Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation.

OBJECTIVE: The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). DESIGN: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. RESULTS: Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). CONCLUSIONS: The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.

High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus.

PURPOSE: The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return to play guidelines and subsequent rates and timing of return to play following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT). METHODS: MEDLINE, EMBASE and the Cochrane Library were searched according to the PRISMA guidelines in September 2017. The rate and timing of return to play was assessed. The rehabilitation protocols were recorded, including time to start range of motion, partial weight-bearing and complete weight-bearing. RESULTS: Fifty-seven studies with 3072 ankles were included, with a mean age of 36.9 years (range 23-56.8 years), and a mean follow-up of 46.0 months (range 1.5-141 months). The mean rate of return to play was 86.8% (range 60-100%), and the mean time to return to play was 4.5 months (range 3.5-5.9 months). There was large variability in the reported rehabilitation protocols. Range of motion exercises were most often allowed to begin in the first week (46.2%), and second week postoperatively (23.1%). The most commonly reported time to start partial weight-bearing was the first week (38.8%), and the most frequently reported time of commencing full weight-bearing was 6 weeks (28.8%). Surgeons most often allowed return to play at 4 months (37.5%). CONCLUSIONS: There is a high rate of return following BMS for OLT with 86.8% and the mean time to return to play was 4.5 months. There is also a significant deficiency in reported rehabilitation protocols, and poor quality reporting in return to play criteria. Early weightbearing and early postoperative range of motion exercises appear to be advantageous in accelerated return to sports. LEVEL OF EVIDENCE: Level IV.

[Comprehensive rehabilitation of the subjects presenting with occupational muscular-skeletal abnormalities].

The methodological approach to the rehabilitative treatment of the subjects presenting with occupational muscular-skeletal abnormalities in the upper limb girdle associated with their occupational activities implies the combined application of a pulsed magnetic field, therapeutic peloids and ultrasound therapy to the neuromuscular apparatus and tendinous-capsular structures of the rotator cuff undergoing dystrophic degeneration. This therapeutic modality makes it possible to improve the biomechanical conditions of the patients by broadening the range of active painless movements in the affected shoulder joint by 42% (p < 0.05), normalizing tonal and load-bearing characteristics of the muscles (increase of the initially reduced muscular tone at rest by 27% (p < 0.05) at a maximum voluntary tension (16%, p > 0.05), changing trophicity of periarticular tissues (elevation of the pain sensitivity threshold of tendons and painful indurations in the functionally active muscles of the thoracic girdle of the upper extremity by 76% (p < 0.05). It is concluded that these changes contribute to the improvement of professional activities of the patients.

Complicaciones osteomusculares en el trasplante cardíaco / Musculoskeletal complications in heart transplant

Objetivo. Conocer la incidencia, etiología y tratamiento de las complicaciones osteomusculares más frecuentes que pueden surgir en los pacientes en la fase pre y postrasplante cardíaco. Estrategia de búsqueda. Se realiza búsqueda bibliográfica de los trabajos relevantes en las bases de datos: PubMed, PEDro, Cochrane, Tripdatabase. Las palabras clave para la búsqueda han sido: trasplante cardíaco, complicaciones, osteomuscular, osteoporosis, densidad mineral ósea, osteonecrosis, efectos secundarios, inmunosupresores. Selección de artículos. Se consideran los artículos escritos en castellano e inglés relativos a pacientes adultos. Síntesis de resultados y conclusiones Las complicaciones osteomusculares que más morbilidad ocasionan a los pacientes con trasplante cardíaco son la osteoporosis, fracturas vertebrales, osteonecrosis y complicaciones de los fármacos inmunosupresores. Se revisa la bibliografía actual sobre el diagnóstico y tratamiento de estas patologías en los pacientes con trasplante cardíaco (AU)

Aim. To know the incidence, etiology ant treatment of the most frequent osteomuscular complications in pre and post- transplant phase patients. Search strategy. A bibliographic search was performed in the following databases: PubMed, PEDro, Cochrane, Tripdatabase. Keywords used for the search were: Heart, cardiac, transplant, complications, osteoporosis, osteomuscular, bone mineral density, osteonecrosis, side effects, immunosupressants. Study selection. All articles found in Spanish or English regarding adult patients were considered. Results summary and conclusions. Musculoskeletal complications resulting in the most morbidity heart transplant patients are: osteoporosis, vertebral fractures, osteonecrosis and immunosuppressant-induced complications. The current bibliography on the diagnosis and treatment of these conditions in heart transplant patients has been reviewed (AU)

Rehabilitation and return-to-sports activity after debridement and bone marrow stimulation of osteochondral talar defects.

