Osteochondrosis in the central and third tarsal bones of young horses.

Recently, the central and third tarsal bones of 23 equine fetuses and foals were examined using micro-computed tomography. Radiological changes, including incomplete ossification and focal ossification defects interpreted as osteochondrosis, were detected in 16 of 23 cases. The geometry of the osteochondrosis defects suggested they were the result of vascular failure, but this requires histological confirmation. The study aim was to examine central and third tarsal bones from the 16 cases and to describe the tissues present, cartilage canals, and lesions, including suspected osteochondrosis lesions. Cases included 9 males and 7 females from 0 to 150 days of age, comprising 11 Icelandic horses, 2 standardbred horses, 2 warmblood riding horses, and 1 coldblooded trotting horse. Until 4 days of age, all aspects of the bones were covered by growth cartilage, but from 105 days, the dorsal and plantar aspects were covered by fibrous tissue undergoing intramembranous ossification. Cartilage canal vessels gradually decreased but were present in most cases up to 122 days and were absent in the next available case at 150 days. Radiological osteochondrosis defects were confirmed in histological sections from 3 cases and consisted of necrotic vessels surrounded by ischemic chondronecrosis (articular osteochondrosis) and areas of retained, morphologically viable hypertrophic chondrocytes (physeal osteochondrosis). The central and third tarsal bones formed by both endochondral and intramembranous ossification. The blood supply to the growth cartilage of the central and third tarsal bones regressed between 122 and 150 days of age. Radiological osteochondrosis defects represented vascular failure, with chondrocyte necrosis and retention, or a combination of articular and physeal osteochondrosis.

Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study.

INTRODUCTION: Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals. MATERIALS AND METHODS: An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured. RESULTS: On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy. CONCLUSION: Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments.

CT-based five-segment classification in Freiberg's infarction: Evaluation of its intraobserver and interobserver reliability.

BACKGROUND: According to the location and frequency of osteonecrosis zone of metatarsal head, a map of osteonecrosis zone was drawn for Freiberg's infarction. The objective of the current study is to develop a new computed tomography-based Five-Segment classification system for Freiberg's infarction and testify if it has good intra- and interobserver reliability or not. METHODS: According to the location and its frequency of osteonecrosis zone of metatarsal head, a map of osteonecrosis zone was drawn. According to the distribution of osteonecrosis zones of metatarsal heads, we proposed the Five-Segment classification system. Four evaluators evaluated each radiography and computed tomography (CT) twice at 8-week intervals. To test the reproducibility of the Five-Segment classification system, the interobserver and intraobserver reliability of this classification system comparing with that of the Smillie classification by four observers using the kappa statistic. RESULTS: The 80 cases were classified into five reproducible types by using Five-Segment classification system: type Ⅰ, two (2.5%) cases; type Ⅱ, ten (12.5%) cases; type Ⅲ, 42 (52.5) cases; type Ⅳ, 24 (30.0%) cases; type Ⅴ, two (2.5%) cases. The mean kappa value for interobserver reliability using Smillie classification systems was 0.562 (95% CI: 0.531-0.585), whereas the mean kappa value was 0.828 (95% CI: 0.801-0.852), by using Five-Segment classification; the mean kappa values for intraobserver reliability by using Smillie classification and Five-Segment classification were 0.777 (95% CI: 0.762-0.792) and 0.860 (95% CI: 0.843-0.895), respectively. CONCLUSIONS: The new Five-Segment classification system demonstrated perfect interobserver and intraobserver agreement between evaluators in the management of Freiberg's infarction. Prospective studies should be done to evaluate its prognostic value and utility in clinical practice. LEVEL OF EVIDENCE: Level IV, retrospective.

Endoscopic and morphological features of chronic gastritis in patients with lumbar spine osteochondrosis.

OBJECTIVE: Aim: of the study is to determine the endoscopic and morphological features of chronic gastritis (CG) in patients with lumbar spinal OC. PATIENTS AND METHODS: Materials and Methods: 102 patients with lumbar spine OC and CG were examined. The patients were diagnosed with Helicobacter pylori (HP) infection, according to which the patients were divided into two groups: the first group included 92 HP-positive patients, the second group consisted of 10 HP-negative patients. RESULTS: Results: Among HP infected patients with lumbar spine OC, erosive gastropathy was most often diagnosed (in 40 (43.5%) of the examined), as well as erosive-papular and erosive-hemorrhagic gastropathy (in 14 (15.2%) and in 16 (17, 4 %) of patients, respectively), while erythematous gastropathy was more often diagnosed among HP-negative patients (in 7 (70.0 %) cases, respectively). CONCLUSION: Conclusions: 1. 90.2% of patients with lumbar spine OC and CG have been diagnosed with HP infection. 2. Endoscopically, the lesion of the stomach MM in patients with lumbar spine OC corresponds mainly to erosive and erosive-hemorrhagic forms of gastropathy. 3. During histological examination of stomach MM, mainly 2nd and 3rd degrees of inflammation were established, especially in patients with erosive, erosive-papular and erosive-hemorrhagic forms of gastropathy.

