BMC Musculoskeletal Disorders

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ISSN / EISSN : 1471-2474 / 1471-2474
Current Publisher: Springer Science and Business Media LLC (10.1186)
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Jian Wang, Liucai Wang
BMC Musculoskeletal Disorders, Volume 22, pp 1-18; doi:10.1186/s12891-021-04383-6

Abstract:
Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA). In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring. The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.
, Ralf Henkelmann, Claus Zhang, Tobias Schöbel, Georg Osterhoff, Pierre Hepp
BMC Musculoskeletal Disorders, Volume 22, pp 1-9; doi:10.1186/s12891-021-04406-2

Abstract:
Background The purpose of this study was to present a navigated image-free augmentation technique for the acromioclavicular joint (ACJ) and coracoclavicular (CC) ligaments and to report the clinical and radiological outcomes. Methods From 2013 to 2018, 35 eligible patients were treated with our navigated image-free ACJ- and CC-augmentation technique. The average follow-up was 3 years. Follow-up evaluations included the Constant-Murley Score, subjective shoulder value, Taft score, and the acromioclavicular joint instability (ACJI) score. The patients’ quality of life was assessed using the EuroQol-5D (EQ-5D) questionnaire. In addition, in accordance with the instability criteria, radiographs were evaluated before surgery, after surgery, and during follow-up. Results Overall, 25 patients (71%) suffered an acute type V disruption, 5 (14%) had a type IV disruption, and 5 (14%) had an acute Rockwood type IIIb injury. The mean Constant-Murley Score was 90 (range: 56–100; p = 0.53) on the injured side, and the mean subjective shoulder value was 92% (range: 80–100%). The mean Taft and ACJI scores were 10 (range: 4–12) and 86 (range: 34–100), respectively and the mean EQ-5D was 86 (range: 2–100). The mean CC difference of the injured side was 4 mm (range: 1.9–9.1 mm) at follow-up, which was not significantly different than that of the healthy side (p = 0.06). No fractures in the area of the clavicle or the coracoid were reported. Conclusions The arthroscopic- and navigation-assisted treatment of high-grade ACJ injuries in an anatomical double-tunnel configuration yields similar clinical and radiological outcomes as the conventional technique using an aiming device. Precise positioning of the navigation system prevents multiple drillings, which avoids fractures.
, Richard Glaab, Meinhard Mende, Christopher Ull, Philipp-Johannes Braun, Christoph Katthagen, Tobias J Gensior, Karl-Heinz Frosch, Pierre Hepp, Committee TRAUMA of the AGA-Society for Arthroscopy and Joint Surgery
BMC Musculoskeletal Disorders, Volume 22, pp 1-9; doi:10.1186/s12891-021-04402-6

Abstract:
Background Surgical site infection (SSI) occurs in 3–10 % of patients with surgically treated tibial plateau fractures. This study aimed to evaluate the impact of SSI on patients’ outcome after fixation of tibial plateau fractures. Methods We conducted a retrospective multicenter study in seven participating level I trauma centers between January 2005 and December 2014. All participating centers followed up with patients with SSI. In addition, three centers followed up with patients without SSI as a reference group. Descriptive data and follow-up data with patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Lysholm knee scoring scale score) were evaluated. Results In summary, 287 patients (41 with SSI and 246 without SSI; average 50.7 years) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with SSI had a significantly poorer overall KOOS (KOOS5) (48.7 ± 23.2 versus [vs.] 71.5 ± 23.5; p < 0.001) and Lysholm knee scoring scale score (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) than patients without SSI. This significant difference was also evident in the KOOS subscores for pain, symptoms, activities of daily living (ADL), and quality of life (QoL). SSI remained an important factor in multivariable models after adjusting for potential confounders. Clinically relevant differences in the KOOS5 and KOOS subscores for symptoms, pain, and ADL were found between those with SSI and without SSI even after adjustment. Furthermore, the number of previous diseases, Arbeitsgemeinschaft für Osteosynthesefragen Foundation (AO) C fractures, and compartment syndrome were found to be additional factors related to poor outcome. Conclusions Compared to previous studies, validated patient-reported outcome scores demonstrated that the impact of SSI in patients with surgically treated tibial plateau fractures is dramatic, in terms of not only pain and symptoms but also in ADL and QoL, compared to that in patients without SSI.
Wenle Li, Shengtao Dong, HaoSheng Wang, Rilige Wu, Huitao Wu, Zhi-Ri Tang, Junyan Zhang, Zhaohui Hu, Chengliang Yin
BMC Musculoskeletal Disorders, Volume 22, pp 1-8; doi:10.1186/s12891-021-04414-2

