Enhanced Pain Relief and Function Improvement in Children with Osgood-Schlatter Disease: Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) as a Complementary Treatment to Standard Conservative Therapy.

BACKGROUND Osgood-Schlatter disease (OSD) causes pain and loss of function of the knee in growing children. This study aimed to evaluate pain and function of the knee joint in 152 growing children with chronic OSD before and after treatment with LR-PRP when used with standard conservative treatment. MATERIAL AND METHODS Treatment efficacy was evaluated using the VAS, Tegner, Lyshom, and KOOS scales. Patient satisfaction, post-surgery athletic performance, and X-ray assessment were also used to determine the success of the procedure. RESULTS We found that 75% of the subjects were satisfied with the results of the treatment, and 72% of the subjects returned to full physical activity. The analysis showed a significant decrease in the median VAS score after treatment compared to the pre-treatment score (P<0.05), and an increase in the median scores of the Tegner, Lysholm, and KOOS scales compared to the pre-treatment score (P<0.05; P<0.05; P<0.05, respectively). The results showed that the shorter the duration of the disease, the better the treatment results were received. Return to activity and patient satisfaction were highest in the study group previously rehabilitated. CONCLUSIONS LR-PRP injection of the tibial tuberosity in patients with chronic OSD with open growth cartilage is an effective and uncomplicated method. We did not observe any adverse effects, which suggests the relatively high safety of the procedure. The use of PRP in the earlier phase of the disease and additional rehabilitation before treatment significantly increases the effectiveness of treatment.

EVALUATION OF THE EFFECTIVENESS OF PHYSIOTHERAPEUTIC INTERVENTIONS IN THE TREATMENT OF THORACIC PAІN IN PATIENTS WITH THORACIC OSTEOCHONDROSIS.

The purpose of the study is to improve the results of complex restorative treatment of patients with pain syndrome in osteochondrosis of the thoracic spine. The study was conducted on the basis of the Rehabilitation Department of the State Institution "ITO NAMSU" in Kiev (from 2020 to 2022). The study involved 150 patients with pain in the thoracic spine, who were treated in the rehabilitation department. The mean age of the patients was 44.7±1.5 years. The average duration of the disease was 10.2±0.3 years, treatment - 13.5±1.0 days. Evaluation of treatment results using the Visual Analogue Scale of pain (Visual Analogue Scale) and electromyography on DIGITAL M - TEST was carried out 14 days after the program of physiotherapy interventions. The developed program of rehabilitation interventions included the use of myofascial release of the thoracic spine, physical exercises, breathing exercises during the myofascial release of the thoracic spine. The analysis of the obtained results showed that after the rehabilitation measures with the use of myofascial release, there was a statistically significant decrease in the level of pain in the group of examined patients (before PT - 4.87±0.47 cm, after PT - 1.17±0.26*) * (x±S), (p<0.01), which allows us to conclude that the program of physiotherapy interventions is effective. The use of myofascial release in the complex of physiotherapeutic interventions improves the quality of life and saves patients from thoracic paіn caused by degenerative changes in the spine in the short term.

Not all the bowlegs is rickets! (a case report).

Bowing of the legs is common in childhood. Most times it is considered to be rickets without considering other possibilities. Blount´s disease is a close differential diagnosis which is developmental deformity characterized by intorsion of tibia leading to varus angulation. This case report aims to encourage pediatricians to expand their vision and consider other possibilities when a case of bowing of legs is encountered. Here we report a case of a four-year-old boy with bowing of both legs noticed first at 2.5 years of age. There was no history suggestive of trauma. Development of the child was age appropriate in all domains. He was receiving treatment for rickets for 1.5 years in form of oral vitamin D3 and calcium supplementations. He had no other clinical signs of rickets like frontal bossing, widening of wrists, and rachitic rosary except bowing of legs. His biochemical parameters did not show any alterations that would support the diagnosis of rickets. Weight-bearing radiographs of lower limbs showed medial intorsion of bilateral tibia with metaphyseo-diaphysial angle to be 25º on the right side and 20º on the left side, which was beyond the physiological normal angulation, therefore he was diagnosed as a case of Blount´s disease, stage III as per Langenskiöld classification. All the bow legs is not always rickets in pediatric practice. Therefore, various differential diagnoses should be kept in mind as early diagnosis and intervention can change a child´s life.

