Apophyseal injuries in soccer players.

Soccer is the most popular sport worldwide, and it is associated with high injury rates, with most of these injuries occurring in the lower extremities. Particularly, in youth soccer players with immature skeleton, the physeal plate is two to five times weaker than the surrounding fibrous structures, and therefore more vulnerable to injury. The physeal plate consists of epiphyses and apophyses, with the former serving as tendon attachment sites and being subject to traction forces. There are two types of apophyseal injury: (i) apophyseal avulsion, which consists of an acute separation across the physeal plate; and (ii) apophysitis, an injury caused by chronic and repetitive contraction of musculotendon unit, leading to inflammation of the growth plate cartilage. Apophyses of the hip and pelvis are the most commonly injured in youth soccer players, due to vigorous contractions during sports activities and the fact that they tend to fuse later compared to other epiphyseal centers, making them more susceptible to injury. In this review, we will discuss the anatomy of lower limb apophyses and clinical and imaging findings of apophyseal injuries in youth soccer players, as well as briefly review treatment options and complications.

Capsular and retinaculum thickening in type II mucopolysaccharidosis: a novel MRI finding.

Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by a deficiency of glycosaminoglycan (GAG) catalytic enzymes, resulting in an accumulation of unprocessed or partly degraded GAGs in different tissues, including bones and joints. Notably, skeletal and joint abnormalities may be the first complaint that prompts patients to seek medical attention, especially in the milder forms of the disease. To our knowledge, there are no prior imaging reports that have documented capsuloligamentous thickening in patients with MPS on MRI. In this study, we present four cases of patients with clinically and genetically confirmed diagnosis of type II MPS, encompassing seven MRI examination of different joints, including cervical spine, hip, wrist, knee, and shoulder. All of the patients were male, aged between 14 and 35 years, and exhibited varying degrees of joint stiffness in the clinical examination and carpal tunnel syndrome in cases of the wrist joint was affected. None of the patients had a history of surgical procedures on the affected joint, other metabolic or deposit diseases, or sports activity practice. The MRI revealed significant capsuloligamentous and retinaculum thickening, up to eight times greater than the normal capsular thickness reported in the literature.

Rare Association Between Osteogenesis Imperfecta and Chondrosarcoma: Could a Pathogenic Variant in the Gene SERPINF1 Explain It?

Osteogenesis imperfecta (OI) type VI is a rare inherited disorder of the connective tissue caused by pathogenic variants in SERPINF1 gene, which encodes the pigment epithelium-derived factor (PEDF). PEDF is implicated in many biologic processes, including an anti-cancer role. This information is supported by in vitro and in vivo studies that evidenced its anti-angiogenic, anti-tumorigenic, and anti-metastatic properties. Although OI is related to skeletal changes such as bone fragility and deformities, as well as to other connective tissue defects, it does not represent a greater predisposition to the development of skeletal tumors. Here, we report on an adult with OI in which a deletion in exon 8 of the SERPINF1 gene (c.1152_1170del; p.384_390del) was identified. The patient presented popcorn calcification in both femoral epiphyses, but one of them presented radiological characteristics and evolution suspected of malignancy. Later, it was diagnosed as chondrosarcoma. This paper discusses that OI type VI patients may be at risk of developing some types of cancer.

Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?

OBJECTIVE: To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports. MATERIAL AND METHODS: Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data. RESULTS: Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment. CONCLUSION: Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.

MR imaging of inherited myopathies: a review and proposal of imaging algorithms.

PURPOSE OF REVIEW: The aims of this review are to discuss the imaging modalities used to assess muscle changes in myopathies, to provide an overview of the inherited myopathies focusing on their patterns of muscle involvement in magnetic resonance imaging (MR), and to propose up-to-date imaging-based diagnostic algorithms that can help in the diagnostic workup. CONCLUSION: Familiarization with the most common and specific patterns of muscular involvement in inherited myopathies is very important for radiologists and neurologists, as imaging plays a significant role in diagnosis and follow-up of these patients. KEY POINTS: • Imaging is an increasingly important tool for diagnosis and follow-up in the setting of inherited myopathies. • Knowledge of the most common imaging patterns of muscle involvement in inherited myopathies is valuable for both radiologists and neurologists. • In this review, we present imaging-based algorithms that can help in the diagnostic workup of myopathies.

Relationship between anterior cruciate ligament rupture and the posterior tibial and meniscal slopes in professional soccer athletes.

