Anterolateral talar palpation: A complementary test for ankle instability.

BACKGROUND: The anterior drawer test is traditionally used to assess ankle instability, but we believe that there is room for a small but effective improvement by adding digital palpation of the talus. We aimed to determine the accuracy of anterolateral talar palpation (ATP) in the diagnosis of ankle instability by comparing it with the traditional anterior drawer test. METHODS: Fourteen symptomatic and 10 asymptomatic patients were examined for excessive mobility through comparison of both ankles by two blinded orthopedic surgeons, each one using one of the above-mentioned tests. Symptomatic patients were also referred for stress radiography and magnetic resonance imaging (MRI). RESULTS: ATP was the most sensitive test, but also the least specific, yielding more positive results than the other tests, including tests with negative MRI. ATP and radiography had the highest accuracy and highest level of agreement with MRI. CONCLUSIONS: ATP significantly improved diagnostic accuracy in detecting ankle instability. LEVEL OF EVIDENCE: IV: cross-sectional study.

Frog-Leg Test Maneuver for the Diagnosis of Injuries to the Posterolateral Corner of the Knee: A Diagnostic Accuracy Study.

OBJECTIVE: To determine the sensitivity and specificity of a new clinical test for the diagnosis of injuries to the posterolateral corner of the knee by using magnetic resonance imaging (MRI) as the reference standard. DESIGN: Diagnostic accuracy study. SETTING: A tertiary care teaching hospital. PARTICIPANTS: Twelve subjects with chronic instability of the knee and posterolateral corner injury diagnosed by intraoperative findings and 9 subjects without posterolateral corner injury (used as controls). INTERVENTIONS: Injured and uninjured knees were assessed blindly by 2 examiners using a new clinical diagnostic test (the frog-leg test) and the classic varus stress test. MAIN OUTCOME MEASURES: Injuries to the posterolateral corner of the knee identified by the 2 clinical tests. Findings were compared and examined for reproducibility, and kappa statistic was used to assess interobserver agreement. Test results were compared with those of MRI and intraoperative findings to determine diagnostic accuracy. RESULTS: The frog-leg test showed high interobserver agreement (kappa, 0.86), with a high rate (83%-100%) of agreement with the intraoperative diagnosis. The frog-leg test had high sensitivity (91.7%) and specificity (94.5%) for detecting posterolateral corner injuries. The sensitivity of the varus stress test increased from 83.3% to 90.0% when combined with the frog-leg test. CONCLUSIONS: Examiners were able to identify posterolateral corner injuries and differentiate injured from uninjured knees using the frog-leg test, which could potentially be used as an ancillary tool to the varus stress test in diagnosing injuries to the posterolateral corner of the knee. Larger studies are needed to confirm our findings.

Influence of hip restriction on noncontact ACL rerupture.

PURPOSE: This study investigated variables associated with hip restriction (reduced range of motion) in a group of soccer players presenting with noncontact rerupture of the anterior cruciate ligament (ACL) and compared results with a group of sport-matched healthy professional athletes. METHODS: In this case series, 28 male soccer players with noncontact ACL rerupture were examined for clinical hip range of motion findings potentially associated with ACL rerupture, namely anterior knee displacement, internal-external hip rotation, and cruciate ligament insufficiency. Results were compared with data obtained from 27 healthy professional players. Patients presenting gross surgical errors (e.g. poorly positioned tunnel) or reporting major accidents affecting the lower limbs, such as leg or ankle fractures, were excluded from analysis. Internal-external rotation was measured in the supine position, with knee and hip at 90° of flexion. ACL insufficiency was assessed using the Pivot Shift test and the Lachman's test with the aid of a Rolimeter RM(®) arthrometer and confirmed by magnetic resonance imaging. RESULTS: The most prevalent finding was a significantly lower mean internal-external hip rotation in the rerupture group (45.0°) when compared with healthy professional soccer players (56.2°). CONCLUSION: Assessing hip restriction in patients presenting noncontact ACL rerupture showed to be extremely important during ACL reconstruction planning.

Aerobic exercise training mitigates tumor growth and cancer-induced splenomegaly through modulation of non-platelet platelet factor 4 expression.