The use of radon baths in the rehabilitation of patients with osteochondrosis.

OBJECTIVE: One of the most common methods of rehabilitation for this disease is balneotherapy. Radon therapy is one of the types of balneotherapy based on radon radiation (Rn) for therapeutic, prophylactic, and rehabilitation purposes. A significant number of authors report a positive effect of radon baths on the condition of patients with osteochondrosis. Some authors report the absence of a real therapeutic effect when using radon therapy. The work aimed at investigating the therapeutic efficacy of radon baths in patients suffering from osteochondrosis. PATIENTS AND METHODS: We examined 40 patients with osteochondrosis of various parts of the spine with radicular syndrome. The patients were randomly divided into two groups of 20 people with an equal number of men and women. The study group received a course of balneotherapy using radon water (general baths at a temperature of 34-36°C, duration 10-15 minutes, every other day, No. 10). The control group received balneotherapy using ordinary tap water in the same regimen to decrease placebo effects. RESULTS: Decreased pain and movement difficulties were observed only in the study group. These changes refer only to the spine but not to the joints of the extremities. CONCLUSIONS: Our studies have shown that using radon baths helps to reduce pain and increase the mobility of the spine in patients with osteochondrosis. These data substantiate the prospects for further research of this technique in the complex rehabilitation of osteochondrosis.

Hyperosmolar dextrose injection for Osgood-Schlatter disease: a double-blind, randomized controlled trial.

OBJECTIVE: Osgood-Schlatter disease (OSD) is one of the common causes of long-term knee pain, leading to functional limitations, long-term deformity of the tubercle interfering with kneeling, and impaired peer-important sport participation. Nonetheless, patient management continues to rely on the usual conservative methods. This study examined the use of hyperosmolar dextrose injection in patients with OSD. METHODS: We conducted a randomized, double-blind clinical trial involving 70 patients with OSD. One group received a hyperosmolar dextrose injection (12.5%), while the other received a saline injection. The injections were conducted under ultrasound guidance. The Victorian Institute of Sport Assessment (VISA) score was used to assess each patient's pain and sport level. RESULTS: The dextrose group outperformed the saline group in improvement in the VISA-Patella (VISA-P) score from baseline to 3 months (27.1 ± 6.5 vs. 1.4 ± 2.6; mean difference 25.4 (22.4 to 28.3); p < .0001), 6 months (31.7 ± 7.9 vs. 25.2 ± 7.8; mean difference 6.2 (3.2 to 9.4); p < .0001), and 12 months (34 ± 9.0 vs. 28.2 ± 7.5; mean difference 5.5 (1.9 to 9.1); p = .0026). The changes in both groups were clinically important, suggesting that both therapies were active treatments. The dextrose group improved too rapidly for spontaneous improvement to explain much of this change. CONCLUSION: After three injections, at the 6-month and 12-month follow-up visits, the VISA-P scores of the two groups were significantly improved; the dextrose group score was better than the saline group score, and there were significant differences between the two groups.

[Development of an algorithm for the appointment of biofeed-back therapy and Cytoflavin for the treatment of osteochondrosis in elderly patients.]

Continuous improvement of protocols for the treatment of various ailments, in particular, osteochondrosis, is one of the important tasks of providing medical care to elderly patients. Supplementation of treatment with Cytoflavin and biofeed-back therapy seems to be a promising solution, however, it is necessary to develop an algorithm to predict it effectiveness in patients taking into account their initial clinical and psychophysiological status. As a result of the treatment, predictors of the effectiveness of the use of Cytoflavin and biofeed-back therapy have been identified and an algorithm for their administration has been developed.