OBJECTIVE: Several anatomical parameters have been associated with increased risk of anterior cruciate ligament rupture; however, published studies provide conflicting results. The objectives of this study are to assess whether there is a relationship between anterior cruciate ligament rupture and the lateral and medial posterior tibial slopes, as well as the lateral and medial posterior meniscal slopes and posterior tibial and meniscal delta-slopes. MATERIALS AND METHODS: A retrospective case-control study was conducted in professional soccer athletes, using images from knee magnetic resonance imaging scans in athletes with clinical and radiological diagnosis of anterior cruciate ligament rupture, and control group, with no signs of ligament rupture. RESULTS: The lateral and medial posterior tibial slopes, the lateral and medial posterior meniscal slopes, and the posterior tibial and meniscal delta-slopes showed significant differences between the groups (p < 0.05). Multivariate analysis logistic regression revealed that the lateral and medial posterior meniscal slopes proved to be predictors for increased risk of anterior cruciate ligament rupture in professional soccer players. CONCLUSION: Posterior tibial and meniscal slopes and tibial and meniscal delta-slopes are related to a greater risk of rupture of the anterior cruciate ligament in professional male soccer athletes. The lateral and medial posterior meniscal slopes are predictors for ligament rupture.

Effectiveness of Nighttime Orthoses in Controlling Pain for Women With Hand Osteoarthritis: A Randomized Controlled Trial.

IMPORTANCE: Hand osteoarthritis is a musculoskeletal problem that is associated with hand pain, stiffness, functional limitation, decreased grip strength, and reduced quality of life. OBJECTIVE: To evaluate the effectiveness of nighttime orthoses on the second or third finger of the dominant hand in controlling pain in women with symptomatic osteoarthritis (OA) in the interphalangeal joint. DESIGN: Randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Fifty-two women with symptomatic OA and presence of Heberden's and Bouchard's nodes, allocated randomly to the intervention group or the control group. INTERVENTION: The intervention group used a nighttime orthosis on the second or third finger of the dominant hand. Both groups participated in an educational session. OUTCOMES AND MEASURES: The following parameters were measured: pain (numerical rating scale, Australian/Canadian Osteoarthritis Hand Index), grip and pinch strength, function (Cochin Hand Functional Scale), and manual performance (Moberg Pick Up Test). RESULTS: The intervention group showed a statistically significant improvement in pain (p < .001) and hand function. The improvement in pain correlated with Cochin Hand Functional Scale scores and the absence of Bouchard's nodes in the third finger, which are predictors of the best prognosis for treatment with a nighttime orthosis. CONCLUSIONS AND RELEVANCE: This study demonstrates that nighttime orthoses are effective in reducing pain and lead to improvement in hand function in women with hand OA. They are therefore specifically recommended for nonpharmacological treatment of hand OA. WHAT THIS ARTICLE ADDS: Orthoses can be considered, together with manual exercises and joint protection, as an intervention to reduce symptoms and improve hand function in people with hand OA. This study is an important step in empowering occupational therapists to determine appropriate and effective intervention for clients with OA.

Professional football can be considered a healthy sport?

PURPOSE: This study aimed to compare the results of knee MRIs of former football players with no previous knee surgeries with non-regular practitioners of impact sports, matched by age and sex, and combine these results with other variables such as current quality of life and pain in the knees. METHODS: The study participants were 16 male former professional football players and 21 male volunteers from different non-sports professional areas. All participants underwent bilateral magnetic resonances. Specific knee evaluations with regard to osteoarthritis and quality of life were performed in both groups by applying the Knee Injury and Osteoarthritis Outcome Score (KOOS) subjective questionnaires and SF-36, respectively. RESULTS: The between-group comparison revealed significant differences on: pain, symptoms, and quality of life related to the knee in KOOS subscales; physical aspects and vitality subscale of SF-36; and former soccer players had worst magnetic resonances scores than controls. CONCLUSION: Results of this study indicate probable specific adverse effects associated with participating in professional football. LEVEL OF EVIDENCE: Cross-sectional study, Level III.

Usefulness of US to show subclinical joint abnormalities in asymptomatic feet of RA patients compared to healthy controls.

