Pain in Osteochondral Lesions of the Ankle - an Investigation Based on Data from the German Cartilage Registry (KnorpelRegister DGOU).

BACKGROUND: The aim of the study was to investigate parameters influencing the preoperative pain intensity in patients with osteochondral lesions of the ankle. The evaluation covered patient-related parameters such as age, sex, body mass index (BMI), as well as defect-related parameters, such as localisation, size and stage (according to the classification of the International Cartilage Repair Society [ICRS] and the Berndt-Harty-Loomer classification). We also examined the correlation between the different surgical techniques and additional factors, such as debridement of an impingement or stabilisation of the ankle on the one hand, and the preoperative pain intensity on the other. MATERIAL AND METHODS: 259 patients with osteochondral lesions of the ankle were operated in 32 clinical centres between October 2014 and December 2016 and enrolled consecutively in the German Cartilage Registry (KnorpelRegister DGOU). 151 patients were available for analysis. The preoperative pain intensity was assessed at the time of surgery with online questionnaires, using the Numeric Rating Scale for pain (NRS). RESULTS: The median preoperative pain intensity in the complete study population (n = 151) was 3 (range 0 - 10). There was no correlation between the age and the preoperative pain intensity (ρ = - 0.06). Further, there was not detected a difference between the two genders according to the preoperative pain intensity (p = 0.31). In female patients a higher BMI correlated with a higher preoperative pain intensity (ρ = 0.16). Within the group of patients with a solitary treated talus lesion there was no difference according to the preoperative pain intensity between the different localizations of the defect (medial vs. lateral talus) (p = 0.82). Within the group of patients with a solitary treated talus or tibia lesion there was no correlation between the defective area or the lesion stage according to the ICRS classification on the one hand, and the preoperative pain intensity on the other (ρ = 0.09, and ρ = 0.04, respectively). According to the Berndt-Harty-Loomer classification a higher lesion stage (stage four and five) was associated with a higher preoperative pain intensity (ρ = 0.13). There was no difference according to the preoperative pain intensity between the group of patients that received a debridement of a bony or soft tissue impingement in addition to the cartilage therapy and the group of patients without this kind of additional therapy (p = 0.10). Further, there was no difference according to the preoperative pain intensity between the group of patients that received a stabilisation of the ankle joint in addition to the cartilage therapy and the group of patients without a stabilisation procedure (p = 0.83). CONCLUSION: Osteochondral lesions of the ankle can be associated with a moderate and in some cases high pain intensity. In female patients a higher BMI is associated with a higher pain intensity. Further, a higher lesion stage according to the Berndt-Harty-Loomer classification is associated with a higher pain intensity, which highlights the clinical relevance of this classification.

Caracterización del dolor torácico en pacientes que consultan al Servicio de Urgencias de una institución de salud de alto nivel de complejidad, en el periodo 2014-2015, en Medellín, Colombia / Characterization of chest pain in patients attending the emergency department of a high-complexity-level health-care institution, during 2014-2015, in Medellin, Colombia

Introducción: El dolor torácico agudo es una sensación dolorosa que se manifiesta entre el diafragma y la base del cuello, e implica un reto diagnóstico para cualquier médico en el servicio de urgencias. Objetivo: Determinar las principales características clínicas y epidemiológicas de los pacientes que consultan por dolor torácico en una clínica privada de la ciudad de Medellín. Metodología: Estudio observacional retrospectivo transversal, realizado con la información consignada en las historias clínicas de los adultos que consultaron por dolor torácico en el servicio de urgencias, en el periodo 2014-2015, y que cumplieron con los criterios de elegibilidad. La información se analizó en el programa SPSS 21, a las variables cualitativas se les calcularon frecuencias absolutas y relativas y a las cuantitativas se utilizaron promedios con desviación estándar o medianas. Resultados: Se evaluaron un total de 231 historias clínicas de pacientes que consultaron por dolor torácico. La edad promedio fue 49,5 ± 19,9 años, sexo femenino 56,7 %. Los antecedentes personales más frecuentes fueron hipertensión arterial 35,5 %, diabetes 10,8 %, dislipidemia 10,4 % y enfermedad coronaria 5,2 %. Respecto a las características del dolor, el 40,3 % fue de inicio súbito, de localización precordial el 38,2 %, para el 20 % el desencadenante fue la actividad física y el 60,6 % era de carácter opresivo. De los pacientes con diagnóstico etiológico, el más frecuente fue costocondritis con 18,2 %. Conclusiones: A pesar de que las características clínicas del dolor reportadas coinciden con la presentación clínica de un síndrome coronario agudo, la etiología más frecuente no fue esta, sino que fue la costocondritis, indicando que es un diagnóstico diferencial en el enfoque de un paciente con dolor torácico agudo (AU)

