Tunnel osteolysis post-ACL reconstruction: a systematic review examining select diagnostic modalities, treatment options and rehabilitation protocols.

PURPOSE: The purpose of this systematic review was to (1) identify the optimal diagnostic modality for tunnel widening in skeletally mature patients; (2) identify potentially modifiable risk factors for tunnel widening, such as graft type, and (3) determine what elements of a post-operative rehabilitation program exert the most influence on TW. METHODS: The electronic databases MEDLINE, EMBASE, PubMed, and Cochrane Library were searched from database inception to January 2018. Studies that discussed tunnel widening following anterior cruciate ligament reconstruction (ACLR) of skeletally mature patients and written in English were included. Descriptive statistics, such as means, ranges, and measures of variance (e.g. standard deviations, 95% confidence intervals (CI)) are presented where applicable. RESULTS: 103 studies (6,383 patients) were included. Plain radiographs were the most commonly used diagnostic modality, but radiographs on average required 10 months longer than CT and 2 months longer on average than MRI to diagnose tunnel widening after ACLR. Although CT was the least commonly used modality, it was the shortest time to diagnose tunnel widening at 9.5 months after ACLR. Bone-patellar tendon-bone (BPTB) allograft had the largest average tunnel widening overall. BPTB autograft had the lowest average tunnel widening overall. Double-bundle hamstring graft configuration had a lower average tunnel widening than single-bundle configuration. Rehabilitation protocols after ACLR that used a full weight-bearing prescription in rehabilitation showed a greater average femoral tunnel widening than partial weight-bearing, and partial weight-bearing showed a greater average tibial tunnel widening than full weight-bearing. CONCLUSIONS: Based on this systematic review and the descriptive data evaluated, CT demonstrated a time of 9.5 months on average from ACLR to diagnosing tunnel osteolysis post-ACLR. With respect to graft types, double-bundle hamstring autografts reported lower average femoral and tibial TW than single-bundle hamstring autografts. BPTB autografts reported the lowest average TW and BPTB allograft the largest average TW of all the grafts. Furthermore, extension-locked bracing had the lowest TW of all the brace protocols. Lastly, several other surgical technical parameters influencing tunnel osteolysis remain to be determined. No definitive recommendations can be made at this time due to the high heterogeneity of data and the lack of comparative studies analysed in this systematic review. LEVEL OF EVIDENCE: IV.

The use of physiotherapy in the regeneration of periapical bone structures of the teeth, prepared to load the prosthetic.

The aim of this work was to investigate whether the use of magnetoledotherapy will accelerate the elimination of osteolytic lesions of the dental periapical area, and provide for prosthetic treatment. What impact on time of healing does the inflammatory change location, type of treatment or patient's age have? 69 patients underwent the examination. The problem of osteolytic lesions in the course of protracted or protracted acute dental periapical tissue inflammation was determined. Patients were divided into two research groups: group L - treated with magnetoledotherapy and group K - treated without the support of magnetoledotherapy. In the first group we applied the electromagnetic field, generated using the Viofor JPS Clinic apparatus. Our studies have confirmed the effectiveness of magnetoledotherapy in the accelerated decommissioning of the osteolytic lesion. This provides evidence of the appropriateness of this method in the treatment of protracted dental periapical tissue inflammation, in teeth qualified for prosthetic load. Magnetostimulation combined with LED energy is an adjunctive procedure, adopted in order to eliminate osteolytic inflammatory changes of dental periapical tissues. It can be used in all age groups with the same good result. After applying magnetoledotherapy, in the course of the dental periapical tissue repair process of tooth treated endodontically for the first time as well as reendodontically, no differences were found. This shows the opportunity of using magnetoledotherapy in all cases of protracted periapical tissue inflammation.

Polyethylene wear and osteolysis after cementless total hip arthroplasty with alumina-on-highly cross-linked polyethylene bearings in patients younger than thirty years of age.

BACKGROUND: We asked whether cementless total hip arthroplasties that made use of alumina-on-highly cross-linked polyethylene bearings would improve hip score and functional activity and reduce the prevalence of polyethylene wear, osteolysis, and aseptic loosening. METHODS: Consecutive primary total hip arthroplasties were performed in fifty patients (a total of sixty hips among thirty-four men and sixteen women) who were younger than thirty years of age. The average age at the time of the index arthroplasty was 28.3 years (range, twenty-one to twenty-nine years). The average follow-up was 10.8 years (range, ten to twelve years). Osteolysis and polyethylene wear rates were evaluated with use of radiography and computed tomography. RESULTS: The mean Harris hip score, which was 38 points (range, 6 to 45 points) preoperatively, had improved to 95 points (range, 85 to 100 points) at a mean follow-up time of 10.8 years. The mean penetration (and standard error of the mean) of the polyethylene liner was 0.031 ± 0.004 mm per year. No hip had osteolysis or aseptic loosening. CONCLUSIONS: At a minimum of ten years and an average of 10.8 years postoperatively, the current generation of cementless acetabular and femoral components with alumina-on-highly cross-linked polyethylene bearings was functioning well and was not associated with the development of osteolysis in our group of patients younger than thirty years of age. While the long-term prevalence of polyethylene wear and osteolysis remains unknown, the midterm data are promising.

Hajdu-Cheney syndrome: rehabilitation after decompression of cervical spinal cord compromise.

Cervical spinal cord compromise can be caused by many pathologic conditions. In this case report, a patient with Hajdu-Cheney syndrome, an exceedingly rare disorder of bony elements which led to basilar skull invagination and subsequent cervical cord compression, is described. Postoperatively, the patient continued to have difficulty with self-care and ambulation and required an extensive rehabilitation program which included mat activities, progressive resistive exercises, activities of daily living, and gait training. She was able to become independent in transfers, ambulation, and activities of daily living. The patient's rehabilitation course after cervical spinal cord decompression is presented, along with a brief description of the clinical features of this unusual disease process.