Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis?

OBJECTIVE: The metatarsophalangeal joints (MTPJs) are the most common location for synovitis in people with rheumatoid arthritis (RA), yet their association with plantar foot pressures has received very little attention. This study aimed to determine whether plantar pressures differed based on sonographic evidence of MTPJ synovitis in people with RA. METHOD: Ultrasound was used to assess synovitis (grey scale synovial hypertrophy and power Doppler signal) in MTPJs 1 to 5 using the combined EULAR/Outcome Measures in Rheumatology scoring system. Peak pressure (PP) and pressure time integrals (PTIs) were assessed during barefoot walking for seven plantar foot regions (heel, midfoot, first metatarsal, second metatarsal, third to fifth metatarsals, hallux, lesser toes). Mixed-effects linear regression was used to determine the difference in PP and PTI between MTPJs with none/minimal synovitis and MTPJs with moderate/severe synovitis. RESULTS: Thirty-five participants with RA were included. Mean age was 66.3 years and mean disease duration was 22.2 years. Participants with sonographic evidence of moderate/severe synovitis at the first MTPJ had reduced PTI at the hallux compared with those with none/minimal synovitis at this joint (P = 0.039). Participants with moderate/severe synovitis at the second MTPJ and fourth MTPJ had reduced PP and reduced PTI at lesser toes compared with those with none/minimal synovitis in these joints (all P ≤ 0.048). No significant differences were observed for synovitis in other joints. CONCLUSION: These findings may be suggestive of an inverse relationship between plantar pressure and soft tissue pathology, which is consistent with an offloading strategy and reduced use of the toes during propulsion.

The history of suture anchors in orthopaedic surgery.

The suture anchor allows secure fixation of soft tissue to bone and has become an invaluable tool for the orthopaedic surgeon. The original suture anchor was developed over 3 decades ago when a suture was bonded to a headless screw. Since then anchors have undergone a wide variety of design modifications to increase strength and allow for new applications based on biomechanical and clinical evidence. The suture anchor chain consists of the anchor to bone fixation, anchor suture interface, suture itself and suture to soft tissue interface. The early suture anchors failed most commonly from anchor pull out or breakage, with the strongest early design being a bone-screw-suture complex. Early concerns of metalwork complications saw the introduction of biodegradable suture anchors, originally lactic acid polymers and then osteoconductive bio-composites. Improvements in anchor design saw the suture become the main link of failure until the advent of novel suture materials made of ultrahigh molecular weight polyethylene. A form failure of suture at the anchor eyelet via cut-out led to redesign of the anchor suture interface with novel eyelet designs. Further innovations in the anchor suture interface have seen the advent of knotless anchors, especially useful in arthroscopic surgery. The newest products are all-suture anchors which show impressive strength whilst reducing the iatrogenic damage caused by insertion. The further biomechanical development of suture anchors is likely to produce new designs that continue to increase strength whilst managing size requirements for tailored clinical applications.

Knee arthroplasty: a cross-sectional study assessing energy expenditure and activity.

BACKGROUND: What has been missing from current assessment tools post knee arthroplasty is a means by which a patient's mobility and activity levels can be objectively measured over time in a real world setting. The Intelligent Device for Energy Expenditure and Activity (Minisun, Fresno, USA) (IDEEA) is one such device that meets these criteria. It quantifies activity by measuring energy expenditure and records the type of activity performed. The purposes of this study were to (i) determine if there were differences in energy expenditure in different groups of patients at various time points pre- and post-surgery and (ii) determine the correlations between energy expenditure and each of the subjective International Knee Documentation Committee (IKDC), Oxford and Tegner scoring systems. METHODS: Sixty-five total knee arthroplasty (TKA) patients were recruited into a cross-sectional study to collect energy expenditure and activity data using the IDEEA. Data were collected preoperatively and post-operatively at 6-week, 3-month, 6-month and 12-month time intervals. RESULTS: Energy expenditure and type of activity did not significantly change over the five recording periods. The patients spent <5% of the recording time walking, stepping or in transitions between movements. Energy expenditure showed a low to moderate correlation with the subjective IKDC, Oxford and Tegner questionnaires. CONCLUSIONS: Current evaluation questionnaires may not accurately record activity levels and TKA patients spend less time walking than the normal population. We believe the IDEEA is an effective tool for objectively measuring activity and energy expenditure following knee arthroplasty.

Repair of radial tears and posterior horn detachments of the lateral meniscus: minimum 2-year follow-up.

PURPOSE: The aim of this study was to show that repair of posterior radial tears and horn detachments of the lateral meniscus is possible and to assess the outcomes. METHODS: A retrospective review of 24 patients who had repair of a posterior defunctioning tear of the lateral meniscus combined with anterior cruciate ligament reconstruction was undertaken. Patients completed a follow-up postal questionnaire that included Lysholm, subjective International Knee Documentation Committee (IKDC), and Tegner scoring systems. RESULTS: Eight patients had suture repair of a lateral meniscal radial tear. The mean Lysholm, IKDC, and Tegner scores were 86.9 (SD, 11.6), 81.6 (SD, 13.9), and 5.8 (SD, 2.7), respectively, at a mean follow-up of 70.5 months (range, 29.0 to 168.0 months). Subsequent arthroscopy in 2 patients confirmed meniscal healing. Sixteen patients underwent a posterior horn reattachment. The mean Lysholm, subjective IKDC, and Tegner scores were 86.1 (SD, 13.3), 84.3 (SD, 17.0), and 6.5 (SD, 2.1), respectively, at a mean follow-up of 53.6 months (range, 26.0 to 116.0 months). Three patients had subsequent magnetic resonance imaging and/or arthroscopy that indicated meniscal healing. Two further patients had reinjury, and magnetic resonance imaging and/or arthroscopy showed that their repairs had failed. CONCLUSIONS: Posterior radial tears that extend to the capsule and posterior horn detachments of the lateral meniscus are frequently amenable to repair. In this study 22 of 24 repairs functioned successfully over a mean follow-up of 58.6 months (range, 26.0 to 168.0 months). LEVEL OF EVIDENCE: Level IV, therapeutic case series.