Introduction: Acute chest pain is a distressing sensation between the diaphragm and the base of the neck and it represents a diagnostic challenge for any physician in the emergency department. Objective: To establish the main clinical and epidemiological characteristics of patients who present with chest pain to the emergency department in a private clinic from the city of Medellin. Methods: Cross-sectional retrospective observational study, were patients who consulted for chest pain in the emergency department who met the eligibility criteria during 2014-2015. The information was analyzed in SPSS program vr.21; qualitative variables were described through relative frequencies, and the quantitative through mean and standard deviation or medians according to their distribution in the study population. Results: A total of 231 patients were evaluated, the mean age was 49.5 ± 19.9 years, 56.7 % were females. The most frequent pathological antecedents were hypertension 35.5 %, diabetes 10,8 %, dyslipidemia 10.4 % and coronary disease 5.2 %. Regarding pain features, in 40.3 % of the patients the pain began abruptly, in 38.2 % it had a precordial location, for 20 % of the cases physical activity acted as a trigger, and 60.6 % was oppressive. Costochondritis was the most common cause of chest pain among patients with an established etiologic diagnosis, representing the 18.2 %. Conclusions: Although the clinical features of pain reported coincide with the clinical presentation of an acute coronary syndrome, the most common cause of chest pain in study population was costochondritis instead, indicating that it is a differential diagnostic in the approach of patients with pain acute chest (AU)

Osteochondral Lesions in Surgically Treated Hallux Valgus.

BACKGROUND: Patient dissatisfaction following surgical correction of hallux valgus remains a clinical problem. The aim of this study was to investigate articular erosion patterns of the first metatarsal head in patients with hallux valgus, to evaluate if the cartilage damage was associated with the degree of hallux valgus deformity, and to prospectively evaluate the effect on patient outcomes. METHODS: Fifty-six consecutive feet undergoing surgical correction for hallux valgus were prospectively enrolled and followed for 24 months postoperatively. In addition to clinical and radiographic examinations, intraoperative measurements were obtained to quantify osteochondral lesion location, size, and grade of the first metatarsal head cartilage. RESULTS: Fifty-one of 56 feet (91%) had osteochondral lesions. The mean number of zones affected was 2.9, and the mean maximum International Cartilage Repair Society (ICRS) scale lesion grade was 2.9 out of 4. A total of 44/56 (79%) completed a minimum of 24 months of follow-up. The grade of the lesion and the extent of the lesion did not have a strong correlation with the radiographic measures or clinical outcome scores. CONCLUSIONS: This study showed a high prevalence of osteochondral lesions in patients undergoing operative correction of hallux valgus. Since the grade and the extent of the lesions did not have a strong correlation with the severity of the deformity or the clinical outcome, the significance of these lesions remains unknown. LEVEL OF EVIDENCE: Level III, comparative series.

Owner survey of tarsocrural effusion (bog spavin) in Clydesdale horses.

A postal survey of the owners of Clydesdale horses in the UK and USA was conducted to obtain information on tarsocrural effusion ('bog spavin') as an indicator of osteochondrosis from 935 horses. Additional information requested included details of how this condition was investigated and treated. The reported tarsocrural effusion incidence was 10 per cent. The majority of respondents believed the condition to be of concern to Clydesdale owners, but only a minority were aware of the implications of tarsocrural effusion, suggesting that owner education would be of benefit.

