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Clinical Advances in Musculoskeletal Disorders
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Clinical Advances in Musculoskeletal Disorders

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 1 May 2025 | Viewed by 9859

Special Issue Editors

Prof. Dr. Peter V. Giannoudis

E-Mail Website
Guest Editor
Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
Interests: pelvic instability; pelvic reconstruction; non-union; bone regeneration; post fracture fixation complications
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Sushrut Babhulkar

E-Mail Website
Guest Editor
Centre for Joint Reconstruction Surgery, Sushrut Institute of Medical Sciences, Nagpur, India
Interests: trauma; arthroplasty; joint reconstruction

Special Issue Information

Dear Colleagues,

Musculoskeletal disorders encompass various clinical conditions that affect the human musculoskeletal system. Bones, joints, muscles, tendons, ligaments, nerves, and connective tissues can all be afflicted, leading to pain, tenderness, inflammation, swelling, muscle spasm, and functional restrictions.

Overall, these conditions may be caused by hereditary, congenital or acquired pathological developments. Inflammatory, infectious, degenerative, traumatic, vascular, metabolic and neoplastic processes can lead to various types of impairment and degrees of severity. The three most prevalent musculoskeletal conditions known to be associated with the greatest number of health care-related visits to emergency departments and hospitals are trauma, backache and arthritis.

Musculoskeletal disorders of traumatic origin develop due to a sudden intensity (i.e., lifting a heavy object) or due to the repeated exposure to force, vibration, or an awkward posture. They can affect any part of the body, including the upper extremities, hands, neck, spine, pelvis, lower extremities and feet.

The most popular diagnostic tests employed to screen and diagnose musculoskeletal disorders include radiographs, computed tomography, magnetic resonance, and ultrasonography. 

Musculoskeletal disorders represent the second most prevalent cause of disability globally; this is measured in terms of the number of years those affected live with disability and the fact that it continues to be a burden on society as a whole, due to the enormous direct costs to the health care system it incurs and the indirect costs  suffered due to the loss of work. As the global population ages, it is envisaged that the number of people suffering from musculoskeletal conditions will also increase. Currently, the global prevalence of MSDs is reported to be as high as 40%.

In this Special Issue, we invite authors to submit their research work on this important topic. Papers focusing on epidemiological studies, diagnostic techniques, novel treatment modalities, either surgical, non-invasive or non-operative, rehabilitation protocols, and patient-reported outcomes are all welcome; this is with the aim of enhancing our knowledge and providing further insight into these ever-growing disabling and costly conditions.

Prof. Dr. Peter V. Giannoudis
Prof. Dr. Sushrut Babhulkar
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • musculoskeletal disorders
  • disability
  • pain
  • inflammation
  • arthritis

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Published Papers (8 papers)