[Efficacy of manual correction of cervical spine osteochondrosis in the treatment of arterial hypertension syndrome and prediabetes]. / Effektivnost' manual'noi korrektsii osteokhondroza sheinogo otdela pozvonochnika v terapii sindroma arterial'noi gipertenzii i prediabeta.

Cardiovascular diseases and diabetes mellitus, debuting as arterial hypertension (AH) syndrome and prediabetes, are common types of chronic non-communicable processes, that are the leading cause of death in the world. The main treatment method for above mentioned disorders, according to the current guidelines, is pharmacotherapy. However, it is possible to effectively apply non-pharmacological correction methods, aimed at the probable etiological factor and inversive mechanism involved in AH maintenance, in the early stages when no permanent changes are maintaining a high level of blood hypertension (BH) and glycemia. Frequently, this mechanism is hypoxia in the vertebral arteries system due to cervical spine osteochondrosis. OBJECTIVE: To evaluate the therapeutic effect of non-pharmacological methods of restoring brainstem blood supply in patients with AH and prediabetes. MATERIAL AND METHODS: The number of patients equal 125 (57 men and 68 women, mean age 63.3±11.5 and 65.4±11.8 y.o., respectively) with prediabetes and 1st degree of AH without target organs damage, among whom 102 patients with prehypertension or 1st degree of hypertension and 24 ones with 2nd degree of hypertension, were examined. The original method of manually restoring brainstem blood supply developed in the Shishonin's Clinic was applied to all patients. The control group included patients with the same disorder, who did not receive manipulations. Blood pressure (BP) measurement, ultrasound and triplex ultrasonography of vertebral arteries, biochemical blood test, and estimation of glycemia and glycated hemoglobin were performed. RESULTS: All patients of the study group had decreased levels of systolic BP (by 23.8±10.7 mm Hg for men and 32.8±11.9 mm Hg for women), an increase of flow velocity in vertebral arteries (by 20.6±7.5 and 21.5±7.2 cm/s, respectively), a decrease of glycated hemoglobin concentration (by 0.32±0.51 and 0.34±0.41%, respectively). In the comparison group, there were no patients with improvement in these indicators. CONCLUSION: The effectiveness of the author's manual method of cervical spine osteochondrosis correction in the reduction of BP and glycemia levels in the early stages of the disease is shown.

Sinding-Larsen-Johansson syndrome with minimally displaced patellar sleeve avulsion fracture: a case report with multimodality approach and literature review.

Sinding-Larsen-Johansson syndrome is an osteochondrosis affecting the inferior pole of the patella. Most cases can be easily diagnosed with adequate clinical history, physical examination, and proper imaging, including conventional radiography, ultrasound, and magnetic resonance imaging. Differentiating this condition from patellar sleeve avulsion fractures is important, since treatment is frequently surgical in the latter. Overlap between these two conditions can also occur. We present a case of an 11-year-old boy, with Sinding-Larsen-Johansson syndrome on both knees and a minimally displaced acute patellar avulsion sleeve fracture of the left knee, which was treated conservatively.

Angular limb deformities due to distal radial physeal osteochondrosis in farmed deer stags in New Zealand.