Prevalence of osteochondritis among preparatory and primary school children in an Egyptian governorate.

Epiphyseal osteochondritis is a localized disorder in childhood. Vascular insufficiency is thought to be the most significant etiologic factor. This study had been carried on Primary and Preparatory school children in Zagazig City and surrounding villages in Sharkia Governorate, Egypt. Total number of studied children were 16,060, 7,380 males, 8,680 females. The mean age was 11.41 ± 1.99. Our results showed that the prevalence of osteochondritis was 21:10,000. Distribution of Sever's and Osgood-Shlatter diseases were significantly high compared with other osteochondritis. Regarding the sex distribution, osteochondritis was frequent in males. Our results showed that there was history of trauma especially in Sever's and Osgood-Schlatter diseases.

Incidence of meniscal and osteochondral lesions in patients undergoing delayed anterior cruciate ligament reconstruction.

OBJECTIVE: Unreconstructed anterior cruciate ligament (ACL) tears cause repeated incidences of giving-way and rotational-translational instability. The aim of this study was to test our hypothesis that delayed surgical treatment of patients with ACL tears, especially those with high Tegner activity levels, results in more severe and complicated meniscal and osteochondral lesions with potential affect on the outcome. METHODS: This study included 385 patients who underwent arthroscopic ACL reconstruction between 2001 and 2009. Patients arthroscopic video records or MRI scans and patient files at the time of surgery were analyzed. We defined severe meniscal and osteochondral lesions which could negatively affect the outcome and labeled them meniscal lesions affecting outcome (MLAO) and osteochondral lesions affecting outcome (OLAO). The relation between MLAO, OLAO, time since injury and Tegner activity levels were statistically analyzed. RESULTS: The incidences of MLAO and OLAO grew statistically higher as time elapsed between the injury and surgery increased (p=0.001, p<0.05; p=0.001, p<0.05). The relation between the Tegner activity score, MLAO and OLAO risk were found to be statistically insignificant (p=0.317, p=0.184, p>0.05). CONCLUSION: Delays in ACL reconstruction surgery result in an increase in the incidence of meniscal and osteochondral lesions which have the potential to negatively affect the surgical outcome.

Association of baseline knee bone size, cartilage volume, and body mass index with knee cartilage loss over time: a longitudinal study in younger or middle-aged adults.

OBJECTIVE: To determine the association of knee bone size, cartilage volume, and body mass index (BMI) at baseline with knee cartilage loss over 2 years in younger or middle-aged adults. METHODS: A total of 324 subjects (mean age 45 yrs, range 26-61) were measured at baseline and about 2 years later. Knee cartilage volume and bone size were determined using T1-weighted fat-saturated magnetic resonance imaging. RESULTS: In multivariable analysis, baseline knee bone size was negatively associated with annual change in knee cartilage volume at medial and lateral tibial sites (ß = -0.62% to -0.47%/cm(2), all p < 0.001). The associations disappeared at medial tibial site after adjustment for baseline cartilage volume and became of borderline statistical significance at lateral tibial site after adjustment for both baseline cartilage volume and osteophytes (ß = -0.29, p = 0.059). Baseline knee cartilage volume was consistently and negatively associated with annual change in knee cartilage volume at all 3 medial tibial, lateral tibial, and patellar sites (ß = -4.41% to -1.37%/ml, all p < 0.001). Baseline BMI was negatively associated with an annual change in knee cartilage volume, but only in subjects within the upper tertile of baseline cartilage volume, even after adjusting for cartilage defects (ß = -0.16% to -0.34%/kg/m(2), all p < 0.05). CONCLUSION: Our study suggests that both higher baseline tibial bone area and knee cartilage volume (most likely due to cartilage swelling) are associated with greater knee cartilage loss over 2 years. A higher BMI was associated with greater knee cartilage loss only in subjects with higher baseline cartilage volume.