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16 pages, 1829 KiB  
Article
Sonographic Characterization of the Pericruciate Fat Pad with the Use of Compression Elastography—A Cross-Sectional Study among Healthy and Post-Injured Patients
by Michał Kanak, Natalia Pawłuś, Marcin Mostowy, Marcin Piwnik, Marcin Domżalski and Jędrzej Lesman
J. Clin. Med. 2024, 13(9), 2578; https://doi.org/10.3390/jcm13092578 - 27 Apr 2024
Viewed by 1104
Abstract
Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them [...] Read more.
Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them with cases of post-traumatic injuries. Methods: Conducted as a retrospective cross-sectional study (n = 110 knees each) following STROBE guidelines, it employed grayscale ultrasound with echogenicity measurement, compression elastography with elasticity measurement, and Color Doppler for blood flow assessment. Results: PCFP showed a homogenic and hyperechoic echostructure. The echogenicity of the PCFP was higher than that of the posterior cruciate ligament (PCL) (p < 0.001, z-score = 8.97) and of the medial head of gastrocnemius (MHG) (p = 0.007, z-score = 2.72) in healthy knees, but lower than subcutaneous fat (SCF) (p < 0.001, z-score = −6.52). Post-injury/surgery, PCFP echogenicity surpassed other structures (p < 0.001; z-score for PCL 12.2; for MHG 11.65 and for SCF 12.36) and notably exceeded the control group (p < 0.001, z-score = 8.78). PCFP elasticity was lower than MHG and SCF in both groups, with significantly reduced elasticity in post-traumatic knees (ratio SCF/PCFP 15.52 ± 17.87 in case group vs. 2.26 ± 2.4 in control group; p < 0.001; z-score = 9.65). Blood flow was detected in 71% of healthy PCFPs with three main patterns. Conclusions: The main findings, indicating increased echogenicity and reduced elasticity of PCFP post-trauma, potentially related to fat pad fibrosis, suggest potential applications of echogenicity and elasticity measurements in detecting and monitoring diverse knee pathologies. The description of vascularity variations supplying the PCFP adds additional value to the study by emphasizing the clinically important role of PCFP as a bridge for the middle genicular artery on its way to the inside of the knee joint. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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<p>Flowchart presenting the step-by-step methodology of the study. MRI—magnetic resonance imaging, PCL—posterior cruciate ligament, ICC—intraclass correlation coefficient.</p> Full article ">Figure 2
<p>(<b>a</b>) Probe positioning. (<b>b</b>) Ultrasound longitudinal image of the pericruciate fat pad (PCFP). MHG—medial head of gastrocnemius, PCL—posterior cruciate ligament, SCF—subcutaneous fat.</p> Full article ">Figure 3
<p>Elastography measurement. Histograms show mean value and standard deviation of a measurement. Z1 histogram pertains to the pericruciate fat pad (PCFP), Z3 to the medial head of gastrocnemius (MHG), and Z2 to subcutaneous fat (SCF). Compression quality icon is visible under the soft/hard color scale.</p> Full article ">Figure 4
<p>Epidemiology of knee pathologies or surgeries in the case group. ACL—anterior cruciate ligament, LCL—lateral collateral ligament, LFC—lateral femoral condyle, LM—lateral meniscus, LPFL—lateral patellofemoral ligament, MCL—medial collateral ligament, MM—medial meniscus, MPFL—medial patellofemoral ligament.</p> Full article ">
10 pages, 1665 KiB  
Article
Vitamin D Deficiency Is Frequent in Patients with Rapidly Destructive Osteoarthritis—Data from a Single-Center Analysis
by Konstantin Horas, Gerrit Maier, Maximilian Rudert, Axel Jakuscheit, Manuel Weißenberger, Ioannis Stratos, Tizian Heinz, Dominik Rak, Philip Mark Anderson and Jörg Arnholdt
J. Clin. Med. 2024, 13(5), 1296; https://doi.org/10.3390/jcm13051296 - 25 Feb 2024
Cited by 1 | Viewed by 1007
Abstract
Background: Rapidly destructive osteoarthritis (RDO) of the hip joint is characterised by the rapid destruction of the femoral head with or without acetabular involvement. There has been increasing interest in this disease over the past years; however, the entity is still poorly understood, [...] Read more.