Exercise training reduces the incidence of several cancers, but the mechanisms underlying these effects are not fully understood. Exercise training can affect the spleen function, which controls the hematopoiesis and immune response. Analyzing different cancer models, we identified that 4T1, LLC, and CT26 tumor-bearing mice displayed enlarged spleen (splenomegaly), and exercise training reduced spleen mass toward control levels in two of these models (LLC and CT26). Exercise training also slowed tumor growth in melanoma B16F10, colon tumor 26 (CT26), and Lewis lung carcinoma (LLC) tumor-bearing mice, with minor effects in mammary carcinoma 4T1, MDA-MB-231, and MMTV-PyMT mice. In silico analyses using transcriptome profiles derived from these models revealed that platelet factor 4 (Pf4) is one of the main upregulated genes associated with splenomegaly during cancer progression. To understand whether exercise training would modulate the expression of these genes in the tumor and spleen, we investigated particularly the CT26 model, which displayed splenomegaly and had a clear response to the exercise training effects. RT-qPCR analysis confirmed that trained CT26 tumor-bearing mice had decreased Pf4 mRNA levels in both the tumor and spleen when compared to untrained CT26 tumor-bearing mice. Furthermore, exercise training specifically decreased Pf4 mRNA levels in the CT26 tumor cells. Aspirin treatment did not change tumor growth, splenomegaly, and tumor Pf4 mRNA levels, confirming that exercise decreased non-platelet Pf4 mRNA levels. Finally, tumor Pf4 mRNA levels are deregulated in The Cancer Genome Atlas Program (TCGA) samples and predict survival in multiple cancer types. This highlights the potential therapeutic value of exercise as a complementary approach to cancer treatment and underscores the importance of understanding the exercise-induced transcriptional changes in the spleen for the development of novel cancer therapies.

Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells.

PURPOSE: To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone marrow mononuclear cells (BMMC). METHODS: Fourteen consecutive patients (9 women, 5 men, mean age of 59.2 years) with complete rotator cuff tears (mean preoperative UCLA score of 12 ± 3.0) were fixed by transosseous stitches through mini-open incision, with subsequent injection of BMMC into the tendon borders, obtained from the iliac crest just prior to surgery. Magnetic resonance images (MRI) were acquired before and after surgery and evaluated by two musculoskeletal radiologists regarding new postoperative findings of patients treated with BMMC. RESULTS: After a minimum 12-month follow-up period, the UCLA score increased from 12 ± 3.0 to 31 ± 3.2. Clinical findings remained unaltered in the following year in all but one patient (13/14). MRI analysis after a 12-month follow-up period demonstrated tendon integrity in all cases (14/14), presence of low-signal intensity areas along the supraspinatus tendon and distal muscle belly in 8 cases (8/14), and high-intensity blooming small round artifact at the bursal and tendon topography in 11 cases (11/14). Six patients (6/14) showed formation of a high-signal intensity zone at the critical zone. Clinical findings remained unaltered in the following year in all but one patient, who relapsed into loss of strength and pain, being considered a bad result. CONCLUSION: Implantation of BMMC in rotator cuff sutures appears to be a safe and promising alternative to other biological approaches currently used to enhance tissue quality in affected tendons.

Dilated cardiomyopathy and sinoatrial dysfunction in an Estrela mountain dog.

A 1 yr old male Estrela mountain dog was evaluated as a part of a screening program for dilated cardiomyopathy. The dog came from a family with a history of dilated cardiomyopathy but was asymptomatic. Occult dilated cardiomyopathy and sino-atrial dysfunction were diagnosed based on echocardiography and electrocardiography. These two disorders may be associated given that related dogs have been diagnosed with the same disorders. The dog has remained asymptomatic for 4 years following initial evaluation.

mTOR signaling-related microRNAs as cardiac hypertrophy modulators in high-volume endurance training.