Alleged predisposing dietary factors fail to increase the incidence of osteochondrosis-like lesions in growing pigs at 14 and 24 wk of age.

Early lesions of osteochondrosis (OC) are exhibited by regions of cartilage retention along the growth plate and articular cartilage. Progression of OC lesions may impair locomotion and necessitate euthanasia in adherence to animal welfare guides. Little is known about the role of nutrition in the initiation and early stages of OC. However, dietary components are commonly implicated as predisposing factors. In this study, diets were altered as an attempt to induce early stage OC lesions under controlled conditions. At 8 wk of age, 96 crossbred gilts (body weight [BW] = 17.4 ± 0.18 kg) were randomly assigned to one of four corn-soybean meal-based diets (four pens per diet, six pigs per pen) to assess diet effects on the number and volume of OC lesions in the distal femur. Diets included a non-pelleted control diet (Ctl); Ctl plus 20% glucose (Glc); the Ctl with increased concentrations of lysine, Ca, and P (+CaP); and the +CaP diet in a pelleted form (PEL). Femurs were collected from pigs euthanized at either 14-wk (Wk 14) or 24-wk (Wk 14) of age for assessments of OC lesions. Based on a mixed model analysis with pen as the experimental unit, dietary treatments did not affect final BW (129.3 ± 3.8 kg) or average daily gain (ADG) (1.00 ± 0.03 kg/d) over the trial. As expected, pigs fed PEL and Glc diets were more efficient (P < 0.05) in feed conversion compared with Ctl and +CaP. Using femurs as the experimental unit at Wk 14 (collected from two of the six pigs per pen), bone mineral content, determined by dual-energy x-ray absorptiometry scans, was greater (P < 0.05) in pigs fed +CaP and PEL than Ctl or Glc diets; however, only +CaP group differed (P < 0.05) at Wk 24 (collected from four pigs per pen). Computed tomography (CT) scans of femurs were reconstructed as three-dimensional images to allow detection of the number, volume, and surface area of lesions in distal growth plates. At Wk 14, pigs fed Ctl had fewer number of lesions (P < 0.05); however, no differences were detected among dietary treatments in lesion volume or lesion surface area. Pigs had fewer lesions at Wk 24 than Wk 14; however, differences were not detected among dietary treatments. At Wk 24, pigs fed Ctl diets had the greatest lesion volume among dietary treatments (P < 0.05). In conclusion, none of the pigs exhibited symptoms of lameness regardless of dietary treatment or OC lesion traits. Diet modifications due to pelleting or inclusion of rapidly digestible ingredients, such as glucose, did not increase prevalence or size of OC lesions. Image analysis of CT scans was a reliable method to quantify the number, size, and location of OC lesions.

Response of cattle with clinical osteochondrosis to mineral supplementation.

Since 1982, farmers in the North West province and other parts of South Africa have noticed an increase in the incidence of lameness in cattle. Macro- and microscopical lesions of joints resembled osteochondrosis. Pre-trial data indicated that cattle with osteochondrotic lesions recovered almost completely when fed a supplement containing bio-available micro- and macrominerals of high quality. In the present trial, 43 clinically affected cattle of varying ages (1-5 years) and sexes were randomly divided into three groups. Each group was fed the same commercial supplement base with differing micro- and macromineral concentrations to determine the effect of mineral concentrations on the recovery from osteochondrosis. Both supplements 1 and 2 contained 25% of the recommended National Research Council (NRC) mineral values. Additional phosphate was added to supplement 2. Supplement 3, containing 80% of the NRC mineral values, was used as the control. Results from all three groups indicated no recovery from osteochondrosis. Urine pH of a small sample of the test cattle showed aciduria (pH < 6). Supplement analysis revealed addition of ammonium sulphate that contributed sulphate and nitrogen to the supplement. Supplementary dietary cation anion difference (DCAD) values were negative at -411 mEq/kg, -466 mEq/kg and -467 mEq/kg for supplements 1, 2 and 3, respectively, whereas the pre-trial supplement was calculated at +19.87 mEq/kg. It was hypothesised that feeding a low (negative) DCAD diet will predispose growing cattle to the development of osteochondrosis or exacerbate subclinical or clinical osteochondrosis in cattle.

