Pre-operative arthritic glenoid assessment: 3D automated planning software versus manual multiplanar measurements of version and inclination.

Background: Preoperative CT-based planning is established in shoulder arthroplasty surgery. Automated planning software has become available to assist the surgeon and may increase reliability and efficiency. This study aims to evaluate the reliability of an automated 3-dimensional (3D) planning software package (Blueprint™ v2.1.5, Wright Medical Ltd) in the assessment of the arthritic shoulder against manual multiplanar measurement (MM). Methods: 74 CT studies acquired for preoperative shoulder arthroplasty planning were reviewed on two occasions by four different evaluators, taking manual measurement (MM) of glenoid version and inclination adjusted with multiplanar reformation and adhering to modified Freidman and Maurier methods. 15 scans were not processed by Blueprint due to incompatible scanning protocols or severe scapular dysmorphia. 59 Blueprint measures were compared with the manual data. Results: Version: Intra-observer reliability of glenoid version MM was excellent (mean ICC 0.92). Inter-observer reliability between all four readers was good (ICC 0.89). A Bland-Altman analysis of Blueprint versus MM for version measurements demonstrated a mean pair difference of -5.77 (95% CI -7.25 to 4.29). Inclination: Intra-rater and inter-rater reliabilities were good (ICC 0.85 and 0.80 respectively). Blueprint and MM values for inclination followed a more convergent pattern than for version. Bland-Altman analysis for inclination did not show substantial bias, with a mean pair difference of 1.4 (95% CI -0.1 to 2.9). Conclusion: Manual preoperative planning for shoulder arthroplasty is time consuming and requires experience. Automated 3D planning offers a consistent tool to assist the surgeon, notwithstanding intra-operative anatomical and technical variation, and margin of error. Surgeons should as ever be mindful of the specifics of a given automated program and our data quantified a bias for retroversion which may be important for measures close to the thresholds for augmentation or customised implants.

The use of platelet-rich plasma therapy in treating tennis elbow: A critical review of randomised control trials.

Tennis elbow (TE) is a painful and debilitating condition of the elbow. Recently, the use of orthobiologics, such as platelet-rich-plasma (PRP), has been proposed to promote tendon regeneration. Despite their popularity, there is a paucity of updated reviews on the use of PRP compared with other treatment modalities for treating TE. The aim of this review is to summarise high quality studies that compare the use of PRP therapy with other therapies for TE and to identify areas where further research is warranted. This systematic review was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search of PubMed, Scopus and Cochrane Library databases was undertaken in May 2021. Articles were screened for the following criteria: randomised control trials (RCTs) involving PRP in at least one of the treatment arms for tennis elbow. The quality of the RCTs included were analysed for their risk of bias using the modified Cochrane Collaboration Risk of Bias Assessment Tool for randomised trials. A total of 20 RCTs of which 1520 TE patients were analysed. The RCTs included in this review compared PRP with various treatment modalities routinely used in clinical practice such as physiotherapy, steroid injections, Autologous Whole Blood (AWB) and surgical interventions. With regards to the quality of RCTs, collectively, selection bias was found to be low risk however, performance bias in terms of blinding of participants and personnel performed poorly. Of the 20 RCTs, only 5 studies were classified as low risk of bias. In these 5 studies, 2 RCTs compared PRP with steroids and reported contrasting results, 1 RCT compared PRP with AWB injections which reported both to be similarly efficacious, 3 RCTs included a placebo group and only 1 reported superior effects with PRP. There are 2 main types of PRP classified according to the number of pro-inflammatory leukocyte i.e. leukocyte-rich and leukocyte-poor PRP. However, only 8 studies documented the formulation of PRP used. While the heterogeneity of PRP formulations could in-part explain the reported differences in outcomes, overall there is limited robust evidence to recommend PRP therapy for TE. Further research is required to establish the optimal formulation and administration of PRP injections. Proper documentation of TE patients need to be standardised before concrete recommendations on the use of PRP therapy may be offered.

Use of Traction Table for Reducing Complex Distal Femur Fractures: A Technical Trick.

Complex intra-articular distal femur fractures (AO 3.3.C) present many challenges, especially with regard to patient preparation and approach. Traditionally, patients lie supine with a bolster or triangular wedge placed below the knee to allow knee flexion. This corrects the hyperextension deformity of the distal femoral fragment caused by the gastrocsoleus complex. Although well established, the minimally invasive plate osteosynthesis (MIPO) technique presents with limitations, especially with regard to patient preparation and approach. In this case report, we describe a lateral approach to the MIPO technique using the Eschmann traction table with the tibia nailing attachment and femoral condyle pads to achieve and maintain satisfactory fracture reduction throughout the procedure. Importantly, this also allows less dependency on surgical assistance. To our knowledge, this is the first case report describing a lateral approach to the MIPO technique using the Eschmann traction table for the reduction of complex distal femur fractures.