Sever's disease: a prospective study of risk factors.

BACKGROUND: Sever's disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. METHODS: Children with Sever's disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever's disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al-type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. RESULTS: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. CONCLUSIONS: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever's disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation.

Enfermedad de Osgood-Schlatter: deporte, adolescencia y dolor / Osgood-Schlatter disease: sports, adolescence and pain

La enfermedad de Osgood-Schlatter es una de las causas más frecuentes de gonalgia en niños mayores y adolescentes deportistas. Es la consecuencia de la tracción ejercida por el tendón rotuliano sobre el centro de osificación de la tuberosidad tibial anterior. Los cambios radiológicos incluyen condensación, fragmentación, aparición de osículos y edema de partes blandas. Su tratamiento puede ser iniciado por parte de los pediatras de Atención Primaria, e incluye analgesia, estiramientos, potenciación del cuádriceps y modificación de la práctica deportiva (AU)

Osgood-Schlatter’s disease is one of the most common causes of knee pain in older children and adolescent athletes. It is the result of the traction by the patellar tendon on the centre of ossification of the anterior tibial tuberosity. Radiographic changes include condensation, fragmentation, appearance of ossicles and soft tissue edema. The treatment may be initiated by primary care pediatricians, including analgesia, stretching, quadriceps strengthening and modification of the sport (AU)

Pediatric running injuries.

As more children have become involved in athletic activities and running, there has been a significant increase in overuse injuries. The young athlete with open growth plates is vulnerable to unique overuse injuries involving the apophyses, articular cartilage, and growth plate. The physician caring for these young athletes needs to be aware of these conditions to diagnose and treat them appropriately. Physicians should also be aware of the risk of overtraining and overuse injury in athletes participating in year-round sports and competition. Current guidelines for overuse injury prevention in young athletes are primarily based on consensus and expert opinion. Further research is needed to provide evidence-based guidelines for overuse injury prevention in young athletes and runners.

Early changes in biomarkers of skeletal metabolism and their association to the occurrence of osteochondrosis (OC) in the horse.

REASON FOR PERFORMING STUDY: Diagnosis of osteochondrosis (OC) is based on clinical signs and radiography, but alternative methods for detection at an early stage would be useful. OBJECTIVES: To determine in the juvenile horse the relationship between serum concentrations of a number of biomarkers that reflect changes in cartilage and bone turnover and age, feeding level, growth, and the occurrence of OC. METHODS: Foals were assigned to a high (n = 20) or moderate (n = 19) feeding level group from birth to age 1 year. Bodyweight, withers height and cannon width were measured. Osteoarticular status was assessed radiographically at 5.5 and 11 months in all foals, and by necropsy at 12 months for 8 foals/group. Serum biomarkers of bone (osteocalcin, CTX-1) and cartilage (CPII, C2C) metabolism were assayed at 8 time points between ages 2 and 52 weeks. Ratios between biomarkers of tissue formation and degradation were calculated at each time point. RESULTS: Consistent age-related patterns in biomarker serum concentrates were found, indicating a markedly higher metabolism before age 20 weeks but concentrations were not affected by feeding level. Bodyweight was correlated negatively to C2C and CTX-1, and withers height was positively correlated to osteocalcin and the osteocalcin/CTX-1 and CPII/ C2C ratios. Osteocalcin concentration at 2 weeks and CPII/ C2C ratio at 20 weeks had strong positive correlations to OC, as diagnosed radiographically at 5.5 months. Osteocalcin had a strong correlation with radiographically detected OC at 11 months but at that time there was no significant relationship between CPII/C2C ratio and OC. CONCLUSIONS: Occurrence of OC lesions is significantly associated with anabolic changes in bone metabolism during the first weeks post partum, given the strong relation with osteocalcin. POTENTIAL RELEVANCE: Measuring osteocalcin concentrations during the first few weeks post partum may have potential value for the prediction of risk for OC development.