Background: Rapidly destructive osteoarthritis (RDO) of the hip joint is characterised by the rapid destruction of the femoral head with or without acetabular involvement. There has been increasing interest in this disease over the past years; however, the entity is still poorly understood, and its pathophysiology remains unknown. Yet, there is ample evidence today that increased bone metabolism might play a role in the onset and progression of the disease. Vitamin D is of utmost importance to maintain a balanced bone metabolism. However, whether vitamin D deficiency is involved in disease development remains to be elucidated. Further, the vitamin D status of patients with RDO has not yet been analysed. For this reason, the objective of this study was to assess the vitamin D status of patients with RDO. Moreover, the aim was to clarify whether there is a difference in the vitamin D status of patients with RDO compared with patients with primary osteoarthritis (OA). Methods: In this single-centre analysis, the 25(OH)D, PTH, and calcium levels of 29 patients who presented with RDO between 2020 and 2022 were assessed. Results: Altogether, 97% of patients (28/29) were vitamin D deficient, a further 3% (1/29) were vitamin D insufficient, and not a single patient presented with a sufficient vitamin D status. Notably, the vitamin D levels of RDO patients (mean = 11.04 ng/mL) were significantly lower than the vitamin D levels of patients with OA (mean = 22.16 ng/mL, p = 0.001). Conclusion: In conclusion, we found a widespread and high rate of vitamin D deficiency in patients with RDO. Hence, we believe that 25(OH)D status should routinely be analysed in these patients. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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<p>X-ray of a right hip joint (ap) of a 77-year-old female patient with osteoarthritis (<b>left</b>) and X-ray 9 weeks later showing rapidly destructive osteoarthritis (arrow) (<b>right</b>). The patient had no known risk factors for osteoporosis.</p> Full article ">Figure 2
<p>Serum vitamin D levels of patients with RDO grouped according to age (n = 29).</p> Full article ">Figure 3
<p>Serum vitamin D levels of patients with RDO grouped according to gender ((<b>A</b>), n =19 for female and n = 10 for male) and affected side ((<b>B</b>), n = 19 for right and n = 10 for left side).</p> Full article ">Figure 4
<p>Serum vitamin D (25(OH)D) levels of patients with RDO in correlation with the season (n = 10 for spring (March–May); n = 7 for summer (June–August); n = 9 for autumn (September–November); n = 3 for winter (December–February) * <span class="html-italic">p</span> &lt; 0.05).</p> Full article ">Figure 5
<p>Comparing serum vitamin D (25(OH)D) levels of patients with RDO (mean 11.04 ng/mL (27.6 nmol/L); n = 29) to patients with primary osteoarthritis (mean 22.16 ng/mL (55.4 nmol/L); n = 118) revealed significant differences between groups (<span class="html-italic">p</span> = 0.001).</p> Full article ">
11 pages, 7324 KiB  
Article
Three-Dimensional Quantitative Magnetic Resonance Imaging Cartilage Evaluation of the Hand Joints of Systemic Sclerosis Patients: A Novel Insight on Hand Osteoarthritis Pathogenesis—Preliminary Report
by Michał Waszczykowski, Michał Podgórski, Jarosław Fabiś and Arleta Waszczykowska
J. Clin. Med. 2023, 12(23), 7247; https://doi.org/10.3390/jcm12237247 - 23 Nov 2023
Cited by 1 | Viewed by 1028
Abstract
Background. Osteoarthritis of the hand joints in systemic sclerosis (SSc) patients might be an independent manifestation leading to limitation of upper extremity function. There is no publication quantitatively assessing the thickness of articular cartilage within the hand joints of SSc patients by MRI. [...] Read more.
Background. Osteoarthritis of the hand joints in systemic sclerosis (SSc) patients might be an independent manifestation leading to limitation of upper extremity function. There is no publication quantitatively assessing the thickness of articular cartilage within the hand joints of SSc patients by MRI. The purpose of our study was to quantify the condition and thickness of hand joints cartilage with three-dimensional quantitative MRI (3D q-MRI). Methods. The study was conducted in twenty people: ten patients with SSc and ten healthy individuals. All participants were examined with the 3D q-MRI with 3T scanner. The cartilage thickness of proximal (PIP) and distal interphalangeal (DIP) joints as well as metacarpophalangeal joints was measured. Results. There was no significant difference in cartilage thickness between both groups. However, the joint cartilage was thinner in fingers with acro-osteolysis. In PIP joint of the fingers with acro-osteolysis, the mean cartilage thickness was 0.5 mm (p = 0.0043) and 0.4 mm (p = 0.0034) in DIP joints. Conclusions. Quantitative MRI analysis of the joints of the hands of SSc patients does not indicate changes in thickness of the articular cartilage. A significant reduction in the articular cartilage thickness of the fingers with acro-osteolysis indicates the potential of an ischemic basis of articular cartilage destruction in SSc patients. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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<p>Clinical manifestations of pathological changes in the hands in SSc patient: thickening of the skin and subcutaneous tissue; claw-type deformity of the fingers: a limited extension in proximal and distal interphalangeal joints (PIP, DIP); a hyperextension in metacarpophalangeal joints (MCP); oedema and deformities of proximal and distal interphalangeal joints (PIP, DIP).</p> Full article ">Figure 2