Zinc: the Other Suspected Environmental Factor in Kashin-Beck Disease in Addition to Selenium.

Kashin-Beck disease (KBD) is an endemic chronic osteochondral disease characterized by high prevalence, disability, and morbidity and is distributed from the northeast to the southwest in China, in some regions of Eastern Siberia in Russia, and in North Korea. Although the selenium deficiency etiological hypothesis for KBD has been proposed by scientists for decades, the idea that selenium deficiency is one of the most important environmental factors but not the primary and sole pathogenic factor for KBD has been widely accepted. Zn2+, which is closely involved in the synthesis of enzymes, nucleic acids, and proteins, is an essential microelement in vivo. A conundrum still exists in research on the relationship between Zn2+ and KBD due to inconsistent results, but it has been confirmed that Zn2+ can help repair metaphyseal lesions in patients with KBD, indicating that Zn2+ might play a key role in the pathogenesis of KBD, although the mechanism is unknown. The zinc-ZIP8-MTF1 axis in chondrocytes forms a catabolic cascade that promotes upregulation of the crucial effector matrix-degrading enzymes MMP3, MMP13, and ADAMTS5, thereby leading to osteoarthritis (OA) cartilage destruction. Zinc finger protein-related genes, the ZNT family, and the ZIP family of Zn2+ transporter genes have been found to be differentially expressed in KBD by high-throughput screening. Therefore, Zn2+ could play a key role in the pathogenesis of KBD.

[The application of the biological feedback technique for the treatment of the patients presenting with chronic somatic diseases]. / Primenenie metoda biologicheskoi obratnoi svyazi pri lechenii patsientov s khronicheskimi somaticheskimi zabolevaniyami.

The objective of the present work was to study the influence of the application of the biological feedback (BFB) technique on the dynamics of the psychological and clinical status of the patients presenting with various chronic somatic diseases (CSD) and to identify the predictors of the effectiveness of the treatment by this method. PATIENTS AND METHODS: The study included 337 patients suffering from CSD who were interviewed with the use of the concise standardized multifactorial personality inventory (SMPI), the Spielberger State-Trait Anxiety Inventory (STAI), and the Beck depression inventory (BDI) scales. The patients were randomly distributed into two groups. Group 1 (main) was comprised of 168 patients who underwent psychotherapeutic treatment based on the BFB method, group 2 (control) consisted of 169 patients who did not receive the psychotherapeutic treatment. In order to identify the predictors of the effectiveness of the treatment by the biological feedback technique, the patients of the main group were subdivided into two subgroups at the end of the study period. Subgroup A contained 112 (67%) patients whose health status was normalized under the influence of psychotherapy, subgroup B included 56 (33%) patients who experienced the improvement of the somatic conditions. We undertook the comparative analysis of the background characteristics of the patients belonging to each group. RESULTS AND DISCUSSION: The study has demonstrated that by the end of the observation period the patients of the main group showed a significantly more pronounced (compared with controls) decrease of the parameters estimated based on the scales 1, 2, and 7 and an increase of those evaluated based on the (SMPI) scale 9. Simultaneously, the levels of state and trait anxiety estimated based on the Spielberger и Beck inventory scales decreased. These findings give evidence of the improvement of psychological adaptation of the patients, decrease of the anxiety level and emotional stress under the influence of the treatment with the use of the biological feedback technique; these changes were concomitant with the enhancement of the general activity of the patients, the improvement of their working capacity, mood, and feelings of optimism. The study of the predictors of the effectiveness of the BFB method revealed the significantly higher background values estimated based on the SMPI scales 1, 4, and 6 in the patients with the improvement of the health status compared with those exhibiting normalized conditions (p<0,01). In 12% of the patients in the former subgroup (but in none of the patients of the latter subgroup), the values obtained based on the Beck scale were higher than 20 scores which suggested either the moderate or high level of depression. These data give reason to conclude that the patients that exhibited a relatively weak response to the treatment with the application of the biological feedback technique were initially predisposed to the un-necessary excessive fixation of attention on their sensations in the combination with enhanced impulsivity, rigidity of attitudes, and the presence of depressive disorders.

