa Rhizome Extracts Improves Knee Joint Function and Alleviates Pain in Non-Arthritic Adults Following Physical Activity.

Background: Knee joint pain is the most common reason for physical disability which associates with age. TamaFlexTM (NXT15906F6) is a synergistic anti-inflammatory formulation which contains ethanol/aqueous extracts of Tamarindus indica seeds and ethanol extract of Curcuma longa rhizome. Methods: In a 90-day randomized, double-blind, placebo-controlled study, we evaluated efficacy of NXT15906F6 in relieving pain and improving joint function in non-arthritic adults. Ninety non-arthritic subjects who experienced knee pain and joint discomfort following a six-minute walk test (SMWT) and Stair climb test (SCT) participated in the present trial. Subjects received either 250 mg (n=30) or 400 mg (n=30) of NXT15906F6 or matched placebo (PL: n=30) daily for 90 days. Improvement from baseline six-minute walk distance (SMWD) in NXT15906F6 groups, compared with placebo (PL) was the primary outcome of the study. Results: At post-intervention, subjects in NXT15906F6-250 (p<0.001) and NXT15906F6-400 (p<0.0001) groups showed substantial improvements in mean changes of SMWD from baseline compared to placebo. The 250 mg and 400 mg NXT15906F6 groups also improved average walking speed from baseline by 0.08±0.07 m/s (p=0.0010) and 0.11±0.08 m/s (p<0.0001), respectively. The NXT15906F6 groups experienced significant improvement in SMWT performances as early as 14 days. NXT15906F6-supplemented participants showed a consistent benefit of pain relief and improved musculoskeletal functions, compared to placebo. Conclusion: NXT15906F6 provided substantial relief from knee pain after physical activity and improved joint function in non-arthritic adults. Study participants did not show any major adverse events, and they tolerated well this novel herbal formulation.

Lateral ligament repair and reconstruction restore neither contact mechanics of the ankle joint nor motion patterns of the hindfoot.

BACKGROUND: Ankle sprains may damage both the lateral ligaments of the hindfoot and the osteochondral tissue of the ankle joint. When nonoperative treatment fails, operative approaches are indicated to restore both native motion patterns at the hindfoot and ankle joint contact mechanics. The goal of the present study was to determine the effect of lateral ligament injury, repair, and reconstruction on ankle joint contact mechanics and hindfoot motion patterns. METHODS: Eight cadaveric specimens were tested with use of robotic technology to apply combined compressive (200-N) and inversion (4.5-Nm) loads to the hindfoot at 0° and 20° of plantar flexion. Contact mechanics at the ankle joint were simultaneously measured. A repeated-measures experiment was designed with use of the intact condition as control, with the other conditions including sectioned anterior talofibular and calcaneofibular ligaments, the Broström and Broström-Gould repairs, and graft reconstruction. RESULTS: Ligament sectioning decreased contact area and caused a medial and anterior shift in the center of pressure with inversion loads relative to those with the intact condition. There were no significant differences in inversion or coupled axial rotation with inversion between the Broström repair and the intact condition; however, medial translation of the center of pressure remained elevated after the Broström repair relative to the intact condition. The Gould modification of the Broström procedure provided additional support to the hindfoot relative to the Broström repair, reducing inversion and axial rotation with inversion beyond that of intact ligaments. There were no significant differences in center-of-pressure excursion patterns between the Broström-Gould repair and the intact ligament condition, but this repair increased contact area beyond that with the ligaments intact. Graft reconstruction more closely restored inversion motion than did the Broström-Gould repair at 20° of plantar flexion but limited coupled axial rotation. Graft reconstruction also increased contact areas beyond the lateral ligament-deficient conditions but altered center-of-pressure excursion patterns relative to the intact condition. CONCLUSIONS: No lateral ankle ligament reconstruction completely restored native contact mechanics of the ankle joint and hindfoot motion patterns.

Forefoot injuries in dancers.