<p>Radiological manifestations of pathological changes in the hands in SSc patients’: Resorption of bilateral 2nd distal phalanxes and 1st phalanx of the right hand (acro-osteolysis); joint space narrowing of PIP and DIP joints; erosions and juxta-articular osteopenia; calcinosis of the 2nd fingertip.</p> Full article ">Figure 3
<p>The application of a 3D sequence of MRI to obtain the true sagittal cross-section of each finger.</p> Full article ">Figure 4
<p>Three measurements of cartilage thickness in each finger joint (in volar 1/3, dorsal 1/3, and middle 1/3)—finger without acro-osteolysis.</p> Full article ">Figure 5
<p>Three measurements of cartilage thickness in each finger joint (in volar 1/3, dorsal 1/3, and middle 1/3)—finger with acro-osteolysis.</p> Full article ">
15 pages, 1248 KiB  
Article
Automatic Variable Selection Algorithms in Prognostic Factor Research in Neck Pain
by Bernard X. W. Liew, Francisco M. Kovacs, David Rügamer and Ana Royuela
J. Clin. Med. 2023, 12(19), 6232; https://doi.org/10.3390/jcm12196232 - 27 Sep 2023
Viewed by 1072
Abstract
This study aims to compare the variable selection strategies of different machine learning (ML) and statistical algorithms in the prognosis of neck pain (NP) recovery. A total of 3001 participants with NP were included. Three dichotomous outcomes of an improvement in NP, arm [...] Read more.
This study aims to compare the variable selection strategies of different machine learning (ML) and statistical algorithms in the prognosis of neck pain (NP) recovery. A total of 3001 participants with NP were included. Three dichotomous outcomes of an improvement in NP, arm pain (AP), and disability at 3 months follow-up were used. Twenty-five variables (twenty-eight parameters) were included as predictors. There were more parameters than variables, as some categorical variables had >2 levels. Eight modelling techniques were compared: stepwise regression based on unadjusted p values (stepP), on adjusted p values (stepPAdj), on Akaike information criterion (stepAIC), best subset regression (BestSubset) least absolute shrinkage and selection operator [LASSO], Minimax concave penalty (MCP), model-based boosting (mboost), and multivariate adaptive regression splines (MuARS). The algorithm that selected the fewest predictors was stepPAdj (number of predictors, p = 4 to 8). MuARS was the algorithm with the second fewest predictors selected (p = 9 to 14). The predictor selected by all algorithms with the largest coefficient magnitude was “having undergone a neuroreflexotherapy intervention” for NP (β = from 1.987 to 2.296) and AP (β = from 2.639 to 3.554), and “Imaging findings: spinal stenosis” (β = from −1.331 to −1.763) for disability. Stepwise regression based on adjusted p-values resulted in the sparsest models, which enhanced clinical interpretability. MuARS appears to provide the optimal balance between model sparsity whilst retaining high predictive performance across outcomes. Different algorithms produced similar performances but resulted in a different number of variables selected. Rather than relying on any single algorithm, confidence in the variable selection may be increased by using multiple algorithms. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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Figure 1
<p>Overview of workflow. Abbreviations: stepP: stepwise logistic regression based on <span class="html-italic">p</span> values with no adjustment; stepPAdj: stepwise logistic regression based on <span class="html-italic">p</span> values with adjustment; stepAIC: stepwise logistic regression based on AIC; Best subset: best subset regression; LASSO: least absolute shrinkage and selection operator; MuARS: multivariate adaptive regression spline; MCP: Minimax concave penalty; mboost: model-based boosting; area under the receiver operating characteristic curve (AUC).</p> Full article ">Figure 2