Osteochondrosis prevalence and severity at 12 and 24 weeks of age in commercial pigs with and without organic-complexed trace mineral supplementation.

Maternal and progeny diets supplemented with 2 sources of trace mineral (TM) were evaluated for effects on the size and severity of osteochondrosis (OC) lesions in progeny produced by 64 Landrace × Large White sows. At breeding, sows were randomly assigned to maternal diets (gestation and lactation) consisting 1 of 2 TM treatments. One treatment consisted of inorganic TM (ITM) with ZnO, MnSO, and CuSO at concentrations to provide 150, 50, and 16.5 mg/kg diet of Zn, Mn, and Cu, respectively. The other treatment consisted of the same ITM concentrations plus an additional 50, 20, and 10 mg/kg diet of Zn, Mn, and Cu, respectively, supplied by a blend of AA-complexed TM (CTM) using Availa Sow. Within maternal dietary treatment groups, selected progeny ( = 280) were fed either ITM- or CTM-supplemented diets. The humerus and femur (1 each) from progeny euthanized at 12 ( = 80) or 24 wk ( = 200) were collected for microscopic (12 wk) or gross (24 wk) assessment of OC lesions. Microscopic OC lesions were present in all pigs at 12 wk. Dietary treatments had limited effects on OC prevalence or severity. A maternal × progeny diet interaction ( = 0.044) revealed femoral OC latens lesions that were approximately twice the size in progeny fed CTM that were produced by sows fed CTM compared with those found in pigs in the other 3 dietary treatment groups. At 24 wk, the sum of gross OC scores at predilection sites of the thoracic (elbow joint) and pelvic (stifle and hock joints) limbs remained similar among treatments, despite greater ( = 0.004) gross OC scores of the medial femoral condyle in progeny from sows fed CTM diets than in progeny from sows fed ITM diets, regardless of progeny diet. Progeny produced by sows fed CTM vs. ITM had increased ADG (0.71 vs. 0.68 ± 0.01 kg/d), regardless of the diet fed to progeny during the growth phases. Covariant analysis using ADG did not alter inferences about maternal or progeny diet effects on OC responses. Although 100% of progeny at 12 wk had histologically apparent OC lesions, only 3 of the 200 pigs examined at 24 wk had gross lesions of sufficient severity to potentially result in clinically apparent disease. Therefore, although some results imply that maternal and progeny CTM diets increased the size (12 wk) and severity (24 wk) of OC in 1 site (the femur), on the whole animal level, no evidence of lameness was noted.

Acupuncture in Osgood-Schlatter disease.

This article describes the use of acupuncture in the management of knee pain in Osgood-Schlatter disease. Manual and electroacupuncture were used. The patient responded well to acupuncture and found it effective in relieving his knee pain. Acupuncture should be considered in Osgood-Schlatter disease, both to manage the pain and to limit the need to take oral analgaesics for a prolonged period.

The aetiology of rickets-like lower limb deformities in Malawian children.