An osteochondral defect (OD) is a lesion involving the articular cartilage and the underlying subchondral bone. ODs of the talus can severely impact on the quality of life of patients, who are usually young and athletic. The primary treatment for ODs that are too small for fixation, consists of arthroscopic debridement and bone marrow stimulation. This article delineates levels of activity, determines times for return to activity and reviews the factors that affect rehabilitation after arthroscopic debridement and bone marrow stimulation of a talar OD. Articles for review were obtained from a search of the MEDLINE database up to January 2012 using the search headings 'osteochondral defects', 'bone marrow stimulation', 'sports/activity', 'rehabilitation', various other related factors and 'talus'. English-, Dutch- and German-language studies were evaluated.The review revealed that there is no consensus in the existing literature about rehabilitation times or return-to-sports activity times, after treatment with bone marrow stimulation of ODs in the talus. Furthermore, scant research has been conducted on these issues. The literature also showed that potential factors that aid rehabilitation could include youth, lower body mass index, smaller OD size, mobilization and treatment with growth factors, platelet-rich plasma, biphosphonates, hyaluronic acid and pulse electromagnetic fields. However, most studies have been conducted in vitro or on animals. We propose a scheme, whereby return-to-sports activity is divided into four phases of increasing intensity: walking, jogging, return to non-contact sports (running without swerving) and return to contact sports (running with swerving and collision). We also recommend that research, conducted on actual sportsmen, of recovery times after treatment of talar ODs is warranted.

Pharmacokinetics of gallium maltolate after intragastric administration in adult horses.

OBJECTIVE: To determine the pharmacokinetics of gallium maltolate (GaM) after intragastric administration in adult horses. ANIMALS: 6 adult horses. PROCEDURES: Feed was withheld for 12 hours prior to intragastric administration of GaM (20 mg/kg). A single dose of GaM was administered to each horse via a nasogastric tube (time 0). Blood samples were collected at various time points from 0 to 120 hours. Serum was used to determine gallium concentrations by use of inductively coupled plasma-mass spectroscopy. Noncompartmental and compartmental analyses of serum gallium concentrations were performed. Pharmacokinetic models were selected on the basis of the Akaike information criterion and visual analysis of plots of residuals. RESULTS: Serum concentration data for 1 horse were such that this horse was considered an outlier and excluded from noncompartmental and compartmental analyses. Noncompartmental analysis was used to determine individual pharmacokinetic parameters. A 1-compartment model with first-order input and output and lag time was selected as the best-fit model for the data and used to determine mean ± SD values for maximum observed serum concentration (0.28 ± 0.09 µg/mL), time of maximum concentration (3.09 ± 0.43 hours), time to the first measurable concentration (0.26 ± 0.11 hours), apparent elimination half-life (48.82 ± 5.63 hours), area under the time-concentration curve (20.68 ± 757 h•µg/mL), and apparent volume of distribution (73,493 ± 18,899 mL/kg). CONCLUSION AND CLINICAL RELEVANCE: Further studies are necessary to determine the bioavailability of GaM after intragastric administration in adult horses.

Osteotomia de nivelamento do platô tibial no tratamento da ruptura do ligamento cruzado cranial estudo clínico em cães / Tibial plateau leveling osteotomy on the treatment cranial cruciate ligament rupture – clinic study in dogs