Aerobic exercise training (ET) promotes cardiovascular adaptations, including physiological left ventricular hypertrophy (LVH). However, the molecular mechanisms underlying these changes are unclear. The study aimed to elucidate specific microRNAs (miRNAs) and target genes involved with the protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling in high-volume ET-induced LVH. Eight-week-old female Wistar rats were assigned to three groups: sedentary control (SC), trained protocol 1 (P1), and trained protocol 2 (P2). P1 consisted of 60 min/day of swimming, 5 times/wk, for 10 wk. P2 consisted of the same protocol as P1 until the 8th week; in the 9th week rats trained 2 times/day, and in the 10th week they trained 3 times/day. Subsequently, structure and molecular parameters were evaluated in the heart. Trained groups demonstrate higher values of peak oxygen uptake ([Formula: see text]), exercise tolerance, and LVH in a volume-dependent manner. The miRNA-26a-5p levels were higher in P1 and P2 compared with the SC group (150 ± 15%, d = 1.8; 148 ± 16%, d = 1.7; and 100 ± 7%, respectively; P < 0.05). In contrast, miRNA-16-5p levels were lower in P1 and P2 compared with the SC group (69 ± 5%, d = 2.3, P < 0.01; 37 ± 4%, d = 5.6, P < 0.001; and 100 ± 6%, respectively). Additionally, miRNA-16-5p knockdown and miRNA-26a-5p overexpression significantly promoted cardiomyocyte hypertrophy in neonatal rat cardiomyocytes. Both miRNAs were selected, with the DIANA Tools bioinformatics website, for acting in the mTOR signaling pathway. The protein expression of AKT, MTOR, ribosomal protein S6 kinase beta-1 (P70S6K), and eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1) were greater in P1 and even more pronounced in P2. Nonetheless, glycogen synthase kinase 3 beta (GSK3ß) protein expression was lower in trained groups. Together, these molecular changes may contribute to a pronounced physiological LVH observed in high-volume aerobic training.NEW & NOTEWORTHY Physiological hypertrophic growth of the heart as a compensatory response to exercise training (ET) is coupled with recent progress in dissecting the microRNA (miRNA)-mediated molecular basis of hypertrophy. Aerobic ET seems to reduce miRNA-16-5p and increase miRNA-26a-5p expression in a volume-dependent mode, activating protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathways, and likely produces an enhanced left ventricular hypertrophy (LVH) in high-volume endurance training. New insight into these mechanisms can be useful in understanding physiological LVH and how it might be harnessed as a therapeutic application.

Radiographic findings in restrained hip joints associated with ACL rupture.

Although decreased hip range of motion has been detected in many soccer players with noncontact anterior cruciate ligament (ACL), it is not clear whether it is associated with bone spurs, capsular soft tissue stiffness or both. Our aim was to investigate abnormal radiographic findings in soccer players with limited hip range of motion and noncontact ACL injury. Fifty consecutive male soccer players with restricted hip range of motion and noncontact ACL injury were subjected to radiographic examination to identify bone changes that could be associated with decreased hip range of motion. Of 50 patients, 56% revealed abnormal radiographic findings: pericapsular calcifications or acetabular rim osteophytes (24%), femoral neck deformity (10%), femoral neck and acetabular rim disorders (18%), neck groove caused by impingement (4%). Radiographic evaluation of those individuals showed a high number of bone abnormalities around the hip joint. This was considered to be an important finding to guide a decision-making process between three different approaches: changing the type of sports practiced, undergoing a more restrictive surgery (such as a double-bundle intra-articular reconstruction or an intra plus extra technique) or the onset of a hip-stretching program in addition to the conventional ACL rehabilitation protocol. In this last option, ACL-operated patients without radiographic hip abnormalities may have better outcomes for their decreased hip range of motion when submitted to a stretching program targeting the prevention of rotational overload on the reconstructed intra-articular grafts. The decision-making process concerning soccer players with ACL ruptures should take into consideration the amount of motion-limiting abnormalities around the hip joint.

Femoral pseudoarthrosis and knee stiffness: long-term results of a one-stage surgical approach.

INTRODUCTION: The objective of this study was to analyze the surgical results of the simultaneous treatment of femoral pseudoarthrosis and knee stiffness using a combined one-stage approach (quadricepsplasty + osteoperiosteal decortications + bone autografting + fracture stabilization). PATIENTS AND METHOD: Twelve patients (six men) followed up for a minimum of 10 years and who had undergone surgery for these combined procedures were contacted for evaluation. Their mean age at the time of the surgery was 30 years (standard deviation, SD 15; range 22-65 years), and mean time from initial trauma was 16 months (SD 6, range 10-32 months). RESULTS: Mean range of motion improved from 10 degrees (SD 9) to 112 degrees (SD 13) postoperatively. Fractures healed in all patients, and improvement in their range of motion was statistically significant (Student's t-test = 31; P

Effects of aerobic and inspiratory training on skeletal muscle microRNA-1 and downstream-associated pathways in patients with heart failure.