<p>Predictive performance of eight algorithms for the clinical outcomes of (<b>A</b>) neck pain improvement, (<b>B</b>) arm pain improvement, and (<b>C</b>) disability improvement. Abbreviations. stepP: stepwise logistic regression based on <span class="html-italic">p</span> values with no adjustment; stepPAdj: stepwise logistic regression based on <span class="html-italic">p</span> values with adjustment; stepAIC: stepwise logistic regression based on AIC; BestSubset: best subset regression; LASSO: least absolute shrinkage and selection operator; MuARS: multivariate adaptive regression spline; MCP: Minimax concave penalty; mboost: model-based boosting; area under the receiver operating characteristic curve (AUC).</p> Full article ">
11 pages, 10343 KiB  
Article
Analysis of Discordant Findings between 3T Magnetic Resonance Imaging and Arthroscopic Evaluation of the Knee Meniscus
by Pieter Van Dyck, Jasper Vandenrijt, Thijs Vande Vyvere, Annemiek Snoeckx and Christiaan H. W. Heusdens
J. Clin. Med. 2023, 12(17), 5667; https://doi.org/10.3390/jcm12175667 - 31 Aug 2023
Cited by 1 | Viewed by 1269
Abstract
Numerous studies have assessed the performance of magnetic resonance imaging (MRI) in detecting tears of the knee menisci using arthroscopy results as the gold standard, but few have concentrated on the nature of discordant findings. The purpose of this study was to analyze [...] Read more.
Numerous studies have assessed the performance of magnetic resonance imaging (MRI) in detecting tears of the knee menisci using arthroscopy results as the gold standard, but few have concentrated on the nature of discordant findings. The purpose of this study was to analyze the discordances between 3T MRI and arthroscopic evaluation of the knee meniscus. Medical records of 112 patients who underwent 3T MRI and subsequent arthroscopy of the knee were retrospectively analyzed to determine the accuracy of diagnoses of meniscal tear. Compared with arthroscopy, there were 22 false-negative and 14 false-positive MR interpretations of meniscal tear occurring in 32 patients. Images with errors in diagnosis were retrospectively reviewed by two musculoskeletal radiologists in consensus and all errors were categorized as either unavoidable, equivocal or as interpretation error. Of 36 MR diagnostic errors, there were 16 (44%) unavoidable, 5 (14%) interpretation errors and 15 (42%) equivocal for meniscal tear. The largest categories of errors were unavoidable false-positive MRI diagnoses (71%) and equivocal false-negative MRI diagnoses (50%). All meniscal tears missed by MRI were treated with partial meniscectomy (n = 14) or meniscal repair (n = 8). Discordant findings between 3T MRI and arthroscopic evaluation of the knee meniscus remain a concern and primarily occur due to unavoidable and equivocal errors. Clinicians involved in the diagnosis and treatment of patients with meniscal tears should understand why and how the findings seen on knee MRI and arthroscopy may sometimes differ. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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<p>Unavoidable false-negative MRI diagnosis (patient 1). Coronal MRI shows normal appearance of the posterior horn of the medial meniscus (arrow), whereas the arthroscopic image indicates degenerative fraying with tear (arrow). Note status after ACL reconstruction (*).</p> Full article ">Figure 2
<p>Unavoidable false-negative MRI diagnosis (patient 5). MRI shows normal appearance of the posterior horn of the lateral meniscus (arrows), whereas the arthroscopic image indicates an upper surface tear (arrows). Note bone contusions (*) at the lateral knee compartment due to acute ACL injury.</p> Full article ">Figure 3
<p>Unavoidable false-positive MRI diagnosis (patient 8). MRI shows unequivocal signs of a tear at the posteromedial meniscocapsular junction (arrows). Also note tearing at the medial collateral ligament (MCL, *) and acute ACL injury (**). Arthroscopy indicates a normal medial meniscus and hematoma at the MCL (arrow).</p> Full article ">Figure 4
<p>Interpretation false-negative MRI diagnosis (patient 18). MRI shows a tear at the posterolateral meniscal root that was missed at prospective reading and confirmed by arthroscopy (arrows). Also note lateral bone contusions and acute ACL injury (*).</p> Full article ">Figure 5
<p>Interpretation false-negative MRI diagnosis (patient 19). MRI shows a tear at the posterior horn of the lateral meniscus that was missed at prospective reading and confirmed by arthroscopy (arrows). Also note lateral bone contusions due to acute ACL injury (*).</p> Full article ">Figure 6
<p>Equivocal false-negative MRI diagnosis (patient 27). MRI shows questionable grade 2 signal change at the anterior horn of the lateral meniscus (arrow) with a parameniscal cyst (*), but arthroscopy confirmed a degenerative tear at this location (arrow).</p> Full article ">