A ruptura do ligamento cruzado cranial (RLCC) é a causa comum de claudicação no membro pélvico em cães. Estudosrecentes demonstram que o ângulo de inclinação do platô tibial está associado à RLCC. A partir dessa descoberta,desenvolveu-se a técnica de osteotomia e nivelamento do platô tibial (TPLO). A técnica consiste na osteotomia, rotação eestabilização da porção proximal da tíbia, alterando a mecânica da articulação, neutralizando o impulso tibial cranial. Aproposta do presente estudo é revisar a técnica de TPLO, enfatizando o procedimento, técnica cirúrgica, cuidados pósoperatóriose complicações. O grupo estudado era composto de 40 cães. Dezessete pacientes apresentaram RLCC nomembro pélvico esquerdo e 23 no membro pélvico direito. Os ângulos do platô tibial variaram de 16o 36o. Trinta animais(75%) voltaram a apoiar o membro operado nos primeiros sete dias, enquanto seis animais (15%) apoiaram até o 15o dia,um animal (2,5%) apoiou até o 21o dia e outro (2,5%) até o 28o dia. Três animais (7,5%) apresentaram complicações pósoperatórias,sendo elas: deiscência de sutura, fratura tibial, falha no implante. A técnica de TPLO mostrou-se eficaz notratamento de cães com diferentes pesos com RLCC. O apoio precoce do membro afetado ocorreu na maioria dos animais.As complicações encontradas, que envolviam o procedimento cirúrgico, puderam ser corrigidas.

Cranial cruciate ligament rupture (CCLR) frequently causes hindlimb limping in dogs. Recent studies showed that tibial plateau angle shift is associated with CCLR. Based on this founding the tibial plateau leveling osteotomy (TPLO) technique was developed. It consists about osteotomy, rotation and stabilization of tibial proximal portion, which modify joint mechanics thus neutralizing tibial cranial thrust. The proposal of this study is to report a review of the TPLO procedure, emphasizing procedure, surgical technique, post operative care and complications. Fourty dogs presenting CCLR were submitted to surgery, seventeen with the left limb affected, 23 on the right. The tibial plateau angles before surgery varied from 16o to 36o. Thirty animals (75%) returned to limb normal use in a week; six animals (15%) were back to normal deambulation to the fifteenth day, one animal (2,5%) were back to normal deambulation to the 200 day other one before the 30o day. Three animals (7,5%) had surgical post-operatory complications, including suture descending, tibial fracture and implant failure. TPLO technique seemed appropriate for treatment of CCLR from dogs within a broad weight range. Early limb use occurred in most animals. Eventual problems arose from surgical procedure, and were promptly corrected.

Rehabilitation after one-stage anterior cruciate reconstruction and osteochondral grafting.

At least 10-20% of all ACL reconstructions require additional cartilage repair. The aim of this study was to compare the activity recovered by patients after one-stage open ACL reconstruction and osteochondral autologous grafting of articular cartilage lesions and after isolated open ACL reconstruction. The study group included 21 patients with chronic ACL deficiency and grade III or IV cartilage lesion according to the ICRS scale who were treated with combined ACL reconstruction and osteochondral grafting in one step. The control group included 32 patients with chronic ACL insufficiency and no chondral deficit higher than grade I on the ICRS scale who underwent isolated reconstruction of the ligament. For the assessment, the Lysholm and Gillquist (L&G) score and the functional Marshall score were used. Both groups displayed a statistically significant improvement in the L&G score and the Marshall score between the preoperative and 12-month assessments. The mean gain in L&G score over this period was 30.66+/-7.79 in the study group and 31.65+/-6.96 in the control group. The difference between the control group and the study group was not significant. The difference between 12 months and initial assessment was counted. The mean gain in Marshall score was 9.05+/-3.81 in the study group and 10.71+/-3.43 in the control group. The difference between the initial and the 12-month evaluation was statistically significant (p=0.49). Return to normal activity was slower and patient satisfaction was lower during the first year after operation in the study group than in the control group, however the overall advantage of the one-step operation outweighs the slightly inferior functional results at 12 months.

[An empirical structural analysis of the IRES questionnaire version 2, dependent on indication, gender and age]. / Eine empirische Strukturanalyse des IRES-Patientenfragebogens Version 2 in Abhängigkeit von Indikation, Geschlecht und Alter.

The patient questionnaire "Indicators of Reha Status" (IRES, Version 2) is used for assessing the need for rehabilitation and the success of rehabilitation. It is one of the most frequently used questionnaires in measuring subjective health conditions in medical rehabilitation in Germany. Based on the data of 8600 inpatient rehabilitees, the underlying structural model is examined by a confirmatory factor analysis. The model deviates in part from the original model of the questionnaire authors. The modified model was tested within 12 sub-groups. The sub-groups were divided depending on sex, age and indications (orthopaedic, cardiologic and psychosomatic) of the patients. Multi-group comparisons made between those 12 sub-groups showed specific structures within the groups of psychosomatic patients while no differences between female/male and younger/older patients were found. Furthermore, comparable structures of orthopaedic and cardiologic patients were found. Therefore the dimension values of the IRES patient questionnaire are not suited for a comparison between psychosomatic patients and patients from the somatic indications.