BACKGROUND: The exercise intolerance in chronic heart failure with reduced ejection fraction (HFrEF) is mostly attributed to alterations in skeletal muscle. However, the mechanisms underlying the skeletal myopathy in patients with HFrEF are not completely understood. We hypothesized that (i) aerobic exercise training (AET) and inspiratory muscle training (IMT) would change skeletal muscle microRNA-1 expression and downstream-associated pathways in patients with HFrEF and (ii) AET and IMT would increase leg blood flow (LBF), functional capacity, and quality of life in these patients. METHODS: Patients age 35 to 70 years, left ventricular ejection fraction (LVEF) ≤40%, New York Heart Association functional classes II-III, were randomized into control, IMT, and AET groups. Skeletal muscle changes were examined by vastus lateralis biopsy. LBF was measured by venous occlusion plethysmography, functional capacity by cardiopulmonary exercise test, and quality of life by Minnesota Living with Heart Failure Questionnaire. All patients were evaluated at baseline and after 4 months. RESULTS: Thirty-three patients finished the study protocol: control (n = 10; LVEF = 25 ± 1%; six males), IMT (n = 11; LVEF = 31 ± 2%; three males), and AET (n = 12; LVEF = 26 ± 2%; seven males). AET, but not IMT, increased the expression of microRNA-1 (P = 0.02; percent changes = 53 ± 17%), decreased the expression of PTEN (P = 0.003; percent changes = -15 ± 0.03%), and tended to increase the p-AKTser473 /AKT ratio (P = 0.06). In addition, AET decreased HDAC4 expression (P = 0.03; percent changes = -40 ± 19%) and upregulated follistatin (P = 0.01; percent changes = 174 ± 58%), MEF2C (P = 0.05; percent changes = 34 ± 15%), and MyoD expression (P = 0.05; percent changes = 47 ± 18%). AET also increased muscle cross-sectional area (P = 0.01). AET and IMT increased LBF, functional capacity, and quality of life. Further analyses showed a significant correlation between percent changes in microRNA-1 and percent changes in follistatin mRNA (P = 0.001, rho = 0.58) and between percent changes in follistatin mRNA and percent changes in peak VO2 (P = 0.004, rho = 0.51). CONCLUSIONS: AET upregulates microRNA-1 levels and decreases the protein expression of PTEN, which reduces the inhibitory action on the PI3K-AKT pathway that regulates the skeletal muscle tropism. The increased levels of microRNA-1 also decreased HDAC4 and increased MEF2c, MyoD, and follistatin expression, improving skeletal muscle regeneration. These changes associated with the increase in muscle cross-sectional area and LBF contribute to the attenuation in skeletal myopathy, and the improvement in functional capacity and quality of life in patients with HFrEF. IMT caused no changes in microRNA-1 and in the downstream-associated pathway. The increased functional capacity provoked by IMT seems to be associated with amelioration in the respiratory function instead of changes in skeletal muscle. ClinicalTrials.gov (Identifier: NCT01747395).

Decreased hip range of motion and noncontact injuries of the anterior cruciate ligament.

PURPOSE: Our purpose was to investigate whether there is an association between decreased hip range of motion and noncontact anterior cruciate ligament (ACL) injuries in soccer players. METHODS: In this case-control study, 50 soccer players with noncontact ACL injuries confirmed by surgery had their hips examined and compared with those of a control group. Findings were statistically analyzed according to 2 cutoff points (70 degrees and 80 degrees of total internal-external rotation sum) for both groups. RESULTS: A significant decrease in hip range of motion was found in 38% of all individuals studied at the lower cutoff point (70 degrees ) and for 64% at the upper cutoff point (80 degrees ). The decrease in hip range of motion was greater in the group with ruptured ACLs than in the control group, with little difference between the 2 cutoff points (70 degrees and 80 degrees ). The difference between patients and control subjects was statistically significant (P < .001). CONCLUSIONS: There was a strong association between decreased hip range of motion and ACL ruptures in soccer players, not only but mainly because of internal rotation lessening. Despite lacking comparison with other sports, our findings showed a higher decrease in hip range of motion in the group of soccer players when compared with the general population. LEVEL OF EVIDENCE: Level III, prognostic case-control study.

Corrigendum to "Exercise Training Restores Cardiac MicroRNA-1 and MicroRNA-29c to Nonpathological Levels in Obese Rats".

[This corrects the article DOI: 10.1155/2017/1549014.].

The GO-DACT protocol: a multicentre, randomized, double-blind, parallel-group study to compare the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy.

The GO-DACT is an investigator-initiated, national, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoriatic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial.

Osteochondral Allograft Transplantation for Treatment of Focal Patellar Osteochondral Lesion.