Protocolo del tratamiento de las Osteocondrosis más frecuentes en el Servicio de Ortopedia Pediátrica / Treatment protocol of the most frequent osteochondroses in our Pediatric Orthopedic Service

Se realiza un estudio de los pacientes tratados en nuestro servicio por Osteocondrosis, en el período comprendido de enero de 1985 a enero del 2000, con el objetivo de precisar las osteocondrosis que con mayor frecuencia se presentan en nuestro servicio, así como el tipo de tratamiento aplicado a cada uno, de acuerdo al estadio clínico en que se encuentra, y mostrar éste en forma de protocolo. Concluimos que las Osteocondrosis más frecuentes son las del miembro inferior, y de ellas: Enfermedad de Perthes y la enfermedad de Osgood Schlatter...(AU)

[Prevalence of hereditary diseases in three-year-old Swiss Warmblood horses]. / Erhebung der Prävalenz von Erbkrankheiten bei dreijährigen Schweizer Warmblutpferden.

The objective of this study was to investigate clinical signs indicating hereditary diseases like equine sarcoid, osteochondrosis (OC) and the idiopathic laryngeal hemiplegia (ILH), and to demonstrate relationships between environment, feeding habits and conformation ("exterieur" evaluation) of the horses. For this purpose, we analyzed veterinary examinations of 403 stallions at the approvals since 1994 examined 493 three-year-old Swiss Warmblood horses, which were shown at the Swiss-Field-Tests in 2005. With the help of the owners a questionnaire on health, environment and feeding habits of the animals was completed. At the same time, the horses were assessed and graded for their "exterieur" (type, conformation, gaits) by judges of the Swiss Sporthorse breeding association. In 11.5% of horses sarcoids were found, 8.7% showed one and 2.8% several tumors. The prevalence of sarcoids in offspring of sires with known sarcoids was not significantly higher than in descendants from stallions without a known history of sarcoids. We found distended joints as a possible symptom of OC in 11.4% of the horses, 3.9% (n = 19) in both tarsal joints. We did not find a relationship between enlarged joints in the offspring and the presence of OC in the sires. Abnormal respiratory noise at work, as a possible sign for ILH, was heard only in 1.2% (n = 6). It is important to note that while we found a high number of sarcoid affected horses compared to other studies, presence of enlarged joints was not very frequent and very few horses showed abnormal respiratory noise. Additionally, we found no correlation between "exterieur" marks and the horse's general health.

Overuse injuries in adolescents.

The incidence of overuse injuries in young athletes is on the rise and accounts for a significant number of visits to the primary care office. There are distinctive intrinsic and extrinsic factors that place young athletes at risk for overuse injuries. These injuries vary in severity from being a temporary inconvenience to having potential lifelong morbidity. An understanding of the young athlete and their unique injuries is important for enabling early recognition and treatment. Prevention strategies are also discussed.

[Vertebral syndrome in multiple sclerosis: causes, clinical peculiarities and problems of differential diagnosis].

Presented is a review of the literature on the main causes of vertebral syndrome in multiple sclerosis (MS): dystrophic processes in spinal motor segments, disturbance of spinal static, development of functional blockade, osteoporosis, appearance of demyelinization foci in roots and the spinal cord, myelopathy, replacing foci by cavities. The authors report the results of clinical and MRI study of 115 patients with MS and single out some dissimilarities of vertebral syndrome in MS and dystrophic lesion of spinal cord as follows: in MS pain is long-term, non-intensive, without distinct periods of deterioration and improvement; muscle tonic disturbances are less pronounced but present on the level of all spinal compartments; intensity of root disorders is significantly less and location of clinical symptoms often does not correspond to the level of altered spinal motor segments. The Lermitt symptom and its analogs are described, the former being found in 14.7% of patients with remitting course, and their relation to the loci in the cervical part of the spinal cord is revealed. It is stressed that these loci could lead to an earlier onset of vertebral pain syndrome in patients with MS.

