The Acute and Long-Term Effects of Olympic Karate Kata Training on Structural and Functional Changes in the Body Posture of Polish National Team Athletes.

The aim of this study was to assess the acute and long-term effects of karate kata training on body posture (range of motion (ROM)) and musculoskeletal pain in elite karate athletes. Twelve kata athletes from the Polish national team participated in the study. A cross-sectional study protocol was used, with direct participatory observation (NMQ-7/6 questionnaire, spinal curvatures and spinal ROM testing, ROM of joints) and natural experiment (225 min of kata training) methods of assessment. Age and number of weekly kata sessions were found to correlate with ROM of the lumbar spine (R = (-0.6), p < 0.05). High increase in the prevalence of lumbar hypolordosis and posterior pelvic tilt was noted after karate training sessions. ROM of the inclination in the sagittal plane differed significantly between the first and second trials, by 10.0 degrees on average. Kata stances and their movement pattern seem to be related to the occurrence of disturbances in the ROM of the internal and external rotations of the hip joints and decreased depth of the lumbar lordosis, pelvic tilt, and their ROM. The locations of the long-term musculoskeletal complaints (NMQ-6) seem to result from compensatory changes that occur in the musculoskeletal structures as a result of elite-level kata training.

Regeneration of Humeral Head Using a 3D Bioprinted Anisotropic Scaffold with Dual Modulation of Endochondral Ossification.

Tissue engineering is theoretically thought to be a promising method for the reconstruction of biological joints, and thus, offers a potential treatment alternative for advanced osteoarthritis. However, to date, no significant progress is made in the regeneration of large biological joints. In the current study, a biomimetic scaffold for rabbit humeral head regeneration consisting of heterogeneous porous architecture, various bioinks, and different hard supporting materials in the cartilage and bone regions is designed and fabricated in one step using 3D bioprinting technology. Furthermore, orchestrated dynamic mechanical stimulus combined with different biochemical cues (parathyroid hormone [PTH] and chemical component hydroxyapatite [HA] in the outer and inner region, respectively) are used for dual regulation of endochondral ossification. Specifically, dynamic mechanical stimulus combined with growth factor PTH in the outer region inhibits endochondral ossification and results in cartilage regeneration, whereas dynamic mechanical stimulus combined with HA in the inner region promotes endochondral ossification and results in efficient subchondral bone regeneration. The strategy established in this study with the dual modulation of endochondral ossification for 3D bioprinted anisotropic scaffolds represents a versatile and scalable approach for repairing large joints.

Is routine gleno-humeral exploration a risk factor for adhesive capsulitis after arthroscopic removal of rotator cuff calcifications? A comparative retrospective study in 340 cases.

BACKGROUND: Arthroscopic surgery has earned its place as the reference standard treatment for rotator cuff calcific tendinopathy refractory to conservative medical treatment. Adhesive capsulitis of the shoulder is the most common complication (12%). Standard practice involves routine gleno-humeral exploration before calcification removal. The objective of this study was to identify risk factors for adhesive capsulitis. HYPOTHESIS: The development of adhesive capsulitis is associated with gleno-humeral exploration. METHODS: We conducted a multicentre, multi-surgeon, retrospective cohort study of 340 consecutive patients who underwent arthroscopic removal of rotator cuff calcifications between 1 January 2012 and 1 January 2018. We collected epidemiological data (age, sex, work-related physical activity), the history of previous treatments (local injections, needling), the type and location of the calcifications as assessed radiologically, the clinical findings (Constant score before and 6 months after surgery, diagnosis of adhesive capsulitis defined as shoulder pain with motion range limitation in all directions), and the surgical details (type of anaesthesia, gleno-humeral exploration). RESULTS: Of the 340 patients, 251 underwent routine gleno-humeral exploration and 89 did not. Adhesive capsulitis developed in 40 (12%) patients. By multivariate analysis, gleno-humeral exploration was an independent risk factor for adhesive capsulitis (p=0.022; odds ratio, 5.60). Of the 251 gleno-humeral explorations, 8% identified concomitant lesions and only 4% led to a curative procedure. CONCLUSION: Given our results and the data in the literature, we believe that routine gleno-humeral exploration during the arthroscopic treatment of rotator cuff calcific tendinopathy is inadvisable. LEVEL OF EVIDENCE: III; case-control study.