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12 pages, 870 KiB  
Systematic Review
Nutritional Indicators of Bone Nonunion: A Systematic Review
by Eleanor Christianson, Margaret Thomas, Sheila Sprague, Jessica Rivera, Andrew Chapple and Robert Zura
J. Clin. Med. 2024, 13(21), 6553; https://doi.org/10.3390/jcm13216553 - 31 Oct 2024
Viewed by 425
Abstract
Background/Objectives: Bone nonunion remains a clinical challenge in orthopedic surgery with significant impacts on mental and physical wellbeing for patients. There are several previously established risk factors of nonunion that are connected to nutrition, but this has yet to be substantially explored. [...] Read more.
Background/Objectives: Bone nonunion remains a clinical challenge in orthopedic surgery with significant impacts on mental and physical wellbeing for patients. There are several previously established risk factors of nonunion that are connected to nutrition, but this has yet to be substantially explored. This review seeks to assess all studies that present associations between nutrition and nonunion to understand the potential for clinical relevance in nonunion prevention. Methods: Case–control and cohort studies comparing nonunion risk based on nutritional factors were gathered through PubMed in July 2024. Data were extracted with dual verification through Covidence and assessed for bias using the Newcastle–Ottawa Scale. Results: A total of 21 studies were included in this literature review. Vitamin D deficiency was a significant risk factor of nonunion in six studies and not significant in six other studies. Albumin was significant in three of the five studies addressing this lab value. Iron deficiency anemia was significant in a study assessing its impact on nonunion. Calcium was not significant in the one study mentioned. ICD-10-coded malnutrition was significant in one of the two studies. Sarcopenia, nutritional care plans, and dietitian-diagnosed malnutrition were statistically significant clinical indicators for predicting nonunion, but food insecurity was insignificant. Conclusions: Vitamin D, calcium, albumin, iron deficiency anemia, sarcopenia, and clinically diagnosed malnutrition have all been associated with an increased risk of nonunion in observational studies and should be considered when preventing nonunion development. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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<p>PRISMA chart which summarizes the literature review process.</p> Full article ">Figure 2
<p>An inclusion of nutrition in orthopedic practice. Several nutritional risk factors may impact initial fracture and risk of nonunion. Labs, questionnaires, and imaging can be used together to create a clinical picture. From there, surgical intervention and supportive nutritional care can prevent nonunion.</p> Full article ">
17 pages, 1767 KiB  
Systematic Review
Is There a Strength Deficit of the Quadriceps Femoris Muscle in Patients Treated Conservatively or Surgically after Primary or Recurrent Patellar Dislocations? A Systematic Review and Meta-Analysis
by Carlo Biz, Pietro Nicoletti, Mattia Agnoletto, Nicola Luigi Bragazzi, Mariachiara Cerchiaro, Elisa Belluzzi and Pietro Ruggieri
J. Clin. Med. 2024, 13(17), 5288; https://doi.org/10.3390/jcm13175288 - 6 Sep 2024
Viewed by 899
Abstract
Background: Patellar dislocation is a knee injury affecting generally young, active individuals, damaging joint ligaments and structures, and impacting sports activity and quality of life. Objective: This review aimed to evaluate the role of the quadriceps femoris muscle in knee extension and to [...] Read more.
Background: Patellar dislocation is a knee injury affecting generally young, active individuals, damaging joint ligaments and structures, and impacting sports activity and quality of life. Objective: This review aimed to evaluate the role of the quadriceps femoris muscle in knee extension and to consider whether extensor strength deficits are present in patients who have suffered from a primary or recurrent patellar dislocation and have been treated surgically or conservatively. Methods: This systematic literature review with meta-analysis was performed following the PRISMA Statement criteria. The search engines consulted to select studies were MEDLINE/PubMed, Scopus, and Web of Science/ISI. The JBI Critical Appraisal Checklist tools were applied for the quality assessment based on the specific study design. The outcomes were measurements of the knee extension force of the quadriceps femoris muscle, which were objectively quantifiable with an isokinetic or mobile dynamometer. Results: Of the 891 articles initially identified through the databases, 10 studies with a total of 370 patients were included in the analysis. The results indicated a strength deficit of the quadriceps in patients who had undergone a patellar dislocation, in comparison with the control group, when examining the uninvolved limb or in comparison with the pre-operative values. The overall effect size was large, with a value of −0.99. Conclusions: Our review concluded that after a primary or recurrent patellar dislocation, strength deficits of the quadriceps femoris muscle in the knee extension of the affected limb are frequently observed in surgically or conservatively treated patients. This deficit may persist even after a protracted follow-up of up to three years after injury. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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<p>Flowchart of the search strategy conducted in compliance with the criteria outlined in the “Preferred Reporting Item for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines [<a href="#B33-jcm-13-05288" class="html-bibr">33</a>].</p> Full article ">Figure 2