Pre-Operative Digital Templating Aids Restoration of Leg-Length Discrepancy and Femoral Offset in Patients Undergoing Total Hip Arthroplasty for Primary Osteoarthritis.

Background Pre-operative planning and templating is a crucial pre-requisite for total hip arthroplasty (THA). Recently, the use of digital radiography has allowed templating to be digitalised instead of traditional methods involving the use of radiograph transparencies. The primary aim of this study was to compare the accuracy in correction of leg length discrepancy (LLD) and restoring femoral offset in patients undergoing THA for primary osteoarthritis with pre-operative digital templating (PDT) versus conventionalplanning without digital templating. Methods This retrospective cohort study compared two groups of patients who underwent THA for primary osteoarthritis. During the period of the year 2020, 56 patients underwent THA with pre-operative digital templating and 50 patients without digital templating. Two independent blinded observers recorded all radiological data. Results The digital templated and non-digital templated cohorts were matched for variables including age (mean = 71.8 years vs 70.9 years), pre-operative LLD (-4.9mm vs -5.2mm) and pre-operative offset (41.2mm vs 43.7mm). PDT resulted in correction of LLD to <5mm compared to the contralateral hip in 76.8% of cases, 5-10mm in 21.4% and >10mm in one case (1.8%). The non-digital templated cohort had a LLD of <5mm in 50% of cases, 5-10mm in 28% and >10mm in 22%. Chi-square testing demonstrated these results to be statistically significant (p = 0.002). The mean pre-operative offset in the digital templated group was 40mm and 46mm post-operatively. The non-digital templated cohort had a mean pre-operative offset of 42mm and 36mm post-operatively. Independent t-testing revealed statistical significance of these results (p = 0.05). Conclusion PDT leads to an increased likelihood of restoring LLD to <5mm and a significantly increased likelihood of preventing lengthening >10mm. PDT also significantly increases the chance of restoring femoral offset to match the pre-operative native hip. Decreased offset is seen predominantly in the non-digitally templated patients.

A Case of Axial Spondyloarthritis Triggered by SARS-CoV-2 Infection.

Ever since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there has been a noticeable change in atypical presentations of several rheumatological diseases following COVID-19 infections. In this case report, we present a case of SARS-CoV-2-induced axial and peripheral spondyloarthritis. This case highlights the possibility of SARS-CoV-2 infection accelerating the onset of autoimmune diseases such as axial spondyloarthritis. Although uncommon, these cases warrant a referral to the rheumatologist for appropriate diagnosis and management. This case also highlights the need for further research on the mechanisms behind the viral interaction of SARS-CoV-2 infections with the host immune system, especially about accelerating the onset of autoimmune diseases.

Mesenchymal Stem Cell Exosomes for Cartilage Regeneration: A Systematic Review of Preclinical In Vivo Studies.

Clinical and animal studies have demonstrated efficacy of mesenchymal stem/stromal cells (MSCs) in cartilage repair. Although MSCs were originally predicated to mediate tissue repair through cellular differentiation and cell replacement, it is now recognized that MSCs exert most of their paracrine effects on tissue repair through the release of extracellular vesicles (EVs). In particular, 50-200 nm small EVs that also include exosomes carry a rich cargo of lipids, nucleic acids, and proteins, and have been reported to be therapeutically efficacious in various disease indications, including osteochondral injuries and osteoarthritis (OA). This systematic review aimed to assess the preclinical studies that used MSC exosomes for cartilage repair. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed and Cochrane Library databases were searched for relevant controlled preclinical animal studies. A total of 13 studies were identified, with the total sample size being 434. This included 378 (87.1%) mice or rats and 56 (12.9%) rabbits. According to Systematic Review Centre for Laboratory Animal Experimentation risk of bias assessment, all the studies presented with unclear-to-low risk in bias. In general, MSC exosomes were found to be efficacious in promoting repair and regeneration of osteochondral defects and alleviating OA degeneration. In most studies, exosome-treated animals displayed increased cellular proliferation, enhanced matrix deposition, and improved histological scores. Having assessed the relevant preclinical animal studies reported to date, this systematic review shows the therapeutic benefit of MSC exosome therapy in cartilage repair. Standardization of animal models and outcome measurements would be needed to facilitate more robust analysis and improve the validity of the results in future studies.