[Modification of the subjective prognosis of gainful employment during inpatient rehabilitation. Findings of a study of 180 orthopaedic patients]. / Veränderung der subjektiven Prognose der Erwerbstätigkeit im Verlauf der stationären Rehabilitation--Eine Untersuchung an 180 orthopädischen Patienten.

Modifications of the subjective prognosis of gainful employment during in-patient rehabilitation were assessed by means of a 3-item scale (SPE scale) in 180 orthopaedic patients. Statistically significant improvements were found as to the subjective prognosis of gainful employment and other measures of vocational ability as well. Patients showing lower risk at the beginning profited to a greater degree from rehabilitation as compared to patients with higher scores in SPE scale. To improve the effects of rehabilitation for patients with a high subjective risk as to gainful employment specific interventions are recommended. Further research is discussed.

[Effect of secondary prophylaxis on quality of life in gerontologic patients at the rehabilitation center for the disabled Patriotic war veterans in local sanatorium]. / Vliianie vtorichnoi profilaktiki na kachestvo zhizni gerontologicheskikh bol'nykh v usloviiakh tsentra reabilitatsii invalidov Otechestvennoi voiny na baze mestnogo sanatoriia.

AIM: To study efficacy of sanatorium treatment of aged patients with gastroenterological and locomotor diseases in the heriatric center. MATERIAL AND METHODS: 100 patients were investigated for effects of sanatorium treatment on quality of life. RESULTS: Clinical symptoms depended on the patients' age. Patients under 70 years of age had leading symptoms from gastrointestinal organs and locomotor system. These patients were most responsive to rehabilitation measures. In 70-year-olds and older patients cardiovascular and cerebral pathologies are of special importance limiting usage of physiotherapy and necessitating wider application of medicines: hypotensive, antianginal, circulation correcting, etc. The sanatorium stage of rehabilitation creates a positive emotional background in these patients. CONCLUSION: Sanatorium treatment resulted in improvement of life quality in gerontological patients.

Influencia del círculo de abuelos en la evolución de las enfermedades articulares / Influence of the grandparents' circle on the evolution of articular diseases

Se realizó un estudio longitudinal y prospectivo en 60 abuelos que tenían alguna enfermedad articular de un total de 70 dispensarizados en el consultorio del médico de la familia No. 50 del policlínico comunitario "Alberto Fernández Montes de Oca", San Luis, Santiago de Cuba. El objetivo del estudio fue valorar la influencia del circulo de abuelos, con su programa de actividades físicas y recreativas, sobre la salud de los ancianos y específicamente, en la evolución de las enfermedades articulares. La edad del grupo osciló entre 65 y 69 años, con predominio del sexo femenino, la osteoartritis fue la enfermedad más generalizada, la mayoría de los abuelos estaban deprimidos y pocos usaban el bastón. Después de la incorporación al circulo de abuelos, el grupo refirió mejoría en el estado de salud, fundamentalmente en sus dolencias articulares y el estado depresivo. La atención de enfermería se clasificó de buena por todos los pacientes. Se puede concluir que el círculo de abuelos desempeñó un importante papel en la recuperación de las capacidades físicas y psíquicas del adulto mayor(AU)

The FIM instrument in the United States and Italy: a comparative study.

OBJECTIVE: To compare FIM instrument ratings between Italy and the United States. DESIGN: This study utilized 169,835 United States and 4,536 Italian FIM instrument records for stroke with the left side of the body affected, stroke with the right side of the body affected, and orthopedic conditions. RESULTS: Case-mix, patient age, and admission and discharge FIM instrument scores were similar. The delays between onset of disability and admission to rehabilitation and lengths of stay in rehabilitation were 2-4 times longer in Italy. In Italy, some 88-95% of the subjects were discharged to the community vs. 74-88% in the United States. Hierarchies of FIM instrument ratings across the motor and cognitive items were similar, but there were interesting differences. The hierarchical patterns showed that dressing, bathing, perineal hygiene, and tub or shower transfer were relatively more difficult in Italy compared with the Unites States, whereas walking was easier in Italy compared to the United States. CONCLUSION: The Italian health care payment system offers less incentive for early discharges from acute care and rehabilitation. In Italy, nursing homes are less accessible, whereas family support is more available. Apparently less intensive treatment is applied in Italy, where a minimum time per day for rehabilitation services is not mandatory for payment. Occupational therapy is not used in Italy and the focus is more on physical therapy.

