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Research in Orthopedic Science - Volume:9 Issue: 1, Feb 2022

Journal of Research in Orthopedic Science
Volume:9 Issue: 1, Feb 2022

  • تاریخ انتشار: 1401/09/21
  • تعداد عناوین: 8
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  • Saeideh Hosseini* Pages 1-13

    Increasing the average age of the population as well as sports injuries, bone-related diseases, such as osteoporosis, rupture or damage to cartilage and bone tissues, and bone fractures, has dramatically increased the need for repair and joint replacement surgeries. Biocompatible materials that are used as prosthetic stabilizers and bone fillers in orthopedic surgery are known as injectable bone cement (IBCs). Available clinical IBCs, such as polymethyl methacrylate and calcium phosphate cement are the most important of these materials. This paper presents the most popular substances for medical use. Although this replacement procedure reduces the pain and restores joint function, it is associated with several drawbacks that limit its efficiency and effectiveness, and sometimes patients should undergo revision surgeries. Recently, the development of the next generation of IBCs, which are bioactive and degradable with good mechanical properties, is of great interest. For the long-term clinical performance in cement arthroplasty, the next generation of bone cement with far greater mechanical and biological properties than acrylic bone cement on the market is required. As a result, new approaches and formulas have been developed using various techniques from different disciplines. This study summarizes the challenges, developments, and recommendations for the future. For this purpose, various literature from databases, such as ScienceDirect, SpringerLink, PubMed, and so on were consulted from 2000 to 2020.

    Keywords: Bone tissue engineering, Bone cement, Polymethylmethacrylate (PMMA), Tri-calcium phosphate (TCP), Setting characteristics, Modification, Filling materials, Nanostructured materials
  • Mohamadreza Ahmadi, Ali Yalfani* Pages 15-23
    Background

    Anterior cruciate ligament (ACL) reconstruction is performed as the gold standard of care for patients with ACL rupture. ACL reconstruction provides successful clinical outcomes, however, it cannot repair faulty lower limb mechanics. The loading asymmetry between right and left limbs during movement is often used to measure the effectiveness of surgical interventions and the potential risks of re-injury.

    Objectives

    This study aims to evaluate the interlimb asymmetry of vertical ground reaction in patients with ACL reconstruction. 

    Methods

    An online search was done in the following databases: Science Direct, Scopus, PubMed, and Google Scholar. Then, studies from 2000 to 2022 were extracted. Selected articles were screened in a 4-step process according to the inclusion and exclusion criteria. Two researchers evaluated the methodological quality of the articles with the modified Downs and Black checklist. Finally, studies were classified into 3 categories: low (< 40%), medium (40% - 69%), and high quality (≥ 70%). 

    Results

    Finally, 9 studies were selected for the systematic review. The average methodological quality was 68.33% (range 54% - 80%), which shows the medium quality of the studies. A total of 4 articles had high methodological quality and 5 articles had medium quality. The results of 8 studies reported asymmetric vertical ground reaction force after ACL reconstruction. Only 1 study reported no significant difference in the asymmetrical vertical ground reaction force.

    Conclusion

    Patients undergoing ACL reconstruction have knee flexion limitation and decreased quadriceps muscle strength. Eventually, this mechanism of energy absorption by the active tissue decreases, and mainly the shock absorption by the passive tissue increases. As a result, this mechanism leads to ACL re-injury and tibiofemoral joint cartilage damage.

    Keywords: Symmetry, Vertical ground reaction force, Anterior cruciate ligament reconstruction, Locomotion
  • Farid Najd Mazhar, Mojtaba Moztarzadeh, Ali Mohammad Sharifi, Alireza Mirzaei* Pages 25-35
    Background

    Avascular necrosis of the lunate or Kienböck‎ disease is a rare disorder with unknown etiology and challenging treatment. 

    Objectives

    In this study, we evaluated the effects of local deferoxamine injection as an angiogenic molecule and core decompression to treat Kienböck‎ disease.

    Methods

    In a pilot clinical trial, 8 patients with stage I to IIIA of Kienböck‎ disease were treated with core decompression and local deferoxamine injection (0.5 mL 500 mg/mL). The outcome measures included wrist range of motions, pinch and grip strength, patient-rated ‎wrist/hand evaluation (PRWE), a short form of disabilities of the arm, shoulder, and hand (Quick-DASH), and visual analog scale (VAS) for pain. The assessment of lunate revascularization was also done by T1- and T2-weighted magnetic resonance imaging. All measurements were done before the intervention and 3, 6, and 12 months after the intervention.

    Results

    Wrist flexion, extension, ulnar and ‎radial deviation, and pinch and grip strength were continuously improved over the postoperative periods. These improvements were statistically significant. The mean final pinch and grip strength averaged 87.4% and 72.8% of the non-involved hand, respectively. PRWE, Quick-DASH, and VAS scores were also continuously and significantly improved over the study period. The lunate vascularization revealed a continuous improvement in 6(75%) patients.

    Conclusion

    Local deferoxamine injection in addition to core decompression could improve the radiologic and clinical outcomes of patients suffering from Kienböck‎ disease.

    Keywords: Kienböck‎ disease, Lunate, Avascular necrosis, Deferoxamine
  • Hooman Shariatzadeh, Farid Najd Mazhar, Meysam Fathi Choghadeh*, Farhad Soltani, Maziar Rajei, Mohammad Hassanzadeh, Hossein Gholampour Pages 37-40
    Background

    Scaphoid fracture is the most common wrist injury with a high rate of misdiagnosis and subsequent complications. As the morphology of the distal radius affects the load transmission through the carpal bones, radiographic wrist indices may help prevent missing occult fractures.