Prevalence of osteochondrosis in the limb joints of South German Coldblood horses.

This study aimed to quantify the factors associated with the prevalence of the radiological signs of osteochondrosis (OC) and osteochondrosis dissecans (OCD) in South German Coldblood (SGC) horses. The prevalence of OC and OCD in fetlock and hock joints was analysed in 167 young coldblood horses with a mean age of 14 months. The presence of at least one osteochondrotic lesion (OC) in fetlock or hock joints was documented for 61.7% of the horses and 26.9% of the horses had osseus fragments. Osteochondrotic findings at the dorsal aspect of the sagittal ridge of the third metacarpal/metatarsal bone were seen in 53.9% of the horses and palmar/plantar osseous fragments in fetlock joints in 16.2% of the horses. Hock joint OC was found in 40.1% of the horses and hock OCD in 0.6%. Osteochondrotic findings in the distal part of the tibia were prevalent in 28.1% and in the lateral trochlea tali in 17.4% of the horses. The sex of the investigated horses significantly influenced the prevalence of OC in fetlock and hock joints, as well as the findings in the distal part of the tibia and lateral trochlea tali. Age at radiological examination was significant for the prevalence of OC in hock joints, palmar/plantar osseous fragments in fetlock joints and osteochondrotic findings in the distal part of the tibia. Female horses showed a 2-fold higher risk for OC in fetlock and hock joints than male horses. The distribution of the affected horses by age classes showed that radiographic signs of OC in fetlock and hock joints significantly increased at an age of about 1 year. We can conclude from our study that fetlock and hock OC is a prevalent radiographic finding in more than 1-year-old female and male SGC horses.

Prevalence of bowlegs among child and adolescent soccer players.

OBJECTIVE: Little is known about the interactions of sports-related demands and human body, in particular on musculoskeletal features, during growth. Focusing on the relationship between soccer and lower limb alignment, we examined the hypothesis that varus knee deviation is more prevalent among high-performance pediatric and adolescent soccer players. DESIGN: Cross-sectional study with focused sampling. SETTING: First league sports clubs. PARTICIPANTS: 106 male child/adolescent soccer players aged 10 to 21 years and 68 age-matched tennis players. INTERVENTIONS: All athletes completed a demographic questionnaire and underwent physical examinations, which included height, weight, generalized laxity, knee, ankle, foot and spine axis, hip range of motion, tibial torsion, Q angle, foot navicular height, and progression angle. MAIN OUTCOME MEASUREMENT: Varus/valgus axis was determined by the intercondylar intermalleolar distance while standing. Soccer and tennis players were compared on knee axis and other outcome variables by analysis of covariance, adjusting for age and by t-tests within age groups. RESULTS: A significantly higher prevalence of knee varus was found among the soccer players compared to that among the tennis players. The difference in intracondylar distance was statistically significant after the age of 13 years (P < 0.001). In addition, compared to tennis players, soccer players had higher foot arches, decreased hip external rotation and increased external tibial torsion. CONCLUSIONS: Varus knee axis deviation was more common among children and adolescent soccer players than among tennis players. The prevalence was more pronounced among players aged 13 years or older. Further research is needed to explore the rationale of this phenomenon.

Lameness and fertility of sows and gilts in randomly selected loose-housed herds in Finland.

The prevalence of lameness among 646 sows and gilts in 21 selected herds was determined; 8.8 per cent of the animals were lame and the most common clinical diagnoses were osteochondrosis, infected skin lesions and claw lesions. The lame animals had higher serum concentrations of haptoglobin and C-reactive protein than the sound animals. Animals housed on slatted floors had twice the odds of being lame and 3.7 times the odds of being severely lame than animals housed on solid floors. Yorkshire pigs had 2.7 times the odds of being lame than Landrace or crossbred animals. Higher parity and the use of roughage decreased the odds of the sows not becoming pregnant; however, lameness was not a risk factor for non-pregnancy.