CASE HISTORY: Three different farms reported cases of angular limb deformities (ALD) in rising 2-year-old velvet, mostly red deer (Cervus elaphus), stags with the earliest recorded cases occurring in 2010. Farm 1 reported a prevalence of 10-35%, farm 2, 5-11.5%, and farm 3, 2-5%. Farms 1, 2, and 3 are located in South Canterbury, northern Southland, and the Waikato, respectively. CLINICAL FINDINGS: Affected animals developed ALD, with predominantly varus forelimb (bowed) deformities. On all farms serum calcium and phosphorus concentrations in affected animals were normal. Serum and liver copper concentrations were variable across the period of the study and between farms. Although some measurements were below the reference ranges, there was no evidence for a statistical association with the prevalence of abnormalities. PATHOLOGICAL FINDINGS: The distal radius from 25 affected and four control red and red-wapiti (Cervus canadensis) cross deer from Farm 1 in 2010/2011, two affected red deer from Farm 2 in 2016, and one affected red deer from Farm 3 in 2021, were examined. The most consistent lesions were present in the distal radial physis, most commonly the lateral edge. There was mild-to-severe segmental thickening of the physis and, in some animals, physeal cartilage was duplicated with both sections of physis varying in thickness. Microscopically, in severely affected animals there was massive segmental thickening of physeal cartilage which often contained large cystic cavities. The cartilage matrix was eosinophilic and showed a loss of metachromatic staining with toluidine blue. In less severe cases, necrotic physeal vessels were present, consistent with vascular failure. In more chronic cases, there was duplication of the physis, the two layers being separated by a combination of normal trabecular bone and dense fibrous connective tissue. DIAGNOSIS: Physeal osteochondrosis. CLINICAL RELEVANCE: Osteochondrosis has a multifactorial aetiology and we propose that an increased requirement for nutrients for velvet production and increased weight-bearing stress (behaviour and rapid weight gain) may lead to progression of osteochondrosis and ALD in these deer. The involvement of periods of copper deficiency is unclear at this time.

Lumbosacral endplate contour defect is frequently observed concurrent with other lumbosacral abnormalities on spinal CT of French Bulldogs.

Lumbosacral osteochondrosis has been previously described in large breed dogs with variable clinical signs. Its CT features are a contour defect at the dorsal aspect of either vertebral endplate, commonly with an adjacent fragment. Descriptions of this condition have not been previously published in an increasingly popular breed, French Bulldogs. Aims of this retrospective, descriptive, single center study were to evaluate CT lumbosacral abnormalities and the frequency of lumbosacral endplate contour defect in a large sample of French Bulldogs. The presence and location of lumbosacral endplate contour defect and the presence of a concurrent osseous fragment were recorded. Other abnormal CT findings such as L7-S1 disc herniation, cauda equina nerve roots compression or thickening, disc mineralization, endplate sclerosis, spondylosis deformans, S1 articular processes hypertrophy, transitional vertebrae, hemivertebrae, spina bifida, and block vertebrae were recorded. Lumbosacral CT abnormalities were present in 91.8% of dogs (168/183). The most common abnormality was an L7-S1 dorsal disc herniation (77.4%, 130/168). Among dogs with lumbosacral abnormalities, the frequency of a lumbosacral endplate contour defect was 47% (79/168). It mostly involved L7 (78.5%, 62/79) at its dorsolateral aspect (61.3%, 38/62). A mineralized fragment was identified in 62% of the defects (49/79). Endplate contour defects were most frequently seen with a concurrent disc herniation (93.7%, 74/79) causing nerve root compression in 63.3% (50/79) and with sclerosis (65.8%, 52/79). There was no definitive evidence of a relationship with clinical presentation in this sample of French Bulldogs; therefore, this finding should be interpreted with caution. The etiology remains unclear.

A method for labelling lesions for machine learning and some new observations on osteochondrosis in computed tomographic scans of four pig joints.

BACKGROUND: Osteochondrosis is a major cause of leg weakness in pigs. Selection against osteochondrosis is currently based on manual scoring of computed tomographic (CT) scans for the presence of osteochondrosis manifesta lesions. It would be advantageous if osteochondrosis could be diagnosed automatically, through artificial intelligence methods using machine learning. The aim of this study was to describe a method for labelling articular osteochondrosis lesions in CT scans of four pig joints to guide development of future machine learning algorithms, and to report new observations made during the labelling process. The shoulder, elbow, stifle and hock joints were evaluated in CT scans of 201 pigs. RESULTS: Six thousand two hundred fifty osteochondrosis manifesta and cyst-like lesions were labelled in 201 pigs representing a total volume of 211,721.83 mm3. The per-joint prevalence of osteochondrosis ranged from 64.7% in the hock to 100% in the stifle joint. The lowest number of lesions was found in the hock joint at 208 lesions, and the highest number of lesions was found in the stifle joint at 4306 lesions. The mean volume per lesion ranged from 26.21 mm3 in the shoulder to 42.06 mm3 in the elbow joint. Pigs with the highest number of lesions had small lesions, whereas pigs with few lesions frequently had large lesions, that have the potential to become clinically significant. In the stifle joint, lesion number had a moderate negative correlation with mean lesion volume at r = - 0.54, p < 0.001. CONCLUSIONS: The described labelling method is an important step towards developing a machine learning algorithm that will enable automated diagnosis of osteochondrosis manifesta and cyst-like lesions. Both lesion number and volume should be considered during breeding selection. The apparent inverse relationship between lesion number and volume warrants further investigation.