Abstract:
Background The prognosis of lung metastasis (LM) in patients with chondrosarcoma was poor. The aim of this study was to construct a prognostic nomogram to predict the risk of LM, which was imperative and helpful for clinical diagnosis and treatment. Methods Data of all chondrosarcoma patients diagnosed between 2010 and 2016 was queried from the Surveillance, Epidemiology, and End Results (SEER) database. In this retrospective study, a total of 944 patients were enrolled and randomly splitting into training sets (n = 644) and validation cohorts(n = 280) at a ratio of 7:3. Univariate and multivariable logistic regression analyses were performed to identify the prognostic nomogram. The predictive ability of the nomogram model was assessed by calibration plots and receiver operating characteristics (ROCs) curve, while decision curve analysis (DCA) and clinical impact curve (CIC) were applied to measure predictive accuracy and clinical practice. Moreover, the nomogram was validated by the internal cohort. Results Five independent risk factors including age, sex, marital, tumor size, and lymph node involvement were identified by univariate and multivariable logistic regression. Calibration plots indicated great discrimination power of nomogram, while DCA and CIC presented that the nomogram had great clinical utility. In addition, receiver operating characteristics (ROCs) curve provided a predictive ability in the training sets (AUC = 0.789, 95% confidence interval [CI] 0.789–0.808) and the validation cohorts (AUC = 0.796, 95% confidence interval [CI] 0.744–0.841). Conclusion In our study, the nomogram accurately predicted risk factors of LM in patients with chondrosarcoma, which may guide surgeons and oncologists to optimize individual treatment and make a better clinical decisions. Trial registration JOSR-D-20-02045, 29 Dec 2020.
, Nathan Brookes, Anita E. Williams, Richard K. Jones, Chelsea Starbuck, Anthony Jones, Nicola E. Walsh
BMC Musculoskeletal Disorders, Volume 22, pp 1-14; doi:10.1186/s12891-021-04389-0

Abstract:
Background Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention. Conclusion We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes. Trial registration ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered).
Forouzan Rezapur-Shahkolai, , Akram Karimi-Shahanjarini, Leili Tapak, Rashid Heidarimoghadam, Iman Dianat
BMC Musculoskeletal Disorders, Volume 22, pp 1-12; doi:10.1186/s12891-021-04413-3

Abstract:
Background Musculoskeletal pains are among evident health problems in children and adolescents. Backpack carrying behaviors and the sitting postures are among behavioral factors associated with musculoskeletal pain in schoolchildren. Therefore, this study aims to identify the factors related to these important musculoskeletal behaviors, using Health Promotion Models. Methods In this cross-sectional study, a questionnaire was created based on PRECEDE Model and Health Belief Model and was administered to 673 Iranian students, whom were selected randomly from elementary schools of Hamadan, Iran, in 2018. Results The findings of the study revealed that proper sitting postures and backpack carrying were 42 and 33%, respectively. The findings also showed that predisposing factors including perceived susceptibility (p < 0.05, β = 0.219), perceived severity (p < 0.05, β = 0.166), perceived barriers (p < 0.05, β = − 0.191), perceived self-efficacy (p < 0.05, β = 0.188) and also enabling factors (p < 0.05, β = 0.329) were significantly related to sitting behaviors. Moreover, backpack carrying behaviors had significant relationships with predisposing factors of perceived susceptibility (p < 0.05, β = 0.198), perceived barriers (p < 0.05, β = − 0.258), perceived self-efficacy (p < 0.05, β = 0.185) and reinforcing factors (p < 0.05, β = 0.208). Conclusions It seems necessary for future preventive programs to take factors of musculoskeletal pains among children and adolescents into account.
, M. Bauer, A. Hapfelmeier, M. Salzmann, P. M. Prodinger
BMC Musculoskeletal Disorders, Volume 22, pp 1-8; doi:10.1186/s12891-021-04327-0

Abstract:
Background There is no universally accepted treatment standard for idiopathic toe walking patients (ITW) in the current literature. None of the established methods provide homogenous satisfying results. In our department we treat ITW patients with lower leg orthoses with a circular foot unit for a total of 16 weeks. In this study we reviewed our database to evaluate the success of our treatment protocol for a 24 months follow up period. Results Twenty-two patients were included in this study. Age at the beginning of treatment was 7.0 years +/− 2.9 (range 2.5-13.1). Percentage of ITW at the beginning of treatment according to the perception of the parents was 89% +/− 22.2 (range 50-100). Immediately after the treatment with our device, percentage of ITW dropped to 11% +/− 13.2 (range 0-50). After 12 months, 73% of the patients (16/22) walked completely normal or showed ITW less than 10% of the day. After 24 months, 64% of the patients kept a normal gait (14/22). Conclusion This study provides evidence that the treatment of idiopathic toe walking with lower leg orthoses with a circular foot unit results in satisfying long-term results in two thirds of the patients.
, Christopher P. Carty, Claudia Giacomozzi, Teresa Phillips, Henry P. J. Walsh, David Bade, Sean Horan
BMC Musculoskeletal Disorders, Volume 22, pp 1-15; doi:10.1186/s12891-021-04364-9