UNLABELLED: Debilitating rickets-like lower limb deformities are common in children throughout the world, particularly in Malawi, Africa where the causes are unknown. We have identified that Blount disease and calcium deficiency rickets are the likely causes of these deformities and propose calcium supplementation as a potential treatment of Malawian rickets. INTRODUCTION: Surgical correction of rickets-like lower limb deformities is the most common paediatric operation performed at Beit Cure Orthopaedic Hospital, Malawi. The aim of this study was to investigate the aetiology of these deformities. METHODS: Children with a tibio-femoral angle of deformity >20° were enrolled (n = 42, 3.0-15.0 years). Anthropometric and early life and well-being data were collected. Early morning serum and urine samples were collected on the morning of the operation for markers of calcium and phosphate homeostasis. Knee radiographs were obtained, and the children were diagnosed with either Blount (BD, n = 22) or evidence of rickets disease (RD, n = 20). As BD is a mechanical rather than metabolic disease, BD were assumed to be biochemically representative of the local population and thus used as a local reference for RD. RESULTS: There were no differences in anthropometry or early life experiences between BD and RD. Parathyroid hormone (PTH), 1,25-dihydroxyvitamin D, total alkaline phosphatase and urinary phosphate were significantly higher and serum phosphate, 25-hydroxyvitamin D (25OHD) and tubular maximal reabsorption of phosphate significantly lower in RD than BD. There was no difference in serum calcium, fibroblast growth factor 23 or markers of iron status between groups. All children had 25OHD > 25 nmol/L. CONCLUSIONS: Vitamin D deficiency is not implicated in the aetiology of RD or BD in Malawian children. The cause of RD in Malawi is likely to be dietary calcium deficiency leading to elevated PTH resulting in increased losses of phosphate from the bone and glomerular filtrate. The causes of BD remain unclear; there was no evidence in support of previously suggested risk factors such as being overweight or starting to walk early. Prior to surgical intervention, supplementation with calcium should be considered for children with RD.

Effects of moderate amounts of barley in late pregnancy on growth, glucose metabolism and osteoarticular status of pre-weaning horses.

In stud management, broodmares are commonly fed concentrates in late pregnancy. This practice, however, was shown to correlate with an increased incidence of osteochondrosis in foals, which may be related to insulin sensitivity. We hypothesized that supplementation of the mare with barley in the last trimester of pregnancy alters the pre-weaning foal growth, glucose metabolism and osteoarticular status. Here, pregnant multiparous saddlebred mares were fed forage only (group F, n=13) or both forage and cracked barley (group B, n=12) from the 7th month of pregnancy until term, as calculated to cover nutritional needs of broodmares. Diets were given in two daily meals. All mares and foals returned to pasture after parturition. Post-natal growth, glucose metabolism and osteoarticular status were investigated in pre-weaning foals. B mares maintained an optimal body condition score (>3.5), whereas that of F mares decreased and remained low (<2.5) up to 3 months of lactation, with a significantly lower bodyweight (-7%) than B mares throughout the last 2 months of pregnancy. B mares had increased plasma glucose and insulin after the first meal and after the second meal to a lesser extent, which was not observed in F mares. B mares also had increased insulin secretion during an intravenous glucose tolerance test (IVGTT). Plasma NEFA and leptin were only temporarily affected by diet in mares during pregnancy or in early lactation. Neonatal B foals had increased serum osteocalcin and slightly increased glucose increments and clearance after glucose injection, but these effects had vanished at weaning. Body measurements, plasma IGF-1, T4, T3, NEFA and leptin concentrations, insulin secretion during IVGTT, as well as glucose metabolism rate during euglycemic hyperinsulinemic clamps after weaning, did not differ between groups. Radiographic examination of joints indicated increased osteochondrosis relative risk in B foals, but this was not significant. These data demonstrate that B or F maternal nutrition has very few effects on foal growth, endocrinology and glucose homeostasis until weaning, but may induce cartilage lesions.

[THE APPLICATION OF ANTIHOMOTOXIC DRUG PREPARATIONS IN THE COMPLEX TREATMENT IN PATIENTS WITH NEUROLOGICAL MANIFESTATIONS OF LUMBAR OSTEOCHONDROSIS].