Dancers, particularly ballet dancers, are artists and athletes. In dance, the choreographer acts as a sculptor, using the dancer as a medium of expression. This often entails placing the dancer's body in positions that require extraordinary flexibility and movement, which requires controlled power and endurance. Ballet and other forms of dance can be highly demanding activities, with a lifetime injury incidence of up to 90%. Ballet is stressful particularly on the dancer's forefoot. The en pointe position of maximal plantarflexion through the forefoot, midfoot, and hindfoot requires tremendous flexibility and strength that only can be attained safely through many years of training. The forces experienced by the toes and metatarsals are extraordinary.

Ankle fractures in diabetics.

Treatment of the diabetic patient with ankle fracture presents a unique set of challenges to the surgeon. The care of these patients should follow a multidisciplinary approach with a team of orthopedic and vascular surgeons, internists, anesthesiologists, nurses, and diabetic educators. Meticulous preoperative planning, intraoperative technique, and postoperative care can be decrease potential limb-threatening complications; however, complications will occur despite excellent care. Early recognition and treatment of preoperative complications is imperative. These patients require close attention for long periods, and the surgeon should plan on building a strong relationship with these patients.

Inhibited skeletal muscle healing in cyclooxygenase-2 gene-deficient mice: the role of PGE2 and PGF2alpha.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat skeletal muscle injury. However, studies have shown that NSAIDs may be detrimental to the healing process. Mediated by prostaglandin F(2alpha) (PGF(2alpha)) and prostaglandin E(2) (PGE(2)), the cycloxygenase-2 (COX-2) pathway plays an important role in muscle healing. We hypothesize that the COX-2 pathway is important for the fusion of muscle cells and the regeneration of injured muscle. For the in vitro experiments, we isolated myogenic precursor cells from wild-type (Wt) and COX-2 gene-deficient (COX-2(-/-)) mice and examined the effect of PGE(2) and PGF(2alpha) on cell fusion. For the in vivo experiments, we created laceration injury on the tibialis anterior (TA) muscles of Wt and COX-2(-/-) mice. Five and 14 days after injury, we examined the TA muscles histologically and functionally. We found that the secondary fusion between nascent myotubes and myogenic precursor cells isolated from COX-2(-/-) mice was severely compromised compared with that of Wt controls but was restored by the addition of PGF(2alpha) or, to a lesser extent, PGE(2) to the culture. Histological and functional assessments of the TA muscles in COX-2(-/-) mice revealed decreased regeneration relative to that observed in the Wt mice. The findings reported here demonstrate that the COX-2 pathway plays an important role in muscle healing and that prostaglandins are key mediators of the COX-2 pathway. It suggests that the decision to use NSAIDs to treat muscle injuries warrants critical evaluation because NSAIDs might impair muscle healing by inhibiting the fusion of myogenic precursor cells.

Transforming growth factor-beta1 induces the differentiation of myogenic cells into fibrotic cells in injured skeletal muscle: a key event in muscle fibrogenesis.

Transforming growth factor-beta1 (TGF-beta1) is thought to play a crucial role in fibrotic diseases. This study demonstrates for the first time that TGF-beta1 stimulation can induce myoblasts (C2C12 cells) to express TGF-beta1 in an autocrine manner, down-regulate the expression of myogenic proteins, and initiate the production of fibrosis-related proteins in vitro. Direct injection of human recombinant TGF-beta1 into skeletal muscle in vivo stimulated myogenic cells, including myofibers, to express TGF-beta1 and induced scar tissue formation within the injected area. We also observed the local expression of this growth factor by myogenic cells, including regenerating myofibers, in injured skeletal muscle. Finally, we demonstrated that TGF-beta1 gene-transfected myoblasts (CT cells) can differentiate into myofibroblastic cells after intramuscular transplantation, but that decorin, an anti-fibrosis agent, prevents this differentiation process by blocking TGF-beta1. In summary, these findings indicate that TGF-beta1 is a major stimulator that plays a significant role in both the initiation of fibrotic cascades in skeletal muscle and the induction of myogenic cells to differentiate into myofibroblastic cells in injured muscle.