Osteochondrosis and other lesions in all intervertebral, articular process and rib joints from occiput to sacrum in pigs with poor back conformation, and relationship to juvenile kyphosis.

BACKGROUND: Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal curvature of the spine including juvenile kyphosis. It has been suggested that osteochondrosis-like changes cause vertebral wedging and kyphosis, both of which are identifiable by CT. The aim of the current study was to examine the spine from occiput to sacrum to map changes and evaluate relationships, especially whether osteochondrosis caused juvenile kyphosis, in which case CT could be used in selection against it. Whole-body CT scans were collected retrospectively from 37 Landrace or Duroc boars with poor back conformation scores. Spine curvature and vertebral shape were evaluated, and all inter-vertebral, articular process and rib joints from the occiput to the sacrum were assessed for osteochondrosis and other lesions. RESULTS: Twenty-seven of the 37 (73%) pigs had normal spine curvature, whereas 10/37 (27%) pigs had abnormal curvature and all of them had wedge vertebrae. The 37 pigs had 875 focal lesions in articular process and rib joints, 98.5% of which represented stages of osteochondrosis. Five of the 37 pigs had focal lesions in other parts of vertebrae, mainly consisting of vertebral body osteochondrosis. The 10 pigs with abnormal curvature had 21 wedge vertebrae, comprising 10 vertebrae without focal lesions, six ventral wedge vertebrae with ventral osteochondrosis lesions and five dorsal wedge vertebrae with lesions in the neuro-central synchondrosis, articular process or rib joints. CONCLUSIONS: Computed tomography was suited for identification of wedge vertebrae, and kyphosis was due to ventral wedge vertebrae compatible with heritably predisposed vertebral body osteochondrosis. Articular process and rib joint osteochondrosis may represent incidental findings in wedge vertebrae. The role of the neuro-central synchondrosis in the pathogenesis of vertebral wedging warrants further investigation.

Gross, histopathologic, microbiologic, and radiologic characterization of lesions associated with clinical lameness in a cohort of group-housed sows euthanized for lameness.

Lameness in sows is reported as the most frequent cause of early culling from commercial farms and results in reduced productivity, economic losses, and a negative impact on animal welfare. Osteochondrosis was reported as the leading cause of lameness in North American sows and, although more recent European studies report infectious arthritis as the leading cause, lameness in US production facilities using group housing for gestating sows has not yet been evaluated. This study's aim was to characterize lesions associated with lameness in the appendicular musculoskeletal system of 26 sows euthanized for lameness using pathologic, radiologic, and microbiologic analyses. Of 178 total lesions, infectious lesions were most common (54%), predominated in distal limb segments (ie, at or distal to carpi and tarsi) and more often correlated with the clinically lame limb, whereas osteochondrosis and degenerative osteoarthritis predominated in proximal limb segments (ie, at or proximal to cubital and stifle joints) and rarely correlated with the clinically lame limb. The location and characteristics of infectious lesions, including mixed bacterial growth isolated from 22/22 orthopedic sites representing 19 sows with Trueperella pyogenes isolated in 16/22 (73%) of samples, suggest an etiologic component involving trauma. Radiography had a 70.6% sensitivity and 93.9% specificity for detecting infectious lesions affecting tarsocrural, antebrachiocarpal, and digital (ie, claw) regions combined. The frequency, type, and location of infectious lesions identified in this cohort of sows euthanized for lameness differ from previous reports, indicating the need for further investigation of the etiopathogenesis, earlier detection methods, and prevention.

[Physical rehabilitation for osteochondrosis of the cervical and thoracic spine in elderly and senile people (Stage 2).]

The main and most frequently used means of physical rehabilitation for osteochondrosis of the cervical and thoracic spine is motor rehabilitation. The goals of physical rehabilitation of persons suffering from osteochondrosis are to strengthen the muscles of the back, reduce the load on the intervertebral discs, improve blood circulation, restore a normal motor stereotype and, as a result, reduce pain. The use of means of motor rehabilitation is scientifically substantiated, the mechanisms of their effect on the functional state of the body have been studied, and the effectiveness of their use is beyond doubt. However, the lack of multidisciplinary programs, at the heart of rehabilitation measures specifically for elderly and senile people with osteochondrosis of the cervical and thoracic spine, in practice leads to the widespread use of drug and targeted therapy, involving the use of only drugs that reduce pain and muscle tension. The lack of an individual approach, group exercises for physical therapy, handing out to patients advertising brochures, schemes for physical therapy, without practicing exercises in practical classes, lead to negative consequences and relapses of diseases and a negative attitude of patients towards the discipline as a whole. In this regard, it is necessary to develop and introduce into practice various complexes of physiotherapy exercises for elderly and senile patients with osteochondrosis of the cervical and thoracic spine.