The expediency of application homeosyniatry by preparations of Traumel S and Placenta Compositum after the offered chart in relation to a complex with classic acupuncture and in relation to the group of the generally accepted treatment has been proved in complex treatment patients with reflex syndromes of lumbar osteochondrosis. A similar conclusion was done after the statistically reliable (P < 0.05) dynamics of parameters of endogenous intoxication, liperoxydation and antioxydant systems of the protection (by the level of katalase, superoxyddismutase, SH-groups, ceruloplasmine).

Chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells in a simulated osteochondral environment is hydrogel dependent.

Hydrogels pose interesting features for cartilage regeneration strategies, such as the option for injectability and in situ gelation resulting in optimal filling of defects. We aimed to study different hydrogels for their capability to support chondrogenesis of human bone marrow-derived mesenchymal stem cells (hBMSCs). hBMSCs were encapsulated in alginate, alginate with hyaluronic acid (alginate/HA), fibrin or thermoresponsive HA grafted with poly(N-isopropyl acrylamide) side-chains (HA-pNIPAM). Glycosaminoglycan production and cartilage-related gene expression were significantly higher in hBMSC-alginate and hBMSC-fibrin constructs than in the other constructs. Supplementation of alginate with HA was not beneficial. hBMSC-alginate, hBMSC-fibrin and hBMSC-HA-pNIPAM constructs were placed in simulated defects in osteochondral biopsies and cultured in vitro for 28 d. Biopsies containing hBMSC-alginate and hBMSC-fibrin were implanted subcutaneously in nude mice for 12 weeks. hBMSC-alginate constructs had significantly higher cartilage-related gene expression after 28 d of culture as well as significantly more safranin-O positive repair tissue after 12 weeks in vivo than hBMSC-fibrin constructs. Although initial experiments with hBMSC-hydrogel constructs suggested comparable results of hBMSC-alginate, hBMSC-fibrin and hBMSC-HA-pNIPAM constructs, culture in the osteochondral biopsy model in vitro as well as in vivo revealed differences, suggests that chondrogenesis of hBMSCs in an osteochondral environment is hydrogel-dependent.

Problems and pointers in osteochondrosis: Twenty years on.

Twenty years ago a supplement of Equine Veterinary Journal was devoted to equine osteochondrosis (OC) and recognised the importance of this developmental disease to the equine industry. In the accompanying editorial several controversial issues were identified and a number of areas for further research were highlighted. Today, equine OC is still a major clinical problem, but the on-going research has resulted in much improved knowledge and understanding of this highly complicated disease. There is still conflicting evidence on the prevalence of OC due to the dynamic character of the condition, widely varying definitions in the literature, and the range of joints affected. Nevertheless there is now convincing evidence that early vascular damage, leading to chondronecrosis, is the major mechanism of onset. The aetiological factors that determine whether a horse will develop clinical signs of OC remain obscure and the complex nature of OC and its multi-factorial character has been clearly demonstrated by genetic studies. These have shown a multitude of loci on a variety of chromosomes linked to osteochondrotic phenotypes, depending on the type of manifestation of OC, the joint involved and the breed. The controversy surrounding the possible key role of copper in the pathogenesis of OC in the early 1990s has evolved into a more limited contribution to repair thus making it just one of the many environmental factors that may have an effect on the occurrence of OC, but not a decisive one. The semantic debate concerning the most appropriate nomenclature seems to have crystallised into a consensus on terminology at three levels: OC or osteochondritis dissecans (OCD) for the disturbance in the process of endochondral ossification, juvenile ostechondral conditions (JOCC) for all joint and growth plate related disorders, and developmental orthopaedic diseases (DOD) for the full range of skeletal conditions in young horses. Future progress in improved management of OC can be expected from more research on cellular and molecular processes and the influences that determine the process of endochondral ossification, the process of articular cartilage maturation, and from epidemiological studies quantifying the long-term effects of OC on health and performance.

Effects of 25-hydroxy-cholecalciferol on the development of osteochondrosis in swine.