OBJECTIVES: The aim of the present study was to demonstrate the utility of ultrasound to show subclinical feet disease in RA. METHODS: The foot joints (talocrural, talocalcaneal, talonavicular, naviculocuneiform, calcaneocuboid, 5th tarsometatarsal and 1st to 5th metatarsophalangeal [MTP] joints) of 50 healthy subjects and 50 RA patients, with asymptomatic feet, were compared bilaterally. Statistical significance was set at 5%. RESULTS: Twenty-two joints were examined per individual (2200 in the entire sample). Significantly higher values were found in the RA group regarding quantitative synovitis in all joints recesses (p<0.003), the presence of synovitis (p<0.035) (except the 5thtarsometatarsal and 3rdMTP joint), power Doppler (PD) signals (p<0.029) (talocalcaneal, talonavicular, 1st, 2nd, 3rd and 4thMTP joints) and bone erosion (p<0.003) (except for the talocrural and talocalcaneal joints). Synovitis, PD signals and erosion were observed in 18.3% and 3.05% (p<0.001), 5.77% and 0.22% (p<0.001) and 34.45% and 2.85% (p<0.001) of the RA group and control group, respectively. Greater DAS-28, HAQ and FFI values were associated with ultrasound findings in only some joints (p<0.046). Interobserver agreement was ≤0.686 for semi-quantitative synovitis, ≤0.641 for quantitative synovitis, ≤0.474 for PD signals and ≤1.000 for erosion. Low Cohen Kappa values were found in the correlation between radiography and ultrasound (0.084-0.400). CONCLUSIONS. Ultrasound on RA asymptomatic feet demonstrated a significantly greater number of inflammatory changes in current activity (synovitis, PD signals) and sequelae (erosion) in comparison to control subjects. In the midfoot, the talonavicular joint has the greatest number of ultrasound findings.

Effects of strength and power training on neuromuscular variables in older adults.

The purpose of this study was to compare the neuromuscular adaptations produced by strength-training (ST) and power-training (PT) regimens in older individuals. Participants were balanced by quadriceps cross-sectional area (CSA) and leg-press 1-repetition maximum and randomly assigned to an ST group (n = 14; 63.6 ± 4.0 yr, 79.7 ± 17.2 kg, and 163.9 ± 9.8 cm), a PT group (n = 16; 64.9 ± 3.9 yr, 63.9 ± 11.9 kg, and 157.4 ± 7.7 cm), or a control group (n = 13; 63.0 ± 4.0 yr, 67.2 ± 10.8 kg, and 159.8 ± 6.8 cm). ST and PT were equally effective in increasing (a) maximum dynamic and isometric strength (p < .05), (b) increasing quadriceps muscle CSA (p < .05), and (c) decreasing electrical mechanical delay of the vastus lateralis muscle (p < .05). There were no significant changes in neuromuscular activation after training. The novel finding of the current study is that PT seems to be an attractive alternative to regular ST to maintain and improve muscle mass.

RADIOGRAPHIC ABNORMALITIES OF THE TALUS IN PATIENTS WITH CLUBFOOT AFTER SURGICAL RELEASE USING THE MCKAY TECHNIQUE.

OBJECTIVE: To analyze morphological abnormalities of the talus in patients with clubfoot after surgical treatment using the McKay technique. METHOD: Lateral standing-position radiographs of the feet of 14 patients with unilateral clubfoot who underwent treatment by means of the doubleincision McKay technique were retrospectively analyzed. All the patients were operated by the same surgeon, with an average of 6.53 years between surgery and the radiograph. We compared the radiographic characteristics of the talus between the operated and the contralateral foot. We assessed the presence of deformity of the talar dome and head (sphericity evaluation); the talar length and height; the percentage and degree of navicular subluxation; abnormalities of the Gissane angle; and the trabecular bone pattern. RESULTS: Abnormalities of the talar head occurred in 92.8% of the patients; of the talar dome in 92.8%; and of the trabecular pattern in 100%. The talar length ratio between the operated and the contralateral foot ranged from 0.61 to 0.88 (mean 0.79; SD = 0.09), while the height ratio ranged from 0.57 to 0.98 (mean 0.82; SD = 0.12). The Gissane angle was greater in all of the operated feet, and all of them also showed navicular subluxation, at a rate ranging from 6.43 to 59.75% (mean 26.34%; SD = 16.66%). CONCLUSION: Talar abnormalities occurred in 100% of the feet treated using the McKay technique. It was shown that establishing radiographic parameters to describe and quantify these deformities was feasible, through simple and easy-to-perform techniques.