[Physical rehabilitation for osteochondrosis of the cervical and thoracic spine in elderly and senile people (Stage 3).]

The concept of a multidisciplinary approach to the treatment of osteochondrosis in elderly and senile patients by specialists of various profiles using medicinal and non-medicinal methods is especially relevant today, therefore, it is necessary to develop and put into practice various options for the combined use of physical rehabilitation means at different stages of rehabilitation treatment of elderly and senile patients with osteochondrosis of the cervical and thoracic spine. The dynamics of clinical manifestations of osteochondrosis after rehabilitation treatment relative to the age of patients in groups showed that the effectiveness of the technique is much higher in elderly patients, in contrast to senile patients and centenarians. The study revealed no significant complications and side effects when using this technique, which allows us to recommend it as a means of secondary prevention of diseases of the cervical and thoracic osteochondrosis, especially in the presence of contraindications to the use of non-steroidal anti-inflammatory drugs and glucocorticoids. The technique can be recommended for use in fitness clubs, athletic halls and medical and physical education dispensaries.

Surgical treatment of atraumatic osteochondrosis dissecans of the immature talus-Clinical results and prevalence of radiographic joint degeneration after a median follow-up of 72.5 months.

BACKGROUND: This study aimed to assess the clinical and radiographic outcomes of different surgical procedures in atraumatic osteochondrosis dissecans (OCD) of the talus in youth and adolescence. METHODS: 32 joints in 30 patients (mean age 14.7 ± 2.2 years) were evaluated. Numeric Rating Scale (NRS), Foot and Functional Index (FFI), American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Pediatric Outcome Data Collection Instrument (PODCI), and sport participation were recorded. We compared preoperative and follow-up ankle radiographs to identify specific features in the OCD morphology and any signs of joint degeneration. RESULTS: After a median follow-up period of 72.5 months the drilling group showed significantly better scores than the combined fixation and reconstruction groups (AOFAS, p = 0.024; PODCI, p = 0.003; NRS, p = 0.027). Signs of joint degeneration were observed in 50% of all ankles, especially in those treated by OCD-fixation and reconstruction. CONCLUSIONS: Advanced fixation and reconstruction procedures in unstable and non-salvageable atraumatic talar OCD resulted in inferior clinical scores and a higher prevalence of joint degeneration than drilling procedures in stable OCD in young patients.

CHANGES IN PROSTAGLANDIN LEVELS IN BLOOD SERUM OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE ON THE BACKGROUND OF THE OSTEOCHONDROSIS OF THE SPINE AND OBESITY.

OBJECTIVE: The aim: To study the features of changes in the level of prostaglandins (I2 and F2α) in blood serum of patients GERD on the background of OH of the cervical and thoracic spine and obesity. PATIENTS AND METHODS: Materials and methods: The examined patients included 56 patients with GERD and OH of the cervical and thoracic spine. All patients had their blood serum prostaglandin (Pg) F2α and 6-keto prostaglandin F1α (blood prostacyclin - Pg I2) levels examined using the method of immunoassay analysis. RESULTS: Results: In all patients with GERD and OH an excessive body weight or obesity of varying degrees was found while analyzing anthropometric study results. The determination of prostaglandin F2α and prostacyclin (Pg I2) levels in blood serum in patients with GERD and OH and healthy individuals was performed. A more pronounced increase of Pg I2 and Pg F2α in blood serum in patients with GERD and OH with III degree obese was found and the smallest concentration of prostaglandines in blood serum was diagnosed in patients with excessive weight (p<0.05). CONCLUSION: Conclusions: 1. In patients with GERD and OH, an increase in levels of prostaglandins F2α and I2 in blood serum has been established. 2. The relationship between the duration of excess body weigh, obesity and the dynamics of the level of prostaglandin Pg I2 and F2α in blood serum in patients with GERD on the background of OH has been established.