Bony pathology in the cancer patient.

Bony pathology in the cancer patient represents a significant source of morbidity and mortality. Complications include insufficiency and pathological fractures resulting from either medical treatments or bony metastases that can cause significant functional limitations. Additional complications include spinal cord compression, hypercalcemia, and bone marrow failure. Rehabilitation management of such conditions is reviewed, with an emphasis on diagnostic and therapeutic management. Bracing and focused rehabilitation programs facilitate maximal participation and functional outcomes, which can result in an enhanced quality of life. Specific rehabilitation goals and strategies are discussed, with an emphasis on tailoring these according to the functional staging of the patient.

Biopolímero da mamona na reconstrução de falhas ósseas após ressecção de tumores no esqueleto apendicular / Clinical application of pre molded mamona polymer for the reconstruction of bone defescts after resectiion of tumores of the skeleton

O estudo teve por objetivo avaliar os resultados da utilização do polímero da mamona em forma de blocos pré-fabricados, como biomaterial para utilização nas reconstruções de grandes falhas ósseas decorrentes da ressecção de tumores benignos agressivos e tumores malignos. foram avaliados 20 pacientes entre 2000 e 2002 com tempo de seguimentode 26 e 147 semanas (78,3 ñ35,1 semanas). As falhas ósseas foram reconstruídas com blocos pré-fabricados de polímero de mamona, tendo sido adaptados e fixados ao leito recptor de acordo com a margem e o tipo de ressecção. Foi utilizado o método de avaliação clínica proposto por Mankin et al. Tendo-se obtido 7 (35por cento) de resultado excelente, 4 (20por cento) bons, 4(20por cento) regulares e 5 (25por cento) de falhas. O biopolímero apresentou como vantagens: disponibilidade; baixo custo; ausência de riscos de transmissão de doenças; ser biocompativel e osteointegrável. O polimero da mamona foi considerado uma alternativa viável para reconstrução de falhas ósseas pós ressecção de tumores benignos agressivos e maliginos

[Chronic chondromalacia of the patella: comparison of morphological (magnetic resonance) and functional findings (isokinetic parameters) after rehabilitation]. / Sofferenze condrali rotulee croniche: confronto fra dati morfologici (Risonanza Magnetica) e funzionali (parametri isocinetici) dopo rieducazione.

The knee is a common site for injuries of the cartilage, capsule and ligament, which calls for the use of noninvasive techniques to assess injury severity properly and to plan adequate rehabilitation. Our study was aimed at comparing MR with isokinetic findings. To this purpose, 40 patients were examined; they were all affected with chondromalacia patellae, grades I-III, previously diagnosed at arthroscopy. Namely, 8 patients had grade I and 32 grades II and III chondromalacia. After MR and isokinetic exams, all patients were submitted to a standardized rehabilitation program. Our results indicate a marked decrease in quadriceps strength, especially in the most severe cases; in less severe cases, recovery was complete at 6 months, while the deficit remained in grades II and III injuries. MR yield was not relevant in 4 of 8 cases, while isokinetic findings were negative in one case. Both methods were positive in the most severe cases. At 6 months, both functional and MR findings were normal in grade I injuries, while some alterations remained in the others.

Lásers de baja potencia: resultados de su aplicación en la rehabilitación / Low powers lasers: results of their application on rehabilitation

Se analizan los resultados alcanzados con la aplicación de los lásers de helio-neón y galio-arsenio a 204 pacientes en el tratamiento de diversas afecciones, fundamentalmente osteomioarticulares, dermatológicas y trastornos de la cicatrización. Se tomaron como base las propiedades fisiológicas fundamentales del láser: acción antiinflamatoria, antiflogística y efectos espasmolíticos y bioestimulantes. Se consideran prometedores los resultados, por cuanto el 77 por ciento de los pacientes mejoraron notablemente o desaparecieron sus síntomas(AU)