    Objectives

    The current retrospective case-control study compared the distal radius radiographic indices of patients with a scaphoid fracture with a control group.

    Methods

    Wrist X-rays of 129 patients with scaphoid fractures (case group) and the contralateral uninjured side of 101 patients with distal radius fractures (control group) were assessed by two orthopedic surgeons. Anteroposterior and lateral radiographs were evaluated to measure the radial height (RH), radial inclination (RI), ulnar variance (UV), and volar tilt (VT).

    Results

    The student t-test was used to compare the distal radius radiographic indices between the two groups. The average RI was 27.14 in the scaphoid fracture group and 24.35 in the control group (P<0.05). Mean VT, RH, and UV of the case group were, 12.32, 15.01, and - 0.73, respectively; this is while in the control group, the above measures were 10.76, 13.52, and - 0.11, respectively (P<0.05).

    Conclusion

    High values of RH, RI, and VT, and negative amount of UV are significantly correlated with scaphoid fracture after a Fall Onto an Outstretched Hand (FOOSH) injury.

    Keywords: Distal radius, Scaphoid, Risk factors
  • Mohsen Mardani-Kivi*, Ehsan Kazemnejad Leili, Fatemeh Sharifi, Zoleikha Azari Pages 41-52
    Background

    Graft type selection is still a controversial issue in anterior cruciate ligament (ACL) reconstruction. The type of graft is a determinant of return to sport and its quality.

    Objectives

    This study aims to evaluate results and rate of return to sport using quadriceps autograft compared to hamstring autograft.

    Methods

    The present prospective cohort study investigated the results of using quadriceps and hamstring autografts in athletes with an ACL tear. Our variables included age, sex, and body mass index, type of sports activity, infection, meniscus tear and chondral lesion, time and quality of return to sport, range of motion, KT-1000, Lachman and knee injury and osteoarthritis outcome score, international knee documentation committee grade, and Lysholm score.

    Results

    A total of 71 out of 139 studied patients were operated on hamstring autografts and 68 patients by quadriceps autografts. The patients showed no significant differences (P>0.05) in terms of age, sex, body mass index, sports group, and meniscus tear. In the final follow-up, the chondral lesion was 26.47 vs 16.90, anterior knee pain was 5.8 vs 2.81, and the return to sport was 71.64 vs 78.87 in the quadriceps group vs the hamstring group. The extension loss involved 2 patients per group. The scores of the international knee documentation committee and knee injury and osteoarthritis outcome, the Lysholm test, KT-1000, and the Lachman test had no significant differences in the two groups.

    Conclusion

    The results of the present study indicated that the use of both quadriceps and hamstring autografts was appropriate for the ACL tear. Also, the orthopedic surgeon should be responsible for deciding to select one of the two grafts.

    Keywords: Autograft, Hamstring, Quadriceps, Anterior cruciate ligament, ACL tear
  • Khodakaram Rastegar, Hasan Ghandhari, Ebrahim Ameri, Farzam Mokarami* Pages 53-56

    A 30-year-old man presented to our clinic with progressive neck pain and dysphagia. He had been operated on for an atlantoaxial instability (os odontoideum) 7 years ago. Imaging studies revealed cervical spondyloptosis of C5-C6 and C7-T1; the neurologic examination was intact. It was decided to correct the deformity through a circumferential approach. Thus C5, C6, and C7 corpectomy, alongside anterior column reconstruction using titanium expandable cage, reinforced by posterior spinal instrumentation from occipital bone to T3 vertebra were performed; his symptoms resolved completely following an uneventful surgery.

    Keywords: Cervical spondylolisthesis, Cervical anterolisthesis, Cervical retrolisthesis
  • Afshin Taheriazam*, Behzad Khanmohammadi, Atieh Asadollah, Mohammadamin Dindar Pages 57-64

    The incidence of Zimmer modular revision (ZMR) hip system fractures is rare. The material of the component decreases the risk of corrosion which titanium-based modular would lower the degree of degradation despite cold welding of the component. In this case presentation, we will discuss 2 cases of implant failure from the cone taper junction of the stem and discuss the susceptible causes of the failure. The new generation of surgery products has numerous successful outcomes and has facilitated the way for modern orthopedic surgeons. Despite the high rate of satisfying results, reports of implant failure are rare.  We present 2 patients in similar situations referring to the same model implant failure. It can be noticed that the force tolerance because of their weight might be a risk factor and some other factors may be missed, including providing sufficient distal bone support for the implant.

    Keywords: Total hip arthroplasty, Replacement, Hip, Stem fracture, Revision arthroplasty
  • Ali Torkaman, Ahmad Azizi, Jaber Kazemi, Ali Mousapour* Pages 65-68

    Awareness of the long-term COVID-19 complications is of significant importance in reducing its morbidity through the implementation of timely interventional programs. In this study, we report an anterior cruciate ligament (ACL) tear in athlete identical twin sisters almost 2 months after the COVID-19 infection. The patients had 15 years of professional futsal experience and showed no obvious risk factors for an ACL tear, such as familial history, abnormal menstruation, oral contraceptive consumption, reduced intercondylar notch, or increased tibial slope. However, they experienced a non-contact complete ACL tear within 1 month of re-participation in professional exercise after the COVID-19 infection. Both patients reported a sense of muscle weakness during the COVID-19 recovery period, and ligamentous laxity was obvious according to the clinical examination and the Beighton criteria. This report shows persistent muscle weakness after the COVID-19 infection that could increase the risk of ACL injury in female athletes and suggests taking a prophylactic rehabilitating program to prevent its catastrophic consequences.

    Keywords: COVID-19, Long-term complications, Muscle weakness, ACL tear