Descripción histológica de los daños ocasionados por monoiodo acetato de sodio en articulación humeral de rata / Histologyc description of monosodium iodoacetate damage in rat humeral joint

La inyección con monoiodo acetato de sodio (MIA) es ampliamente utilizada para producir osteoartritis en diversas articulaciones. El objetivo fue describir los daños histológicos provocados por MIA en la articulación humeral de rata. Se inyectó 0,1 mL de mezcla de 0,5 mg de MIA disuelto en 10 mL de solución fisiológica en la articulación humeral izquierda de 21 ratas SpragueDawley. Como control se utilizó la articulación derecha de cada rata. Se realizó la eutanasia a las 4, 8 y 12 semanas post inyección en grupos de 7 ratas. Los miembros mantenidos en formalina tamponada al 10% fueron descalcificados con EDTA por tres meses. Para la evaluación histológica se realizó la inclusión en parafina y se realizaron cortes coronales de 5 µm de espesor, para posterior tinción con azul de toluidina. En el cartílago sano, se observó una superficie lisa sin fisuras, todas las células de las zonas del cartílago se observaron normales. Se observaron cambios en el cartílago articular a partir de las 4 semanas post inyección, los condrocitos de la zona radial hipertróficos con gran producción de proteoglicanos. A las 12 semanas post inyección, se observa un gran deterioro, el espacio articular se ve disminuido, La superficie del cartílago se observa con fisuras y grietas que llegan hasta la zona radial. Las células alrededor de estas fisuras han desaparecido. Se observa una pérdida prominente de proteoglicanos debido a la débil tinción con azul de toluidina. La inyección articular con MIA produce lesiones similares a la OA. La gran ventaja de la OA inducida por MIA, es la facilidad de su aplicación y la rapidez en la progresión de OA.

Injection with monoiode sodium acetate (MIA) is widely used to produce osteoarthritis in various joints. The aim of this work was to describe the histological damage caused by MIA in the rat humeral joint; 0.1 mL of 0.5 mg mixture of MIA dissolved in 10 mL of physiological solution was injected into the left humeral joint of 21 Sprague-Dawley rats. As a control, the right joint of each rat was used. Euthanasia was performed at 4, 8 and 12 weeks post injection in groups of 7 rats. The samples maintained in 10 % buffered formalin were descaled with EDTA for three months. For histological evaluation, paraffin inclusion was performed and 5 µm thick coronal cuts were made for subsequent staining with toluidine blue. In the healthy cartilage, a smooth surface was observed, all cells in the cartilage areas were normal. Changes in articular cartilage were observed after 4 weeks post injection, hypertrophic radial chondrocytes with high proteoglycan production. At 12 weeks post injection, a great deterioration was observed, the articular space was diminished. The surface of the cartilage was observed with fissures and cracks that reach the radial zone. The cells around these fissures have disappeared. A prominent loss of proteoglycans was observed due to weak toluidine blue staining. Joint injection with MIA produced lesions similar to OA. The great advantage of the OA induced by MIA, is the ease of its application and the rapidity in the progression of OA.

Ulna-humerus contact mechanics: Finite element analysis and experimental measurements using a tactile pressure sensor.

Elbow articular cartilage withstands high compressive and shear forces while protecting the bone from excessive loading. Better understanding of elbow cartilage contact mechanics can provide insight into cartilage degeneration. In this study a tactile pressure sensor was used to measure the contact pressure distribution within the ulno-humeral joint of two cadaver specimens at 20° flexion angle across three different axial loads of 80 N, 110 N, and 140 N. Corresponding 3D finite element (FE) models were constructed from magnetic resonance imaging (MRI) and contact analysis was performed for each specimen with boundary and loading conditions identical to the experiment. Direct comparison between FE results and experimental measurements was conducted for the validation of the FE models and a sensitivity analysis was employed for assessing the effect of cartilage parameters on the model's outputs. The results showed a good agreement between the FE models and the experiments in terms of contact characteristics. The sensitivity analysis demonstrated that outcomes of the model, particularly peak contact pressure is more sensitive to the Poisson's ratio rather than to Young's modulus under static conditions. This result suggests that selection of Poisson's ratio is very critical for accurate prediction of contact mechanics within the ulno-humeral joint.

In vivo estimation of the shoulder joint center of rotation using magneto-inertial sensors: MRI-based accuracy and repeatability assessment.

BACKGROUND: The human gleno-humeral joint is normally represented as a spherical hinge and its center of rotation is used to construct humerus anatomical axes and as reduction point for the computation of the internal joint moments. The position of the gleno-humeral joint center (GHJC) can be estimated by recording ad hoc shoulder joint movement following a functional approach. In the last years, extensive research has been conducted to improve GHJC estimate as obtained from positioning systems such as stereo-photogrammetry or electromagnetic tracking. Conversely, despite the growing interest for wearable technologies in the field of human movement analysis, no studies investigated the problem of GHJC estimation using miniaturized magneto-inertial measurement units (MIMUs). The aim of this study was to evaluate both accuracy and precision of the GHJC estimation as obtained using a MIMU-based methodology and a functional approach. METHODS: Five different functional methods were implemented and comparatively assessed under different experimental conditions (two types of shoulder motions: cross and star type motion; two joint velocities: ωmax = 90°/s, 180°/s; two ranges of motion: Ɵ = 45°, 90°). Validation was conducted on five healthy subjects and true GHJC locations were obtained using magnetic resonance imaging. RESULTS: The best performing methods (NAP and SAC) showed an accuracy in the estimate of the GHJC between 20.6 and 21.9 mm and repeatability values between 9.4 and 10.4 mm. Methods performance did not show significant differences for the type of arm motion analyzed or a reduction of the arm angular velocity (180°/s and 90°/s). In addition, a reduction of the joint range of motion (90° and 45°) did not seem to influence significantly the GHJC position estimate except in a few subject-method combinations. CONCLUSIONS: MIMU-based functional methods can be used to estimate the GHJC position in vivo with errors of the same order of magnitude than those obtained using traditionally stereo-photogrammetric techniques. The methodology proposed seemed to be robust under different experimental conditions. The present paper was awarded as "SIAMOC Best Methodological Paper 2016".