Proteoglycan-4 and hyaluronan composition in synovial fluid and serum from clinical equine subjects: relationship to cartilage boundary lubrication and viscosity of synovial fluid.

Purpose: In experimental models of equine joint-injury and osteoarthritis synovial fluid (SF) composition (proteoglycan-4, hyaluronan) can vary, along with changes to SF mechanical function (lubrication, viscosity). The study hypotheses were a) clinical equine joint-injury and disease results in altered SF composition and diminished mechanical function, and b) serum composition (proteoglycan-4 or hyaluronan) changes concurrently. The objectives were to characterize composition (proteoglycan-4, hyaluronan), and function of SF and serum from normal horses compared to clinical groups: osteoarthritis, acute-joint-injury, and osteochondrosis.Materials and Methods: Equine samples of SF (from various joints) and blood were collected at the point-of-care. Proteoglycan-4 concentrations were measured by amplified-luminescence-proximity-assay and enzyme-linked-immunosorbent-assay in SF and serum, respectively. Molecular-weight of hyaluronan was characterized by agarose-gel-electrophoresis, and concentrations were measured by enzyme-linked-immunosorbent-assay kit. Biomechanical function of SF was characterized by an in vitro cartilage-on-cartilage friction test, and viscosity test.Results: SF proteoglycan-4 concentration increased in acute-joint-injury (1185 ± 276 versus normal 205 ± 106 µg/mL, µ± SEM, p < 0.01), with increased percentage of lower molecular-weight hyaluronan in acute-joint-injury and osteochondrosis. SF and serum proteoglycan-4 concentrations were correlated in normal horses (r2 = 0.85, p < 0.05), but not in clinical groups. Cartilage-lubricating ability was unchanged, although steady-shear viscosity of acute-joint-injury SF decreased from normal.Conclusion: Composition of SF from cases of equine acute-joint-injury changed; both proteoglycan-4 concentration and hyaluronan molecular-weight were altered, with decreased SF viscosity, but no associated changes to serum. Serum proteoglycan-4 and hyaluronan concentrations alone may not be useful biomarkers for equine joint-injury or disease.

Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients.

INTRODUCTION: Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting. MATERIALS AND METHODS: Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24-45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected. RESULTS: All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165-200), 94 (range, 70-100), and 92 (range 83-98; normative score 47; range 35-55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, - 27-100%; 52%, 4-100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted. CONCLUSION: This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.

[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.

Current management strategies in Osgood Schlatter: A cross-sectional mixed-method study.

BACKGROUND: Osgood Schlatter disease (OSD) is the most common knee condition in adolescent athletes aged 9-16. Without evidence to guide clinical practice, it is unclear how OSD is managed. The aim of this study was to investigate how international healthcare professionals (general practitioners, physiotherapists, rheumatologists, sports and exercise medicine doctors, and orthopedic surgeons) diagnose and manage OSD. METHODS: This mixed-method study used a convergent parallel design. A quantitative questionnaire and semi-structured interview covered prognosis, diagnosis, treatment, and return to play of adolescents with OSD. For quantitative data, those who reported likely/very likely considered "for" and unlikely/very unlikely "against" (for specific diagnostic/management strategy). Qualitative data analysis used a phenomenological approach. RESULTS: Two hundred and fifty-one healthcare professionals completed the questionnaire. The most common diagnostic criterion was pain at the tibial tuberosity (97% for). The most common treatments were patient education (99%) and exercise therapy (92%). Other treatment options were more heterogeneous, for example, pain medication (31% for and 34% against). Managing training load (97%), pain intensity (87%), and psychological factors (86%) were considered the most important factors influencing the return to activities. Several themes emerged from the interviews (on N = 20) including imaging, pain management, family, and psychosocial factors influencing prognosis. CONCLUSION: Diagnosis criteria of OSD were relatively well agreed upon, whereas the triangulation of qualitative and quantitative data showed heterogeneity of treatments. Psychosocial factors including family were highlighted as critical in the management of OSD.

Genetics of Equine Orthopedic Disease.

Orthopedic diseases are a common cause for limited exercise capacity in the horse. They often underlie genetic risk factors, which can affect bone, articular cartilage, tendons, ligaments, and adnexal structures among others. The genetic effects can directly interfere with tissue development and skeletal growth or can trigger degenerative or inflammatory processes. Many of these diseases of the locomotor system like osteochondrosis are complex and can be affected by multifactorial influences. For this reason, it is important for those performing diagnostic procedures to have a comprehensive knowledge of orthopedic diseases, their prevalence within breeds, and genetic background.