Abstract:
Background Typical gait is often considered to be highly symmetrical, with gait asymmetries typically associated with pathological gait. Whilst gait symmetry is often expressed in symmetry ratios, measures of symmetry do not provide insight into how these asymmetries affect gait variables. To fully understand changes caused by gait asymmetry, we must first develop a normative database for comparison. Therefore, the aim of this study was to describe normative reference values of regional plantar load and present comparisons with two pathological case studies. Methods A descriptive study of the load transfer of plantar pressures in typically developed children was conducted to develop a baseline for comparison of the effects of gait asymmetry in paediatric clinical populations. Plantar load and 3D kinematic data was collected for 17 typically developed participants with a mean age of 9.4 ± 4.0 years. Two case studies were also included; a 10-year-old male with clubfoot and an 8-year-old female with a flatfoot deformity. Data was analysed using a kinematics-pressure integration technique for anatomical masking into 5 regions of interest; medial and lateral forefoot, midfoot, and medial and lateral hindfoot. Results Clear differences between the two case studies and the typical dataset were seen for the load transfer phase of gait. For case study one, lateral bias was seen in the forefoot of the trailing foot across all variables, as well as increases in contact area, force and mean pressure in the lateral hindfoot of the leading foot. For case study two, the forefoot of the trailing foot produced results very similar to the typical dataset across all variables. In the hindfoot of the leading foot, medial bias presents most notably in the force and mean pressure graphs. Conclusions This study highlights the clinical significance of the load transfer phase of gait, providing meaningful information for intervention planning.
BMC Musculoskeletal Disorders, Volume 22, pp 1-10; doi:10.1186/s12891-021-04415-1

Abstract:
Background The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Therefore, our aim was to assess the effect of global sagittal spinal deformity on post-operative disability. Methods This analysis was based on 208 cases of THA, with functional disability measured at a follow-up of 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health), was used to divide eligible patients into two groups, namely with and without disability, using a score of 70 as the cut-off. The following factors were compared between the two groups using multivariate analysis: age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience. To identify the cut-off value of the parameters for predicting disability (HOOS-JR < 70/100), we used the receiver-operating characteristic curve. Results The disability (30 hips) and control (178 hips) groups showed a significant difference in pre-operative body height (p = 0.020), T1 pelvic angle divided by pelvic incidence (T1PA/PI; p = 0.018), PI minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), patient satisfaction (p = 0.033), and the modified Harris Hip Score (p = 0.038). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI > 0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p < 0.001) and height < 148 cm equivalent to legal standards as short stature (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was > 0.19, with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001), HOOS-JR (p = 0.023), and EuroQol 5-Dimension (p = 0.041) differed between the two groups when the pre-operative cut-off value was chosen as 0.2. Conclusions A T1PA/PI > 0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.
Anshum Sood, Ashley Klein, Samir Kaveeshwar, Derek L. Jones, Grant Duvall, James Paul Hovis, Tristan B. Weir, Blessing Enobun, S. Ashfaq Hasan, R. Frank Henn, et al.
BMC Musculoskeletal Disorders, Volume 22, pp 1-7; doi:10.1186/s12891-021-04396-1

Abstract:
Background The effect of postoperative shoulder sling compliance on surgical outcomes is unknown. The goal was to determine an accurate method to measure sling compliance. We compared volunteer recorded sling wear time with temperature-based sensors to monitor sling compliance. Methods Data loggers sutured at three locations measured heat generated in 15-minute intervals. Slings wearers logged sling wear to accurately cross-reference with temperature sensors. Secondary experiments analyzed whether surrounding ambient temperature can be discerned from actual sling wear. We created an algorithm to describe actual sling wear time as a function of heat recorded and calculated percent wear accuracy. Results The modified sling was worn for 172 h. The algorithm modeled sling on/off times by analyzing cutoff temperatures. Diagnostic accuracy was >99 % for the three locations, with no statistically significant differences among them. Compared with sling wear, ambient temperature took longer to reach critical temperature values determined by the algorithm, helping distinguish compliance from false positives. Conclusions The described algorithm can effectively quantify shoulder sling wear time based on heat-generated sensor readings. False positives from ambient temperature are minimal. This measurement method could be used to study the relationship between postoperative sling use and functional outcomes after shoulder surgery.
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