When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm.

INTRODUCTION: Shoulder dislocations are common. It is known that incongruent shoulder should be promptly reduced. However, when associated with fracture of the proximal humerus, there is a clinical dilemma if reduction under sedation is a safe option. We wanted to establish when it is safe to attempt reduction of a shoulder fracture dislocation under sedation in emergency room. METHODS: This is a retrospective cohort study assessing consecutive patients presenting with a dislocation of a gleno-humeral joint with an associated fracture of the humerus between 2007 and 2015. The radiographs and patients' records were examined. The number of fragments according to Neer's criteria and size of fragments were recorded. RESULTS: We identified 102 patients who presented with 104 cases of fracture dislocation of shoulder joint. 10 of the dislocations were posterior, remainder were anterior. All posterior dislocations were reduced under general anaesthesia. Sixty-two anterior fracture dislocations had attempted reduction under sedation in emergency department. Eight of those were unsuccessful, and patient required general anaesthetic for further management. In five of those cases, significant displacement of humeral head in relation to the shaft after attempted reduction. CONCLUSION: We propose pragmatic approach to the initial treatment of fracture dislocations of shoulder. In type I injury, where there is an anterior dislocation with greater tuberosity fracture, one should attempt a reduction under sedation; 94% of attempted reductions under sedation were successful and no fracture propagation occurred. In case of a type II injury, when the fracture is involving a surgical neck of the humerus with or without greater tuberosities fracture, our experience suggests that no attempt of reduction is undertaken under sedation and patient has general anaesthetic. Posterior dislocation with any fracture remains an unsolved problem, but in our series no attempt of reduction under sedation was made.

Complex Elbow Dislocations and the "Terrible Triad" Injury.

BACKGROUND: The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. These injuries can be categorised into groups according to their mechanism and the structures injured. METHODS: This review includes a literature search of the current evidence and personal experiences of the authors in managing these injuries. RESULTS: All injuries are initially managed with closed reduction of the ulno-humeral joint and splinting before clinical examination and radiological evaluation. Dislocations with radial head fractures should be treated by restoring stability, with treatment choice depending on the type and size of radial head fracture. Terrible triad injuries necessitate operative treatment in almost all cases. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. Varus posteromedial rotational instability fracture-dislocations have only recently been described as having the potential to cause severe long-term problems. Cadaveric studies have reinforced the need to obtain post-reduction CT scans as the size of the coronoid fragment influences the long-term stability of the elbow. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism. CONCLUSION: Complex elbow dislocations are injuries with significant risk of long-term disability. There are several case-series in the literature but few studies with sufficient patient numbers to provide evidence over level IV.

Propagation of soft tissue artifacts to the center of rotation: a model for the correction of functional calibration techniques.

This paper presents a mathematical model for the propagation of errors in body segment kinematics to the location of the center of rotation. Three functional calibration techniques, usually employed for the gleno-humeral joint, are studied: the methods based on the pivot of the instantaneous helical axis (PIHA) or the finite helical axis (PFHA), and the "symmetrical center of rotation estimation" (SCoRE). A procedure for correcting the effect of soft tissue artifacts is also proposed, based on the equations of those techniques and a model of the artifact, like the one that can be obtained by double calibration. An experiment with a mechanical analog was performed to validate the procedure and compare the performance of each technique. The raw error (between 57 and 68mm) was reduced by a proportion of between 1:6 and less than 1:15, depending on the artifact model and the mathematical method. The best corrections were obtained by the SCoRE method. Some recommendations about the experimental setup for functional calibration techniques and the choice of a mathematical method are derived from theoretical considerations about the formulas and the results of the experiment.

Construcción de modelos computacionales para el análisis de esfuerzos mecánicos de piezas óseas utilizando imágenes de TC: aplicación a la articulación gleno-humeral / Construction of computational models for the stress analysis of the bones using CT imaging: application in the gleno-humeral joint

Se presenta en este trabajo una metodología para el procesamiento de imágenes de estudios de TC para la construcción de modelos computacionales de piezas óseas. Los modelos computacionales son utilizados para el análisis de esfuerzos utilizando el Método de los Elementos Finitos. Las constantes elásticas del tejido óseo son calculadas a partir de los datos de densidad de las TC. La metodología propuesta es aplicada en la construcción de un modelo para el análisis de la articulación gleno-humeral.

A methodology for the construction of computational models from CT images is presented in this work. Computational models serve for the stress analysis of the bones using the Finite Element Method. The elastic constants of the bone tissue are calculated using the density data obtained in from the CTs. The proposed methodology is demonstrated in the construction of a model for the gleno-humeral joint.