The principal objective of this experiment was to evaluate the effect of 25-hydroxy-cholecalciferol (25-OH-D3 ) on the development of osteochondrosis in 6- to 110-kg castrated male pigs. The growth rate and serum calcium and inorganic phosphate levels neither increased nor decreased in response to supplementation of 25-OH-D3 . However, supplemental 25-OH-D3 significantly increased serum levels of 25-OH-D3 and 1α,25-hydroxy-cholecalciferol without any influence on bone mineral density. The 25-OH-D3 -treated group had significant (P < 0.05) reduced incidence of osteochondrotic lesions compared to the control group as evidenced by macroscopically examining the articular cartilage of the distal humerus (32.4% vs. 59.3%) and distal femur (47.1% vs. 87.5%). Likewise, supplemental 25-OH-D3 significantly reduced osteochondrotic lesions over the control when histologically examining humerus (20.6% vs. 43.8%) and femur (52.9% vs. 87.5%). The results of this experiment suggested that 25-OH-D3 supplementation in pig diets had a tendency to promote normal endochondral ossification, inhibit osteochondrosis progression and possibly regenerate destroyed cartilage tissue.

Tissue mineral concentrations and osteochondrosis lesions in prolific sows across parities 0 through 7.

Mortality in swine herds is often associated with lameness, and trace minerals are implicated in maintaining integrity of skeletal tissues. The objectives of this study were to determine if prolific sows displayed evidence of trace mineral depletion with age and to determine the prevalence of osteochondrosis (OC) lesions. Reduced mineral concentrations with age would support recommendations for an increase in the amount of dietary minerals. Tissue samples were collected from 66 sows selected to represent a cross-sectional profile of a prolific herd fed diets with inorganic sources of trace minerals fortified at concentrations typically found in commercial diets. Females ranged from nulliparous (parity 0) to parity 7 with a lifetime average of 12.9 ± 0.5 pigs born alive per litter. Minerals were assessed in humerus, scapula, ovary, liver, and muscle (psoas major) tissues. Percent bone ash increased (P < 0.05) with parity from 64 to 66% but differed among bone sections. The Ca (39.0%) and P (18.9%) concentrations in bone ash were essentially constant in all sections and parities. Bone Cu, Fe, Mn, and Zn concentrations varied among sections, but differences due to parity (P < 0.05) were only detected in Fe. Bone Fe decreased from approximately 49 µg/g ash in parity 0 and 1 sows to approximately 29 µg/g ash in parity 7, likely reflecting loss of hemopoietic tissue with age. No evidence was detected in liver for depletion of trace minerals across parity; however, liver Cu and Zn concentrations tended to increase with age. Liver Mn concentrations varied with parity, but no consistent trend with parity was evident. Ovary Cu and Mn concentrations varied dramatically as a function of the reproductive status, but no evidence was detected for depletion with parity. Articular surfaces of the distal scapula and proximal and distal humerus were evaluated grossly for prevalence of OC; bones were then sectioned to evaluate lesions in subchondral bone and physis. Incidence of OC lesions on the articular-epiphyseal cartilage complex varied among bone sites, but differences across parities were not detected. In a subset of sows with subchondral bone lesions, the lesions appeared severe enough to contribute to clinical lameness, particularly in the distal humerus site. However, none of the sows exhibited lameness at slaughter. As no reductions in mineral concentrations with age were detected, recommendations to increase dietary mineral supplementation with age were not supported.

Approach to the patient with noninflammatory musculoskeletal pain.

Musculoskeletal pain is one of the most common presenting symptoms at the pediatrician's office. Etiology ranges from benign conditions to serious ones requiring prompt attention. This article addresses entities that present as musculoskeletal pain but are not associated with arthritis. The most common nonarthritic conditions are benign limb pain of childhood (growing pains), hypermobility, overuse syndromes with or without skeletal abnormalities, malignancies, and pain amplification syndromes. The| initial decision process, diagnosis, and treatment options for each of these conditions are discussed.