<p>Forest plot of the studies assessing the recovery in quadriceps strength post intervention overall (<b>A</b>) and stratified based on the type of intervention—conservative or surgical (<b>B</b>) [<a href="#B45-jcm-13-05288" class="html-bibr">45</a>,<a href="#B46-jcm-13-05288" class="html-bibr">46</a>,<a href="#B48-jcm-13-05288" class="html-bibr">48</a>].</p> Full article ">Figure 3
<p>Forest plot of the studies assessing the residual deficit in quadriceps strength post-intervention compared to a control sample or to an unaffected contralateral limb, overall (<b>A</b>) and stratified based on the type of intervention—conservative or surgical (<b>B</b>) [<a href="#B39-jcm-13-05288" class="html-bibr">39</a>,<a href="#B40-jcm-13-05288" class="html-bibr">40</a>,<a href="#B42-jcm-13-05288" class="html-bibr">42</a>,<a href="#B44-jcm-13-05288" class="html-bibr">44</a>,<a href="#B47-jcm-13-05288" class="html-bibr">47</a>,<a href="#B48-jcm-13-05288" class="html-bibr">48</a>].</p> Full article ">Figure 4
<p>Funnel plot showing no evidence of publication bias.</p> Full article ">
10 pages, 19635 KiB  
Case Report
Bilateral Atypical Femoral Fracture in a Bisphosphonate-Naïve Patient with Prior Long-Term Denosumab Therapy: A Case Report of the Management Strategy and a Literature Review
by Kyle Auger, Jason Lee, Ian S. Hong, Jaclyn M. Jankowski, Frank A. Liporace and Richard S. Yoon
J. Clin. Med. 2024, 13(10), 2785; https://doi.org/10.3390/jcm13102785 - 9 May 2024
Viewed by 1183
Abstract
The benefits of denosumab as an antiresorptive therapy and in reducing fragility fractures are well documented. However, its association with atypical femur fractures (AFFs), especially in the absence of prior bisphosphonate use, remains poorly understood and warrants further investigation. This case report presents [...] Read more.
The benefits of denosumab as an antiresorptive therapy and in reducing fragility fractures are well documented. However, its association with atypical femur fractures (AFFs), especially in the absence of prior bisphosphonate use, remains poorly understood and warrants further investigation. This case report presents a rare instance of bilateral AFFs in a 78-year-old bisphosphonate-naïve patient with a history of long-term denosumab therapy for previous metastatic breast cancer. Management involved intramedullary nail fixation after initial presentation with a unilateral AFF and a recommendation to cease denosumab therapy. However, the patient subsequently experienced a contralateral periprosthetic AFF below a total hip implant 5 months thereafter and was treated with open reduction internal fixation. This case report highlights the critical need for orthopedic surgeons to maintain a high level of suspicion and vigilance in screening for impending AFFs, especially in patients with a prolonged history of denosumab therapy without prior bisphosphonate use. Furthermore, the growing report of such cases emphasizes the urgent need for comprehensive research aimed at refining treatment protocols that balance the therapeutic benefits of denosumab and its associated risks of AFFs. Full article
(This article belongs to the Special Issue Clinical Advances in Musculoskeletal Disorders)
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Figure 1
<p>Radiographs demonstrating a transverse left subtrochanteric femur fracture with a medial spike in a 78-year-old female patient.</p> Full article ">Figure 2
<p>Radiographs of contralateral right femur demonstrating lateral cortical thickening distal to stem of femoral implant in 78-year-old female patient.</p> Full article ">Figure 3
<p>(<b>A</b>)—Three-month postoperative radiographs of left femur demonstrating delayed healing of subtrochanteric fracture with stable intramedullary nail fixation (<b>top</b>). (<b>B</b>)—Radiographs of the contralateral femur demonstrating lateral cortical beaking and thickening distal to the previous hip prosthesis (<b>bottom</b>).</p> Full article ">Figure 4
<p>Radiographs demonstrating an acute atypical mid-shaft right periprosthetic femur fracture distal to the femoral stem (Vancouver Type C).</p> Full article ">Figure 5
<p>Immediate postoperative radiographs following open reduction and internal fixation with a lateral periprosthetic femoral plate.</p> Full article ">Figure 6
<p>Most recent follow-up radiographs demonstrating healing of both femur fractures with no evidence of hardware failure: (<b>A</b>)—approximately 10 months following left femur nonunion surgery (<b>top</b>) and (<b>B</b>)—2 years after right atypical periprosthetic femoral shaft fixation (<b>bottom</b>).</p> Full article ">
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