Patellar osteochondral lesions are common and particularly disabling injuries that can affect young and highly active patients. If enough functional impairment, ranging from difficulty climbing stairs to pain with squatting, is present, surgical treatment may be warranted. For the treatment of these lesions, various techniques have been described, including autologous osteochondral transplantation, as well as microfracture surgery. However, these are not without disadvantages. Although morbidity is noted in cases of autologous osteochondral transplantation, uncertain and possibly unsustainable results are associated with the microfracture procedure. Therefore, we present an alternative surgical treatment option for this pathology. The objective of this Technical Note is to describe our preferred approach for an osteochondral allograft transplant procedure to treat a focal patellar osteochondral lesion.

Arthroscopic Bony Resection for Treatment of Symptomatic Bipartite Patella.

Bipartite patella is a common pathology, affecting 2% to 3% of the population. Usually these cases are bilateral and asymptomatic. However, a patient with a bipartite patella may complain of pain, which is most likely related to fragment mobility. Conservative treatment with physiotherapy, immobilization, and nonsteroidal drugs are encouraged during the initial 6 months following diagnosis. This option is effective in most patients. For patients who do not improve with these conservative measures, surgical intervention is indicated. Many surgical treatment options have been described including excision of the fragment, as well as fixation. Fragment excision has demonstrated positive outcomes and is associated with an asymptomatic return to sport activities. The purpose of this Technical Note is to describe our preferred arthroscopic technique for the treatment of symptomatic bipartite patella.

Simultaneous Bilateral Knee Valgus Stress Radiographic Technique.

The medial collateral ligament is the most commonly injured knee ligament. Valgus stress radiographs are reported to be an effective way to quantify the medial compartment opening. However, most of the techniques require the presence of a physician in the radiograph room to apply a manual valgus stress force, and can only be performed in 1 knee at a time. These techniques, although extremely effective, increase radiation exposure to physicians, are time consuming, and require additional radiographs to compare the side-to-side difference. The purpose of this Technical Note is to describe our preferred valgus stress radiographic technique to evaluate medial side laxity, which offers several advantages compared with conventional manual techniques.

Acromioclavicular Joint Dislocation: Repair Through Open Ligament Transfer and Nonabsorbable Suture Fixation.

Acromioclavicular (AC) joint instability is a fairly common and particularly limiting injury that may result in persistent pain and reduced quality of life. In most cases, conservative management is successful. However, in the case of a severe AC joint dislocation, surgical intervention may be warranted. Previous surgical techniques for treatment of AC joint instability include screw fixation between the coracoid and clavicle, coracoacromial ligament transfer from its acromial insertion to the clavicle, and reconstruction of the coracoacromial and/or coracoclavicular ligaments. The purpose of this Technical Note is to describe our preferred technique for the treatment of a high-grade AC dislocation through coracoacromial ligament transfer to the lateral clavicle and nonabsorbable suture fixation between the coracoid process and clavicle.

Exercise Training Restores Cardiac MicroRNA-1 and MicroRNA-29c to Nonpathological Levels in Obese Rats.

We previously reported that aerobic exercise training (AET) consisted of 10 weeks of 60-min swimming sessions, and 5 days/week AET counteracts CH in obesity. Here, we evaluated the role of microRNAs and their target genes that are involved in heart collagen deposition and calcium signaling, as well as the cardiac remodeling induced by AET in obese Zucker rats. Among the four experimental Zucker groups: control lean rats (LZR), control obese rats (OZR), trained lean rats (LZR + TR), and trained obese rats (OZR + TR), heart weight was greater in the OZR than in the LZR group due to increased cardiac intramuscular fat and collagen. AET seems to exert a protective role in normalizing the heart weight in the OZR + TR group. Cardiac microRNA-29c expression was decreased in OZR compared with the LZR group, paralleled by an increase in the collagen volumetric fraction (CVF). MicroRNA-1 expression was upregulated while the expression of its target gene NCX1 was decreased in OZR compared with the LZR group. Interestingly, AET restored cardiac microRNA-1 to nonpathological levels in the OZR-TR group. Our findings suggest that AET could be used as a nonpharmacological therapy for the reversal of pathological cardiac remodeling and cardiac dysfunction in obesity.

Arthroscopic protocol for treatment of knee extension block after patellar ACL reconstruction.

This study presents a new protocol for arthroscopic approach based on the treatment of 36 patients with extension block of the knee as a result of intra-articular reconstruction of the anterior cruciate ligament (ACL) using the patellar tendon. Arthroscopy not only allowed the identification of the active mechanical extension block of the knee, but also the passive mechanical block that can occur with a functional or loose ligament. This protocol can be useful in the treatment of postoperative extension block of the knee as a complication of ACL reconstruction.